Full-time Equivalent Positions Research Articles

A preliminary characterization of and call for benchmarking pharmacy alumni engagement

IntroductionAlumni are essential but often overlooked stakeholders for pharmacy programs, and engaging alumni in philanthropy, volunteerism, events, and communication may have important implications for the growth and success of pharmacy programs. This research aims to preliminarily characterize pharmacy alumni engagement across four metrics and provide a call to action for standardized tracking and reporting of alumni engagement efforts across the Academy. MethodsA cross-sectional survey was sent to alumni relations and advancement personnel at United States schools and colleges of pharmacy. The survey gathered information on the accuracy of pharmacy alumni records, alumni engagement within four categories (philanthropy, communication, events, and volunteering), alumni relations personnel, and barriers to alumni engagement efforts. ResultsRespondents reported using various database systems to track and measure alumni engagement, and 41% noted having accurate pharmacy alumni records. Opportunities for alumni engagement within the four categories varied across institutions. Fifty percent of respondents indicated that one full-time equivalent position is allocated to pharmacy alumni engagement efforts at their institution. Barriers to alumni engagement efforts included limited budgets, and staff, engaging alumni via in-person events, and maintaining accurate alumni records. ConclusionsThe Academy may benefit from expanding the annual alumni survey and developing a consistent tracking mechanism to capture and report alumni engagement activities. Additionally, education on alumni engagement metrics and potential collaborative efforts with institutional alumni relations personnel would be of value. This is vital in developing and optimizing alumni relations efforts and engaging pharmacy alumni bases.

Supply and Demand for Radiation Oncologists in Canada: Workforce Planning Projections From 2020 to 2040

The number of Canadians diagnosed with cancer, and subsequent demand for radiation therapy, are expected to increase over time. This study aimed to update our needs-based workforce planning model to ensure appropriate staffing levels in the future. The supply of radiation oncologists, by age group, sex, and full-time equivalent status, was projected from 2020 to 2040 using a recursive-aging, input-output model developed with seeding parameters derived from national sources. The demand for radiation oncologists until 2040 was estimated using referral patterns for radiation therapy and consultation workload metrics applied to projected annual cancer incident cases to calculate required full-time equivalent positions. Baseline model parameters were also applied to the 2005-2019 workforce and incident case data to evaluate preprojection supply and demand trends. Preprojection trends for 2005 to 2019 revealed accelerated staffing growth that transitioned from a workforce shortage to a surplus state in 2014 followed by substantial growth slowdown in 2016. The model predicts a transient surplus of radiation oncologists until 2026 followed by a projected deficit in subsequent years. Sensitivity analyses using the plausible range for each parameter continued to favor an undersupply, suggesting a trainee shortage unable to meet workforce expansion needs. Considering possible future declining trends in radiotherapy utilization and workload, calculations to inform corrective efforts in resident numbers resulted in 25 entry positions per year, up from 21 per year currently. Geographic distribution of trainees, relative to workforce and cancer incidence distributions, could be improved with more residency positions in Canadian regions outside Ontario. Demand for radiation therapy and radiation oncologists in Canada are expected to grow more quickly than future expansion in staffing levels. Our workforce planning model provides evidence for more trainee requirements to inform stakeholders of possible corrective actions to training programs and recruitment. Further research is needed to explore additional strategies to expand capacity and high-quality delivery of radiation therapy to meet the foreseeable increase in Canadian patients with cancer.

Midwifery Autonomy and Employment Changes During the Early COVID-19 Pandemic.

