Changing Workforce Research Articles

Promises in action: The role of employer brand, employee value proposition and employee experience in delivering on psychological contract expectations

The shifting world of work and the resultant impact on organizations has fundamentally changed the relationship between employees and employers. With the reality of changing workforce demographics, gig-workers, nomad work and evolving talent marketplaces placing organizational talent supply processes under pressure, there is a need to evaluate the effectiveness of people management practices to access talent pools. In particular, the impact of employer branding, the employee value proposition, and the employee experience on attracting and retaining talent has to be re-evaluated in light of shifting expectations. We propose that traditional human resource (HR) practices, which have predominantly been focused on procedural elements of the employee lifecycle, have to evolve to intentionally create more human-centric working environments. This implies incorporating principles from design thinking and servicebased design, which positions the human being as the focal point. A shift towards a more human-centric perspective should not be disconnected from the contextual realities of the organization and its objectives while also taking the dynamic nature of the evolving psychological contract into account. The purpose of this article can be described as follows. First, we aim to discuss the psychological contract as the focal point for aligning employer brand, employee value propositions and employee experience. Second, we propose an employee-centric design methodology for human resource practices and third, we illustrate the use and application of this method by applying it to the off-boarding process in a global organization.

Seven Years, 3 Surveys, a Changed World: The State Public Health Workforce 2014-2021.

The COVID-19 pandemic and other public health challenges have increased the need for longitudinal data quantifying the changes in the state public health workforce. To characterize the state of governmental public health workforce among state health agency (SHA) staff across the United States and provide longitudinal comparisons to 2 prior fieldings of the survey. State health agency leaders were invited to have their workforce to participate in PH WINS 2021. As in prior fieldings, participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey. State health agency staff. PH WINS 2021 maintains the 4 primary domains from 2014 and 2017 (ie, workplace engagement, training needs assessment, emerging public health concepts, and demographics) and includes new questions related to the mental and emotional well-being; the impact of the COVID-19 pandemic on staff retention; and the workforce's awareness of and confidence in emerging public health concepts. The percentage of SHA staff who self-identify as Black, Indigenous, and people of color increased from 30% (95% confidence interval [CI]: 29%-32%) to 35% (95% CI: 35%-37%) between 2014 and 2021. Staff younger than 31 years accounted for 11% (95% CI: 10%-12%) of the SHA workforce in 2021 compared with 8% in 2014 (95% CI: 8%-9%). From 2014 to 2021, staff who self-identify as a woman increased from 72% (95% CI: 71%-74%) to 76% (95% CI: 75%-77%). Overall, 22% (95% CI: 21%-23%) of the SHA workforce rated their mental health as poor/fair. The 2021 PH WINS results represent unique and current perspectives on the SHA workforce and can inform future public health infrastructure investments, research, and field practice to ensure a strong public health system.

Residency Education in Oral and Maxillofacial Surgery: A New Curriculum Framework.

Residency education in oral and maxillofacial surgery (OMS) exists in an environment of transformation unlike anything seen in the past. Changes in American society accelerated by the COVID-19 pandemic are impacting all of health-care education and demand a comprehensive response by OMS programs and in standards for education. The oral health in America report of the National Institutes of Health and actions of the American Council on Graduate Medical Education provides a new framework for structuring and adapting OMS programs. These include incorporating the Quadruple Aims and ACGME core competencies into OMS education. The evolution of clinical education is being adapted to changes in technology and the American higher education environment. A changing workforce and practice model combined with today's technology revolution are being incorporated into OMS residency education.

