The Healthcare Labor Force

The professional character of the health care labor force creates challenges for managers. Professionalism may reduce the range of services available to the public and raises costs. Examination of three professions helps identify a range of issues associated with the professional labor force from a management and policy perspective. These include: medicine, nursing, and health administration. Patient care professionals play an important part in the management of health services. Basic statistics on health professions and related occupations illustrate the importance of the health care sector within the U.S. labor force. Supply and compensation constitute basic facts and figures regarding the health care labor force. The dynamics of professional labor supplies present challenges for both management and policy. The actions and decisions of health professionals determine the benefits, risks, and costs of the health care system to the public.

Background: COVID-19 is leading to the implementation of social distancing policies around the world and in the United States, including school closures. The evidence that mandatory school closures reduce cases and ultimately mortality mostly comes from experience with influenza or from models that do not include the impact of school closure on the healthcare labor supply or the role of the healthcare labor force in reducing the per infection mortality from the pathogen. There is considerable uncertainty of the incremental effect of school closures on transmission and lives saved from school closures. The likely, but uncertain, benefits from school closure need to be weighed against uncertain, and seldom quantified, costs of healthcare worker absenteeism associated with additional child care obligations. Methods: We analyze data from the US Current Population Survey to measure the potential child care obligations for US healthcare workers that will need to be addressed if school closures are employed as a social distancing measure. We account for the occupation within the healthcare sector, state, and household structure to identify the segments of the healthcare labor force that are most exposed to child care obligations from school closures. We use these estimates to identify the critical level for the importance of healthcare labor supply in increasing a patient’s COVID-19 survival probability that would undo the benefits of school closures and ultimately increase cumulative mortality. Findings: The US healthcare sector has some of the highest child care obligations in the United States. 29% of healthcare provider households must provide care for children 3-12. Assuming non-working adults or a sibling 13 years old or older can provide child care, leaves 15% of healthcare provider households in need of childcare during a school closure, while 7% of healthcare households are single-parent households. We document the substantial variation within the healthcare system. For example, 35% of medical assistants and 31% of nursing, psychiatric, and home health aide households have child care obligations, while only 24% of emergency medical personnel have childcare obligations. Child care obligations can vary between states by over 10 percentage points. A 15% decline in the healthcare labor force, combined with reasonable parameters for COVID-19 such as a 15% case reduction from school closings and 2% baseline mortality rate implies that a 15% loss in the healthcare labor force must decrease the survival probability per percent healthcare worker lost by 17.6% for a school closure to increase cumulative mortality. This means that the per infection mortality rate cannot increase from 2% to 2.35% when the healthcare workforce declines by 15%; otherwise, school closures will lead to a greater number of deaths than they prevent. For school closures to unambiguously provide a net reduction in COVID-19 mortality with these parameters, the school closures must reduce cases by over 25%. Conclusion: School closures come with many tradeoffs. Setting aside economic costs, school closures implemented to reduce COVID-19 spread create unintended childcare obligations, which are particularly large in healthcare occupations. Detailed data are provided to help public health officials make informed decisions about the tradeoffs associated with closing schools. The results suggest that it is unclear if the potential contagion prevention from school closures justifies the potential loss of healthcare workers from the standpoint of reducing cummulative mortality. Funding Statement: No external funding.Declaration of Interests: The authors declare no competing interests.

Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study

Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed.

Nursing is grounded in care of the body. This article examines nursing as bodywork, as experienced intersubjectively by nurses together with patients and collectively as a body within the health care labor force. The relation of nurses to the body generates conflicting and contradictory social meanings from intimate and sacred work to dirty work. Such meanings have contributed to stigmatizing the work and the worker within the labor force as well contributing to an ongoing stratification in the labor force as nurses have shifted bodywork "to lower level" or ancillary workers.

Cost containment efforts will fail if they continue to ignore the structural relationships between health care costs and private profit in capitalist society. The recent history of coronary care shows that apparent irrationalities of health policy make sense from the standpoint of capitalist profit structure. Coronary care units (CCUs) gained wide acceptance, despite high costs. Studies of CCU effectiveness, using random controlled trials and epidemiologic techniques, do not show a consistent advantage of CCUs over non-intensive ward care or simple rest at home. From a Marxian perspective, the proliferation of CCUs and similar innovations is a complex historical process that includes initiatives by industrial corporations, cooperation by clinical investigators at academic medical centers, support by private philanthropies linked to corporate interests, intervention by state agencies, and changes in the health care labor force. Cost-effective methodology obscures the profit motive as a basic source of high costs and ineffective practices. Health-policy alternatives curtailing corporate involvement in medicine would reduce costs by restricting profit.

With the increased emphasis on engagement of patients as partners in their care, there is a need to determine effective ways to involve them in the process by which health care decisions are made. As clinical options multiply and health-related decisions become more challenging, it is expected that patients will require more guidance to make informed decisions. At the same time, in response to the growing needs of their population and the shortage in the health care labour force, in many industrialized countries, there is also an expectation that interprofessional health care team approaches will be encouraged and developed. Consequently, the process by which patients are engaged to share their preferences and become involved in decisions with their practitioners will have to change to accommodate this new interprofessional health care environment (Coulter, 1999).