The COVID-19 pandemic presented the midwifery workforce with challenges for maintaining access to high-quality care and safety for patients and perinatal care providers. This study analyzed associations between different types of professional autonomy and changes in midwives' employment and compensation during the early months of the pandemic. An online survey distributed to midwifery practices in fall 2020 compared midwives' employment and compensation in February 2020 and September 2020. Chi-square analysis determined associations between those data and measures of midwives' autonomy: state practice environment, midwifery practice ownership, intrapartum practice setting, and midwifery participation in practice decision-making. Participants included lead midwives from 727 practices, representing 50 states and the District of Columbia. Full-time equivalent (FTE) positions and number of full-time midwives were stable for 77% of practices, part-time employment for 83%, and salaries for 72%. Of the remaining practices, more practices lost FTE positions, full-time positions, part-time positions, and salary (18%, 15%, 9%, and 18%, respectively) than gained (11%, 8%, 8%, and 9%, respectively). Early retirements and furloughs were experienced by 9% of practices, and 18% lost benefits. However, midwifery practice ownership was significantly associated with increased salaries (20.3% vs 7.1%; P < .001) and decreased loss of benefits (7.8% vs 19.9%; P = .002) and furloughs (3.8 vs 10.1%; P = .04). Community-based practice was significantly associated with increased FTE positions (19.0% vs 8.8%; P = .005), part-time positions (17.4% vs 5.1%; P < .001), and salary (19.7% vs 7.0%; P < .001), as well as decreased loss of benefits (11.5% vs 21.1%; P = .02) and early retirement (1.4% vs 6.6%; P = .03). State practice environment and participation in practice decision-making were not directly associated with employment and compensation changes. Policies should facilitate midwifery practice ownership and the expansion and integration of community birth settings for greater perinatal care workforce stability, greater flexibility to respond to disasters, and improved patient access to care and health outcomes.

Optimizing Care Teams by Leveraging Advanced Practice Providers Through Strategic Workforce Planning.

Advanced practice providers (APPs) are integral members of the healthcare delivery team. However, there has been a lack of standardization and uniformity in how they are utilized across inpatient, ambulatory, and procedural settings. A multidisciplinary workforce planning committee was formed in March 2021 to evaluate all new and replacement full-time equivalent APP positions at Stanford Health Care (SHC), an academic medical center of more than 600 APPs, to optimize and standardize the role of APPs as per national benchmarks. Six months since the launch of the committee, there has been a 10% increase in the number of visits and procedures performed by APPs providing better access for patients. In addition, there has been a 38.7% improvement in ambulatory APPs meeting their productivity target, 19.4% improvement in ambulatory APPs meeting utilization targets, and 36.8% improvement in ambulatory APPs meeting the 50th percentile and above as per the relative value unit benchmark published by the Medical Group Management Association for Academic Medical Centers. For inpatient APPs, there has been a 38.8% improvement in APPs meeting the average daily census target. APP utilization is an important topic that has not been consistently addressed in the literature. Inappropriate utilization and lack of top of licensure practice have been associated with increased turnover, decreased job satisfaction, and professional development. By developing a multidisciplinary workforce planning committee, full-time employee positions are evaluated with a goal of optimizing and standardizing the role of APPs at SHC.

Regional Public Health Training Centers: An Essential Partner in Workforce Development.

Regional Public Health Training Centers: An Essential Partner in Workforce Development.

Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study.

Background:The proportion of women entering medicine has increased in recent years, and understanding the different practice patterns of female and male family physicians (FPs) will provide important information for health workforce planning. We sought to evaluate differences by sex in the supply, payments and clinical activity among FPs in Ontario.Methods:We conducted a cohort study using claims data from the Ontario Health Insurance Plan. We included all Ontario FPs who submitted claims from 1992 to 2018. We analyzed data using regression analyses for our outcomes of yearly number of FPs, payments, patient visits and distinct patients.Results:The number of practising FPs increased from 10 370 in 1992 to 14 329 in 2018, with an annual increase of 155 female FPs and 13 male FPs. In 2018, male FPs outnumbered female FPs by 1159. Among male FPs, 32.7% worked less than 1 full-time equivalent (FTE) position, 18.1% worked 1 FTE and 49.2% worked more than 1 FTE, with little change over the 27-year study period. Among female FPs, the percentage of those who worked less than 1 FTE position decreased over time (58.6% in 1998 to 48.3% in 2015), those who worked 1 FTE was stable (22.2%–24.3%) and those who worked more than 1 FTE increased (18.7% in 1998 to 28.0% in 2017). Yearly payments were higher for male FPs than female FPs by 40%–60% overall and by 10%–20% in FPs who worked more than 1 FTE. For FPs who worked 1 FTE or less than 1 FTE, both sexes had similar payment amounts (from 2005–2018). For FPs who worked 1 FTE, female FPs were less likely to receive payments from fee-for-service after 2004, and had 550 fewer visits and 121 fewer patients annually than male FPs.Interpretation:In Ontario, there are differences by sex in FP supply, payments, percentages of FTE groups, number of patient visits and number of distinct patients. Health administrators should be mindful of these differences when considering FP workforce plans to ensure a stronger primary health care system, with adequate health care delivery for the population.

