Shortage Of Physicians Research Articles

Physician Numbers and Employment in Bavaria: Trends in statistics of the Bavarian Medical Association and the Association of Statutory Health Insurance Physicians of Bavaria

Although the number of places at medical schools and physicians in Germany has increased continuously over the past 25 years, there is a threat of a shortage of physicians. Based on data from the Bavarian Medical Association (BLÄK) and the Association of Statutory Health Insurance Physicians of Bavaria (KVB), an analysis of the number of physicians in Bavaria over a longer period of time was carried out in order to understand current developments and possible starting points for the future organization of medical care. The figures were analyzed with regard to the distribution of physicians by outpatient and inpatient sector as well as with regard to the development of the number of employees, the scope of employment and the gender distribution in the outpatient sector. Data were taken from the annually published and systematically compiled numbers of physicians from the BLÄK (2000 to 2022) as well as the outpatient billing data of practicing and employed physicians in Bavaria (2010 to 2022), processed by the KVB. Descriptive analyses were performed. Since 2000, the number of physicians in Bavaria has risen by 83% in the inpatient setting and by 35% in the outpatient setting. As a result, more physicians have been working in hospitals than in outpatient care since 2010. In the outpatient setting the trend is moving away from establishing one's own practice and full-time work towards salaried and part-time employment. Employed physicians have lower average working hours than self-employed physicians. The proportion of women among physicians has steadily increased, with female physicians more likely to be employed and working part-time compared with male physicians. Nevertheless, part-time employment is also prominent among male physicians in some specialties today. The trend towards practicing in salaried and part-time positions continues unabated and is represented across all specialties, suggesting that more physicians are needed to maintain the number of working hours over time. In addition to incentives and subsidies, this reality must be taken into account when planning care. At the same time, it is questionable whether increasing medical school places without managing them according to need is the right way to address the shortage of physicians in outpatient care when an ever-increasing proportion of physicians is working in inpatient care.

Current status and the urgent need for a geriatric healthcare system in a super-aged society

Background: The Korean healthcare system is ill-equipped to manage geriatric diseases, even though we are on the verge of becoming a super-aged society.Current Concepts: In Korea’s delivery of healthcare system, which is centered on subspecialty care from primary to tertiary care, older adults with multiple chronic diseases are forced to receive fragmented care from multiple doctors. In medical education and residency programs, even the most fundamental concepts of geriatrics are misunderstood, and geriatricians receive inadequate training. Consequently, along with the rapidly growing elderly population, elderly patients with complex health problems, frailty, and dysfunction are deprived of the opportunity to achieve healthy aging by taking multiple medications and suffering from geriatric syndromes caused by fragmented medical care.Discussion and Conclusion: Establishing a system for training geriatricians and strengthening geriatric education is necessary to ensure existing specialists can assign them the role of primary care geriatricians. Additionally, person-centered, integrated geriatric care that requires appropriate management of various complex diseases, as well as maintenance of function and frailty prevention, will be possible by establishing a geriatric healthcare system that ranges from frailty prevention, polypharmacy management, and home visits in primary healthcare to multidisciplinary geriatric care and transitional care in tertiary healthcare. Implementing this strategy as early as possible will help older adults age well and reduce the caregiving burden in later life. This could also ease concerns regarding physician shortages induced by the rapidly growing elderly population.

Non-Invasive Sensors Integration for NCDs with AIoT Based Telemedicine System.

Thailand's hospitals face overcrowding, particularly with non-communicable disease (NCD) patients, due to a doctor shortage and an aging population. Most literature showed implementation merely on web or mobile application to teleconsult with physicians. Instead, in this work, we developed and implemented a telemedicine health kiosk system embedded with non-invasive biosensors and time-series predictors to improve NCD indicators over an eight-month period. Two cohorts were randomly selected: a control group with usual care and a telemedicine-using group. The telemedicine-using group showed significant improvements in average fasting blood glucose (148 to 130 mg/dL) and systolic blood pressure (152 to 138 mmHg). Data mining with the Apriori algorithm revealed correlations between diseases, occupations, and environmental factors, informing public health policies. Communication between kiosks and servers used LoRa, 5G, and IEEE802.11, which are selected based on the distance and signal availability. The results support telemedicine kiosks as effective for NCD management, significantly improving key NCD indicators, average blood glucose, and blood pressure.

Student-to-Student: A Novel Approach to Community Outreach.