Ready or Not, Here Comes the Digitalization: Assessment of Workforce Readiness and Change Perception

The digital world is an indispensable reality of the new century. While technical aspects for transformation are heavily evaluated, the readiness of human resources for digital transformation is not handled as a basic change management principle. This study aims to enrich the literature by determining the perception of the readiness for a digital change of individuals. The purpose of the study is to investigate the factors that have a direct association with the readiness of the workforce during the digitalization process. The vast majority of the digital integration efforts are aimed at increasing digital maturity levels. However, in order to ensure human resources’ participation in a digital transformation, it will be useful to measure their perception of readiness for digitalization and develop strategies that will enable participation. Therefore, this research will be a guide in the journey of digital change management of the workforce. Structural Equation modelling has been used to analyse the data. The research sample consisted of 460 participants that implement a digital restructuring process in companies. The results of the research evaluated, indicate that an individual’s readiness for digital transformation is related to their perceived self-efficacy, need for change, management support and the benefit for the organization, and they are all like wheels in a machine wheels working for a successful digital transformation of workforce.

The Nurse Empowerment Program for Nurses in Direct Care Positions.

OBJECTIVEAn educational program including online generic and nursing-specific content was evaluated for self-assessed leadership skill outcomes.BACKGROUNDLeadership development for nurses in direct care positions has not received the same support as for nurses in formal leadership positions. Pandemic and workforce changes make it critical that leadership skills be built at all levels of nursing.METHODSEarly-career nurses (≤10 years of experience) were recruited to participate in an online leadership development program offering 9 LinkedIn Learning courses, 3 leadership courses from Sigma, an e-book, and a discussion board.RESULTSMost participants who responded to both immediate postsurvey and 3-month follow-up survey (98.6% of n = 69) reported having applied new or improved abilities in their nursing practice to at least a small degree, and the majority reported having done so to a moderate or great degree.CONCLUSIONThis online leadership development program was valued and was associated with improved self-assessed leadership.

The Growth of Advanced Practice Providers in Urology Procedural Care: Evidence from Public and Private Health Insurers

To understand the growing role of advanced practice providers (APPs) in urologic care, we investigated urology procedural claims submitted to public and private health insurers. We used Medicare summary and commercial health insurance claims from 2010 to 2020 to calculate the number and proportion of common urologic procedures performed by APPs. To characterize broader trends across urology, we categorized the urologic procedures into five groups: cancer procedures, cystoscopy procedures, imaging procedures, urgent procedures, and voiding dysfunction. APPs submitted an increasing proportion of Medicare and commercial urology procedural claims between 2010 and 2020 (2% and 1% more claims, respectively), including several procedure groups: voiding dysfunction (12% and 4%), urgent procedures (8% and 5%), cancer procedures (3% and 2%), and cystoscopy procedures (1% and 1%). APPs consistently submitted a larger proportion of claims to Medicare than private insurers and, as of 2019, voiding dysfunction and cancer procedures were the most common urologic procedures performed by APPs in the Medicare data (82,749 and 73,837 procedures, respectively). In 2020, procedures with the greatest proportion of Medicare and commercial claims submitted by APPs included percutaneous tibial nerve stimulation (24% and 10% of claims, respectively), bladder installations (16% and 8%), neurostimulator programming (14% and 7%), and complicated Foley catheter placement (12% and 7%). APPs account for a growing proportion of urology procedural claims submitted to public and private health insurers. Stakeholders need to be aware of these changes in the urologic workforce to maintain the standard of care across urology.

Developing the mathematics teacher workforce in England’s FE colleges: towards a ‘communities of practice’ strategy

ABSTRACT Since policy changes in 2014 about who studies mathematics post-16 in England, the mathematics teaching workforce in further education (FE) colleges has grown and diversified. The question of how best to develop the professional practice of this changing workforce is, however, unresolved. Teachers in a recent national study report the benefits of non-formal learning but the diverse organisational structures of colleges impact on the size and focus of teacher communities and thereby the nature of professional learning. Where mathematics teachers are enabled to meet regularly or work in close proximity, teacher learning communities emerge but their development is constrained by a lack of consensus on the professional identities and competencies of mathematics teachers in FE colleges. Despite these obstacles, we argue that there is considerable potential to enhance professional learning for mathematics teachers in FE through a communities of practice approach and that such a strategy for professional development is a key component of a self-improving further education system.