Late-Career Pediatric Hospitalists: Programmatic Accommodations and Supports.

As the number of late-career pediatric hospitalists increases, issues regarding aging and retirement will require more attention. Long shifts and overnight clinical responsibilities may be challenging for older physicians. Our study objectives include investigation of the current state of practice regarding work hours, night call responsibilities, productivity requirements, coronavirus disease 2019 (COVID-19) exposure modifications, and division chief knowledge about retirement supports for late-career pediatric hospitalists. This cross-sectional study used a web survey, distributed in spring of 2020 on the American Academy of Pediatrics, Section on Hospital Medicine, Division Chief listserv. The questionnaire asked about (1) program demographics, (2) overnight call responsibilities, (3) clinical schedules, (4) modifications for COVID-19, and (5) retirement benefits and supports. Data were analyzed by using descriptive statistics and the Fisher exact test. The 47 responding programs employ 982 hospitalists in 728 full-time equivalent positions. Division chiefs estimated 117 (12%) individuals were aged 50 to 64 years and 16 (1.6%) were 65 years or older. Most programs (91%) had at least 1 member 50 to 64 years of age; 13 programs (28%) had a member aged 65 or older. Larger programs were more likely to allow older physicians to opt out of some night call responsibilities. Most programs made some accommodations for COVID-19 exposure. Other than financial counseling and academic benefits, most programs did not provide retirement counseling or other supports for retiring physicians. Although limited by a low response rate, we found most programs had older faculty. Substantial variation exists in how programs make accommodations and offer support for older members.

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors.

This study aimed to (1) estimate the total pool of neonatal therapists (occupational therapists, physical therapists, and speech-language pathologists who work in the neonatal intensive care unit [NICU]) and the average number represented in each U.S. based NICU, and (2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors. This study used several methods of data collection (surveys, phone calls, and web site searches) that were combined to establish a comprehensive list of factors across each NICU in the United States. We estimate that there are 2,333 full-time equivalent (FTE) positions designated to neonatal therapy coverage, with 4,232 neonatal therapists covering those FTEs. Among 564 NICUs with available neonatal therapy staffing data, 432 (76%) had a dedicated therapy team, 103 (18%) had pro re nata (as the circumstances arise; PRN) therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level-IV (n = 112; 97%) and -III (n = 269; 83%) NICUs compared with level-II NICUs (n = 51; 42%; p < 0.001). Having a dedicated therapy team was related to having more NICU beds (p < 0.001), being part of a free-standing children's hospital or children's hospital within a hospital (p < 0.001), and being part of an academic medical center or community hospital (p < 0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p = 0.001) but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p > 0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred U.S. based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of level-IV NICUs had at least one CNT). Understanding the composition of neonatal therapy teams at different hospitals across the U.S. can drive change to expand neonatal therapy services aimed at optimizing outcomes of high-risk infants and families. · We estimated that there are 4,232 neonatal therapists working in NICUs in the United States.. · Dedicated therapy teams for the NICU are more common in large, high acuity NICUs.. · An average of 17 beds per neonatal therapy FTE was observed.. · In 2020, 22% of NICUs had CNTs, and CNTs were more common in large and high acuity NICUs.. · Benchmarking neonatal therapy staffing can aid in expanding NICU therapy services where needed..

Starting from scratch: Developing and sustaining a rural research team lessons from a nutrition and dietetics case study.

