Shortage Of Healthcare Professionals Research Articles

RADIANCE: Reliable and interpretable depression detection from speech using transformer

Depression is a common but severe mental disorder that adversely impacts the ability of an individual to function normally in their day-to-day life. A majority of depressed individuals remain undiagnosed due to factors such as social stigma and a shortage of healthcare professionals. Consequently, several Machine Learning and Deep Learning (DL) models based on speech have been proposed for automatic depression detection, with the latter generally outperforming the former. However, DL models are blackbox and offer no transparency. In contrast, healthcare professionals prefer models that provide interpretability besides being accurate. In this direction, we propose a method RADIANCE (Reliable AnD InterpretAble depressioN deteCtion transformErs). RADIANCE incorporates a novel FilterBank VIsion Transformer (FBViT) network, which provides the symptoms of depression as interpretable features. Additionally, we employ a novel loss function that handles the class imbalance issue in the datasets. It also incorporates a penalty term that addresses the hierarchy of misclassification errors. We also propose a reliability predictor based on low-level descriptors that provides a reliability score to indicate the trustworthiness of the prediction by FBViT. Furthermore, in contrast to the conventional averaging and majority pooling, RADIANCE consolidates predictions from multiple clips of the input audio by intricately weighing each prediction based on its reliability score, ensuring a more accurate overall prediction. RADIANCE outperforms the state-of-the-art depression detection methods, achieving an accuracy of 89.36%, 80.36%, and 94.44% over the DAIC-WOZ, E-DAIC, and CMDC datasets, respectively. Further, RADIANCE achieves MAE scores of 3.27 and 5.04 on the DAIC-WOZ and E-DAIC datasets, respectively.

Social Accountability at Southern Illinois University School of Medicine: A Focus on Admission Policy

Given the increasing health disparities across regions and populations, social accountability is not an option but an obligation for health professions schools, including medical schools. In this short communication, the authors report the case of Southern Illinois University School of Medicine (SIU SOM), which has been an exemplary medical school for social accountability, receiving the 2013 AMEE ASPIRE Award in social accountability and the 2018 Josiah Macy Jr. Foundation Award for Institutional Excellence in Social Mission in Health Professions Education. This paper focuses on the school’s admission policies in the discussion of its social accountability. It starts with the background of central and southern Illinois, where the school is located to address the shortage of healthcare professionals in the areas. It discusses the school’s holistic admission policies and two pipeline programs—namely, MEDPREP and McNeese Physician Preparatory Pipeline Program (P4)—that are strategically designed as a long-term physician workforce development plan to address health disparities in rural areas. As of January 30, 2024, 3,233 students have earned the MD (Doctor of Medicine) degree at SIU SOM. In total, 770 alumni (33%) are practicing in primary care. Among 901 graduates practicing in Illinois, 484 (54%) are practicing in SIU SOM service area counties (i.e., central and southern Illinois). Social accountability is the core value and organizational identity of SIU SOM and the guiding principle of the school’s innovation and excellence.

Rheumatology in the digital health era: status quo and quo vadis?

Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient-provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care.

National implementation of telehealth in Denmark: A case study

Abstract Background With a growing number of chronic patients and a shortage of healthcare professionals, modern health systems face mounting economic pressures. Telehealth has emerged as a promising solution to address these challenges and is considered a critical component of future healthcare provision. However, implementing telehealth on a large scale is complex and challenging. To fully grasp these challenges, it is essential to look beyond the technology and delve into the processes and actors involved in its implementation. Actors on a political-administrative level are pivotal in large-scale implementation, yet this level remains understudied. Thus, this study investigates the dynamics of large-scale implementation at a political-administrative level through a case study of the national implementation of TeleCOPD in Denmark - a home-monitoring intervention targeting patients with Chronic Obstructive Pulmonary Disease (COPD). Methods An in-depth qualitative study of the implementation process at the political-administrative level was undertaken. Data consisted of comprehensive documentary material, including policy documents and meeting minutes and 12 semi-structured interviews with 16 key stakeholders across all levels of the implementation process. Data was analysed in accordance with thematic analysis using an abductive strategy. Results The analysis shows that large-scale implementation of telehealth is a profoundly complex process, necessitating the collaboration of various stakeholders across organisational hierarchies. Substantial translational work is required at the political-administrative level to implement telehealth across diverse organisational contexts. Moreover, understanding the role of context in this translation process is essential. Conclusions This study generates valuable knowledge about large-scale implementation of telemedicine in addition to insights into the role of the political-administrative level in the implementation process. Key messages • Implementing telehealth nationally involves intricate translation processes at multiple levels. • Balancing local adjustments with degrees of fidelity is crucial in large-scale implementation.

