Shortage Of Physicians Research Articles

Exploring medical students’ perceptions of family medicine in Kyrgyzstan: a mixed method study

BackgroundDespite knowing that health systems with strong primary care improve overall health outcomes within a population, many countries are facing a global trend of declining interest and shortage of family doctors. This is the case of the Kyrgyz Republic, in which rural areas are struggling to attract and retain family medicine (FM) doctors. This study aims to explore how Kyrgyz medical students perceive FM and the factors that influence their specialty choice.MethodsThis study used a cross-sectional explanatory sequential design, including quantitative survey and focus group discussions that were carried out at the Kyrgyz State Medical Academy (KSMA) in Bishkek in 2017. Overall, 66% (953 out of 1449) of medical undergraduate students registered in year 1, 4 and 6 completed the survey, and 42 participated in the focus groups. The results were organized around 7 factors influencing perceptions and attitudes towards FM identified through a qualitative systematic review.ResultsThe interest of Kyrgyz students for FM was the lowest of all specialties. Access to high medical technologies, career opportunities, salary, patient interaction and possibility to work abroad were the five most important factors influencing specialty choice. FM was perceived as a difficult profession, yet with poor prestige, insufficient remuneration, limited career possibilities and poor working conditions, especially in rural areas. The academic discourse, which disregards FM specialty had a negative influence on student’s perceptions and prevented students’ ability to identify with the practice of family medicine. However, students’ awareness of their social accountability arose as a positive leverage to increase the choice of FM, provided other problems were solved.ConclusionThis study highlighted key factors responsible for the low number of students choosing to become FM in Kyrgyzstan. The first major factor, presumably specific to many low- and lower-middle- income countries was the poor working conditions in remote areas. The second factor, common to many countries, was the distorted image of FM and its specialty transmitted through the medical schools’ institutional culture which does not value FM through positive role models. This study served as a basis to establish a strategy to promote FM within the KSMA and potentially at National level.

Early Identification of Family Physicians Using Qualitative Admissions Data.

The medical community has been concerned about the shortage of family physicians for decades. Identification of likely family medicine (FM) student matches early in medical school is an efficient recruitment tool. The objective of this study was to analyze qualitative data from medical school applications to establish themes that differentiate future family physicians from their non-FM counterparts. We conducted a qualitative analysis of admissions essays from two groups of 2010-2019 medical school graduates: a study group of students who matched to FM (n=135) and a random sample comparison group of non-FM matches (n=136). We utilized a natural language modeling platform to recognize semantic patterns in the data. This platform generated keywords for each sample, which then guided a more traditional content analysis of the qualitative data for themes. The two groups shared two themes: emotions and science/academics, but with some differences in thematic emphasis. The study group tended toward more positive emotions and the comparison group tended to utilize more specialized scientific language. The study group exhibited two unique themes: special interests in service and community/people. A secondary theme of religious faith was evident in the FM study group. The comparison group exhibited two unique themes: lab/clinical research and career aspirations. Aided by machine learning, a novel analytical approach revealed key differences between FM and non-FM student application materials. Findings suggest qualitative application data may contain identifiable thematic differences when comparing students who eventually match into FM residency programs to those who match into other specialties. Assessing student potential for FM could help guide recruitment and mentorship activities.

Associations of the Informal Curriculum and Student Perceptions of Research With Family Medicine Career Choice.

The United States is facing a primary care physician shortage that is predicted to continue through the next decade. Determining why graduating medical students pursue a career in family medicine may inform efforts to help address this shortage. Medical student responses to the Family Medicine Attitudes Questionnaire (FMAQ), a 14-item validated questionnaire developed to assess student attitudes toward family medicine, were collected at 16 US medical schools and compared to each institution's proportion of graduates entering family medicine. We also analyzed subscales of the FMAQ, including attitudes toward family medicine lifestyle, research, importance, and shortages, with respect to student choice of family medicine. We used Pearson coefficients to calculate correlations. Student attitudes toward family medicine careers were strongly correlated with an institution's proportion of graduates entering family medicine. Positive perceptions of family medicine research by students was the factor most strongly correlated with matching into a family medicine residency. Strengthening students' exposures and perceptions of family medicine and family medicine research may create viable opportunities for intervention by departments of family medicine and medical schools seeking to increase the number of graduates entering family medicine.