To describe the development of and key factors for sustaining a rural-based research team focussed on nutrition and dietetics. A longitudinal embedded case study approach with data sourced from publicly available records and observations. Case study sub-units were developed into 3 phases with analysis using theoretical propositions and pattern matching. Quantitative data were descriptively analysed. University of Newcastle Department of Rural Health across 4 rural sites. Publicly available data sources from existing team members. Staffing levels, research supervision, internal and external grant outcomes and peer-reviewed journal publications. Academic staffing has increased by 4 full-time equivalent positions over 18years, with 6 current higher-degree research students. Key factors identified in the development of a discipline-specific research workforce included staff higher degree by research completions, longevity of staff in research-active roles, immersive rural placements with a research component and collaborations with nationally competitive researchers. Rural pilot research projects, community connections, understanding of the local context and research networks were fundamental to establishing a viable team. Systematically investing in research that is embedded in local communities will ensure sustainability and relevance, capacity building of existing staff and an ability to problem solve at the local level. Sustained and focussed investment is needed if the current rural research workforce is to develop towards a capacity that meets current demand.

Physician anaesthesia providers in Switzerland today and tomorrow: results of the National Anaesthesia Workforce Study (NAWOS).

The Swiss healthcare system is highly ranked, given its unrestricted access to specialised care and short waiting lists for surgery. However, the need for anaesthetic and surgical care is escalating owing to the increasing size and ageing of the Swiss population. In addition, to address the persistent and recurrent SARS-CoV-2 pandemic crisis, the speciality of anaesthesia is under tremendous pressure to maintain an effective workforce in order to address population needs. The current number, characteristics and future evolution of the physician anaesthesia workforce in Switzerland are currently unknown. The purpose of this study was to assess the size and professional and sociodemographic characteristics of the current anaesthesia workforce in Switzerland and to forecast its development up to 2034. We performed a cross-sectional study using a 150-item questionnaire prepared by the National Anaesthesia Workforce Study Group (NAWOS). We included all physicians (trainees and certified) practising anaesthesia in Switzerland. We collected demographic and professional information, such as the current position, hospital characteristics, workload, number of shifts and future life plans. We built a computer-based Markov model with Monte Carlo simulations to project both supply and demand for physician anaesthesia provider positions. Of the 2661 distributed questionnaires, 1985 (74.2%) were completed and returned. We found that the average age of anaesthesiologists practising in Switzerland was 45.2 years, with 44.3% of them being women and 76.9% holding a Swiss specialist title. Only 59.6% of respondents worked full time. The forecasting model showed a steady increase in the number of anaesthesiologists retiring by 2034, with 27% of full-time equivalent jobs being lost in the next 8 years. Even if existing full-time equivalent training positions are all filled, a gradual deficit of anaesthesiologists is to be expected after 2022, and the deficit should culminate in 2034 with a deficit ratio of 0.87. Due to the upcoming high retirement rate of anaesthesiologists, Switzerland is likely to face a shortage of anaesthesiologists in the near future. To compensate for the shortage, the country will likely increase its reliance on medical staff trained abroad. Southern and eastern cantons of Switzerland are particularly at risk, given that they already heavily rely on foreign anaesthesia workforce. This reliance should be considered a national priority because anaesthesiologists are heavily involved in both the treatment of patients with respiratory complications of SARS-CoV2 infection and the care of surgical patients, the number of which is expected to rise steadily in upcoming years.