A new digital model for Italian Integrated Home Care: strengths, barriers, and future implications

Abstract Issue/Problem After the COVID-19 pandemic, Italy’s National Health Service (NHS) is transforming by adopting telemedicine through its National Recovery and Resilience Plan, aiming to modernize healthcare delivery and ensure equity. In this plan Territorial Coordination Centers (COT) were designed to improve patient access and continuity of care. However, regulatory challenges hinder the widespread adoption of telemedicine. Our work describes the technical, structural, and operational aspects of the new Italian Integrated Home Care (IHC) digital model, addressing strengths, barriers, and future implications. Description of the problem The implementation of the IHC digital model faces multiple challenges. Italy’s poor technical infrastructure, especially in rural areas, hampers access to critical services. Resistance to change among rural systems and the elderly, coupled with low digital literacy, inhibits telemedicine adoption. Fragmentation in the NHS leads to resource disparities, particularly disadvantaging southern regions. Italy also grapples with a severe shortage of healthcare professionals, posing a threat to the model’s sustainability. Results The National Digital Health Agency enacts the IHC model by overseeing telemedicine services through a cloud-based protocol. Each Region provides “Basic Telemedicine Services”: healthcare professionals’ and patient teleconsultation, telemonitoring, teleassistance. Communication between services, infrastructures, and local health authorities is facilitated by a modular interoperability layer, ensuring data standards and quality. A national telemedicine dissemination portal will contain data on all telemedicine solutions provided. Lessons Clear communication is essential for telemedicine acceptance. COTs enhance coordination and management. Bridging the technology gap for disadvantaged groups, supporting frontline employees and addressing adoption factors is vital to overcome the challenges faced. Key messages • The National Digital Health Agency drives telemedicine services under the IHC model. Each region offers Basic Telemedicine Services, ensuring data standards, quality and interoperability of data. • Italy’s telemedicine adoption faces poor infrastructure, resistance and workforce shortages. Focusing on equity, healthcare workers support and bridging the technology gap will be key.

Influencing physician distribution through education: a qualitative study on retention in Japan’s rural hospitals

BackgroundAddressing the shortage of healthcare professionals in rural Japan poses significant challenges. At Sanmu Medical Center, incorporating resident physicians into a general medicine training program has proved effective in retaining them as supervising physicians. This study aims to identify the key factors contributing to the success of such programs.MethodsWe used a qualitative research design to comprehensively understand the factors contributing to physician retention in regional community hospitals in areas with physician shortages. Interviews were conducted with four experienced physicians, including the center director, who participated in the general or family medicine training programs at Sanmu Medical Center. Using a semi-structured questionnaire, we explored the factors influencing physician retention in community-based hospitals experiencing shortages. Two physicians specializing in community medicine conducted a content analysis under the supervision of three experts in community-oriented medical education and qualitative research. This approach helped compare retention factors perceived by physicians and the center director.ResultsContent analysis revealed 10 categories and 47 subcategories. The analysis revealed that “Educational activity” and “Supervising physicians and guidance system” are crucial for physician retention in rural hospitals in Japan. The study highlighted key educational factors contributing to retention: engagement in educational activities led to personal and professional growth, creating a rewarding experience for the physicians. Furthermore, a structured supervising physician system provided essential guidance and mentorship, improving the educational environment. Diverse learning opportunities and protected learning times were identified as critical for fostering a sustainable commitment among physicians to work in rural settings. These findings contribute to existing literature by detailing how structured educational activities and mentorship programs in rural hospital settings can significantly impact physician retention.ConclusionsCommunity-based medical education programs that focus on diverse clinical settings, mentorship, and a supportive work environment can enhance physician retention in rural areas. By fostering such educational and professional environments, healthcare institutions can address physician maldistribution and improve care quality in underserved communities. Our study offers practical insights that can be replicated or adapted by other rural hospitals facing similar challenges. It offers targeted strategies to address the unique challenges faced by female physicians in rural healthcare settings.