Abstract 6497: Availability of healthcare providers and its association with survival outcomes in non-Hodgkin lymphoma in the United States

Abstract Background: Survival outcome in Non-Hodgkin lymphoma (NHL) is significantly better in earlier stages, compared to advanced stages. Early identification of signs and symptoms, and prompt specialist availability and referral, are crucial for diagnosis and treatment at earlier stages. Mounting physician shortages are a growing concern, and we sought to analyze their effect on NHL mortality rates. Methods: We extracted data on the age-adjusted mortality rate (AAMR) and crude incidence rate (CIR) of NHL for all U.S. states and the District of Columbia from the Center for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database (2017-2019). Nevada was excluded due to missing information. Data on the state-wise number of primary care physicians (PCPs) was obtained from the Association of American Medical Colleges (AAMC) state physician workforce data report (2020), and of Hematology/Oncology specialists (HOs) was gathered from the National Provider Identifier (NPI) registry (2020). The number of PCPs and HOs per each NHL incidence (PCP/CIR, HO/CIR respectively) was then calculated. Correlations were analyzed using Pearson’s coefficient. Statistical analysis was performed using VassarStats. Results: Median AAMR for NHL in the US was 5.15 (IQR 4.35, 5.95) per 100, 000 population. The median number of PCP and HO per each case of NHL incidence was 4.32 (IQR 3.43, 5.21), and 0.28 (IQR 0.1, 0.37) respectively. States with fewer PCPs per each NHL incidence had higher AAMR (r=-0.37, p=0.007). States with a lower number of HOs per each NHL incidence had higher AAMR (r=-0.41, p=0.003) Conclusions: Based on the analysis, the availability of a lower number of PCPs and HOs per each NHL incidence is associated with increased AAMR of the disease. This data may strengthen the need for intensification of focus on decreasing the soaring physician shortages in the states, in order to help decrease the overall mortality associated with NHL. Citation Format: Shiva Jashwanth Gaddam, Udhayvir Singh Grewal, Zara Hassan, Poornima Ramadas. Availability of healthcare providers and its association with survival outcomes in non-Hodgkin lymphoma in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6497.

MP57-10 A NEW BARRIER IN THE UROLOGY RESIDENCY APPLICATION PROCESS FOR STUDENTS: GROWTH OF U.S. MEDICAL SCHOOLS INCREASINGLY OUTPACES THE DEVELOPMENT OF UROLOGY PROGRAMS

You have accessJournal of UrologyCME1 Apr 2023MP57-10 A NEW BARRIER IN THE UROLOGY RESIDENCY APPLICATION PROCESS FOR STUDENTS: GROWTH OF U.S. MEDICAL SCHOOLS INCREASINGLY OUTPACES THE DEVELOPMENT OF UROLOGY PROGRAMS David Nelwan, Umberto Donato, Trushar Patel, and Ahmad Saeed Imam David NelwanDavid Nelwan More articles by this author , Umberto DonatoUmberto Donato More articles by this author , Trushar PatelTrushar Patel More articles by this author , and Ahmad Saeed ImamAhmad Saeed Imam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2006, the AAMC recommended that first-year medical school matriculation should increase by 30% to combat the increasing physician shortage in the U.S. Their goal was met in 2018, and as undergraduate medical education has since continued to expand, we wanted to examine the concomitant growth of urology training programs. METHODS: Data on the number of current MD and DO medical schools and urology residencies in the U.S., as well as their year of establishment, were ascertained via internet search, with sources including the AAMC, American Association of Colleges of Osteopathic Medicine, Doximity, and individual programs’ websites. Data were tabulated and stratified by year of establishment (either<2000 or≥2000). RESULTS: Before the year 2000, there were 142 medical schools (126 MD, 16 DO) and 113 accredited urology residencies. Since 2000, 76 new undergraduate medical training sites have been established (33 MD, 43 DO), as well as 35 new urology residency programs. In total, there are presently 218 undergraduate medical training sites (159 MD, 59 DO) and 148 urology residencies.We calculated the percentages of undergraduate medical training sites with a urology residency, comparing pre-2000 to the present: <2000=79.6% (113/142); present=67.9% (148/218). We also stratified by region, using AUA Sections (Table 1). CONCLUSIONS: The growth rate of graduate medical education is lagging behind the increased rate of medical school matriculation. Prior to 2000, nearly 80% of medical schools had an associated urology residency; that number has fallen to 67.9% in the past two decades. The Western AUA Section region shows the greatest discrepancy between growth of medical schools and development of urology residencies. Overall, all AUA Sections have experienced a decrease in the percentage of medical training sites in their region with a urology residency, with the exception of the Mid-Atlantic and New England Sections.Equity is one of the pillars of the AUA’s DEI initiatives; however, students at 1/3rd of medical training sites lack local urologic mentorship. Given the importance of urology research to successfully matching, these students are potentially disadvantaged in their pursuit of a career in urology compared to students at institutions with a urology residency. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e788 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Nelwan More articles by this author Umberto Donato More articles by this author Trushar Patel More articles by this author Ahmad Saeed Imam More articles by this author Expand All Advertisement PDF downloadLoading ...