Analysing the workforce composition of the agrarian sector: a comparison between Uttar Pradesh and Tamil Nadu

Agriculture is the foundational domain of the Indian economy and it still continues to engage a major proportion of the country's workforce. The paper attempts to study the changes in the agrarian workforce of two states namely Uttar Pradesh and Tamil Nadu over a decade. The study makes use of evidence from two census years' data namely 2001 and 2011. This paper attempts to study the characteristics of the agricultural workforce of both states with the application of analytical, interpretative, and graphical techniques. The study makes use of comparative analysis and tries to find out the differences between agrarian workers of Uttar Pradesh, predominantly an agricultural state, and Tamil Nadu, an industrial state. The findings of the study are quite striking, as Tamil Nadu shows positive growth in conditions of agrarian workers while Uttar Pradesh in spite of being an agrarian state shows negative growth in conditions of peasants.

Evaluation of STEM Education by Turkish Science Teachers

STEM education has been adopted all around the world to educate individuals that meet the requirements of the changing workforce. Currently, efforts to integrate STEM education into mainstream education are being made in Turkey as well, and it is critical to review them. Therefore, the aim of the current study is to obtain an evaluation of the developing STEM education in Turkey by science teachers. For this purpose, the surveying method, one of the quantitative research methods, was used. 128 science teachers working in Diyarbakır province participated in the study. The “Criteria for Quality STEM” scale, adapted to Turkish by the researchers, was used as the data collection tool in the study. Based on the results, it was concluded that young teachers have higher score averages in improving relations between school, society and business world. It was also found that teachers who practice STEM in science education by spreading them over a period of time have higher averages in terms of creating a STEM culture and climate and establishing the connection between school, society and business world. It was determined that teachers who read academic studies have higher averages in integration of academic knowledge and providing school, community and cooperation compared to those who do not. It was determined that the teachers who previously took part in projects related to STEM education have higher averages in creating the STEM culture and climate in schools. In the light of these results, it is suggested that future research is needed to help science teachers learn how to implement STEM education in their classes so that they can use it effectively and successfully.

Using national data to model the New Zealand radiation oncology workforce.

IntroductionDemand for radiation therapy is expected to increase over time. In Aotearoa/New Zealand, the radiation oncology workforce experiences high numbers of clinical hours but an intervention rate that is lower than in comparable countries, suggesting unmet treatment need. Accurate models on the supply and demand for radiation oncologists (ROs) are needed to ensure adequate staffing levels.MethodsWe developed a demand model that predicted the future number of ROs required, using national data from the Radiation Oncology Collection (ROC) and a survey of ROs. Radiation therapy intervention and retreatment rates (IR/RTRs), and benign and non‐cancer conditions being treated, were derived from the ROC and applied to Census population projections. Survey data provided definitions of treatment by complexity, time spent in different activities and time available for work. Results were linked to radiation oncology workforce forecasts from a supply model developed by the Ministry of Health.ResultsThe demand model showed that 85 ROs would be needed in 2031, if current IR/RTRs were maintained, an increase from 68 in 2021. The supply model predicted a decrease in ROs over time, leaving a significant shortfall. Model parameters could be modified to assess the impact of workforce or practice changes; more ROs would be needed if average working hours reduced or IR/RTRs increased.ConclusionWorkforce models based on robust data collections are an important tool for workforce planning. The RO demand model presented here combines detailed information on treatment and work activities to provide credible estimates that can be used to inform actions on training, recruitment and retention.