Implementing Task Substitution for Doctors and Nurses as a Key Element of Healthcare Reform

The ongoing global shortage of healthcare professionals, particularly doctors and nurses, presents a critical challenge to the efficiency and accessibility of healthcare systems. This manuscript reviews the concept of task substitution between doctors and nurses, emphasizing the role of Advanced Nursing Practitioners (ANPs) in addressing workforce deficits. Drawing on examples from the United States, Canada, the United Kingdom, and Australia, the study explores how ANPs have been integrated into various healthcare settings, including primary care, geriatrics, mental health, and emergency care. The manuscript also discusses the potential for implementing similar practices in Poland, offering a strategic framework for enhancing nursing education, expanding ANP roles, and improving patient outcomes through healthcare reform. By examining the educational requirements, scope of practice, and existing models of ANP integration, this article provides a comprehensive analysis of how advanced nursing roles can alleviate pressures on healthcare systems and suggests actionable steps for policymakers.

Exploring Nurse Use of Digital Nursing Technology.

Technological developments and nursing shortages have become global trends. To solve the problem of shortage of healthcare professionals, technology may be used as a backup. Nurses constitute the largest working group in the healthcare system. Therefore, nurses are very important to the success of implementing digitization in hospitals. This cross-sectional study used the characteristics and adoption roles of innovation diffusion theory to understand technology use within the organization. Data were collected through structured questionnaires and open-ended questions from March 21 to May 31, 2022, in two hospitals in Taiwan. In total, 159 nurses agreed to participate in the study. The results of this study revealed that observability, simplicity, advantage, trialability, and compatibility positively improved the acceptance of digital nursing technology. In the distribution of users' innovative roles, early adopters had a significant impact on innovation characteristics and technology acceptance. Nurses in acute and critical care units perceived a greater comparative advantage and trial availability of digital nursing technology use than did those in general wards and outpatient clinics. In addition, based on user opinions and suggestions, the development of smart healthcare and the use of digital technology are expected to improve the quality of nursing care.

Back on track - digital health applications to treat back pain of rheumatic patients? Results of a qualitative interview study.

Non-specific low back pain (NLBP) is prevalent among patients with rheumatic conditions. Digital health applications (DiGAs) provide reimbursed, personalized home treatment for patients, promising to overcome limitations of traditional healthcare systems. However, the adoption and effectiveness of back pain-specific DiGAs in rheumatology are not well understood. This study aims to explore the experiences and perspectives of a diverse group of rheumatology stakeholders regarding the use of DiGAs for back pain management. Qualitative interviews and a focus group discussion were conducted with a wide range of stakeholders including rheumatic patients, rheumatologists, nurses and DiGA producers. The data were analysed using qualitative content analysis. The study included 15 interviews (10 rheumatic patients, 4 rheumatologists, 1 DiGA producer) and 1 focus group with mixed participants (n = 12). Most stakeholders valued the instant access to personalized and effective back pain treatment provided by DiGAs. Patients appreciated the flexibility and ease of use of DiGAs which can be used anywhere and anytime. Concerns were raised about insufficient guidance regarding correct execution of exercises, which was seen as potentially dangerous and unsettling for patients. Healthcare professionals (HCPs) highlighted barriers, such as the lack of reimbursement, time constraints, and inadequate DiGA-specific education as barriers to prescribing DiGAs. Additionally, poor patient onboarding often led to delays, increased skepticism, and premature discontinuation of therapy. Stakeholders emphasized the challenges of current care driven by a shortage of HCPs and generally supported usage of back pain DiGAs. Various barriers and solution approaches were identified to enhance the performance, usability, and implementation of DiGAs in rheumatology.