Community outreach is an established method for organizations to interact with the community. It is often done to help improve the community and its members by providing resources and educational opportunities. A growing crisis facing the United States of America is a worsening physician shortage, which will negatively impact many across the nation, especially vulnerable communities. The Student-to-Student organization offers a novel approach to community outreach by helping introduce and inspire high school students and young adults to pursue medicine. The organization is run by medical students and supervised by the College of Medicine faculty. It offers students from local high schools, community colleges, and undergraduate universities the opportunity to visit the medical college, where they can explore human anatomy and discuss the different facets of medicine and medical education with current medical students. This experience provides medical students with the ability to refine their public speaking abilities, gain leadership experience, improve their professional identity, and be involved in meaningful community outreach. These attributes also serve to enhance medical student residency applications at a time when uncertainties abound in the aftermath of Step One becoming pass/fail. The organization has run continuously since 1987 (except for one year during the COVID-19 pandemic). It has evolved over the years to become a high-performing organization that provides more than 80 tours yearly to thousands of students from the surrounding communities. This article aims to provide a detailed description of the history, organization, and impact of the Student-to-Student organization so that other medical students have a framework for implementing a similar program at their institution.

Impact of Nurse Residency Program on Time-to-Fill Nurse Vacancies at the Veterans Health Administration.

The Department of Veterans Affairs (VA) offers a 1-year Post-Baccalaureate-Registered Nurse Residency (PB-RNR) Program. The impact of the PB-RNR program on local RN recruitment was unknown. We aimed to evaluate the effect of the size of the PB-RNR program at a VA facility on its time-to-fill RN vacancies. We used an instrumental variable approach with a 2-stage residual inclusion specification. We included RN filled vacancies in the VA that were posted nationwide between 2020 and 2021. Our independent variable was the facility-year level number of PB-RNR program allocations. The 3 binary outcomes were whether the RN vacancy was filled within 90, 60, or 30 days. An increase of one training allocation was significantly associated with a 5.60 percentage point (PP) (95% CI: 2.74-8.46) higher likelihood of filling a vacancy within 90 days, 7.34 PP (95% CI: 4.66-10.03) higher likelihood of filling a vacancy within 60 days, and 5.32 PP (95% CI: 3.18-7.46) higher likelihood of filling a vacancy within 30 days. The impact was significant in both 2020 and 2021 positions, and in facilities located in areas with lower social deprivation scores, higher-quality public schools, or with either no or partial primary care physician shortages. We found favorable impacts of the size of the PB-RNR program at a VA facility on filling RN vacancies.

Effect of Student-Run Free Clinics on Family Medicine Match Rates: A Multisite, Regression Discontinuity Study.

Student-run free clinics (SRFCs) have been proposed as one educational strategy to increase medical students' interest in primary care careers. We sought to overcome gaps in the literature by investigating the effect of opening an SRFC at different institutions on institution-level match rates into family medicine, the largest source of primary care physicians in the United States. We connected a list of SRFCs from primary care clerkship directors and the Society of Student-Run Free Clinics with a database of institution-level match rates into family medicine from 2000 to 2018. Using regression discontinuity analysis, we assessed whether opening an SRFC would increase family medicine match rates. Across a sample of 58 medical schools in the United States, we found that SRFCs did not significantly change the number (P=.44) or percentage of medical graduates (P=.42) entering family medicine residency. We also found no significant effects of SRFCs on the number of students entering family medicine in different contexts, including public/private institutions (P=.47), geographic areas (P=.26), departmental administrative structures (P=.69), and institutions with higher historical rates of producing graduates entering family medicine (P=.22). Though SRFCs may potentially support other aspects of undergraduate medical training, they should not be used as a singular strategy for addressing shortages in the primary care workforce in the United States. Further educational research should examine multipronged strategies to increase the supply of early-career primary care physicians in the United States.

Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis

BackgroundColorectal cancer (CRC) is the second leading cause of cancer death in US adults but can be reduced by screening. The roles of individual and contextual factors, and especially physician...

