Shortage Of Physicians Research Articles

Toward a Better Understanding of Primary Care Physician Career Typologies.

The nation faces a persistent shortage and maldistribution of primary care physicians (PCPs). A better understanding of PCP career typologies could help policy makers target interventions toward certain subgroups, rather than using a "one-size fits all" approach to improving PCP supply, distribution and diversity across settings and in rural areas. This study used cross-sectional data from 2009 and 2019, derived from the North Carolina (NC) Medical Board, on PCPs in active practice in family medicine, general internal medicine, general pediatrics, geriatrics, and obstetrics and gynecology in NC. We used latent class analysis (LCA) to investigate: (1) whether different career typologies exist in the primary care physician workforce; (2) if so, whether career typologies changed in the 10-year period before the COVID-19 pandemic (2009 and 2019); and (3) whether a physician's generational cohort, age, sex, race/ethnicity, career stage, and medical school location were associated with different career typologies. The LCA yielded 4 distinct career typologies in both 2009 and 2019 with high levels of class separation. The 4 typologies were relatively stable over the decade. Distinguishing factors between typologies included practice in a rural area, hospital, and ambulatory care employment, and provision of obstetric and prenatal care. Understanding PCP career typologies could be used to tailor interventions to improve the supply and distribution of PCP workforce. Medical schools could use this information to support trainees' decision-making about future careers and policy makers to target funding for training to support careers in rural and ambulatory settings.

Expanding healthcare capacity in Canada: the potential of internationally trained physicians.

Expanding healthcare capacity in Canada: the potential of internationally trained physicians.

Workforce Attrition Among Emergency Medicine Non-Physician Practitioners.

Workforce Attrition Among Emergency Medicine Non-Physician Practitioners.

The Scope of Pediatric Forensic Psychiatric Evaluations in Student Run Asylum Clinics

Abstract Student-run asylum clinics (SRACs) are organizations that provide pro bono forensic medical evaluations to support the legal asylum cases of individuals seeking refuge away from their home country, increasing the likelihood that asylum status is granted. Although thousands of children seek asylum in the U.S. every year, there are fewer forensic medical evaluations performed for children relative to adults. This cross-sectional survey study investigates the extent of forensic medical evaluation services provided to children by SRACs in the United States. An online, cross-sectional survey evaluating the scope of pediatric practice and barriers to completing pediatric forensic evaluations was distributed to 27 student-run asylum clinics. Of fourteen organizations that completed the survey, 35.7% (n = 5) received referrals in the past year for pediatric forensic evaluations, while 92.9% (n = 13) received referrals for adult evaluations. 53.8% (n = 7) of respondents indicated that a barrier to performing pediatric evaluations was a limited number of physicians specialized in this area. There is likely an unmet need for pediatric forensic medical evaluations, and a significant barrier is a shortage of physicians specialized in performing these evaluations. Given the large volume of children who seek asylum in the United States every year, it is imperative to train additional physicians to perform pediatric evaluations to expand asylum services nationwide to children.

Rural health: Scope for improvement in return on investment

A significant proportion of the U.S. population live in rural areas with lower population density. Although rural residents tend to be older with more chronic diseases requiring specialists and nursing home care, they have less access to healthcare services. More than half of non-metropolitan counties are considered Primary Care Health Professional Shortage Areas (HPSAs). Although Federally Qualified Health Centers (FQHCs) with government funding mostly provide primary care services in underserved areas, they operate under a narrow profit margin, leading to difficulty in recruiting and retaining healthcare providers. Furthermore, lower population density in rural areas leads to a lower total number of visits in rural clinics. Physician shortage is increasing; doctors have preferentially moved toward cities for better career opportunities, higher pay, and urban amenities. FQHC funding, creating a rural track in medical education, and student loan repayment programs have facilitated improving the physician shortage in HPSA regions. Studies have suggested that these programs support physicians working in rural regions. Still, a significant care gap exists between rural and urban health. Further policy changes should be inculcated for care gap closure. To decrease healthcare provider attrition, part of the funds may be directly invested at primary provider levels by providing tax credits for those who work part-time in rural HPSAs, which would indirectly translate to better salaries without affecting access to urban amenities. Policy changes could support providers to remain in the role for a longer period and motivate older physicians to remain in practice part-time, especially during semi-retirement. In addition, providing telemedicine specialist services to patients from rural HPSA regions could be incentivized by adding a modifier for rural regions that could nearly bring the reimbursement to the cost of in-person visits. Subsequently, this has allowed more specialist clinics to pursue telemedicine to cover rural areas. National medical organizations could provide additional training and support for rural providers through dedicated rural medicine-based conferences and continuing medical education programs. This two-pronged approach to increase primary provider part-time out-migration to rural communities and to increase specialist telehealth access may improve rural health.