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

Barriers and facilitators to recruitment and retention of underrepresented racial and ethnic minoritized students to PhD programs in nursing: A qualitative descriptive study

BackgroundThere is a global shortage of Doctor of Philosophy (PhD)-trained nurses, which is amplified among underrepresented racial and ethnic groups who are minoritized. PurposeThis study explores barriers and facilitators to recruiting under-represented racial-ethnic group who are minoritized (UREM) PhD nursing students, defined as African American, Black, American Indian, Alaskan Native, or Hispanic/Latinx. MethodsUsing a qualitative descriptive design, interviews of 23 UREM PhD nursing students were analyzed with conventional content analysis. DiscussionBarriers to recruitment and retention included identifying students interested in a PhD, organizational culture of programs, student mental health, and lack of social support. Facilitators for recruitment and retention included less discrimination and microaggressions experienced by students, faculty from groups who are minoritized representation, and strong family support. These findings had implications for recruitment and retention and PhD programs in nursing can focus on the above key areas to better recuit and retain UREM students. ConclusionAllocating funding to culturally tailored mental health resources, student scholarships, and increasing UREM members of faculty within PhD programs.

Advanced Practice Nurses' Organization Commitment: Impact of Job Environment, Job Satisfaction, and Person-Organization Fit

The demand for advanced practice nurses has increased globally due to a shortage of physicians and an increased demand for high-quality healthcare. Research is needed on the enhancement of advanced practice nurses' organization commitment. Organization commitment directly impacts the retention of advanced practice nurses. This study aims to identify the key factors affecting the organization commitment of advanced practice nurses. A cross-sectional survey was conducted at the largest hospital in South Korea. A total of 189 advanced practice nurses answered survey questions. A partial least squares-structural equation modeling method with a method was employed to analyze survey responses. A pay scale of advanced practice nurses is positively associated with person-organization fit. However, the effect of job location and computer self-efficacy on person-organization fit is not significant. Job satisfaction plays a salient direct role in supervision and person-organization fit. Job satisfaction is also a significant moderator in the relation between supervision and person-organization fit. Person-organization fit is significantly associated with both organization commitment and supervision. Supervision has a positive effect on organization commitment. Pay scale, job satisfaction, supervision, and person-organization-fit are significant factors affecting organization commitment. Establishing an intra-organization entity, such as APN steering committee, to ensure mutual consensus and transparent communication between administrators and advanced practice nurses would enhance person-organization fit, rating of supervision, and organization commitment.

A Cross-sectional Study of Community-level Physician Retention and Diabetes Management in Rural Ontario

ObjectiveOur aim in this study was to determine the impact of community-level physician retention on the quality of diabetes care in rural Ontario. MethodsUsing administrative data, we compared diabetes quality of care. We defined retention as the proportion of physicians in a community from one year to the next. We grouped retention level by tertile and added a category for those communities with no physician. ResultsResidents of high-retention communities were more likely to have had glycated hemoglobin (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.06 to 1.14) and low-density lipoprotein (OR, 1.17; 95% CI, 1.13 to 1.22) testing, but less likely to have had testing for urine albumin-to-creatine ratio (OR, 0.86; 95% CI, 0.83 to 0.89) or to have received an angiotensin-converting enzyme inhibitor or angiotensin-2 receptor blocker (OR, 0.91; 95% CI, 0.86 to 0.95) or a statin (OR, 0.91; 95% CI, 0.87 to 0.96), when compared with low-retention communities. Communities with no residing physician had care that was equivalent to or better than that in high-retention communities. ConclusionsCommunity-level physician retention, based on a 2-year time frame, was significantly related to quality of diabetes care. A closer look at models of care in communities with no residing physician is warranted. Community-level physician retention can be used to assess the impact of physician shortages on diabetes management in rural communities.