Distributed education enables distributed economic impact: the economic contribution of the Northern Ontario School of Medicine to communities in Canada

BackgroundMedical schools with distributed or regional programs encourage people to live, work, and learn in communities that may be economically challenged. Local spending by the program, staff, teachers, and students has a local economic impact. Although the economic impact of DME has been estimated for nations and sub-national regions, the community-specific impact is often unknown. Communities that contribute to the success of DME have an interest in knowing the local economic impact of this participation. To provide this information, we estimated the economic impact of the Northern Ontario School of Medicine (NOSM) on selected communities in the historically medically underserviced and economically disadvantaged Northern Ontario region.MethodsEconomic impact was estimated by a cash-flow local economic model. Detailed data on program and learner spending were obtained for Northern Ontario communities. We included spending on NOSM’s distributed education and research programs, medical residents’ salary program, the clinical teachers’ reimbursement program, and spending by learners. Economic impact was estimated from total spending in the community adjusted by an economic multiplier based on community population size, industry diversity, and propensity to spend locally. Community employment impact was also estimated.ResultsIn 2019, direct program and learner spending in Northern Ontario totalled $64.6 M (million) Canadian Dollars. Approximately 76% ($49.1 M) was spent in the two largest population centres of 122,000 and 165,000 people, with 1–5% ($0.7 M – $3.1 M) spent in communities of 5000–78,000 people. In 2019, total economic impact in Northern Ontario was estimated to be $107 M, with an impact of $38 M and $36 M in the two largest population centres. The remaining $34 M (32%) of the economic impact occurred in smaller communities or within the region. Expressed alternatively as employment impact, the 404 full time equivalent (FTE) positions supported an additional 298 FTE positions in Northern Ontario. NOSM-trained physicians practising in the region added an economic impact of $88 M.ConclusionsBy establishing programs and bringing people to Northern Ontario communities, NOSM added local spending and knowledge-based economic activity to a predominantly resource-based economy. In an economically deprived region, distributed medical education enabled distributed economic impact.

Program for Supporting Frontline Improvement Projects in an Academic Radiology Department.

OBJECTIVE. The purpose of this study was to describe the results of an ongoing program implemented in an academic radiology department to support the execution of small- to medium-size improvement projects led by frontline staff and leaders. MATERIALS AND METHODS. Staff members were assigned a coach, were instructed in improvement methods, were given time to work on the project, and presented progress to department leaders in weekly 30-minute reports. Estimated costs and outcomes were calculated for each project and aggregated. An anonymous survey was administered to participants at the end of the first year. RESULTS. A total of 73 participants completed 102 projects in the first 2 years of the program. The project type mix included 25 quality improvement projects, 22 patient satisfaction projects, 14 staff engagement projects, 27 efficiency improvement projects, and 14 regulatory compliance and readiness projects. Estimated annualized outcomes included approximately 4500 labor hours saved, $315K in supply cost savings, $42.2M in potential increased revenues, 8- and 2-point increase in top-box patient experience scores at two clinics, and a 60-incident reduction in near-miss safety events. Participant time equated to approximately 0.35 full-time equivalent positions per year. Approximately 0.4 full-time equivalent was required to support the program. Survey results indicated that the participants generally viewed the program favorably. CONCLUSION. The program was successful in providing a platform for simultaneously solving a large number of organizational problems while also providing a positive experience to frontline personnel.

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Nearly one in five pharmacist roles vacant in parts of England, report finds

Nearly one in ten full-time equivalent (FTE) pharmacist positions in England were vacant as of July 2020, a survey by the Community Pharmacy Workforce Development Group (CPWDG) has found. The survey, which collected workforce information from 40% of community pharmacies, found a 9% FTE pharmacist vacancy rate across the country, rising to 15% and 18% […]

(Invited) Brief Overview of Current French Hydrogen Research Activities, Focus on SOFC Materials Development