Automated and AI-Based Communication in the GP Practice as a Replacement for Personal Doctor-Patient Contact - A Patient Survey on Acceptance.

The study examines patient acceptance of automated and AI-based communication as a replacement for personal doctor-patient contact in general practice. A quantitative, empirical, non-randomized, non-controlled cross-sectional survey. The sample size was n = 202 participants. Younger people (χ2(1) = 3.774, p = .026), people with a high level of education (χ2(1) = 7.075, p = .004) and users of everyday digitalization (χ2(1) = 27.900, p < .001) are more often open to automated and AI-based communication as a replacement for personal doctor-patient contact. AI-based communication can serve as a strategic component in the future healthcare framework, particularly in the context of doctor shortages.

Rural Oncologists' Perceptions of Specialty Scarcity and Repercussions for Care Delivery: A Qualitative Study.

To understand oncology physician perceptions of and experiences with specialist scarcity in their referral networks, strategies for delivering care after the departure of a colleague who they view as critical to their cancer care networks (ie, a linchpin colleague), and impacts of shortages on patient care. We conducted semistructured interviews with oncologists who practice in health systems that serve a predominantly rural patient catchment area. We used deductive and inductive approaches to predetermine codes and then performed a thematic analysis. We interviewed 20 oncology physicians from five sites. We identified three major themes related to specialist scarcity. The first theme described the effects of physician shortages on care team expertise, collaborative relationships, and patient volume. The second theme uncovered strategies oncologists use when facing physician shortages, including referrals to outside health systems or generalists, practicing outside their subspecialization, and reallocating time from other responsibilities. The third theme identified unintended consequences of adaptive strategies, including greater patient travel burden, less optimal or delayed treatment, reduced access to clinical trials, and increased physician burnout and lower job satisfaction. Oncology physician shortages lead to myriad adaptive strategies and downstream consequences to patient and physicians. Mapping these cascades can help guide resources to mitigate the negative effects of departures and shortages.

Bridging the Gap: Expanding Graduate Medical Education to Address the Physician Shortage

Graduate Medical Education (GME) plays a fundamental role in shaping the future physician workforce, providing specialized training necessary to physicians. With a growing physician shortage and increasing demands for healthcare services, particularly in rural and underserved communities, expanding GME funding and residency positions has become a critical issue. Understanding the structure of GME funding, the challenges imposed by residency slot caps, and potential legislative solutions is essential to addressing these workforce gaps and ensuring sustainable access to care for patients nationwide.

Pathways To Primary Care: Charting Trajectories From Medical School Graduation Through Specialty Training.

Shortages of primary care physicians threaten access, quality, and equity in US health care. Policy solutions face disinformation about the complex patterns of physician training. This retrospective cohort study used American Medical Association Physician Masterfile and Historical Residency File data to identify physicians' trajectories from medical school graduation through postgraduate training into primary care specialties for doctors of medicine, doctors of osteopathic medicine, and international medical graduates. Sankey diagrams illustrate flows through training programs. Among 353,590 physicians who graduated during the period 2001-15, 11.8percent pursued initial training in family medicine, 33.5percent training in internal medicine, and 10.5percent training in pediatrics. Primary care yield, defined as the percentage of physicians who complete their initial postgraduate training in a primary care specialty and conclude their training in any primary care specialty, was 97.0percent for family medicine, 35.5percent for internal medicine, and 54.4percent for pediatrics. After internal medicine and pediatrics residencies, large percentages of physicians left primary care to train in subspecialties and other fields. Further research must document how many physicians enter careers in primary care practice.

Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022.

An adequate supply of family physicians who deliver comprehensive care is critical for addressing evolving population health needs, fostering health equity, and ensuring a cost-effective health system. Little is known about current trends of family physicians choosing focused practice and concurrent changes in comprehensive family physician numbers relative to population growth. We conducted a repeated cross-sectional population-based study using administrative data to understand sex-stratified trends in focused practice from 1993/1994 through 2021/2022 in Ontario, Canada, accounting for population growth. For each fiscal year, we identified all active family physicians and classified them by practice type, leveraging a previously published algorithm on comprehensiveness. The proportion of family physicians in focused practice increased from 7.7% (856/11,103) in 1993/1994 to 19.2% (3,351/17,413) in 2021/2022. The 3 most prevalent focused practice types at the end of the study period were emergency (37.0%), hospitalist (26.5%), and addiction (8.3%) medicine. A greater proportion of focused practice physicians were male (60.1%) vs female (39.9%) in 2021/2022. Over the study period, the number of family physicians increased from 104 to 118 per 100,000; however, the number of comprehensive family physicians decreased from 71 to 64 per 100,000. Of the additional 6,310 family physicians who entered the workforce, 39.5% (2,495/6,310) were in focused practice. Over the study period, there was a decrease in the percentage of comprehensive family physicians and a substantial increase in family physicians pursuing focused practice, particularly in emergency and hospitalist medicine. Research and policy work is needed to understand and address the complex factors driving these trends.

Peer-led learning: a novel approach to promote rural healthcare interest among medical students.

A persistent maldistribution of medical workforce exists across Canada, with rural areas facing a greater physician shortage. Medical education can be instrumental to increase physicians in rural communities, and medical schools have adapted strategies to generate interest in rural careers among medical students. Many of these efforts occur within formal structured curriculum. This study appraises the effectiveness of peer-led learning (PLL) as a novel approach in rural medical education to provide students with a better understanding of rural life and rural medical practice. This is mixed methods study using a survey and follow-up focus group discussion to evaluate a day-long educational experience organized and led by a medical student to their rural community. Quantitative data were summarized with descriptive statistics. Reflexive thematic analysis was conducted on qualitative insights to describe the students' experiences and perceptions about the educational rural day. Of 54 participants, 50 completed the survey and 13 consented for the follow-up focus group. Most (78%) were female, have non-rural origins (78%), with only 2 having Indigenous status. Majority (61%) have low familiarity with rural medicine. Trustworthiness scores for information about rural life and medical practice were higher for rural-origin peers and rural-origin faculty compared to other sources of information such as government websites, social media, and traditional media. Thematic analysis yielded three main themes: (i) informal teaching facilitated learning, (ii) trust in their peer enabled students to receive information more favorably, and (iii) students gained a better understanding of rural life and medical practice. This study demonstrated that medical students engage differently with peer-led learning activities about rural medical curriculum versus a formal teaching environment. Medical students are cautious about promotional information regarding rural medical education from formal sources but are less skeptical when learning from peers. Information about the way of life and healthcare needs in rural communities may be perceived as more credible and valid if coming from a peer, and hence, is more likely to be received favorably. Thus, when promoting rural education and careers, medical schools should work with rural-origin students, whose messaging may be considered more trustworthy than traditional sources.

Equitable Care for Older Australians: A Comparative Analysis of Aged Care Workforce Shortages in Metropolitan, Rural, and Remote Australia.

