Health Workforce Supply Research Articles

Profile and Attributes of Physician Assistants/Associates in Rheumatology: An In-depth Analysis.

This work describes the demographics and practice characteristics of physician assistants/associates (PAs) practicing in rheumatology. We examined 2022 cross-sectional data from the National Commission on Certification of PAs (NCCPA). The investigation included demographics and practice characteristics of PAs working in rheumatology compared to those working in all other specialties. We analyzed data using descriptive and bivariate statistics comparing the two groups. In 2022, 430 PAs self-reported practicing in rheumatology. The median age of these PAs was 39 years, and 84.7% self-identified as female. They primarily (78.8%) worked in office-based private practices and were more likely to engage in telemedicine services (62.5%) than their colleagues in all other specialties. PAs in rheumatology typically worked similar hours as their peers in other medical disciplines but saw a higher proportion of patients in the 61-80 range. At the same time, PAs in rheumatology reported slightly higher job satisfaction and lower burnout symptom rates compared to PAs practicing in other disciplines. Understanding PAs' characteristics and employment settings in rheumatology is crucial to estimating the health workforce supply and demand in this discipline. Further research should explore the economics of PAs in rheumatology, including aspects of teamwork, scope of practice, patient outcomes, and satisfaction.

Methods for projecting health workforce planning in Ireland: a collaborative approach

Abstract Background Health workforce planning (HWFP) is the process of analysing, forecasting, and planning workforce supply and demand, assessing gaps, and determining target workforce to ensure that health systems are prepared for future demand. HWFP elicits recommendations that are ideally utilised by the health system to support medical workforce over a defined time. Methods The objective of this project is to inform intake for medical and surgical specialties in Ireland to reach the necessary consultant workforce by 2038. A literature search was conducted to help inform the methodology for this project. The most common approach was a needs-based model, and additional reviews discussed the integration of medical engagement into the modelling approach. Results This project will employ a collaborative approach, combining mathematical modelling and a combination of quantitative and qualitative inputs, including the following phases: 1. The research phase will estimate baseline supply and demand data across medical and surgical specialties in Ireland using statistical models; 2. The presentation phase will include input from clinical leads to allow for more accurate assumptions in the baseline of each model; 3. Review of projections will include feedback from the clinical leads to help clarify and improve the initial model; 4. Presentation of the revised projection will include further collaboration with clinical leads to finalise the model. Conclusions The robust methodology for this HWFP project will ideally inform medical and surgical specialities in Ireland through 2038. Specific and extensive predictions of health workforce supply and demand will enhance strategic preparation, which is a key priority for the Health Service Executive in Ireland. Key messages • A collaborative approach to HWFP is essential for health service preparation and improvement. • The project will be finalised by the end of 2024, and the methodology for conducting similar HWFP projects can be adapted by other EU states.

The what, the when and the how: A qualitative study of allied health decision-maker perspectives on factors influencing the development and implementation of advanced and extended scopes of practice in Australia.

Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined. A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions. Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n=8) and non-rational (n=6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct. Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.

The supply and demand for rehabilitation health workforce in Saudi Arabia.

Adequate supply of rehabilitation health workforce is a prerequisite for enhancing access to rehabilitation care. However, there is a lack of comprehensive data regarding the supply of rehabilitation health workers in Saudi Arabia. To determine the need for, and supply of, rehabilitation workforce, and investigate the relationship between rehabilitation workforce supply and rehabilitation needs in Saudi Arabia. This cross-sectional study measured the ratio of physiotherapists and occupational therapists per 10 000 population. Data were obtained from the Ministry of Health, family health survey and census data of the General Authority for Statistics and published literature. To assess the need for rehabilitation services, we computed a composite disability index based on 3 variables: count of individuals with physical disabilities, those with chronic diseases, and those aged > 65 years. Determinants of the supply potential were population size, rural population percentage, and physician supply. Data were analysed using descriptive statistics and simple linear regression. The ratios of physiotherapists and occupational therapists working at the Ministry of Health facilities were 0.69 and 0.03 per 10 000 population, respectively. Overall rehabilitation health workforce ratio was 0.73 per 10 000. Supply varied across regions, from 0.4 for Riyadh to 2.5 for Al Jouf. Nine regions exceeded the overall ratio. Rehabilitation need index ranged from 0.144 in Najran to 0.212 in Aseer. No significant associations were found between rehabilitation workforce supply on one hand, and need and other potential determinants on the other hand. The rehabilitation workforce supply in Saudi Arabia surpassed the regional and global averages, but was lower than the average for high-income countries. Workforce distribution varied by region across the country and was not related to need. It is important to consider the need for rehabilitation services and context-specific factors when determining the optimal size and distribution of the rehabilitation health workforce in Saudi Arabia.