Twenty years ago, the French scientific community working in the field of hydrogen, started to federate under the leadership of the CNRS. It took the form of successive Research Grouping (GdR) bringing together experts in solid oxide fuel cell (SOFC), proton exchange polymer membrane (PEMFC) fuel cells, hydrogen storage and systems mainly from CNRS but also from CEA. These GdRs promoted and structured an interdisciplinary field of research with excellent results.Since January 1st of 2020, the CNRS community has formed the Research network on Hydrogen energy (FRH2) based on the active nucleus of the former GDR laboratories (28 laboratories) with about 90 full-time equivalent positions including researchers and professors, without including technical staff, students, doctoral students and post-docs. A new organization, "from material to system", more visible from industries has been set up around four main technical axes, the production of hydrogen, its storage, and its conversion into electricity for mobile and stationary applications and around 2 transversal axes, education and technological platforms. The first part of the presentation will give a brief overview of this french CNRS research network on hydrogen energy including some highligts for each axes.The second part will be dedicated to the development of materials used in solid oxide fuel cells (SOFC) and more precisely to the ceramic electrolyte. Electrochemical properties of the materials used in SOFC are governed by the defects within the material and limited by the microstructure and the transport mechanisms of charge carrier at the interfaces. Thus, the optimization of the microstructure of the material via accurate monitoring of the synthesis and temperature treatment steps could enhance the conduction properties of existing materials. The usual objective for electrolyte material is to reach a total conductivity level above 10-2 S/cm for operating temperatures below 600°C. Actually, working at low temperature would prevent premature aging of SOFC performance.BCZY type proton conducting electrolyte such as BaCe0.8Zr0.1Y0.1O3-δ has gained a great attention as one of the most promising candidate for intermediate temperature solid oxide fuel cells, due to the combination of a high bulk conductivity associated to a chemical stability [1]. However, some of challenges to manufacture a dense BCZY ceramic are the high sintering temperature typically 1500 to 1600°[2], and the long processing duration in conventional method which can damage the material and cause barium evaporation resulting in a decrease of electrochemical properties.Part of this talk is focused on BaCe0.8Zr0.1Y0.1O3-δ showing properties which are a compromise between the high proton conductivity of BCY and the stability of BZY. The limiting factors are the high sintering temperature (≈1600°C) and intrinsic grain boundaries resistance.The cold sintering process (CSP) is used to reduce the sintering temperature. In this technic, derived from the hydrothermal method, BCZY powder mixed with a small volume of liquid phase (3-30 wt%), is simultaneously pressed (at 50 to 500 MPa) and heat treated during a short time period (1-60 min) at low temperatures (100-200°C), leading to dense pellets.This study deals with the influence of synthesis conditions using the auto combustion and CSP on the microstructure and conductivity. With a calcination temperature of 1000°C and an optimized CSP treatment, a relative density above 93% can be obtained at only 1200°C. We will show also the influence of the cold sintering process (CSP) on the conductivity. Compared to conventional sintering process at about 1600°C, high conductivity level of 10-2 S/cm is obtained at 400°C (figure 1) using CSP process combined with a 1200°C annealing step.[1] K. Thabet, M. Devisse, E. Quarez, O. Joubert, et A. Le Gal La Salle, "Influence of the autocombustion synthesis conditions and the calcination temperature on the microstructure and electrochemical properties of BaCe0.8Zr0.1Y0.1O3−δ electrolyte material", Solid State Ionics, vol. 325, 2018, p. 48-56,[2] F. Iguchi, T. Yamada, N. Sata, T. Tsurui, et H. Yugami, "The influence of grain structures on the electrical conductivity of a BaZr0.95Y0.05O3 proton conductor", Solid State Ionics, vol. 177, no 26, 2006, p. 2381-2384 Figure 1

Predicting the Impact of COVID-19 on Australian Universities

This article explores the impact of the novel coronavirus (COVID-19) upon Australia’s education industry with a particular focus on universities. With the high dependence that the revenue structures of Australian universities have on international student tuition fees, they are particularly prone to the economic challenges presented by COVID-19. As such, this study considers the impact to total Australian university revenue and employment caused by the significant decline in the number of international students continuing their studies in Australia during the current pandemic. We use a linear regression model calculated from data published by the Australian Government’s Department of Education, Skills, and Employment (DESE) to predict the impact of COVID-19 on total Australian university revenue, the number of international student enrolments in Australian universities, and the number of full-time equivalent (FTE) positions at Australian universities. Our results have implications for both policy makers and university decision makers, who should consider the need for revenue diversification in order to reduce the risk exposure of Australian universities.

Fostering Partnerships with the Safety Net: An Evaluation of Kaiser Permanente's Community Ambassador Program in the Mid-Atlantic States.