THE CHANGING WORKFORCE AND ITS IMPLICATIONS TO PRODUCTIVITY: A LITERATURE REVIEW

The changing workforce may to some extent be a boon or bane to the business. Although it may not be absolute to conclude that the current changes in the workforce with regards to attitude, skills, interest and above all how the workforce deal with their fellow employees, managers, and supervisors are entirely beyond control for management to intervene and make it somehow less impairing to the firm. These changes once properly managed and exploited can be beneficial for the firm in terms of higher productivity or even efficiency in the use of resources. But the big question now is how companies may deal productively with these changes in the workforce without undermining or contravening workers’ cultural/behavioural orientation that may lead to resignation or decline in performance. Therefore, due to the foregoing scenarios in workers’ cultural and behavioural conditions today, this study is thus envisioned to explore possibilities and come up with appropriate strategies that may be recommended on human resource policies and strategies that may be beneficial for the firm.

Access to Services for Children and Youth With Special Health Care Needs and Their Families: Concepts and Considerations for an Integrated Systems Redesign.

Access to services for children and youth with special health care needs (CYSHCN) have typically emphasized coverage, service, timeliness, and capability. Yet families of CYSHCN continue to describe a fragmented health care system with significant unmet needs. For many years, the concept of access to services has focused on the services themselves, rather than starting with the needs of CYSHCN and their families. Meeting these needs should be grounded in health equity, address systemic racism and ableism, and emphasize the life course and journey of those with such needs and their families. In this paper, we start with the simple concept of asking that care is available for CYSHCN regardless of when, where, and how they need it. Access to services is built on relationships instead of a series of transactions. Opportunities for innovation include creating a single point of service entry; determining services based on need instead of diagnosis; and emphasizing service continuity, transition, and a place-based approach. The innovations reimagine access throughout the life course, centering care around a proactive, human-centered system that addresses health and all of its determinants. The landscape of antipoverty investments, cultural humility, workforce changes, technology, and human-centered thought in design have the potential to further transform the conceptual framework to improve access to services for CYSHCN and their families.

Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study

Background General practices have had difficulty recruiting and retaining enough general practitioners to keep up with increasing demand for primary health care in recent years. Proposals to increase workforce capacity include a policy-driven strategy to employ additional numbers and a wider range of health professionals. Objectives Our objective was to conduct a comprehensive study of the scale, scope and impact of changing patterns of practitioner employment in general practice in England. This included an analysis of employment trends, motivations behind employment decisions, staff and patient experiences, and how skill mix changes are associated with outcome measures and costs. Design NHS Digital workforce data (2015–19) were used to analyse employment changes and to look at their association with outcomes data, such as the General Practitioner Patient Survey, General Practitioner Worklife Survey, prescribing data, Hospital Episode Statistics, Quality and Outcomes Framework and NHS payments to practices. A practice manager survey (August–December 2019) explored factors motivating general practices’ employment decisions. An in-depth case study of five general practices in England (August–December 2019) examined how a broader range of practitioners is experienced by practice staff and patients. Results We found a 2.84% increase in reported full-time equivalent per 1000 patients across all practitioners during the study period. The full-time equivalent of general practitioner partners decreased, while the full-time equivalent of salaried general practitioners, advanced nurse practitioners, clinical pharmacists, physiotherapists, physician associates and paramedics increased. General practitioners and practice managers reported different motivating factors regarding skill mix employment. General practitioners saw skill mix employment as a strategy to cope with a general practitioner shortage, whereas managers prioritised potential cost-efficiencies. Case studies demonstrated the importance of matching patients’ problems with practitioners’ competencies and ensuring flexibility for practitioners to obtain advice when perfect matching was not achieved. Senior clinicians provided additional support and had supervisory and other responsibilities, and analysis of the General Practitioner Worklife Survey data suggested that general practitioners’ job satisfaction may not increase with skill mix changes. Patients lacked information about newer practitioners, but felt reassured by the accessibility of expert advice. However, General Practitioner Patient Survey data indicated that higher patient satisfaction was associated with a higher general practitioner full-time equivalent. Quality and Outcomes Framework achievement was higher when more practitioners were employed (i.e. full-time equivalent per 1000 patients). Higher clinical pharmacist full-time equivalents per 1000 patients were associated with higher quality and lower cost prescribing. Associations between skill mix and hospital activity were mixed. Our analysis of payments to practices and prescribing costs suggested that NHS expenditure may not decrease with increasing skill mix employment. Limitations These findings may reflect turbulence during a period of rapid skill mix change in general practice. The current policy of employing staff through primary care networks is likely to accelerate workforce change and generate additional challenges. Conclusions Skill mix implementation is challenging because of the inherent complexity of general practice caseloads; it is associated with a mix of positive and negative outcome measures. Future work Findings from this study will inform future funding applications for projects that seek to examine the nature and impact of evolving multiprofessional teams in primary care. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol.