The Australian Royal Commission into Aged Care Quality and Safety has highlighted the chronic shortages of labour to provide care for those aged 65 and over in rural and remote areas of Australia. This descriptive cross-sectional study compares the availability of care provision in metropolitan regions with that in rural and remote regions. We analysed the 2021 Australian Census, grouped according to Aged-Care-Planning Region (ACPR), and investigated the numbers of people aged 65 years and over with different levels of care need, both in residential care and in-home. The available workforce in each ACPR was also examined in detail, using occupational classifications reported in the Census, and shortages of doctors, nurses, allied health and other care workers were identified. Overall, an additional 492,416 care hours were needed per week (or 12,958 full-time equivalent (FTE) care workers) in order to bring remote community ACPRs to parity with provision in metropolitan ACPRs. A further 95,342 FTE workers were needed in rural ACPRs to bring these areas to parity with metropolitan ACPRs. Our findings underscore the ongoing disparities in aged care workforce availability between metropolitan, rural, and remote regions of Australia. Addressing these workforce shortages is crucial to ensuring equitable access to care for older Australians, regardless of their geographical location. The implementation of targeted strategies to enhance workforce recruitment, retention, and training in these underserved areas is essential to bridge the gap and improve the quality of care provided to older adults in rural and remote communities. Such strategies could include targeted recruitment campaigns and incentives for professionals to relocate; further capacity for clinical placements and supervision in rural areas; tailoring funding and employment models for rural needs; and strengthening vocational education in regional areas.

WOEMA Position Paper and Call-to-Action: California needs more physicians specializing in Occupational and Environmental Medicine (OEM).

This paper describes the critical shortage of physicians trained in Occupational and Environmental Medicine (OEM) in California, analyzes the adverse impacts of that shortage, and proposes a specific target for increasing OEM residency slots. Literature review. The US ratio of OEM physicians-to-workers is 2 per 100,000 workers, compared with a ratio of 4 to 40 per 100,000 workers in most industrialized nations. California's shortage OEM physicians costs the state's employers over $1 billion annually in needless workers' compensation losses and other health impacts. Graduating 40 additional OEM residents in the state annually would cost an extra $27 to 32 million per year. The return-on-investment from increasing the number of OEM residencies and residency slots in California would be substantial, approaching at least 10-to-1, benefitting the state's workers and employers, and its environmental quality.

Implementation of an interprofessional staffing model: Utilizing nurse practitioners and the eICU.

There is a growing demand for intensive care unit (ICU) providers at the time of physician shortages, increased provider burnout, and attrition. Evidence supports safe utilization of nurse practitioners (NPs) and physician assistants (PAs) in the ICU. An ICU team using intensivists (medical doctors) and doctors of osteopathic medicine, NPs, and PAs experiencing staffing challenges because of staff shortages and increased clinical responsibilities. An evidence-based pre-post quality improvement project. Utilization of NPs and PAs overnight instead of intensivists in a community medical/surgical ICU with electronic ICU support. Primary measures were mortality, procedural complications, central line-associated bloodstream infection, and catheter-associated urinary tract infections preimplementation and postimplementation. Secondary measure was qualitative data on facilitators and barriers to implementation. Catheter-associated urinary tract infection rates preimplementation and postimplementation were zero. Central line-associated bloodstream infection rates decreased from one pre to zero post. Procedural complication rate decreased by 0.4% (p = .687). The survey had an 80% response rate, with >90% answering that implementation positively affected quality and communication. Communication, collaboration, focus on quality care, and increased accessibility were identified as facilitators. Role understanding, acceptance, and communication with other services were identified as barriers. A collaborative model of care using NPs and PAs overnight in a community ICU is a feasible, safe, and effective staffing solution. The hybrid model provided additional support for NPs, PAs, and nursing staff, which helped with transition and overall satisfaction. Further research on NP and PA implementation in a hybrid model is needed on a national, multisite scale.

Programme administrators' views on barriers in the Cuban-South African medical collaboration at UKZN.

The Cuban-South African medical collaboration, initiated in the early 1990s, aims to address the shortage of medical doctors, particularly in remote and rural South Africa, thereby contributing to achieving health-related outcomes for universal health coverage. This study focusses on the perceptions of programme administrators of the systemic barriers in coordinating the Cuban-South African medical collaboration programme. The main site for this study is the University of KwaZulu-Natal, Nelson Rohihlahla Mandela School of Medicine. It is the only medical university located in KwaZulu-Natal. A qualitative exploratory design was employed to understand the barriers to coordinating the programme. Purposive sampling was used to select participants. Data collection was conducted through semi-structured interviews with participants at the medical school. Data were analysed using thematic analysis. The study revealed several barriers that hinder the smooth operation of the programme, such as incomplete documentation and delays in registration, delays in equipment distribution and transportation complications because of registration issues, language barriers, connectivity issues, and the need for provisions during load shedding and water shortages. Addressing these barriers is crucial for improving the overall experience of the cohort students, who play a vital role in enhancing human resources for health, driving health reforms and supporting primary healthcare in South Africa. The study provides recommendations to enhance the programme's effectiveness. These measures are essential for ensuring the sustainability and success of the Cuban-South African medical collaboration programme.

