Shortage Of Primary Care Physicians Research Articles

Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

BackgroundSymptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral.This review sought to summarise findings from observational studies conducted in high income countries on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care.MethodA rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009–2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation.ResultsFrom 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis.ConclusionThis review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.

Optimizing Dementia Care for Mexicans and for Mexican-Origin U.S. Residents.

In this article, we report on the recommendations of a binational conference that examined the institutional capacities and future ability of Mexico and the United States to address the need for affordable and sustainable dementia care that results from growing older adult populations. These recommendations reflect the large difference in resources between the two nations and each country's political and institutional capacity. Progress in both countries will require an expansion of programs or the generation of new ones, to meet the needs of older adults, including improving access to services and actively managing the dementia care burden. A comprehensive federal health care safety net will be required in both nations, but economic realities will constrain its implementation. Both nations suffer from a persistent shortage of geriatric primary care physicians and geriatricians, especially in rural areas. Advances in diagnosis, treatment, and care management require additional knowledge and skills of general and specialized staff in the health care workforce to deliver evidence-based, culturally and linguistically appropriate long-term care, and human rights-oriented services. We conclude with a discussion of recommendations for binational dementia care policy and practice.

Early generalist placements are associated with family medicine career choice: A systematic review and meta-analysis.

Many developed countries have reported shortages of Primary Care (PC) physicians. The lack of a regular primary physician is associated with inferior health outcomes. One strategy to address this shortage is to increase the proportion of medical students selecting a Family Medicine (FM) or PC career. The purpose of this systematic review is to identify whether pre-clerkship general practice placements increase students' interest in, and selection of FM or PC residencies. Three databases (PubMed, Embase, Web of Science) searched for interventional studies of pre-clerkship generalist placements in medical school. Pooled statistical analysis and meta-analysis were performed, along with narrative summaries when possible. Intervention participants (IP) were compared to controls matched (MC) for baseline interest in FM and an unmatched sample (UC) of contemporary students. A 11 studies were identified including a total of 5430 students (2428 intervention participants and 3002 controls). IPs were more likely to match to FM than both MC (Risk Ratio: 1.62 [95% CI: 1.03-2.55]) and UC (RR: 2.04 [1.46-2.86]). Participation in long interventions (4-11weeks) matched to FM at higher rates than short (25-40hours) interventions (RR: 3.15 [2.28-4.35]). The percentage of students with FM/PC as their top specialty of interest increased after the placements (mean difference: +12.8%, n=586). Medical students who participated in pre-clerkship general practice placements were more likely to match to a FM residency. Longer pre-clerkship placements had a stronger association with FM specialty choice. The implementation of longitudinal block generalist placements in the pre-clerkship years is one strategy for increasing interest in generalist careers. IV, systematic review of level III and IV studies.

Determinanten der Teilnahme an Seminartagen eines Weiterbildungsprogramms: eine qualitative Studie mit Ärztinnen/Ärzten in Weiterbildung Allgemeinmedizin

BackgroundGermany is facing a shortage of primary care physicians (general practitioners, GPs). To improve post-graduate training in general practice, competency centres were established across Germany. The core of their work is a seminar programme. It was observed that some GP trainees constantly participate, while others are seldomly seen. The aim of this study was to explore what helps and what hinders constant participation. MethodsGP trainees of the Verbundweiterbildungplus Baden-Württemberg (2008 – 2017), predecessor of the KWBW Verbundweiterbildungplus© program (2017 – present), were included in the study. First, participation in the years 2014 and 2015 was analysed. We recruited the very active as well as the no-show participants for semi-structured telephone interviews. Content analysis was performed by three independent scientists. ResultsParticipation of n=353 trainees was analysed. N=30 trainees participated in the study (including n=13 no show). The average interview length was 25minutes (13–36minutes). Trainees felt motivated by practice-oriented, varying and learner-oriented subjects. They highlighted the professional and personal interaction and its networking effects. Participants favoured lecturing during working days, topics structuring daily training and supporting every day practice. The seminar moderators’ treasure trove of experience and their teaching competencies were regarded as essential. The fact that employers do not regularly grant time away from work to attend the training programme was cited as a major inhibiting factor. Other reasons given for non-attendance included long travel distances, repeat topics or an imbalance between gain of knowledge and social interactions, and finally, a high individual level of work strain, given the dual burden on those trying to combine work and family life and taking on the main responsibility for children. ConclusionsThe main enablers (motivators) of participation were practice- and learner-oriented topics and beneficial social interactions. During the seminars, participants experience group membership and the enthusiastic (learning) atmosphere boosts trainees to proceed with their training and follow their career paths in general practice. Continuous participation requires protected time. Competence centres for postgraduate medical education should take these findings into consideration for quality management and programme planning, and, if possible, should initiate and evaluate appropriate countermeasures.