Transforming Rural Healthcare in India: The Synergy of Medicine and Technology

Rural healthcare in India faces significant challenges, including a severe shortage of healthcare professionals, inadequate infrastructure, and geographical and socio-economic barriers. Despite these obstacles, the integration of technology offers a promising solution to improve healthcare delivery in these underserved regions. This article explores the transformative potential of various technologies, such as telemedicine, mobile health applications, electronic health records, artificial intelligence, and drone technology, in enhancing rural healthcare. It also emphasizes the importance of interdisciplinary training, combining medical and engineering education to develop contextually appropriate and culturally sensitive healthcare technologies. Through a detailed examination of case studies and potential interventions, the article underscores the critical role of government support, public-private partnerships, and community engagement in successfully implementing these technological solutions. The future of rural healthcare in India is poised for significant advancements, with emerging technologies such as 5G, blockchain, personalized medicine, and virtual reality offering further opportunities to improve healthcare access and outcomes for rural populations.

A low-cost approach to upskilling tutors in frontline health care worker production value chain.

Nigeria, like many countries, struggles with a shortage of healthcare professionals including frontline healthcare providers at the primary healthcare (PHC) level. While the country is pitched towards producing more healthcare professionals, the existing infrastructure to produce them is inadequate. Producing healthcare professional with the required skills to deliver quality services is impeded by several factors including the use of outdated curricula for their training, low application of technology in teaching, and weak tutor capacity that is worsened by the paucity and high cost of opportunities for tutor continuing professional development. To address these issues, the Health Workforce Management Activity (HWM), an initiative of the United States Agency for International Development (USAID), in 2023 designed and implemented a low-cost programme called TutorConnect that offered low-cost continuing professional development to tutors. TutorConnect is a Zoom-based monthly training programme that is facilitated by subject matter experts. The programme offered topics spanning effective learning, enhanced instructional design, and improved student engagement in the 14 months of its operation with over 700 tutors from more than 10 states in Nigeria that benefited from it. Utilising WhatsApp for additional support and peer-to-peer learning was crucial to providing more hands-on support, and institution-specific solutions. This low-cost approach to build competencies enabled access to continuing professional development by tutors, limiting effects of location and finances as barriers to continuing professional development. Developing the teaching capacity of tutors is pivotal to enhancing the quality of frontline healthcare worker training.

The Future of Intelligent Healthcare: A Systematic Analysis and Discussion on the Integration and Impact of Robots Using Large Language Models for Healthcare

The potential use of large language models (LLMs) in healthcare robotics can help address the significant demand put on healthcare systems around the world with respect to an aging demographic and a shortage of healthcare professionals. Even though LLMs have already been integrated into medicine to assist both clinicians and patients, the integration of LLMs within healthcare robots has not yet been explored for clinical settings. In this perspective paper, we investigate the groundbreaking developments in robotics and LLMs to uniquely identify the needed system requirements for designing health-specific LLM-based robots in terms of multi-modal communication through human–robot interactions (HRIs), semantic reasoning, and task planning. Furthermore, we discuss the ethical issues, open challenges, and potential future research directions for this emerging innovative field.

The French Telemedicine System: Challenges, Procedures and Difficulties

In France, telemedicine has been developing rapidly for several years, in response to economic, technical and legal challenges. The aim of the article is to present the broad outlines of the system that has been put in place, from a number of angles. The first deals with the problems to which telemedicine is proposed as a response. These problems are essentially what are known as “medical deserts”. Telemedicine is presented as a tool for compensating for the absence or shortage of healthcare professionals in a given area. This system would then promote reliable access to healthcare for the population. While this is a laudable objective, a more detailed analysis casts doubt on whether this result will be achieved. The second angle of this reflection concerns the conditions and procedures for implementing telemedicine. This involves looking at the players involved in order to determine what type of person can be mobilized, in terms of both the type of healthcare professional involved and the type of patient concerned. It is also a question of determining where a telemedicine procedure should be carried out, which shows the diversity of possibilities: where can the booths be set up and, more generally, where should the patient be on this occasion? The third and final angle of this contribution deals with the question of the risks that the practice of telemedicine may generate for patients over and above the benefits that can be imagined.