Association between mental health workforce supply and clusters of high and low rates of youth suicide: An Australian study using suicide mortality data from 2016 to 2020.

To examine the association between mental health workforce supply and spatial clusters of high versus low incidence of youth suicide. A cross-sectional analysis of spatial suicide clusters in young Australians (aged 10-25) from 2016 to 2020 was conducted using the scan statistic and suicide data from the National Coronial Information System. Mental health workforce was extracted from the 2020 National Health Workforce Dataset by local government areas. The Geographic Index of Relative Supply was used to estimate low and moderate-to-high mental health workforce supply for clusters characterised by a high and low incidence of suicide (termed suicide hotspots and coldspots, respectively). Univariate and multivariate logistic regression was used to determine the association between suicide clusters and a range of sociodemographic characteristics including mental health workforce supply. Eight suicide hotspots and two suicide coldspots were identified. The multivariate analysis showed low mental health workforce supply was associated with increased odds of being involved in a suicide hotspot (adjusted odds ratio = 8.29; 95% confidence interval = 5.20-13.60), followed by residential remoteness (adjusted odds ratio = 2.85; 95% confidence interval = 1.68-4.89), and illicit drug consumption (adjusted odds ratio = 1.97; 1.24-3.11). Both coldspot clusters occurred in areas with moderate-to-high mental health workforce supply. Findings highlight the potential risk and protective roles that mental health workforce supply may play in the spatial distributions of youth suicide clusters. These findings have important implications for the provision of postvention and the prevention of suicide clusters.

The Role of the Temporary Contracting and Visiting Doctor Program in Supporting the Health System during and after COVID-19 Pandemic in Saudi Arabia.

Adequate supply of health workforce with proper skills is essential to deliver appropriate health services in normal times and during disasters. To describe the role of the Saudi Temporary Contracting and Visiting Doctors Program in the provision of critical care during COVID-19 pandemic, and in the clearance of the surgical backlog thereafter. We reviewed reports of General Directorate of Health Services and Saudi Ministry of Health annual statistical books to obtain the following data: number of temporary healthcare professionals contracted from 2019 to 2022; number of intensive care unit beds before and during COVID-19 pandemic; volume of elective surgeries before, during and after COVID-19 pandemic. In 2020, intensive care unit beds increased from 6341 to 9306 in governmental hospitals in response to COVID-19 pandemic. A total of 3539 temporary healthcare professionals were recruited from April to August 2020 to contribute towards staffing the added beds. During the recovery period from COVID-19 pandemic, 4322 and 4917 temporary health care professionals were recruited in 2021and 2022 respectively. Elective surgeries volume increased from 5074 in September 2020 to 17533 in September 2021 to 26242 in September 2022, surpassing the volume of surgeries in pre-COVID-19 period. In response to COVID-19 pandemic, and through the existing temporary contracting program, the Saudi Ministry of Health was able to recruit temporary staff of verified credentials in a timely manner, to supplement the existing staff, for activation of the newly added intensive care unit beds, and for clearing the resulting surgical backlog.

Patients Receive Flexible And Accessible Care When State Workforce Barriers Are Removed.

In response to COVID-19, many states increased their supply of health care workers, using emergency policies to remove barriers such as state licensure requirements. The experience in New Jersey suggests that most health care workers who obtained a temporary license, including physicians, nurses, and mental health providers, provided care for existing patients for COVID-19- and non-COVID-19-related conditions, mostly through telehealth. State variation in licensure requirements, as well as scope of practice, may be a barrier to patients having flexible, accessible, and continuous care. As states emerge from the pandemic, emergency policies that expand health workforce supply by removing these state-level barriers should be made permanent.