Examination of resident characteristics associated with interest in primary care and identification of barriers to cross-cultural care

BackgroundThere is an increasing shortage of primary care physicians in the U.S. The difficult task of addressing patients’ sociocultural needs is one reason residents do not pursue primary care. However, associations between residents’ perceived barriers to cross-cultural care provision and career interest in primary care have not been investigated.ObjectiveWe examined residents’ career interest in primary care and associations with resident characteristics and their perceived barriers in providing cross-cultural care.MethodsWe conducted a cross-sectional analysis of a resident survey from the 2018–2019 academic year. We first described residents’ sociodemographic characteristics based on their career interest in primary care (Chi-square test). Our primary outcome was high career interest in primary care. We further examined associations between residents’ characteristics and perceived barriers to cross-cultural care.ResultsThe study included 155 family medicine, pediatrics, and internal medicine residents (response rate 68.2%), with 17 expressing high career interest in primary care. There were significant differences in high career interest by race/ethnicity, as Non-White race was associated with high career interest in primary care (p < 0.01). Resident characteristics associated with identifying multiple barriers to cross-cultural care included disadvantaged background, multilingualism, and foreign-born parents (all p-values< 0.05). There were no significant associations between high career interest in primary care and barriers to cross-cultural care.ConclusionResidents from diverse racial/ethnic and socioeconomic backgrounds demonstrated higher career interest in primary care and perceived more barriers to cross-cultural care, underscoring the importance of increasing physician workforce diversity to address the primary care shortage and to improve cross-cultural care.

Certified Nurse-Midwives in Rural Kansas Hospitals: A Survey of Senior HospitalAdministrators.

Little is known about the nurse-midwifery workforce in rural Kansas hospitals, despite Kansas facing a shortage of primary care physicians providing maternity care rurally. This study investigated the current number of hospitals with certified nurse-midwives (CNMs) with privileges to attend births in Kansas hospitals located in frontier, rural, and densely settled rural counties and anticipated trends in the size of the CNM workforce at hospitals over the next 5 years. Electronic surveys were distributed to senior hospital administrators at 94 hospitals in rural Kansas from June to July 2019. The survey included both open and closed-ended questions related to scope of CNM privileges, collaborative agreements, and forecasted trends in the CNM workforce in rural Kansas. Fifty-six hospitals completed the survey. Only one hospital reported having CNM-attended births. Twenty-eight of 37 hospital administrators agreed CNMs should have collaborative agreements with physicians. Most respondents did not anticipate the number of CNMs with privileges to increase at their hospitals over the next 5 years. Future research should focus on understanding the factors limiting CNM expansion in rural Kansas, because CNMs represent an untapped, additional maternity care workforce for rural Kansas.

Factors Associated with a Career in Primary Care Medicine: Continuity Clinic Experience Matters.

Due to concerns of inadequate primary care access, national agencies like the Health Resources and Services Administration (HRSA) support primary care (PC) residencies. Recent research demonstrates that up to 35% of PC alumni lost interest in PC during residency. These alumni who lost interest noted that their continuity clinic experience influenced their career choice. The purpose of this study was to identify the specific aspects of PC residency experience that influenced career choice. We conducted a cross-sectional electronic survey of a PC internal medicine alumni cohort (2000-2015) from a large, academic residency. Our primary predictor was PC career and our primary outcome was influential factors on career choice. We performed chi-squared or Fisher's exact tests for categorical variables and t tests for continuous variables. Of the 317 PC alumni in the last 15 years, 305 were contacted. One hundred seventy-two (56%) responded with 94 (55%) reporting current careers in PC and 78 (45%) in non-PC fields. Ninety-four percent of respondents expressed interest prior to residency, while only 68% remained interested at the conclusion of residency. Sixty-one percent of PC alumni rated the overall clinic experience as the most influential factor towards their ultimate career choice. The patient-physician relationship was the most frequently endorsed positively influential factor in career choice in both groups (95% of PC alumni, 76% non-PC). There was no difference among all alumni in common frustrations of clinic including clerical duties, encounter documentation, or visit length. Similarly, resident debt did not differ between groups. Strong interpersonal relationships with patients and clinic mentors were associated with a PC career. These factors may compensate for the reported frustrations of clinic. Enhancing patient and mentor relationships may increase the retention of PC residents in ambulatory careers and may help address the current and projected shortage of primary care physicians.