Health Equity Factors and Healthcare-Associated Infections in Louisiana Facilities, 2022

Background: Health equity is a critical consideration in public health research, emphasizing the importance of fair and just access to healthcare resources. This study explores the impact of health equity factors on the incidence rates of Central Line-Associated Bloodstream Infections (CLABSI) and Methicillin-Resistant Staphylococcus aureus (MRSA) across diverse healthcare facilities in Louisiana. Methods: We conducted a comprehensive analysis utilizing 2022 data from the National Healthcare Safety Network (NHSN). Fourteen healthcare facilities were randomly selected from nine regions in Louisiana, with guidance from the 2022 NHSN external validation toolkit. Key health equity factors from Health Resources and Service Administration (HRSA) were assessed, including urbanicity, MUA/P, and HPSA_Primary Care. Risk ratios were calculated to quantify the association between these health equity factors and the incidence rates of CLABSI and MRSA. Results: The findings reveal intriguing insights into the relationship between health equity factors and infection rates. In urban settings, the risk of CLABSI was lower (Risk Ratio: 0.634, 95% CI: 0.2442–1.646), contrasting with a significantly higher risk of MRSA (Risk Ratio: 1.7, 95% CI: 1.119–2.582). This suggests a complex interplay between urbanicity and the specific infection types. For MUA/P, no significant impact on CLABSI rates was observed (Risk Ratio: 0.963, 95% CI: 0.4225–2.195), but an increased risk of MRSA emerged (Risk Ratio: 1.652, 95% CI: 1.029–2.652). In healthcare professional shortage areas for primary care (HPSA_Primary Care), both CLABSI (Risk Ratio: 1.37, 95% CI: 0.5854–3.204) and MRSA (Risk Ratio: 2.098, 95% CI: 1.305–3.372) exhibited elevated risks, though only MRSA risk was statistically significant. Conclusions: This research underscores the nuanced relationship between health equity factors and infection rates in healthcare facilities. Urban settings may contribute to a lower risk of CLABSI but a higher risk of MRSA, emphasizing the need for tailored preventive strategies. Living in medically underserved areas appears to heighten the risk of MRSA, warranting targeted interventions. Additionally, healthcare professional shortage areas for primary care demonstrate potential associations with increased risks for both CLABSI and MRSA. These findings provide valuable insights for public health practitioners, policymakers, and healthcare administrators aiming to address health disparities and enhance infection control measures in diverse healthcare settings. Further research is encouraged to unravel the multifaceted dynamics influencing infection rates and to inform targeted interventions for improved health outcomes.

Personality portraits, resilience, and professional identity among nursing students: a cross-sectional study

BackgroundThe lack of professional identity can impede the transition from nursing students to qualified nurses and exacerbate the shortage of health care professionals. Personality is important to resilience-building and professional identity development in nursing students. However, the associations among personality, resilience, and professional identity are less explored. The study aims to identify latent subtypes of personality, to evaluate the mediating role of resilience between personality and professional identity in nursing students, and to provide practical guidance for educators’ subsequent interventions with nursing students’ professional identity.Methods1397 nursing students were recruited from Be Resilient to Nursing Career (BRNC) between October 2020 and April 2022 by cluster sampling from 4 universities in China. NEO Five-Factor Inventory, 10-item Connor-Davidson Resilience Scale, and Professional Identity Questionnaire for Undergraduate Students were administered. Analyses of latent profiles and mediations were performed.ResultsThree latent personality types were identified: Over-sensitivity (35.4%), Ordinary (53.8%), and Flexibility (10.8%). Nursing role model was found to be a significant indicator of personality (Ordinary as ref, Over-sensitivity: OR = 0.73, 95% CI: 0.57–0.93, P = 0.010; Flexibility: OR = 1.85, 95% CI: 1.29–2.65, P = 0.001). The association between personality portraits and professional identity were significantly mediated by resilience (P < 0.05).ConclusionsThere exists heterogeneity in nursing students’ personality. Resilience plays a significant role in mediating the relationship between personality and professional identity.

A pilot randomized controlled study to determine the effectiveness of video educational tool in BRCA1/2 pre‐test counseling for Japanese breast cancer patients