Long-term effect of intravenous antimicrobial use in a pharmacist-led ASP at a small Japanese acute care hospital

Background: Antimicrobial resistance (AMR) remains a crucial, healthcare issue for which many countries have devised a national action plan. In Japan as well, antimicrobial stewardship programs (ASP) are being implemented in acute care hospitals under this policy framework. Clinical pharmacists play a central role in ASP, often jointly with infectious disease (ID) physicians. However, in Japan, a shortage of ID physicians has resulted in some ASP being led solely by pharmacists. While reports of the short-term effects of this situation are emerging, the long-term impact of pharmacist-led ASP is still largely unknown in Japan. The present study retrospectively examined the long-term effects of pharmacist-led ASP in a small, Japanese, acute care hospital. Method: The present study examined a pharmacist-led ASP in an acute care hospital (287 beds) in Japan which was launched in August 2015 and assessed the duration of therapy per 1000 patient-days (DOT) as the primary outcome by comparing the pre-intervention period (April 2013-July 2015) with the intervention period (August 2015-March 2023) using linear regression analysis. Additionally, segmented time-series analysis was conducted for each, additional intervention, and the impact of reduced activity due to the coronavirus disease 2019 (COVID-19) pandemic during the intervention. The DOT at the study center were compared with the national average of facilities implementing ASP. Result: While the DOT for all intravenous antimicrobials showed a slight increase on linear regression (r=0.01; P=0.1), the DOT of antipseudomonal intravenous antimicrobials significantly decreased (r=-0.027; P < 0 .01). Moreover, a significant reduction in DOT was observed immediately after the initiation of prospective review and feedback for carbapenems and daily prospective review and feedback for all intravenous antimicrobials (-3.2 and -2.4; P < 0 .001 for the intercept). An increase in DOT was observed during the COVID-19 pandemic-related reduction in activity time, and a rapid decline was observed upon the resumption of activities. Conversely, the average, nationwide DOT significantly increased for all intravenous antimicrobials as well as for antipseudomonal intravenous antimicrobials (r=0.02 and r=0.004; P < 0 .01) Conclusion: Sustaining an effective, pharmacist-led antimicrobial stewardship program led to a continual decrease in the DOT of antipseudomonal intravenous antimicrobials in a small, Japanese, acute care hospital despite a nationwide increase in their use following implementation of the national AMR action plan. Detailed analysis of pharmacists’ activities across multiple facilities is necessary to verify these effects.

Optimale Versorgung am Lebensende aus der Angehörigenperspektive – eine qualitative Interviewstudie in zwei niedersächsischen Landkreisen

BackgroundEstablished as health insurance benefit in 2007, Specialized Palliative Home Care (SPHC) has been continuously expanded. At the same time, health policy initiatives intended to promote general outpatient palliative care. In comparison to urban centers, the development of palliative care networks in rural areas appears to be more difficult. In addition, there is an increasing shortage of family doctors in primary care. Family members play a key role in the home care for seriously ill patients. This paper therefore investigated the experiences of relatives with the end-of-life (EoL) care for family members with life-limiting chronic diseases in more rural regions. The aim was to determine aspects that, from the relatives’ point of view, are essential for optimizing EoL care. MethodsQualitative after-death interviews with relatives in two districts were conducted in the first six months of 2019, who were recruited by the deceased patients’ family doctor. Relatives (age ≥18 years) of patients who died in 2018 were included. The interviews were digitally recorded, transcribed and analyzed using content analysis. ResultsIn the first half of 2019, 28 after-death interviews were conducted with 30 relatives (77% female, age: 32 to 83 years) from rural (n=8) and urban communities (n=22) in two Lower Saxonian counties. They were mostly in a partnership or parent-child relationship with the deceased person.The central categories and needs that emerged in the analysis were: (1) communication about dying and death, (2) information and enabling, (3) support of and relief for relatives, and (4) continuity and cooperation of the services involved in EoL care. The results underline the fact that family caregivers in particular find open communication, information to provide them with the confidence to act, recognizing and responding to support needs and continuity in the course helpful in coping with EoL care situations. Access problems to specialist medical care, deficiencies in care coordination and bureaucratic hurdles in the provision of medical aids proved to be an additional burden. DiscussionThe results underline the importance of open communication and the integration of relatives into the care process for optimal care at the end of life. Close cooperation between the services involved and proactive support for relatives are essential, too, especially in rural areas where the challenges of accessing and coordinating care services are a major concern. ConclusionThe identification and communication of complex problems, the needs of patients and their relatives and possible barriers to accessing care services are prerequisites for the timely initiation of palliative care measures and support for family caregivers. In addition to needs-based care structures, the optimization of EoL care in home settings requires cooperation and networking between professional stakeholders.