Gaps in the Supply of Physicians, Advance Practice Nurses, and Physician Assistants

This JAMA Forum discusses resiliency, telehealth, the health care labor force, and public health in the context of the health system changes occurring since the start of the COVID-19 pandemic.

Role Overlap and Professional Boundaries: Future Implications for Physiotherapy and Occupational Therapy in the NHS: Forum

The widespread devastation caused by the ongoing waves of COVID-19 imposed a significant burden on the healthcare labor force. At the frontline in the battle against the deadly COVID-19 virus, nursing students in Vietnam were at a much-increased risk of developing mental health conditions. This study aims to identify the prevalence of depression and its related factors, along with coping strategies used by nursing students in the COVID-19 pandemic in Vietnam. The study was cross-sectional in nature, with convenient sampling at the epicenters of COVID-19 outbreaks in Vietnam (N = 191) from April to November 2021. After conducting a questionnaire pilot, the data was collected strictly using an internet-based approach. The Depression, Anxiety, and Stress Scale-21 items were used to identify the risk of depression among nursing students. The Chi-square test was used to assess the differences between coping strategies among nursing students. A multivariate logistic regression model was used to identify risk factors associated with depression. The percentage of nursing students affected by depression was 21.5%, and almost half of the nursing students (49.2%) had no coping strategies for dealing with mental health concerns. Among the remaining nursing students, video-based mental consultation was the most popular method (25.7%). Being females (AOR: 2.7, 95% CI: 1.1-6.7), collecting bio-samples (AOR: 2.9, 95% CI: 1.4-6.2), providing support to vaccination spots (AOR: 2.3, 95% CI: 1.1-5.1), and not vaccinating against COVID-19 (AOR: 3.1, 95% CI: 1.1-9.1) were found as risk factors for depression among nursing students. Our research revealed a significant number of nursing students suffering from depressive symptoms and underscoring the need for more effective methods of dealing with this condition. Depression management and coping skills focusing on female populations and those whose direct contacts with infectious sources should be implemented in the nursing curricula and continuous training credits. Those trainings, would support future nurses in handling crisis situations better.

Many of the problems faced by migrant domestic workers in attaining and exercising basic citizenship rights stem from their enforced confinement to employment within private households, where workers’ rights remain unprotected or unregulated. Locating care occupations within the public sphere such as hospitals has not, however, rid the health care labour force of racialized and gendered ideologies, and class-bound structures, which have compromised the ability of migrant women of colour to exercise their full citizenship rights.352 Historically, the nursing profession, health care administrators and immigration authorities vigorously promoted racial and cultural exclusivity in Canadian nursing.353 The women in white tended also to be overwhelmingly white and, outside Quebec, of Anglo-Saxon origins. After the Second World War, formal colour bars were eliminated from nursing education for Black, First Nation and Asian women, and entry for migrant women of colour was facilitated by the liberalization of immigration policy in the late 1960s.354 Since then, the nursing labour force has become increasingly ethnically and racially diverse, especially as a result of immigration from poorer countries in the Southern hemisphere.KeywordsDomestic WorkerMigrant WomanGender IdeologySystemic RacismToronto HospitalThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Education and debate p 1067 The staffing problems of the NHS continue to make headlines.1 Junior doctors are threatening to strike, consultants are voicing their frustration, and nurses are voting...

Understanding relationships between factors that can affect organizational outcomes such as organizational trust, employee commitment and job satisfaction is important to foster healthy work conditions in organizations. This study aimed to determine the perception of Turkish physicians about organizational trust, employee commitment and job satisfaction and determine the relationships between them. A questionnaire was developed based on three standard survey instruments and given to 1679 doctors in four training and research hospitals in Istanbul, Turkey, in 2013. The Pearson correlation coefficient was calculated and regression analyses were conducted. A total of 304 doctors completed the survey (18.1% response rate). Most were males (57%), over 30 years old (62%) and specialists (82%). A strong positive correlation was found among the study variables (P ≤ 0.001). Regression analyses indicated that organizational trust was a significant predictor of job satisfaction and commitment. Policy-makers need to consider implementing interventions in the health care system to improve the working conditions of current and future doctors in Turkey, in order to attract and retain them and prevent health care labour force losses.

Although the international migration of nurses has played a formative role in increasing the racial and ethnic diversity of the health care labor force, nursing historians have paid very little attention to the theme of international migration and the experiences of foreign-trained nurses, A focus on international migration complements two new approaches in nursing history: the agenda to internationalize its frameworks, and the call to move away from "great women, great events" and toward the experiences of "ordinary" nurses. This article undertakes a close reading of the life and work of Filipino American nurse Ines Cayaban to reconceptualize nursing biography in an international framework that is attentive to issues of migration, race, gender, and colonialism. It was a Hannah keynote lecture delivered by the author on June 5, 2008, as part of the CAHN/ACHN (Canadian Association for the History of Nursing/Association Canadienne pour l'Histoire du Nursing) International Nursing History Conference.