Medical specialist distributions in Ecuador: a geographical and temporal analysis of data from 2000 to 2017

BackgroundKnowledge of medical specialists' numbers and geographical distribution are essential for planning health services and health workforce supply. However, although the distribution of physicians is a significant concern for society and policymakers in Ecuador, no studies have evaluated the distribution of specialists in the country. This study aimed to explore the geographical and temporal distribution of medical specialists in Ecuador over 18 years from 2000 to 2017 and analyse its implications for health planning and medical training.MethodsWe conducted an ecological time-series study based on the National Statistical Register of Resources and Health Activities data. This register provides administrative information for health professionals working in public and private health institutions. Rates of medical specialists by year, geographical area, and speciality were estimated. We used joint-point analyses to identify time trends for medical specialists and physicians in training.ResultsFrom 2000 to 2017, medical specialists grew from 2737 to 10,929. The rate of medical specialists per 10,000 population increased from 4 in 2000 to 10.3 in 2017. Based on Joint point analysis, two temporal trends were identified. Between 2000 to 2015, specialists increased by 4.1% per year, and between 2015 and 2017, they increased by 20% per year. For the entire study period, three cities (Quito, Guayaquil, and Cuenca) accounted for more than 50% of the specialists in the country. However, medical specialists in other cities and rural areas increased from 37% in 2000 to 46% in 2017. The provinces of Esmeraldas, Carchi, Bolívar and Los Ríos presented rates of less than 6 specialists per 10,000 population by 2017. Of the 46 medical specialities identified by 2017, three represented more than 30% of the professionals (gynaecology 12%, paediatrics 11% and family and community health 8.4%).ConclusionsThis study shows that the number of medical specialists in Ecuador has increased significantly over the last two decades, although with inequalities in the distribution of specialists between provinces and regions. The results of this study provide background for the Ecuadorian health system when introducing Human Resources of Health (HRH) policies.

Conceptualising and assessing health system resilience to shocks: a cross-disciplinary view.

Health systems worldwide face major challenges in anticipating, planning for and responding to shocks from infectious disease epidemics, armed conflict, climatic and other crises. Although the literature on health system resilience has grown substantially in recent years, major uncertainties remain concerning approaches to resilience conceptualisation and measurement. This narrative review revisits literatures from a range of fields outside health to identify lessons relevant to health systems. Four key insights emerge. Firstly, shocks can only be understood by clarifying how, where and over what timescale they interact with a system of interest, and the dynamic effects they produce within it. Shock effects are contingent on historical path-dependencies, and on the presence of factors or system pathways (e.g. financing models, health workforce capabilities or supply chain designs) that may amplify or dampen impact in unexpected ways. Secondly, shocks often produce cascading effects across multiple scales, whereas the focus of much of the health resilience literature has been on macro-level, national systems. In reality, health systems bring together interconnected sub-systems across sectors and geographies, with different components, behaviours and sometimes even objectives - all influencing how a system responds to a shock. Thirdly, transformability is an integral feature of resilient social systems: cross-scale interactions help explain how systems can show both resilience and transformational capability at the same time. We illustrate these first three findings by extending the socioecological concept of adaptive cycles in social systems to health, using the example of maternal and child health service delivery. Finally, we argue that dynamic modelling approaches, under-utilised in research on health system resilience to date, have significant promise for identification of shock-moderating or shock-amplifying pathways, for understanding effects at multiple levels and ultimately for building resilience.

Health workforce supply, needs and financial feasibility in Lesotho: a labour market analysis

BackgroundThe Government of Lesotho has prioritised health investment that aims to improve the health and socioeconomic development of the country, including the scaling up of the health workforce (HWF) training...

An integrated primary care workforce planning toolkit at the regional level (part 2): quantitative tools compiled for decision-makers in Toronto, Canada