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O'Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.

Sustaining the Australian respiratory workforce through the COVID-19 pandemic: a scoping literature review.

The outbreak of the COVID‐19 pandemic in late 2019 and in 2020 presented challenges to healthcare workers (HCW) around the world that were unexpected and dramatic. The relentless progress of infection, starting in China and rapidly spreading to Europe, North America and elsewhere gave more remote countries, like Australia, time to prepare but also time for unease. HCW everywhere had to readjust and change their work practices to cope. Further waves of infection and transmission with newer variants pose challenges to HCW and health systems, even after mass vaccination. Respiratory medicine HCW found themselves at the frontline, developing critical care services to support intensive care units and grappling with unanticipated concerns about safety, risk and the need to retrain. Several studies have addressed the need for rapid changes in the healthcare workforce for COVID‐19 and the impact of this preparation on HCW themselves. In this paper, we present a scoping review of the literature on preparing HCW for the pandemic, explore the Australian experience of building the respiratory workforce and propose evidence‐based recommendations to sustain this workforce in an unprecedented high‐risk environment.

Physician-scientists in the United States at 2020: Trends and concerns.

Physician‐scientists comprise a unique and valuable part of the biomedical workforce, but for decades there has been concern about the number of physicians actively engaged in research. Reports have outlined the challenges facing physician‐scientists, and programs have been initiated to encourage and facilitate research careers for medically trained scientists. Many of these initiatives have demonstrated successful outcomes, but there has not been a recent summary of the impact of the past decade of effort. This report compiles available data from surveys of medical education and physician research participation to assess changes in the physician‐scientist workforce from 2011–2020. Several trends are positive: rising enrollments in MD‐PhD programs, greater levels of interest in research careers among matriculating medical students, more research experience during medical school and rising numbers of physicians in academic medicine, and an increase in first R01 grants to physician‐scientists. However, there are now decreased levels of interest in research careers among graduating medical students, a steady decline in MDs applying for NIH loan repayment program support, an increased age at first R01 grant success for physicians, and fewer physicians reporting research as their primary work activity: all of these indicators create concern for the stability of the career path. Despite a recommendation by the Physician‐Scientist Workforce in 2014 to create “real‐time” reporting on NIH grants and grantees to help the public assess trends, this initiative has not been completed. Better information is still needed to fully understand the status of the physician‐scientist workforce, and to assess efforts to stabilize this vulnerable career path.

Converting the existing disease surveillance from a paper-based to an electronic-based system using district health information system (DHIS-2) for real-time information: the Lebanese experience