Kaiser Permanente (KP) Mid-Atlantic States has partnered with communities in its service area since 2011 to provide health services to underserved individuals. As part of KP's Community Benefit investment, the Community Ambassador Program places KP advanced-practice clinicians in safety-net clinics to share best practices and to improve access and quality of care. To report program outcomes and disseminate lessons learned. Using data from participating clinics, we retrospectively evaluated the program and estimated Community Ambassadors' contributions to clinic capacity, patient access, evidence-based care, and clinical quality measures. Furthermore, we conducted 29 semistructured phone interviews with stakeholders. Questions focused on program benefits, challenges, learning, and sustainability. From 2013 to 2017, Community Ambassadors filled up to 32.8 full-time equivalent positions and conducted 294,436 patient encounters in 19 clinics. In certain years and for subsets of clinics, Community Ambassadors performed above average on 2 high-priority quality measures: Cervical cancer screening for women aged 21 to 64 years and diabetes (blood glucose) control. Interviews with 15 Community Ambassadors, 15 health centers leaders, and 7 KP Mid-Atlantic States staff members revealed that Community Ambassadors improved patient access, clinic capacity, and care quality. Ambassadors also exported KP best practices and supported KP's community relations. Challenges included patient acuity, clinic resources, staff turnover, and long-term sustainability. The Community Ambassador Program achieved its goals and had clear benefits, offering a model for large health care systems wanting to collaborate with community-based clinics. Careful planning is needed to ensure that positive results are sustained.

A Listening Tour: Pediatric Clinical Ethics Rounds

A two-year rounding program was initiated by the clinical ethics consult service (CECS) to improve ethics program integration and utilization at our 323-bed tertiary care pediatric hospital. Two critical variables were identified for improvement. One: identification of cases in which an ethics consult would have benefited clinical care but was not requested. Two: earlier detection of cases for which the medical team and/or family eventually sought ethics consultation but that worsened during the delay. Improvement relied on eliciting dialogue with the CECS by the medical team and/or patients and families, when it had either not occurred before or had not occurred when it would have been most beneficial. The indirect nature of the improvements sought posed a specific challenge: how does one elicit such action from others? How does a small program with less than one full-time equivalent position that is dedicated to clinical ethics, and little funding, effect such a process change across an organization with more than 600 physicians, 2,000 nurses, 600 medical students, and thousands of other clinicians and staff? The following accounts such an effort and the accompanying two-year study undertaken to document the results. The data presented demonstrate improvement in both identified variables: increased overall utilization of the CECS and earlier detection of cases in which the CECS is typically engaged.

The State of the Job Market for Pathologists: Evidence From the College of American Pathologists Practice Leader Survey.

Disagreement exists within the pathology community about the status of the job market for pathologists. Although many agree that jobs in pathology were harder to come by earlier this decade, recent evidence suggests improvement is occurring. To assess the state of the job market for pathologists. We analyzed data from the 2018 College of American Pathologists Practice Leader Survey. This survey contains data from 253 practice leaders on practices' hiring (and retrenchments) in 2017, the skills and level of experience being sought, success in filling those positions, and expectations for hiring in the next 3 years. Among the surveyed practice leaders, 115 (45.5%) sought to hire at least 1 pathologist in 2017, and together tried to fill 246 full-time equivalent positions that year, of which 93.5 full-time equivalents (38%) were newly created. This hiring was not limited to larger, academic-based practices, but also occurred among smaller practices and practices based in nonacademic hospitals, independent laboratories, and other settings. Although some practices retrenched (60 full-time equivalents in 2017), the net increase was a healthy 187 full-time equivalents. Practices most frequently sought pathologists who had at least 2 years of experience, but the level of experience identified with the "optimal" candidate varied by desired areas of subspecialty expertise. Practice leaders also reported expected growth in hiring, with the number of positions they hope to fill in the next 3 years exceeding those vacated by retirement. Our findings support the proposition that the demand for pathologists is strong, at least at the current time.

Seven Challenges Assisted Living Must Get Right

Seven Challenges Assisted Living Must Get Right