BackgroundHealth workforce planning capability at a regional level is increasingly necessary to ensure that the healthcare needs of defined local populations can be met by the health workforce. In 2016, a regional health authority in Toronto, Canada, identified a need for more robust health workforce planning infrastructure and processes. The goal of this project was to develop an evidence-informed toolkit for integrated, multi-professional, needs-based primary care workforce planning for the region. This article presents the quantitative component of the workforce planning toolkit and describes the process followed to develop this tool.MethodsWe conducted an environmental scan to identify datasets addressing population health need and profession-specific health workforce supply that could contribute to quantitative health workforce modelling. We assessed these sources of data for comprehensiveness, quality, and availability. We also developed a quantitative health workforce planning model to assess the alignment of regional service requirements with the service capacity of the workforce.ResultsThe quantitative model developed as part of the toolkit includes components relating to both population health need and health workforce supply. Different modules were developed to capture the information and address local issues impacting delivery and planning of primary care health services in Toronto.ConclusionsA quantitative health workforce planning model is a necessary component of any health workforce planning toolkit. In combination with qualitative tools, it supports integrated, multi-professional, needs-based primary care workforce planning. This type of planning presents an opportunity to address inequities in access and outcome for regional populations.

Riding the waves: lessons learnt from Victoria's COVID-19 pandemic response for maintaining effective allied health student education and clinical placements.

Victoria was the Australian state most significantly affected by the COVID-19 pandemic in 2020, which caused significant disruption to Victorian health services. The aim of this case study is to describe the experience of the Victorian public health system in adapting to support allied health student education during the pandemic. Factors that affected student education were complex and dynamic, and included a decrease in traditional face-to-face learning opportunities due to a transition to telehealth, social distancing requirements, furlough of staff and travel restrictions. Impacts on placement capacity across allied health professions were highly variable. Strategies used to enable the continuation of student work-integrated learning (WIL) (also referred to as clinical placements or fieldwork) included an increase in remote placements and the use of technology. Enhanced communication between government and health service educators enabled rapid sharing of information and problem solving. At this time, the impacts on student preparedness for practice are unclear but may include deficits in interprofessional learning, clinical skills, increased levels of agility and enhanced resilience. This case study highlights the need for the health system to be adaptable and innovative to maintain the quality of student education, and the future allied health workforce, through the pandemic and beyond.

Return Service Agreement in the Context of the Universal Health Care Act: Using International and Local Experiences to Guide Application of the RSA

Background. Philippines is in a constant struggle to address shortage and maldistribution of health professionals, affecting equity in service delivery. The government endeavors to generate adequate supply of health workforce through scholarship and training programs which have been further expanded with the enactment of the Universal Health Care (UHC) Act. This article aimed to give a background for discussion on the application of return service agreement (RSA) provisions in the light of attaining universal health care.
 Methods. A modified systematic review of literature was conducted guided by the key issues determined by the Department of Health with focus on the extent of scholarship grants and on number of recipients.
 Results. The Philippine government enacted policy reforms through implementing RSA in response to the progressive decline of the net flow of health professionals. However, the criticisms lie in that RSA is not a long-term solution. With the RSA provisions in the UHC Law, metrics on determining the under-produced and maldistributed professional cadre must be created. These should be responsive in addressing facility-level and health system-level gaps.
 Conclusion and Recommendation. Paucity of current local literature impedes attaining a conclusive body of evidence, therefore, further research is needed. Operationalization of RSA should not be viewed as a singular means to solve the health workforce gaps, but as part of holistic assessment, taking into consideration epidemiological, geographical, political, and social determinants. Stakeholders must ingress in collaborative intersectoral policy actions to warrant bottom-up support. Activities related to mapping, monitoring, and incentivizing medical and health-related professionals must be established to support a system conducive for workforce retention.

Time trends in the regional distribution of physicians, nurses and midwives in Europe

BackgroundCountry-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.MethodsWe used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005–2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).ResultsThere was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.ConclusionsThe study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.

A parameter-free population-dynamical approach to health workforce supply forecasting in EU countries

Abstract Many countries face challenges like impending retirement waves, negative population growth, or a suboptimal distribution of resources across medical sectors and fields in supplying their healthcare systems with adequate staffing. An increasing number of countries therefore employs quantitative approaches in health workforce supply forecasting. However, these models are often of limited usability as they either require extensive individual-level data or become too simplistic to capture key demographic or epidemiological factors. We propose a novel population-dynamical and stock-flow-consistent approach to health workforce supply forecasting complex enough to address dynamically changing behaviors while requiring only publicly available timeseries data for complete calibration. We apply the model to 21 European countries to forecast the supply of generalist and specialist physicians until 2040. Compared to staffing levels required to keep the physician density constant at 2016 levels, in many countries we find a significant trend toward decreasing density for generalist physicians at the expense of increasing densities for specialists. These trends are exacerbated in many Southern and Eastern European countries by expectations of negative population growth. For the example of Austria, we generalize our approach to a multi-professional, multi-regional and multi-sectoral model and find a suboptimal distribution in the supply of contracted versus non-contracted physicians. It is of the utmost importance to devise tools for decision makers to influence the allocation and supply of physicians across fields and sectors to combat imbalances. Key messages The trend of increasing supply of physicians continues in most European countries—stronger for specialists than for general physicians. To avoid potential physician shortages, in particular in primary care, we need to combat imbalances of physicians across sectors and medical fields.