Changes in the attractiveness of medical careers and career determinants during the bachelor’s program at Zurich medical schools

BackgroundMonitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor’s studies.MethodsThe design was cross-sectional, recruiting all medical students who started a bachelor’s program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students’ perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option.ResultsWe surveyed 354 medical students at the beginning and 433 at the end of the bachelor’s program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice.ConclusionsDuring the bachelor’s program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession.Trial registrationNot applicable.

Rural physician-community engagement: Building, supporting and maintaining resilient health care strategies in three rural Canadian communities.

To explore rural physician-community engagement through three case studies in order to understand the role that these relationships can play in increasing community-level resilience to climate change and ecosystem disruption. Qualitative secondary case study analysis. Three Canadian rural communities (BC n = 2, Ontario n = 1). Rural family physicians and community members. Twenty-eight semi-structured virtual interviews, conducted between November 2021 and February 2022, were included. Communities were selected from the larger data set based on data availability, level of physician engagement and demographic factors. Thematic analysis was completed in NVivo using deductive coding. The presented qualitative case studies shed light on the strategies employed by physicians to establish and foster relationships within rural communities during challenging circumstances. In Community A, the implementation of a Primary Care Society (PCS) not only addressed physician shortages but also facilitated the development of strong continuity of care through proactive recruitment efforts. Community B showcased the adoption of an 'intentional physician community' model, emphasising collaboration and community consultation, resulting in effective communication of public health directives and innovative interdisciplinary action during the COVID-19 pandemic. In Community C, engaged physicians and community advocates are aligned to contribute to the long-term sustainability of the rural community, particularly in the context of food security and climate change vulnerabilities. These findings underscore the significance of trust building, transparent communication and collaboration in addressing health care challenges in rural areas and emphasise the need to recognise and support physicians as agents of change.

Aspek Hukum Pengaruh Transformasi Digital Terhadap Praktik Telemedicine Di Indonesia

Health is a basic human need that continues to increase along with the progress of the times. Technological advances and lifestyle changes have led to a variety of new diseases, increasing the need for health services. Indonesia, with the fourth largest population in the world (272,229,372 people) and 10.14% of the population poor in 2021, faces significant health challenges. The COVID-19 pandemic has exacerbated the situation by limiting access to health services. Barriers to access, unequal distribution of services, and a shortage of doctors hinder efforts to realize the welfare of citizens as mandated by the 1945 Constitution. However, advances in information and communication technology have brought significant benefits in the health sector. Information technology has had a major impact on health and medicine, enabling the rapid, efficient, and accurate dissemination of information. One important development is the practice of telemedicine, which offers innovative solutions in health care.

Factors Influencing Primary Care Career Choice: A Multi-Institutional Cross-sectional Survey of Internal Medicine Primary Care Residency Graduates.

Although primary care is associated with population health benefits, the supply of primary care physicians continues to decline. Internal medicine (IM) primary care residency programs have produced graduates that pursue primary care; however, it is uncertain what characteristics and training factors most affect primary care career choice. To assess factors that influenced IM primary care residents to pursue a career in primary care versus a non-primary care career. Multi-institutional cross-sectional study. IM primary care residency graduates from seven residency programs from 2014 to 2019. Descriptive analyses of respondent characteristics, residency training experiences, and graduate outcomes were performed. Bivariate logistic regression analyses were used to assess associations between primary care career choice with both graduate characteristics and training experiences. There were 256/314 (82%) residents completing the survey. Sixty-six percent of respondents (n = 169) practiced primary care or primary care with a specialized focus such as geriatrics, HIV primary care, or women's health. Respondents who pursued a primary care career were more likely to report the following as positive influences on their career choice: resident continuity clinic experience, nature of the PCP-patient relationship, ability to care for a broad spectrum of patient pathology, breadth of knowledge and skills, relationship with primary care mentors during residency training, relationship with fellow primary care residents during training, and lifestyle/work hours (all p < 0.05). Respondents who did not pursue a primary care career were more likely to agree that the following factors detracted them from a primary care career: excessive administrative burden, demanding clinical work, and concern about burnout in a primary care career (all p < 0.05). Efforts to optimize the outpatient continuity clinic experience for residents, cultivate a supportive learning community of primary care mentors and residents, and decrease administrative burden in primary care may promote primary care career choice.