AbstractBRCA1/2 genetic testing has become clinically important in breast cancer care, but increasing demand may put a burden on the shortage of healthcare professionals. We performed a single‐center, pilot randomized controlled study to assess the effectiveness of employing a video educational tool that included standard pre‐test genetic counseling elements related to BRCA1/2. Patients with operable breast cancer who met the criteria for genetic testing based on age, sex, subtype, and family history were recruited. Sixty consenting participants were randomized 1:1 and placed in groups that received either traditional face‐to‐face pre‐test counseling or video‐viewing and face‐to‐face decisional support. To assess decisional conflict in the participants, surveys based on the Decisional Conflict Scale (DCS) were administered two times, once immediately after intervention and again 2–4 weeks later. The time taken for counseling and confirmation of whether the participants had undergone testing were also recorded. The difference in the total DCS scores between the two groups was not significantly different for either of the survey periods, and there was no significant difference in the number of participants who underwent testing (23/30 [76.7%] vs. 26/30 [86.7%]; p = 0.51). However, the “effective decision” subscale score was significantly higher in the video group 2–4 weeks after counseling (31.01 ± 16.82 vs. 21.43 ± 16.09; p = 0.04 [mean ± SD]). The time taken for counseling was significantly shorter in the video group (8.00 ± 4.5 vs. 27.00 ± 7.61 min; p &lt; 0.001 [median ± SD]). Our findings indicate the potential benefit of the video educational tool for providing BRCA1/2‐related information. These tools may also enable healthcare professionals to spend more time supporting psychological issues. Notably, after some time, patients may question whether their decision was appropriate. Therefore, it is necessary to identify those in conflict and provide them with proper support.

Non-communicable diseases, digital education and considerations for the Indian context – a scoping review

IntroductionThe increasing ageing of the population with growth in NCD burden in India has put unprecedented pressure on India’s health care systems. Shortage of skilled human resources in health, particularly of specialists equipped to treat NCDs, is one of the major challenges faced in India. Keeping in view the shortage of healthcare professionals and the guidelines in NEP 2020, there is an urgent need for more health professionals who have received training in the diagnosis, prevention, and treatment of NCDs. This paper conducts a scoping review and aims to collate the existing evidence on the use of digital education of health professionals within NCD topics.MethodsWe searched four databases (Web of Science, PubMed, EBSCO Education Research Complete, and PsycINFO) using a three-element search string with terms related to digital education, health professions, and terms related to NCD. The inclusion criteria covered the studies to be empirical and NCD-related with the target population as health professionals rather than patients. Data was extracted from 28 included studies that reported on empirical research into digital education related to non-communicable diseases in health professionals in India. Data were analysed thematically.ResultsThe target groups were mostly in-service health professionals, but a considerable number of studies also included pre-service students of medicine (n = 6) and nursing (n = 6). The majority of the studies included imparted online learning as self-study, while some imparted blended learning and online learning with the instructor. While a majority of the studies included were experimental or observational, randomized control trials and evaluations were also part of our study.DiscussionDigital HPE related to NCDs has proven to be beneficial for learners, and simultaneously, offers an effective way to bypass geographical barriers. Despite these positive attributes, digital HPE faces many challenges for its successful implementation in the Indian context. Owing to the multi-lingual and diverse health professional ecosystem in India, there is a need for strong evidence and guidelines based on prior research in the Indian context.

Are Polish doctors ready to start working right after graduation? The 2023 modification to physicians’ postgraduate internship and possible paths forward

The Polish healthcare system faces many problems, among which the shortage of healthcare professionals is one of the most urgent. In less than ten years, more than twenty Higher Education Institutions (HEIs) have been allowed to add medical programmes to their offer, aiming to increase the number of doctors in Poland. Recently, the healthcare system was faced with a proposal to abolish the mandatory postgraduate internship which has been a mandatory component of medical training for years.Two main reforms were considered. The first one focused on the programme of the internship and aimed to update it. The second one recommended an abolition of the internship. The authors of this article analysed the opinions and positions of key players within the system regarding the postgraduate internship.Opinions in this regard are diverse, leading to the conclusion that additional actions would be required prior to the internship abolition. Undergraduate training has changed and currently students are taught in modern facilities, using new teaching methods. On the other hand, internship allows trainees to improve or even acquire skills they may not have obtained during their studies. The postgraduate internship is an essential part of doctors’ training. However, in Poland, there is still a lack of a well-thought, long-term policy or strategy for physicians' workforce development. Our study presents a Polish perspective on common challenges in medical training and workforce policy, highlighting the clash over the growing demand for physicians and the limitations of the existing system.

An investigation into the present status and influencing factors of nurse retention in grade-a tertiary general hospitals in Shanxi Province within the framework of the magnet hospital concept.