IntroductionThe Ministry of Public Health in Lebanon is in the process of converting the surveillance reporting from a cumbersome paper-based system to a web-based electronic platform (DHIS-2) to have real-time information for early detection of alerts and outbreaks and for initiating a prompt response.ObjectivesThis paper aimed to document the Lebanese experience in implementing DHIS-2 for the disease surveillance system. It also targets to assess the improvement of reporting rates and timeliness of the reported data and to disclose the encountered challenges and opportunities.MethodologyThis is a retrospective description of processes involved in the implementation of the DHIS-2 tool in Lebanon. Initially, it was piloted for the school-based surveillance in 2014; then its use was extended in May 2017 to cover other specific surveillance systems. This included all surveillance programs collecting aggregate data from hospitals, medical centers, dispensaries, or laboratories at the first stage. As part of the national roll-out process, the online application was developed. The customized aggregated-based datasets, organization units, user accounts, specific and generic dashboards were generated. More than 80 training sessions were conducted throughout the country targeting 1290 end-users including health officers at the national and provincial levels, focal persons who were working in all public and private hospitals, laboratories, and medical centers as well. Completeness and timeliness of reported data were compared before and after the implementation of DHIS-2. The unveiled challenges and the main lessons learned during the roll-out process were discussed.ResultsFor laboratory-based surveillance, completeness of reporting increased from 70.8% in May to 89.6% in October. Timeliness has improved from 25 to 74%. For medical centers, an improvement of 8.1% for completeness and 9.4% in timeliness was recorded before and after training sessions. For zero reporting, completeness remains the same (88%) and timeliness has improved from 74 to 87%. The main challenges faced during the implementation of DHIS-2 were mainly infrastructural and system-related in addition to poor internet connectivity, limited workforce, and frequent changes to DHIS-2 versions.ConclusionImplementation of DHIS-2 improved timeliness and completeness for aggregated data reporting. Continued on-site support, monitoring, and system enhancement are needed to improve the performance of DHIS-2.

Vaccinated: Marketing Workforce Hybridization

With a hybrid workplace model, employers offer exceptional workplace places, create greater collaboration and community for workers and showcase an example of the modern workplace that is digitally flexible and hybrid.This article aims to explore how the organizations and workers impacted by the long-term impact of the pandemic have accelerated the work-from-home movement and exacerbated organizational issues associated with remote work. This study used qualitative content analysis methods and relied on recent remote work research articles, digital surveys, and interviews. This article provides a viewpoint based on the authors' professional experiences in academia and the industry. This narrative review aims to underscore how the pandemic brought lasting workforce changes, including the prevalence and permanence of remote and hybrid work. The article aims to present how companies are moving toward a hybrid workforce, capitalizing on both the collaborative nature of in-person work and the flexibility of telecommuting. This research aimed to study the new work models providing opportunities to supercharge customer intimacy, workers' engagement, and productivity. This study finds that the worker's challenges regarding job satisfaction, productivity, and organizational commitment work in progress as the COVID-19 pushed organizations into unprecedented and unplanned remote work, and hybrid work is the best remedial approach.The article adds to the body of knowledge regarding remote work in organizations focused on the new hybrid work environment created by the global pandemic. The result of the study recommends that organizations create a level playing field for workers, regardless of their location, empower managers, and care for workers as their highest priority not only structurally but in ways of workspaces, working, and culture for hybrid work. The general discussion includes the conclusions from the study for further qualitative and quantitative investigations with significant implications for academicians, practitioners, and policy makers.

Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.

We evaluated temporal trends in rural-urban disparities of the surgeon supply among surgeons commonly treating patients with cancer. We performed a retrospective observational study of county-level workforce changes from 2004 to 2017 using the Area Health Resource File. We calculated physician density (providers/100,000 population) for each specialty by rural and urban counties using the 2003 Rural-Urban Commuting Codes (RUCC), and evaluated percent changes in the rural-urban disparity in physician density. Secondary analyses evaluated these changes by Census region. Additionally, Gini indices were calculated by year and RUCC to evaluate the workforce inequality within rural areas. Total surgical specialist density declined in rural areas from 16 to 14 per 100,000 population, and declined slightly from 33 to 31 per 100,000 population in urban areas, for a rural-urban disparity increase of 8% (95% CI 5%,10%). Among specific specialties, the percentage increase in the rural-urban workforce supply disparity was largest for colorectal surgeons and general surgeons at 66% (95% CI 51%,80%) and 72% (95% CI 58%,86%), respectively, although absolute changes were small. Regional heterogeneity of the workforce was higher for rural areas than urban areas. Changes in the rural-urban physician workforce disparities over time are dependent upon specialty, region, and local community factors. This highlights how surgical workforce policy should be oriented to the local area circumstances.