Reproductive, maternal, newborn and child health service delivery during conflict in Yemen: a case study

BackgroundArmed conflict, food insecurity, epidemic cholera, economic decline and deterioration of essential public services present overwhelming challenges to population health and well-being in Yemen. Although the majority of the population is in need of humanitarian assistance and civil servants in many areas have not received salaries since 2016, many healthcare providers continue to work, and families continue to need and seek care.MethodsThis case study examines how reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) services have been delivered since 2015, and identifies factors influencing implementation of these services in three governorates of Yemen. Content analysis methods were used to analyze publicly available documents and datasets published since 2000 as well as 94 semi-structured individual and group interviews conducted with government officials, humanitarian agency staff and facility-based healthcare providers and six focus group discussions conducted with community health midwives and volunteers in September–October 2018.ResultsHumanitarian response efforts focus on maintaining basic services at functioning facilities, and deploying mobile clinics, outreach teams and community health volunteer networks to address urgent needs where access is possible. Attention to specific aspects of RMNCAH+N varies slightly by location, with differences driven by priorities of government authorities, levels of violence, humanitarian access and availability of qualified human resources. Health services for women and children are generally considered to be a priority; however, cholera control and treatment of acute malnutrition are given precedence over other services along the continuum of care. Although health workers display notable resilience working in difficult conditions, challenges resulting from insecurity, limited functionality of health facilities, and challenges in importation and distribution of supplies limit the availability and quality of services.ConclusionsChallenges to providing quality RMNCAH+N services in Yemen are formidable, given the nature and scale of humanitarian needs, lack of access due to insecurity, politicization of aid, weak health system capacity, costs of care seeking, and an ongoing cholera epidemic. Greater attention to availability, quality and coordination of RMNCAH services, coupled with investments in health workforce development and supply management are needed to maintain access to life-saving services and mitigate longer term impacts on maternal and child health and development. Lessons learned from Yemen on how to address ongoing primary health care needs during massive epidemics in conflict settings, particularly for women and children, will be important to support other countries faced with similar crises in the future.

Improving behavioral health workforce supply and needs estimates using active surveillance data.

Previous studies show that supply of behavioral health professionals in rural areas is inadequate to meet the need. Measuring shortage using licensure data on psychiatrists is a common approach. Although inexpensive, the licensure data have many limitations. An alternative is to implement an active surveillance system, which uses licensure data in addition to active data collection to obtain timely and detailed information. Nebraska Health Professions Tracking Service (HPTS) data were used to examine differences in workforce supply estimates between the passive (licensure data only) and active (HPTS data) surveillance systems. The impact of these differences on the designation of psychiatric professional shortage areas has been described. Information regarding the number of psychiatrists, advanced practice registered nurses and physician assistants specializing in psychiatry was not available from the licensure database, unlike HPTS. Using licensure data versus HPTS data to estimate workforce, the counts of professionals actively practicing in psychiatry and behavioral health were overestimated by 24.1-57.1%. Ignoring work status, the workforce was overestimated by 10.0-17.4%. Providers spent 54-78% of time seeing patients. Based on primary practice location, 87% of counties did not have a psychiatrist and 9.6% were at or above the Health Professional Shortage Area designation ratio of psychiatrists to population. Enumeration methods such as ongoing surveillance, in addition to licensure data, curtails the issues and improves identification of shortage areas and future behavioral workforce related planning and implementation strategies.