A model for implementing diagnostic instruction within Doctor of Pharmacy degree programs

AbstractIntroductionHealth care needs in the United States (US) are expanding along with projected primary care physician shortages by the year 2030. Pharmacists' training and broad accessibility make them well positioned to provide primary care for basic medical conditions. As the profession advocates for greater patient care roles, a critical consideration in pharmacist training is a broader introduction to diagnosis; thus, instructional models will need to be developed for US pharmacy curricula.ObjectiveDescribe logistics and evaluation of one model for teaching differential diagnosis in a Pharm.D. curriculum.MethodsA retrospective pre‐post survey measured students' opinions regarding the utility of diagnostic‐related instruction and perceptions regarding its impact on their practice‐based skills and abilities. Objective course performance was also evaluated to determine if students' perceptions reflected their actual abilities. Wilcoxon signed‐rank was used for quantitative data to compare overall total scores and individual survey items pre‐post. Qualitative data were analyzed by exploratory thematic analysis using constant comparative analysis and grounded theory methodology. Descriptive statistics were used to describe objective student performance.ResultsThe survey response rate was 63% (n = 172). On all survey items, students reported improvements in their perceived abilities related to differential diagnosis after completing the course (P &lt; .05). Student performance data indicated successful achievement of differential diagnosis knowledge, skills, and abilities for the vast majority of the class, which is congruent with their perceptions. Three themes were identified from qualitative data in terms of the applicability of diagnostic training for (a) patient assessment, (b) interprofessional communication, and (c) clinical decision‐making.ConclusionDiagnostic instruction should be considered in terms of advancing the profession. Considering benefits related to patient assessment and critical thinking skills, diagnostic instruction enables the use of a common language, fostering interprofessional communication, and understanding of scopes of practice and patient care contributions among pharmacists and diagnosticians.

Assessing factors for choosing a primary care specialty in medical students; A longitudinal study

ABSTRACT A shortage of primary care physicians exists in the US, and medical schools are investigating factors that influence specialty choice. To better understand the factors associated with medical students choosing primary care specialties, a longitudinal annual survey from 2013 to 2019 was administered to students at the University of Iowa Carver College of Medicine, starting pre-matriculation. A logistic regression model examined factors of interest. Matching into a primary care specialty (family medicine, internal medicine, pediatrics) for residency was the primary outcome. Our study compared factors students reported in annual surveys: demographics, mentorship, debt, and lifestyle. Factors significantly associated with primary care specialty included pre-medical and medical school research, a family member in primary care, student age and gender. 28% of men chose primary care, and 47% of women. Although there was no gender difference in rates of medical education debt (N = 286,χ2(1) = 0.28, p = 0.60), men were more likely to report being influenced by debt (N = 278, χ2(1) = 10.88, p = 0.001), and students who reported debt-influenced specialty choice were one-third as likely to enter primary care (N = 189, 95% CI [0.11–1.06], p = 0.06). For men, potential salary was negatively associated with entering primary care (p = 0.03). Women were more likely to have a mentor in primary care (N = 374, χ2(1) = 13.87, p < 0.001), but this was not associated with an increased likelihood of entering primary care for men or women. Having a family member who practices primary care was associated with a 2.87 times likelihood of entering primary care (N = 303, 95% CI [1.14–7.19], p = 0.03). The decision to enter primary care is influenced by many factors; a key gender differentiator is that men’s specialty choice is more negatively influenced by financial concerns.

Gastrointestinal Disease-Specific Survivorship Care: A New Personalized Model Integrating Onco-Wellness.

Although the number of gastrointestinal (GI) cancer survivors is projected to increase in the coming years, there are currently no survivorship care models that address the specific and growing needs of this population. Current survivorship care models were evaluated to assess their suitability for GI cancer survivors. A survivorship care model based on foundational wellness principles is under development to address the specific needs of GI cancer survivors. This model delivers a cohesive and collaborative care continuum for survivors of different GI malignancies. Oncology providers in GI departments and internal medicine providers in survivorship programs are positioned to provide a comprehensive approach for the care of patients treated with curative intent. Survivorship care is introduced at the conclusion of active treatment in the form of an Onco-wellness consultation, an in-person or telemedicine comprehensive care plan creation and review by our Survivorship Program. Personalized care plan including long term and late effects of treatment, nutrition, physical activity and rehabilitation recommendations, prevention of secondary malignancies and psychosocial needs are reviewed. As patients transition from active treatment to survivorship within the GI Program, the GI Advance Practice Professionals (APPs) are well-positioned to deliver comprehensive survivorship care specific to the GI patient’s needs while integrating recommendations and principles from the Onco-wellness consultation. With projected shortages of both oncology and primary care physicians, such an APP-based model has the potential to bridge gaps in the survivorship care continuum and mutually benefit patients and physicians.