A case for lifelong learning in emergency medicine: The perspective from a rural state.

The expansive practice of emergency medicine cannot be fully taught or learned in 3 or 4 years. Lifelong learning, self-assessment,1 and ongoing skill acquisition and retention are necessary. How do we teach and acknowledge this during residency training and how do we support our isolated, rural colleagues? Importantly, there is a growing shortage of rural emergency physicians and many of our trainees may work in these environments.2 As educators, we must study potential solutions and bridge these gaps for our trainees entering independent practice and for our colleagues far removed from formal training. Recent cases, and many like them, illustrate this point. A rural emergency physician expertly places a small-bore chest tube for an atraumatic pneumothorax, the pneumothorax resolved, they requested transfer to a larger center for ongoing management. The tertiary care center is at full capacity. A phone consultation with a specialist recommends removal of the chest tube in the emergency department (ED) and discharge home if a follow up chest x-ray shows sustained resolution. The emergency physician has never removed a chest tube before and the patient is transferred to a larger regional ED for uncomplicated removal. In a second case, a patient is transferred from an hour away, during a snowstorm, for a peritonsillar abscess. The procedure is within an emergency physician's scope of practice. The referring physician had never performed this procedure in their decades of practice. The patient is transferred to the tertiary care center where it is drained by the attending emergency physician and emergency medicine resident. On a winter night, an emergency physician intubates a patient with a head injury in their critical-access emergency department. They request lifesaving medications and the respiratory therapist to set the ventilator. It is nighttime; there is no respiratory therapist or pharmacist. The physician must assist in mixing the medications and setting up the ventilator. The skills required for an emergency physician are ever expanding, particularly as access to tertiary care becomes more difficult. Lifelong learning and practice development to best serve our patients is a necessity in our specialty. Solutions may include regional conferences, collaborative case reviews, real-time peer-based decision support with telemedicine, maintenance of board certification, asynchronous, self-directed learning through free open-access medical education (FOAM), podcasts, textbooks or journal articles, and academic–rural partnerships that create shared faculty positions between rural and tertiary sites and rural rotations for trainees. Each of these has its limitations and time represents a major barrier.3-5 The American Board of Emergency Medicine requires continuous learning for maintenance of certification; this is beneficial but is not tailored to the physician's practice environment.6, 7 Our own work in the rural state of Vermont and upstate New York has led us to offer high-acuity, low occurrence (HALO) courses at the regional academic center twice a year for both residents and practicing emergency physicians within our region and create a rural-specific simulation lab at one of our critical-access sites. Additionally, we established a tele-emergency medicine program to offer a virtual resource from the tertiary care center in times of high-acuity, high-complexity care, or volume surge. The skill of delivering and accepting tele-emergency medicine assistance must also be learned and taught. Our education must continue to adapt to meet the needs of our unique and evolving practice environments. We must also acknowledge that many scenarios cannot be predicted. Instilling the motivation for lifelong learning, self-assessment1 and exposure to resource limited settings during training may help prepare trainees for these challenges. Although these issues are not unique to emergency medicine, we are a specialty that prides itself on adaptability. We must confront this challenge with creative solutions. Skyler Lentz, Ashley Weisman, Jordan Ship, and Matthew S. Siket conceived the idea for this manuscript and contributed substantially to the content, design, writing and editing of the commentary. The authors declare no conflicts of interest.

Association of Device Industry Payments, Physician Supply, and Regional Utilization of Orthopedic and Cardiac Procedures.