Operationalizing a 3-year standalone, accelerated medical school curriculum to nurture physicians to become primary care and health system leaders

The United States faces a shortage of primary care physicians. To address this, there have been pioneering efforts to develop accelerated pathways with a primary care focused curriculum for undergraduate medical education. The New York University Grossman Long Island School of Medicine (NYU GLISOM) was conceptualized as the first standalone, accelerated, tuition-free program in the US in over 100 years, with mission-centered curriculum on primary care and health system leadership. The aim of this article is to map the process for the development of a three-year integrated curriculum, describe the pedagogical approach that guided the design of the longitudinal courses, share the student and faculty’s perspective about the curriculum, and describe the early outcomes of the first two graduate classes. A major key driver for curricular design is integrating longitudinal courses of Clinical Ambulatory Practice Experience (CAPE), Health Systems Science (HSS), and Learning Community - Social Sciences, Humanities, Ethics and Professionalism (LC-SHEP) over three years and active learning through Problem Based Learning (PBL). We have successfully operationalized an accelerated, standalone, integrated medical school curriculum mission-centered on primary care and health system leadership. Our outcomes reveal a higher percentage (76% N =45) of NYU GLISOM students entering primary care compared to national benchmarks. The integration of the longitudinal courses of HSS, LC-SHEP, and CAPE is a key pillar to reinforce the tenants of primary care and health system leadership. Focused interview of graduates from the pioneer cohort consistently stated that the longitudinal courses prepared them well for residency in primary care and as a health systems’ change agent. Despite the challenges of an accelerated program, NYU GLISOM successfully integrated the longitudinal courses with optimal performance and achievement of educational program objectives. Our experience can serve as a model for innovation and design of an accelerated three-year primary care curriculum.

Inadequate intensive care physician supply in France: a point-prevalence prospective study

BackgroundThe COVID-19 pandemic has highlighted the importance of intensive care units (ICUs) and their organization in healthcare systems. However, ICU capacity and availability are ongoing concerns beyond the pandemic, particularly due to an aging population and increasing complexity of care. This study aimed to assess the current and future shortage of ICU physicians in France, ten years after a previous evaluation. A national e-survey was conducted among French ICUs in January 2022 to collect data on ICU characteristics, medical staffing, individual physician characteristics, and education and training capacities.ResultsAmong 290 ICUs contacted, 242 responded (response rate: 83%), representing 4943 ICU beds. The survey revealed an overall of 300 full time equivalent (FTE) ICU physician vacancies in the country. Nearly two-thirds of the participating ICUs reported at least one physician vacancy and 35% relied on traveling physicians to cover shifts. The ICUs most affected by physician vacancies were the ICUs of non-university affiliated public hospitals. The retirements expected in the next five years represented around 10% of the workforce. The median number of physicians per ICU was 7.0, corresponding to a ratio of 0.36 physician (FTE) per ICU bed. In addition, 27% of ICUs were at risk of critical dysfunction or closure due to vacancies and impending retirements.ConclusionThe findings highlight the urgent need to address the shortage of ICU physicians in France. Compared to a similar study conducted in 2012, the inadequacy between ICU physician supply and demand has increased, resulting in a higher number of vacancies. Our study suggests that, among others, increasing the number of ICM residents trained each year could be a crucial step in addressing this issue. Failure to take appropriate measures may lead to further closures of ICUs and increased risks to patients in this healthcare system.

The tip of the iceberg: Generalism in undergraduate medical education, a systems thinking analysis.

There is a shortage of generalist physicians globally impacting health equity and access to care. An important way in which medical schools can demonstrate social accountability is by graduating learners interested in careers in generalism. While generalism is endorsed as a matter of principle in medical education, how this translates into curricula is less clear. The aim of this study was to identify how generalism is understood and supported by family physician educational leaders in undergraduate medical education (UME) in Canada. We conducted a qualitative study, interviewing 38 family medicine leaders in UME across all 17 Canadian medical schools. We examined the data with template analysis, informed by the iceberg model of systems thinking. Four themes were identified: (1) Teaching and learning strategies in support of generalism-a consistent range existed across UME curricula; (2) Curriculum patterns-changes in leadership and curriculum reform created positive or negative feedback loops that promoted or hindered initiatives to support generalism; (3) Curriculum structures-organ-system-based curricula and availability of generalist faculty presented particular challenges to teaching generalist approaches; (4) Mental models and ways of knowing-the preponderance of biomedical frameworks of thinking in curricula unconsciously undermined generalist approaches to patient care. UME programmes promoted generalism through a range of teaching activities and strategies, but these efforts were countered by curriculum structures and mental models that perpetuate epistemic inequity between biomedical approaches to medical education and generalist models of care. Novel curricular frameworks are needed to align undergraduate programmes' commitment to social accountability with community-based need.