Perceptions of the Osteopathic Profession in New York City's Korean Communities

Objective: The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Korean communities in New York City.&#x0D; Design: A cross-sectional study was designed in which a culturally appropriate survey in Korean and English versions was administered anonymously to measure community perceptions and knowledge of osteopathic medicine.&#x0D; Setting: Data collection occurred in the municipal delineations for the Bayside neighborhood within the New York, New York borough of Queens.&#x0D; Participants: Community members were selected using convenience sampling from high-density areas to participate. The survey included demographics, education level, health care habits and knowledge of the osteopathic profession.&#x0D; Results: 105 surveys were conducted with 47 males and 58 females, with an average age = 66. Only 14% (n=15) indicated knowledge about osteopathic manipulative medicine (OMM) and 9% (n=9) indicated knowledge of osteopathic physicians (DOs), with the primary language spoken at home (Korean) as the sole statistically significant factor in recognition of OMM and DOs among the study variables.&#x0D; Conclusion: Compared to research on the general U.S. population, a general lack of knowledge of osteopathic medicine exists within New York City's Korean community. Although this difference may be ascribed to linguistics and ethnosociological factors, greater outreach and education is needed in urban minority communities to make immigrants aware of all health care resources available during the current shortage of primary care physicians in the U.S.

System dynamics modeling for general practitioner workforce forecasting in Kazakhstan.

Primary health care has been proven to be a highly effective and efficient way to address the main causes and risks of poor health and well-being today, as well as handling the emerging challenges that will threaten health and well-being tomorrow. In our study we used the System Dynamics approach to develop a model for the population and General Practitioner workforce to include multiple inputs and their relationships in the equations for each stock and flow. We built the model in the Any Logic software to cover the flow of medical workers, demographic data of the population and the prevalence of the disease over time. Three scenarios were examined for forecasting primary health care personnel resources. The base year for forecasting was 2018, and the modeling was carried out until 2030. All of three scenarios indicate that with the current number of graduated General Practitioners, the shortage of primary care physicians will be exacerbated. In general, the shortage can reach more than 2,000 on a population of 18.3 million (2018). The projected shortage of doctors in the primary health care system requires special attention to human resource planning. Only one third of medical graduates in Kazakhstan go to work in the primary health care system. The government needs to develop measures to stimulate and support young medical doctors to become general practitioners.

Job satisfaction among primary care physicians in western China

BackgroundThere has been great shortage of primary care physicians (PCPs) in China, especially in western areas. Job satisfaction plays a great role in retaining people. The aim of this study is to investigate the job satisfaction of PCPs and associated factors in 11 provinces of western China, thus providing necessary reference values for stabilizing the primary care workforce and improving the quality of primary care services.MethodA sample of 2103 PCPs working in western China were surveyed using a stratified, multistage and random sampling method in 2011. The characteristics of participants were recorded by a structured questionnaire. A multilevel model (MLM) and quantile regression (QR) were applied to assess the association between job satisfaction and possible risk factors.ResultsOf the 2103 doctors surveyed, the overall satisfaction score was 3.26 ± 0.68 (from 1 to 5). MLM indicated that age group, income satisfaction, unit policy approval, personal planning, career attitude, work value and patient recognition were positively correlated with job satisfaction, while turnover intention was negatively correlated with job satisfaction. QR were not completely consistent with MLM and further explored the differences in different job satisfaction score percentiles on each domains.ConclusionThis study showed that the job satisfaction of PCPs in western China was not high. The MLM and QR discussed were not entirely consistent, the latter one provided more information and robust results. Measures should be taken in streamlining administration and institute decentralization, creating more opportunities for additional training, raising PCPs’ income, improving the social status of doctors and improving the relationship between doctors and patients.

STFM LAUNCHES INITIATIVE TO POSITION ACADEMIC FAMILY MEDICINE IN HEALTH SYSTEMS

Family physicians have been at the center of the response to COVID-19,[1][1]–[2][2] and the pandemic has underscored what was already an urgent need for more family physicians. The Association of American Medical Colleges estimates a primary care physician shortage of up to 55,200 by 2033.[3][3]

Post-ACA Trends in the US Primary Care Physician Shortage with Index of Relative Rurality.