Geographic variation in high-cost medical procedure utilization in the USA is not fully explained by patient factors but may be influenced by the supply of procedural physicians and marketing payments. To examine the association between physician supply, medical device-related marketing payments to physicians, and utilization of knee arthroplasty (KA) and percutaneous coronary interventions (PCI) within hospital referral regions (HRRs). Cross-sectional analysis of data from the 2018 CMS Open Payments database and procedural utilization data from the CMS Provider Utilization and Payment database. Medicare-participating procedural cardiologists and orthopedic surgeons. Regional rates of PCIs and KAs per 100,000 Medicare fee-for-service (FFS) beneficiaries were estimated after adjustment for beneficiary demographics. Across 306 HRRs, there were 109,301 payments (value $17,554,728) to cardiologists for cardiac stents and 68,132 payments (value $40,492,126) to orthopedic surgeons for prosthetic knees. Among HRRs, one additional interventional cardiologist was associated with an increase of 12.9 (CI, 9.3-16.5) PCIs per 100,000 beneficiaries, and one additional orthopedic surgeon was associated with an increase of 20.6 (CI, 16.9-24.4) KAs per 100,000 beneficiaries. A $10,000 increase in gift payments from stent manufacturers was associated with an increase of 26.0 (CI, 5.1-46.9) PCIs per 100,000 beneficiaries, while total and service payments were not associated with greater regional PCI utilization. A $10,000 increase in total payments from knee prosthetic manufacturers was associated with an increase of 2.9 (CI, 1.4-4.5) KAs per 100,000 beneficiaries, while a similar increase in gift and service payments was associated with an increase of 14.5 (CI, 5.0-24.1) and 3.4 (CI, 1.6-5.2) KAs, respectively. Among Medicare FFS beneficiaries, regional supply of physicians and receipt of industry payments were associated with greater use of PCIs and KAs. Relationships between payments and procedural utilization were more consistent for KAs, a largely elective procedure, compared to PCIs, which may be elective or emergent.

Wearable Hand Orthotic Device for Rehabilitation: Hand Therapy with Multi-Mode Control and Real-Time Feedback

IoT-based wearable devices are significantly contributing to personalized and pervasive modern healthcare. Traditional healthcare systems are handicapped by several factors, including shortages of physicians, nurses, healthcare devices, hospital beds, healthcare cost, etc. Conventional therapy is carried out either at a hospital or at home by certified therapists which is not affordable for many in developing nations. In this research work, we present IoT-based monitoring and an evaluation of key parameters and indicators of a wearable device used during the rehabilitation process in stroke patients’ hand therapy which can be operated by the users at home without the need for therapists. Sensors along with a controller board are used for signal acquisition, processing, and monitoring. The efficiency of therapy can be increased through real-time follow-up and feedback from therapists. Three different control methods are proposed and studied: smartphone-based speech, smartphone-based touch, and Internet of Things (IoT)-based dashboard. In addition, four different architectures, including: therapist therapy wearable, dual therapy wearable, user therapy wearable, and multiuser therapy wearable architectures are discussed. A rehabilitation therapy-based case study using the proposed wearable device with multiple volunteers was conducted. Therapists can remotely operate the device and train the users. Users can benefit and save on costs without the need to visit hospitals or therapy centers or hire therapists. Based on the results of the experiments with volunteers, we can confidently say that the proposed IoT-based wearable device can enhance the quality of life and well-being of the users.

The influence of excessive stress on medical students in the Czech Republic – national sample

PurposeThe Czech Republic has been dealing with a long-term shortage of doctors, which, according to demographic forecasts, will continue to worsen due to the retirement of stronger generations of doctors in contrast to the gradual aging of the population, which will require more health care over time. The country´s political set is trying to respond to this shortage and demographic forecasts by gradually increasing financial funding of medical faculties with the aim of increasing the number of graduates of the program in the field of general medicine.MethodsAnonymous questionnaire survey was conducted among students and graduates of general medicine at all eight Czech medical faculties. A total of 3183 respondents participated in the survey. There were 2843 medical students, which represents approximately 28% of all medical students in the Czech Republic. The distribution of respondents within the study years was approximately even and approximately corresponded to the real distribution of students between individual faculties in country, which makes survey a national sample. The statistical processing was performed in the statistical software R. Apart from the basic comparison using percentage relative frequencies and Pearson´s chi-squared test, in this study we used Odds ratios (OR) with CI 0,95 from logistic regression model for a better interpretation of some outputs.ResultsThe results show that the vast majority of Czech medical students experience excessive stress during their studies, which increases the risk of students´ somatic problems (OR = 4.89, CI 0.95 = (4.11;5.83), p < 0.001)., targeted alcohol use (OR = 2.29, CI 0.95 = (1.73;3.04), p < 0,001) and the use of anxiolytic or antidepressant medication to reduce it (OR = 2.99, CI 0.95 = (2.24;4.01), p < 0.001). Students experiencing higher levels of excessive stress are more likely to leave their studies based on their own decision (4.20 (CI 0.95 (3.39;5.19), p < 0.001) and not to enter clinical practice after graduation (OR = 2.62, CI 0.95 = (2.06;3.33), p < 0.001).ConclusionsThe survey shows the need for an open discussion at the highest level about the possibilities of reasonable reduction of unnecessary stress during medical studies. Medical students in the Czech Republic are exposed to excessive stress with all the consequences described above. All that remains is to state the existence of unnecessary components of stress, which represent an opportunity to reduce it, thereby achieving better conditions for studying, improvement in the staff situation in the Czech healthcare system and a reduction in inefficiently spent financial resources for the education of young doctors.Trial registrationNo registration.