Forecasting imbalances of human resources for health in the Thailand health service system: application of a health demand method

BackgroundFor an effective health system, human resources for health (HRH) planning should be aligned with health system needs. To provide evidence-based information to support HRH plan and policy, we should develop strategies to quantify health workforce requirements and supply. The aim of this study is to project HRH requirements for the Thai health service system in 2026. HRH included in this study were doctors, dentists, nurses, pharmacists, medical technicians (MTs), physiotherapists (PTs), and Thai traditional medicine (TTM) practitioners.Methods and resultsThe study mainly relied on the secondary data in relation to service utilization and population projection together with expert opinions. Health demand method was employed to forecast the HRH requirements based on the forecasted service utilizations. The results were then converted into HRH requirements using the staffing norm and productivity. The HRH supply projection was based on the stock and flow approach in which current stock and the flow in and out were taken into account in the projection. The results showed that in 2026, nurses are likely to be in critical shortages. The supply of doctors, pharmacists, and PTs is likely to be surplus. The HRH requirements are likely to match with the supply in cases of dentists, MTs, and TTM practitioners.ConclusionIn 2026, the supply of key professionals is likely to be sufficient except nurses who will be in critical shortages. The health demand method, although facing some limitations, is useful to project HRH requirements in such a situation that people are accessible to health services and future service utilizations are closely linked to current utilization rates.

Reconciling Supply and Demand for State and Local Public Health Staff in an Era of Retiring Baby Boomers

The purpose of this study is to reconcile public health workforce supply and demand data to understand whether the expected influx of public health graduates can meet turnover events. Four large public health workforce data sources were analyzed to establish measures of workforce demand, voluntary separations, and workforce employees likely to retire at state and local health departments. Data were collected in 2014-2016 and analyzed in 2016 and 2017. Potential workforce supply (i.e., candidates with formal public health training) was assessed by analyzing data on public health graduates. Supply and demand data were reconciled to identify potential gaps in the public health workforce. At the state and local level, ≅197,000 staff are employed in health departments. This is down more than 50,000 from 2008. In total, ≥65,000 staff will leave their organizations during fiscal years 2016-2020, with ≤100,000 staff leaving if all planned retirements occur by 2020. During 2000-2015, more than 223,000 people received a formal public health degree at some level. More than 25,000 students will receive a public health degree at some level in each year through 2020. Demands for public health staff could possibly be met by the influx of graduates from schools and programs of public health. However, substantial implications exist for transferal of institutional knowledge and ability to recruit and retain the best staff to sufficiently meet demand.

Long-term trends in supply and sustainability of the health workforce in remote Aboriginal communities in the Northern Territory of Australia

BackgroundInternational evidence suggests that a key to improving health and attaining more equitable health outcomes for disadvantaged populations is a health system with a strong primary care sector. Longstanding problems with health workforce supply and turnover in remote Aboriginal communities in the Northern Territory (NT), Australia, jeopardise primary care delivery and the effort to overcome the substantial gaps in health outcomes for this population. This research describes temporal changes in workforce supply in government-operated clinics in remote NT communities through a period in which there has been a substantial increase in health funding.MethodsDescriptive and Markov-switching dynamic regression analysis of NT Government Department of Health payroll and financial data for the resident health workforce in 54 remote clinics, 2004–2015. The workforce included registered Remote Area Nurses and Midwives (nurses), Aboriginal Health Practitioners (AHPs) and staff in administrative and logistic roles. Main outcome measures: total number of unique employees per year; average annual headcounts; average full-time equivalent (FTE) positions; agency employed nurse FTE estimates; high and low supply state estimates.ResultsOverall increases in workforce supply occurred between 2004 and 2015, especially for administrative and logistic positions. Supply of nurses and AHPs increased from an average 2.6 to 3.2 FTE per clinic, although supply of AHPs has declined since 2010. Each year almost twice as many individual NT government-employed nurses or AHPs are required for each FTE position.Following funding increases, some clinics doubled their nursing and AHP workforce and achieved relative stability in supply. However, most clinics increased staffing to a much smaller extent or not at all, typically experiencing a “fading” of supply following an initial increase associated with greater funding, and frequently cycling periods of higher and lower staffing levels.ConclusionsOverall increases in workforce supply in remote NT communities between 2004 and 2015 have been affected by continuing very high turnover of nurses and AHPs, and compounded by recent declines in AHP supply. Despite substantial increases in resourcing, an imperative remains to implement more robust health service models which better support the supply and retention of resident health staff.