Index of Relative Rurality (IRR) captures multiple indicators of health care access but is underrepresented in the primary care literature. This research investigates trends in primary care physician supply in US counties with respect to IRR and time since the Affordable Care Act (ACA) was passed. In this ecologic study, annual ratio of primary care physicians per 100,000 population in US counties was computed for 2010-2017 (3,138 counties over 8 years, N = 25,104). IRR assigned in 2010 placed counties on a rural-urban continuum without the use of a threshold. Primary outcomes were associations of IRR and year with physician ratio and annual change in physician ratio. Multivariable regression models were used to detect associations. The a priori hypothesis was that neither rurality nor year was associated with physician ratio or annual growth. IRR and year were independently inversely associated with the ratio of primary care physicians per 100,000 and annual growth in physician ratio. A post-hoc analysis of highly rural US states revealed positive median growth rates in some areas. Despite significant policies in the ACA designed to address the maldistribution of the US primary care physician workforce, more funding and further innovative reforms are urgently necessary to avert a rural workforce crisis in the coming decades. IRR may be a useful continuous, threshold-free metric of rurality in future health services research.

Primary Care Physician Supply, Access to Care, and Market Adjustments to Physician Shortages

Research ObjectiveTo alleviate the problem of primary care physician (PCP) shortage, policy makers have established new medical schools and expanded medical school class sizes over the last 15 years. However, few studies have examined whether the increased PCP supply improves access to care. We aimed to fill the gap by examining the effect of PCP supply on adults’ access to care and assessing the extent to which market adjustments mitigate PCP shortages.Study DesignWe used primary care service areas (PCSAs) as market areas and merged PCSA‐level PCP supply (PCPs per 1000 population) with individual‐level data from the 2004‐2013 Medical Expenditures Panel Survey (MEPS). The data on physician supply and number of patients that PCPs saw per day came from SK&amp;A while all other measures were from the MEPS.We modeled the probability that adults had a nonemergency room usual source of care (USC) as a function of PCP supply and individual sociodemographic characteristics, health status, and beliefs and attitudes regarding health and health care. We estimated analogous models to examine how PCP supply affects travel time to the USC and the ability to get needed care right away and make appointments as soon as needed. To examine market adjustments, we assessed the relationship between PCP supply and whether PCPs offered night and weekend hours, how many patients PCPs saw per day, and how frequently individual adults had office visits. As sensitivity analyses, we tested alternative PCP definitions (eg, including vs. excluding obstetricians/gynecologists) and estimated the models separately for adults with and without health insurance. All the models controlled for nurse practitioners and physician assistants.Population Studied378 400 adults included in the 2004‐2013 MEPS.Principal FindingsPCP supply had no effect on the probability of having a USC or the ability to get needed care right away or make timely appointments by adults. By contrast, higher PCP supply reduced adults’ travel time to the USC. We also found evidence of market adjustments that enhanced the physicians’ capacity to see different patients in areas with low PCP supply. Specifically, PCPs in these areas were more likely to offer night and weekend hours and saw more patients per day (elasticity at mean = −0.19), while adults in these areas had fewer office visits (elasticity at mean = 0.07). Taken together, the latter two adjustments compensate for more than one‐fourth of the lost capacity to see different patients where there are fewer PCPs. The sensitivity analyses confirmed robustness of the results.ConclusionsSince both having a USC and the ability to get timely care when needed and make timely appointments are likely to be more important indicators of access than travel time to the USC, our findings suggest that more PCPs do not improve the most important access indicators for most U.S. adults. Market adjustments in areas with fewer PCPs are at least partly responsible for the lack of effects of PCP supply on having a USC.Implications for Policy or PracticeProducing more physicians may be a blunt instrument for improving access to care. Targeted policies are likely to be more efficient in improving access for adults who currently lack it.Primary Funding SourceAgency for Healthcare Research and Quality.

Choosing Primary Care: Factors Influencing Graduating Osteopathic Medical Students.

Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are making strides to fill this void. Considering the critical need for PC physicians in the United States, this study aims to identify factors related to choosing a PC specialty. To understand possible motivations of osteopathic medical students pursuing a career in PC specialties by examining the role of sex and the influence of 5 key factors in this decision. Responses from the annual American Association of Colleges of Osteopathic Medicine graduate survey (2007-2016) were analyzed. Self-reported practice decision considerations of 5 key factors, including (1) intellectual and technical content, (2) debt level, (3) lifestyle, (4) prestige/income level, and (5) personal experience and abilities were summarized, and their subjective value was contrasted between osteopathic medicine graduates pursuing PC specialties vs those pursuing non-PC specialties. The mean percentage of graduates pursuing PC and non-PC specialties from 2007 to 2016 was 31.3% and 68.7%, respectively. Women were 1.75 times more likely to choose PC than men (95% CI, 1.62-1.89). Regardless of specialty choice, lifestyle was the most important factor each year (1027 for PC [75.3%] vs 320 for non-PC [63.3%] in 2016; P<.0001). Students entering PC were more likely to report prestige and income level to be "no or minor influence" compared with students entering non-PC specialties (P<.0001). Debt level was more likely to be a "major influence" to students choosing to enter non-PC specialties than to those entering PC (P<.0001), and the percentage of non-PC students has grown from 383 in 2007 (22.9%) to 833 in 2016 (30.6%). Sex was found to significantly influence a graduate's choice of specialty, and female graduates were more likely to enter practice in PC. Each of the 5 survey factors analyzed was significantly different between students entering PC and students entering non-PC specialties. Lifestyle was deemed a major influencing factor, and responses suggested that debt level is a strong influencing factor among students pursuing non-PC specialties.

Medical Student Debt Reform: a Proposed Value-Based Loan Repayment Policy.

The call for value-based medicine has augmented the role of primary care physicians, potentially exacerbating the already-acknowledged shortage of primary care physicians in the current delivery landscape. Lifetime earnings for primary care physicians are millions lower than those for other specialties, and the burden of medical school debt is increasing at a rate that outpaces inflation. Given the societal value of primary care entry for newly minted physicians, one option is a loan repayment program that shares some of that societal value with the physicians themselves, essentially a subsidy that is continuous and tied to present-day specialty choice. While income-based options exist currently, these are merely a proxy for specialty, and other service-driven options are finite and may impose undue burden on physicians at an early and pressure-laden time in their careers. Value-based repayment reflects the graduate's benefit from physician training while also rewarding the real-time societal value of specialties such as primary care, allowing doctors to put their talents to their best uses while advancing the transformation of the physician workforce necessary to realize value-based, patient-centered, population-oriented care.

Diabetes Technologies: We Are All in This Together.

The United States faces a shortage of both primary care physicians (PCPs) and endocrinologists—the two groups of clinicians who provide the majority of care to people with diabetes (1–3). Patients treated with intensive insulin therapy, including all of those with type 1 diabetes and many with type 2 diabetes, face numerous daily self-management decisions. These decisions include factoring insulin dosing, glucose management, diet, activity, and other behavioral factors into their decision-making. These patients stand to gain from using the treatment and monitoring technologies that are rapidly advancing and accumulating evidence in support of their benefits. Despite this situation, the actual use of such technologies, including continuous glucose monitoring (CGM) and closed-loop artificial pancreas systems, remains relatively low (4,5). One potential barrier to uptake of such advanced diabetes technologies is a hypothesized mismatch between geographical location of people with diabetes and available clinicians. Employing datasets from the U.S. Census Bureau (6) and the American Medical Association Health Workforce Mapper (7), as well as prevalence estimates from the American Diabetes Association and JDRF, we sought to compare the distribution of PCPs and endocrinologists across the United States to the distribution of people with diabetes. This endeavor was undertaken as a step toward understanding whether encouraging PCP …

Прогнозирование трудовых ресурсов в системе первичной медико-санитарной помощи Казахстана

Primary health care is a highly effective and efficient way to tackle the root causes and risks of poor health status, and to address emerging problems that threaten future health and well-being. Goal: Develop a model for predicting the need for general practitioners (GPs) until 2030, taking into account various input data in the equations describing the movement of labor resources in the form of “flows” and “ stocks “ using the method of system dynamics. Methods: The model was built using the Any Logic program, based on information about the availability of primary health care doctors, demographic data and the general prevalence of diseases in the population. Three scenarios were considered to predict the need for general practitioners. The base year was 2018, the forecast was carried out until 2030. Results: All of three scenarios indicate that with the current number of graduated GPs, the shortage of primary care physicians will be exacerbated. In general, the shortage can reach more than two thousand. Conclusion: Government and medical universities need to take measures to correct the number of students in the specialty of “General Practitioner” in order to avoid a growing shortage of primary care physicians in the future until 2030.