Regional variations in multimorbidity burden among office-based physicians in Germany.

Multimorbidity is associated with higher utilization of healthcare services. However, many countries do not consider multimorbidity when estimating physician supply. The main aim of this study was to assess how regional multimorbidity levels can be integrated when estimating the need for office-based physician supply. Claims data were used to measure and compare the proportions of multimorbid patients of GPs, ophthalmologists, orthopaedic specialists and neurologists, and examine spatial variations through Bernoulli cluster analysis of regional multimorbidity levels. To explore the interrelationship between current capacities and spatial occurrence of high-rate clusters, clusters were compared with the current supply of physicians. About 17239488 individuals out of approximately 67 million records were classified as multimorbid. Multimorbidity levels varied greatly between physician disciplines (31.5-60.1%). Bernoulli cluster analysis demonstrated that many high-rate areas were found for all specialized physicians, but clusters varied partially by size and location. The comparison with current physician supply at cluster level showed that more than a third of clusters with a significantly higher share of morbid patients seeing a GP are met, on an average, by GP supply below targeted values. In turn, clusters with significantly higher multimorbidity levels of specialized physicians were met, on an average, by supply that exceeded targeted values. Our study offers an approach to how to include discipline-specific multimorbidity at area level when estimating physician supply and discusses its relevance. The outcomes of our article can be used by policymakers to advance current planning strategies and to improve the quality of office-based care.

Practical experience of the Sechenov University Reference Centre for immunohistochemical, pathomorphological, molecular genetic diagnostic methods

Against the background of a steady increase in the number of oncological diseases, as well as the complexity of the primary morphological diagnosis of malignant neoplasms (MNT) and precancerous conditions, especially in the regions of the Russian Federation, in 2019, the creation of a number of Reference Centers (RCs) for immunohistochemical, pathomorphological, molecular genetic methods was initiated research within the framework of the federal project “Fight against oncological diseases”. In 2020, on the basis of the centralized pathoanatomical department of the Clinical Center of Sechenov University, the RC began its work. Aim. To analyze the work of the RC of Sechenov University and compare the results obtained with the tasks of the federal project.Materials and methods. The data of histological, immunohistochemical studies from the registers of receipt of biopsy (surgical) materials and the issuance of the results of intravital pathoanatomical studies (account forms 014-2 / y and 057-y / 04), as well as data from the Telemedicine system of remote consultations, were analyzed. Results. For 21 months of work, the RC consulted 1476 requests received from 70 constituent entities of the Russian Federation. More than 10 % of reference diagnoses were made in a remote format through the Telemedicine system of remote consultations at the federal and regional levels using digital pathology techniques.Conclusion. Despite the obvious need for the work of RCs, there are still a number of issues that have a signifcant impact on the quality of diagnostic processes: specialization of specifc RCs, expansion of the range of incoming clinical and morphological diagnoses. It also requires attention to regularly improve the skills of RC employees in Russian and international educational systems and to equip the RC, frst of all, with virtual resources. The experience of the RC has demonstrated the importance of a second medical expert opinion in the primary diagnosis and verifcation of the diagnosis of malignant neoplasms of various localizations for the regions of the Russian Federation, where the acute problem is the general shortage of general pathologists and expert doctors.