The attrition of nursing staff significantly contributes to the shortage of healthcare professionals. This study entailed an examination of the propensity of nurses to sustain employment within Grade-A tertiary general hospitals and the various influencing factors. A total of 2,457 nurses from three grade-A tertiary general hospitals were surveyed. The survey instruments included a general information questionnaire, a scale measuring their willingness to continue working, and a Chinese version of the Magnet Hospital Factor scale. The scores of the willingness to continue working scale and the Magnet Hospital Factor scale were 21.53 ± 4.52 and 145.46 ± 25.82, respectively. There were statistically significant differences in the scores of willingness of nurses to continue working across various factors, including the department, age, marital status, family location, length of service as nurses, professional title, position, and employment type, upon comparison (P < 0.001). The correlation analysis showed that there was a positive correlation between the willingness of nurses to continue working and the magnet hospital factors, with a correlation coefficient of 0.523 (P < 0.01). Regression analysis showed that department, length of service as nurses, professional title, position, average monthly income, number of night shifts, medical care relationship, educational support, and nursing manager support among the magnet hospital factors were important predictors of willingness to continue working (P < 0.001). The willingness of nurses to continue working in grade-A tertiary general hospitals in Shanxi Province was determined to be at an upper-middle level. The magnet status of grade-A tertiary general hospitals needs to be improved, and there are many factors that influenced willingness of nurses to continue working. To cultivate a more favorable environment and bolster nurse recruitment and retention, all healthcare institutions should strive to establish a magnet nursing environment, thereby fostering the robust development of the nursing team.

Replace government healthcare with patient-controlled health care

The purpose of the article is to analyse the shortcomings of the state-run healthcare systems and to substantiate the need for and feasibility of transition to a patient-controlled model. It is shown that patient-controlled health care, free from centralised domination, can provide timely, high-quality, compassionate medical care at an affordable price for both individuals and the nation. It significantly expands the patient’s rights and opportunities to choose a doctor according to their own preferences and financial capabilities. The patient pays for the medical service provided directly to the doctor, who no longer has restrictions on choice of treatment protocols or prescription of medicines. The analysis in the article is based mainly on the example of the United States, where federal control for residents is both direct (194 million Americans are covered by Medicaid, Medicare, Tricare or EMTALA) and indirect (138 Americans have private insurance). In addition, aspects of the article analysis also apply to single-payer countries (Canada, the United Kingdom, France and Spain). The article examines the shortcomings of the current US model of its healthcare system in terms of its compliance with the Constitution. It is noted that, according to the Tenth Amendment to the US Constitution, healthcare powers are not among the 18 powers delegated to the federal government. Also, non-compliance with the law is also observed: government control or administration of state Medicaid programmes is contrary to US law; medical autonomy as the patient’s ability to make personal medical decisions without undue influence from the state. Another disadvantage of state-run healthcare system is that state-controlled healthcare payment structure violates the fiduciary relationship between doctor and patient, as doctors’ authority to make medical decisions is limited. It also calls into question the observance in the United States of the citizen’s “right” to receive medical care in its interpretation as a personal service of a professional caregiver when a patient can demand the desired care and the service provider cannot refuse. The article emphasises that state-run healthcare systems create a conflict between efficient use of financial resources and effective provision of medical care. This issue is considered through the prism of the interests of the main stakeholders: shareholders of companies operating in this area, politicians, patients, healthcare providers and administrators. As evidence of the inefficiency of the existing US healthcare system in comparison with other countries, comparative data for different countries on life expectancy and incidence rates of a number of diseases are provided. The author also discusses the problem of limiting access to medical care (rationing) for patients with public health insurance due to a shortage of healthcare professionals accepting new Medicaid patients. This is caused by low reimbursement rates, overly bureaucratic verification procedures for obtaining payment, overregulation of requirements for doctor-patient relations and procedures for reviewing medical errors, the need to comply with population-based clinical algorithms, etc. It leads to a decrease in the quality of medical care, an increase in patient deaths while waiting for medical care, the risk of disease complications due to delays in diagnosis and timely treatment, ignoring the needs of unique, individual patients, and an increase in the likelihood of medical errors. All of the above disadvantages of state-run healthcare are obviated when the patient is in charge, patient-controlled health care.