ROLE OF CIVIL DEFENCE IN COVID-19 MANAGEMENT IN UNION TERRITORY, CHANDIGARH (INDIA)

Civil defence is a voluntary force of citizens, who respond during any unforeseen situation in the locality. India enacted The Civil Defence Act, 1968to provide basic training to its citizens regarding counter war measures. Later, in 2009 the responsibilities of the civil defence corps were increased, when government amended The Civil Defence Act 1968and added disaster management as well. This paper highlights the role of civil defence in health delivery services and its effectiveness, and the coordination between civil defence organization and Chandigarh Administration in Covid-19 management in Chandigarh. The study is based on meta-analysis of statistical data pertaining to Covid-19 management available at national as well as Chandigarh administration levels. The findings of the study revealed that during the pandemic, civil defence organization played an important role in patient care, para-medical duties including ambulance services, medicines and food distribution, hospital ward maintenance, awareness campaigns, vaccination camps, cremations and para-policing duties like law and order maintenance, traffic management etc. However, as far as the effectiveness of these health services is concerned there are many flaws in it such as inadequate infrastructure including shortage of health care institutions, beds, ambulances, medical equipments, doctors, nursing staff and other medical staff, poor primary health services, high cost of medicines, preference of branded drugs over generic drugs, absence of periodic training to officials etc.

Radiology for kids: Benefits of early education and workplace volunteerism.

Radiology for kids: Benefits of early education and workplace volunteerism.

Lack of 24/7 Attending Physician Coverage in US Emergency Departments, 2022.

Lack of 24/7 Attending Physician Coverage in US Emergency Departments, 2022.

Strategies and reflections on the construction of a comprehensive management system for dementia in the elderly: based on the practice of cognitive disorder specialty capacity building

With the acceleration of population aging, the number of elderly individuals suffering from dementia continues to rise sharply, becoming a significant social issue that affects public health and urgently requires a comprehensive management model throughout the disease course to address it. However, China still faces numerous challenges in the diagnosis and treatment of senile dementia, including insufficient public awareness, limited screening capabilities at the grassroots level, a shortage of specialist physicians, a lack of continuity in management systems, and inadequate rehabilitation and care services. Drawing on the Cognitive Disorder Specialty Capacity Building Project and the establishment of a cognitive disorder diagnosis and treatment center system across various levels of medical and health institutions,the authors conduct a strategic analysis on three key aspects of dementia in the elderly: early screening and intervention, standardized diagnosis and treatment, and rehabilitation and care. It proposes specific measures such as integrating existing resources, conducting screening and early intervention according to local conditions, optimizing referral channels, improving multidisciplinary collaborative diagnosis and treatment models, and promoting the connection between home and community care services. Through these measures, the paper explores a management model and path for the entire course of dementia in the elderly that is suitable for national conditions, providing a reference for the prevention and control of dementia in the elderly in China.

Impact of School-Enforced Step 1 Deadlines on Medical Student Well-Being and Failure Rates: Two Medical Students' Perspective.

The US Medical Licensing Examination Step 1 is a milestone assessment that evaluates a medical student's mastery of foundational medical sciences. Traditionally taken at the end of the preclinical curriculum, it now serves as a pass/fail examination before students begin clinical rotations. This transition, coupled with the enforcement of strict deadlines by various medical schools, has introduced significant challenges for students, including increased stress, potential academic delays, and financial hardship. This perspective explores the implications of these enforced deadlines to complete the US Medical Licensing Examination and how they may exacerbate the physician shortage, and it provides solutions that promote student well-being and maximize Step 1 pass rates.