Characteristics of physician associates/assistants in dermatology

The dermatology workforce includes physicians, nurse practitioners (NPs), and physician associates/assistants (PAs). The number of dermatologists is growing slowly while the growth of PAs working in dermatology is rapid and accelerating. To understand their characteristics, a descriptive study of PAs practicing in dermatology utilizing the National Commission on Certification of Physician Assistants (NCCPA) workforce dataset on PA practices was undertaken. NCCPA certifies PAs who practice in the United States and queries them about their role, employment, salary, and job satisfaction. Analyses consisted of descriptive statistics, Chi-Square, and Mann–Whitney tests for comparisons between PAs practicing in dermatology versus the total of all other PA specialties. As of 2021, 4,580 certified PAs reported practicing in dermatology—a nearly twofold increase since 2013, when 2323 worked in the specialty. This cohort's median age was 39 years, and 82% were female. Almost all (91.5%) are office based, and 81% work more than 31 h per week. The median salary was $125,000 (2020 dollars). Dermatology PAs work fewer hours and see more patients than their counterparts compared to all 69 PA specialties. At the same time, dermatology PAs are more satisfied and less burnt out when compared to all PAs. The increased number of PAs selecting dermatology as their discipline can help lessen the projected physician shortage in this field.

In-hospital Outcomes and the Impact of Transfer Status in Nonelective vs Elective Transcatheter Aortic Valve Replacement

BackgroundNonelective transcatheter aortic valve replacement (TAVR) requires additional research to be fully understood. MethodsUsing the National Inpatient Sample database (2016-2019), we conducted a retrospective cohort study comparing nonelective vs elective TAVR. The primary outcome of interest was the in-hospital mortality rate among patients undergoing nonelective TAVR, compared to that among patients undergoing elective TAVR. We matched patients in a greedy nearest-neighbor 1:1 model and multivariable logistic regression, which was adjusted for demographics, hospital factors, and comorbidities, and was used to compare mortality in our matched cohort. ResultsEach cohort had 4389 patients in each cohort. When adjusted for age, race, sex, and comorbidities, nonelective TAVR patients had 1.99 times higher odds of suffering in-hospital mortality compared to elective admissions (adjusted odds ratio 1.99, 95% confidence interval: 1.42-2.81; P < 0.001). When separated by transfer status, nonelective patients admitted as regular hospital admissions or transferred from other acute-care centres also had higher odds of suffering in-hospital mortality compared to elective admissions. ConclusionsOur findings illustrate that nonelective TAVR patients are a vulnerable population that require additional medical support in the acute-care setting. As the demand for TAVR increases, further discussions regarding access to healthcare in underserved regions, the national physician shortage, and the future of the TAVR industry are imperative.

Exploration of how primary care models influence job satisfaction among primary care providers during the COVID-19 pandemic in New Brunswick: a descriptive and comparative study

BackgroundThe COVID-19 pandemic has highlighted human resource gaps and physician shortages in healthcare systems in New Brunswick (NB), as evidenced by multiple healthcare service interruptions. In addition, the New Brunswick Health Council gathered data from citizens on the type of primary care models (i.e. physicians in solo practice, physicians in collaborative practice, and collaborative practice with physicians and nurse practitioners) they use as their usual place of care. To add to their survey’s findings, our study aims to see how these different primary care models were associated with job satisfaction as reported by primary care providers.MethodsIn total, 120 primary care providers responded to an online survey about their primary care models and job satisfaction levels. We used IBM’s “SPSS Statistics” software to run Chi-square and Fisher’s exact tests to compare job satisfaction levels between variable groups to determine if there were statistically significant variations.ResultsOverall, 77% of participants declared being satisfied at work. The reported job satisfaction levels did not appear to be influenced by the primary care model. Participants reported similar job satisfaction levels regardless of if they practiced alone or in collaboration. Although 50% of primary care providers reported having symptoms of burnout and experienced a decline in job satisfaction during the COVID-19 pandemic, the primary care model was not associated with these experiences. Therefore, participants who reported burnout or a decline in job satisfaction were similar in all primary care models. Our study’s results suggest that the autonomy to choose a preferred model was important, since 45.8% of participants reported choosing their primary care models, based on preference. Proximity to family and friends and balancing work and family emerged as critical factors that influence choosing a job and staying in that job.ConclusionPrimary care providers’ staffing recruitment and retention strategies should include the factors reported as determinants in our study. Primary care models do not appear to influence job satisfaction levels, although having the autonomy to choose a preferred model was reported as highly important. Consequently, it may be counterproductive to impose specific primary care models if one aims to prioritize primary care providers’ job satisfaction and wellness.