Estimates of Physicians Supply in Korea

Estimates of Physicians Supply in Korea

Weaknesses of the existing organization of emergency medical care in European countries

The importance of an emergency medical care system for ensuring affordable and quality healthcare in any country is indisputable. Studying and analyzing existing problems in organizing this system is the first step to solving them. The present study aimed to investigate and outline the possible scope of the problems of emergency medical care, their recurrence, and similarity in 17 European countries. Content analysis of documents was used. The most characteristic organizational problems in providing emergency medical care for each of the countries are identified and grouped into five categories: Direct patient access to hospital emergency departments; Overloading of emergency departments by non-urgent, self-referral patients; Telephone triage by dispatchers - nurses or assistants; Existing and/or impending shortage of doctors in Emergency Medical Services (EMS); Regional and social inequalities in access to emergency medical care. A quantitative measurement of the categories and their relative weight were reported. Based on the analysis, the conclusions of the study were drawn. The identified problems, grouped into categories of weaknesses of the existing emergency medical care organization in European countries, may serve as a basis for undertaking health care reforms.

Travel-time barriers to specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia.

Prior studies demonstrate that 20%-50% of adolescents and young adults (age 15-39 years) with acute lymphoblastic leukemia (ALL) receive care at specialty cancer centers, yet a survival benefit has been observed for patients at these sites. Our objective was to identify patients at risk of severe geographic barriers to specialty cancer center-level care. We used data from the North American Association of Central Cancer Registries Cancer in North America database to identify adolescent and young adult ALL patients diagnosed between 2004 and 2016 across 43 US states. We calculated driving distance and travel time from counties where participants lived to the closest specialty cancer center sites. We then used multivariable logistic regression models to examine the relationship between sociodemographic characteristics of counties where adolescent and young adult ALL patients resided and the need to travel more than 1 hour to obtain care at a specialty cancer center. Among 11 813 adolescent and young adult ALL patients, 43.4% were aged 25-39 years, 65.5% were male, 32.9% were Hispanic, and 28.7% had public insurance. We found 23.6% of adolescent and young adult ALL patients from 60.8% of included US counties would be required to travel more than 1 hour one way to access a specialty cancer center. Multivariable models demonstrate that patients living in counties that are nonmetropolitan, with lower levels of educational attainment, with higher income inequality, with lower internet access, located in primary care physician shortage areas, and with fewer hospitals providing chemotherapy services are more likely to travel more than 1 hour to access a specialty cancer center. Substantial travel-related barriers exist to accessing care at specialty cancer centers across the United States, particularly for patients living in areas with greater concentrations of historically marginalized communities.

Barriers to primary care among immigrants and refugees in Peterborough, Ontario: a qualitative study of provider perspectives

BackgroundCanada’s immigrants and refugees have often settled in large Canadian cities, but this is changing with rising costs of living and rural settlement initiatives. However, little consideration is made regarding systemic changes needed to accommodate this distribution, particularly in healthcare in medium-sized cities or smaller communities. For most Canadians, primary care is an entry point into the healthcare system but immigrants and refugees face unique barriers to accessing care compared to the general Canadian population. This project aimed to better understand the barriers to accessing primary care among newcomers in Peterborough, Ontario from the perspective of newcomer service providers.MethodologyParticipants were recruited from community organizations identified by the local settlement agency, the New Canadians Centre, as having regular interactions with newcomer clients including clinics, not-for-profit organizations, and volunteer groups. Four focus groups were completed, each with three participants (n=12). A coding grid was deductively developed to guide thematic analysis by adapting Levesque et al.’s conceptual framework defining access to healthcare with five specific dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness.ResultsParticipants identified lack of awareness of the healthcare system, stigma, competing priorities, and direct costs as some of the barriers for newcomers. Participants highlighted barriers unique to Peterborough including proximity to services, social isolation, and a shortage of family physicians. The results also highlighted strengths in the community such as its maternal-child health programming.ConclusionThe results provide a glimpse of the challenges to accessing primary care among newcomers in medium-sized communities and identify opportunities to prepare for changing settlement patterns.