When policy meets reality: the new 18-hour on-call shift policy and the Israeli anesthesia workforce crisis

BackgroundThe Israeli physician workforce faces multiple challenges. These include planned policies reducing physician on-call from 26 to 18 h and, from 2026, allowing only graduates of Ministry of Health approved foreign medical schools to take the Israeli licensing examination and an ongoing physician shortage (2019: Israel had 3.19 physicians/1000 persons vs. OECD average of 3.49 physicians/1000 persons). This study examines the potential impact of these planned policies on the Israeli anesthesiology workforce.MethodsSurveys conducted among 34 public and private Israeli hospital anesthesiology department chairs collected data on their department's number of weekday on-call anesthesiologists and current shortage of anesthesiologists. A subsequent survey collected data on each anesthesiologist in the workforce, including the country where they studied medicine.ResultsEach weekday night there were 114 on-call anesthesiologists; 72 residents and 42 attendings. Using productive work coefficients, this translates to 104 resident and 51 attending anesthesiologists. Furthermore, 21 departments had existing anesthesia workforce shortages totaling 110 anesthesiologists. There were 873 anesthesiologists from non-OECD countries whose medical schools are not accredited by the World Federation for Medical Education, of whom 332 were residents (61.9% of residents). Only 20.1% of anesthesiology residents were Israeli medical school graduates.ConclusionsDescriptive survey data assessed the immediate and long-term consequences for the healthcare system and anesthesiology workforce of two new Health Ministry policies. Implementing the 18-h policy will immediately remove from the daytime workforce 155 anesthesiologists and who will be unavailable to staff elective surgery operating rooms. This will compound the current national shortage of 110 anesthesiologists. It is unclear how to replace this shortfall since there are no surplus Israeli physicians and very few Israeli graduates choose anesthesiology as a specialty. This situation will be exacerbated after 2026 when graduates of certain foreign medical schools will be unable to enter the medical workforce, further reducing the pool of potential anesthesiology residents. Both policies were promulgated without adequate operational and budgetary planning or fiscal or workforce resources; implementation of the 18-h on-call policy has already been postponed. Therefore, new or updated policies must be accompanied by specific operational plans, budgetary allocations and funds for additional workforce.

Echocardiography in telemedicine: a possible solution for containing waiting lists in cardiology

The length of waiting lists in Italy for outpatient cardiology investigations provided by the National Health System is a serious dysfunction. The shortage of physicians in hospitals makes it difficult to solve this problem by drawing on internal resources. The waiting list at Valduce Hospital in Como for outpatient echocardiographic examinations was 12 months at the beginning of 2018. Therefore, we experimented a new way to deal with this inefficiency. Starting in February 2018, we have undertaken in Valduce Hospital a partnership between the Department of Cardiology and an external startup (Ecocardioservice LLC) which guarantees for outpatients on-site performance by sonographers of echocardiographic examinations that are subsequently reported remotely via telemedicine by experienced cardiologists. From February 12, 2018 to July 7, 2022, 20 782 examinations were carried out by this mode. The waiting list was reduced from 12 months to 15-20 days. A new diagnosis or a significant change in pre-existing pathology were detected in 3466 patients well in advance of previous timelines. In 5640 patients we found a known stable pathology. Of the 8926 patients with pathologic examination, 3706 patients were taken over by the Cardiology Department for subsequent investigations, possible hospitalization and, when necessary, interventional or cardiac surgical procedures on an elective basis in 2636 cases (71%) and on an urgent basis in 1070 cases (29%). In our experience, a system in which echocardiograms are performed on-site by sonographers and then reported in telecardiology by cardiologists outside the facility makes it possible to meet the demands of the local area and free up internal resources. This organization allowed to bring outpatients waiting lists for echocardiography back within acceptable limits and to intercept early a significant proportion of patients with need for further investigations or procedures.