Shortage Of Physicians Research Articles

Stroke awareness among community health workers from rural health blocks of Thiruvananthapuram, India.

Secondary prevention of stroke largely depends on risk factor control and lifestyle modification. Optimal secondary prevention strategies are limited in rural settings due to the shortage of primary care physicians and neurologists. Awareness of community health workers (CHWs) regarding stroke and its management remains largely unexplored. The current cross-sectional study aimed at assessing the knowledge, attitude, and practice (KAP) of CHWs regarding stroke care. A structured KAP questionnaire was administered among 510 CHWs from randomly selected rural health blocks of Thiruvananthapuram, Kerala, India. Knowledge assessment showed that the CHWs possessed an average knowledge of stroke care. The mean attitude and practice scores were higher, indicating a favorable attitude and good practice. The overall mean (standard deviation) KAP scores of CHWs were 13.54 (4.43) against a total score of 23. The KAP scores were highest among palliative care nurses. The stroke awareness of the accredited social health activists was comparatively lower than other CHWs. Factors such as age and years of work experience were not correlated to the KAP scores. Recurrent strokes remain a major challenge in primary care. Overall, the health workers demonstrated average knowledge, favorable attitudes, and positive practices. The study highlights the importance of training accredited social health activists (ASHAs) and other CHWs in stroke to improve secondary prevention strategies.

The role of different educational programs in specialty preference among Chinese medical students: a cross-sectional study

BackgroundThe imbalanced supply of physicians in different specialties and the decreasing number of young doctors in China have made it important to understand specialty preference and influencing factors and to evaluate the role of different programs in specialty choice and career planning among Chinese medical students to help shape the social healthcare system and ensure adequate medical practitioners in each specialty.MethodA cross-sectional study comprising medical students from 5-year and 8-year program was conducted online. Demographics, specialty preferences and influencing factors, and career planning situations were collected and analysed by the chi-square test. Binary logistic regression analysis was performed in each program to identify the association between influencing factors and each specialty.ResultsA total of 128 students (57.03% 5-year, 42.97% 8-year) responded to our survey. More 8-year students had a doctor in their household than 5-year students (25.45% vs. 10.96%, p < 0.05). The most preferred specialty among 5-year students was surgery, followed by others and internal medicine, while that most preferred by 8-year students was surgery, followed by internal medicine, obstetrics/gynecology and anesthesiology. Compared with 5-year students, more 8-year students considered ‘personal competencies’ (66.67% vs. 40.85%, p < 0.05), ‘the reputation of the specialty’ (18.52% vs. 7.04%, p ≤ 0.05), ‘fewer doctor‒patient disputes’ (27.78% vs. 11.27%, p < 0.05) and ‘advice from family members’ (24.07% vs. 7.04%, p < 0.05) influential. Among 5-year students, ‘personal competencies’ was positively associated with preference for surgery and ‘work-life balance’ was negatively associated. Among 8-year students, ‘personal competencies’ and ‘work-life balance’ were positively associated with internal medicine, while ‘interests in the specialty’ and ‘broad career prospects’ were negatively related. Many students need further career guidance, and personalized tutoring was the most wanted method.ConclusionsThere was no difference between 5-year and 8-year students regarding specialty preference, but bias existed, possibly due to the influence of the real-world situation. Improving the working environment and welfare might be beneficial for developing a balanced distribution of the workforce among different medical departments. It is necessary for medical schools to develop programs accordingly to help them better plan their future careers.

Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study.

Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS. A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria. This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

Physician Assistants als Zukunftsmodell in der hausärztlichen Versorgung – Erfahrungen, Bedarfe, Potenziale und Hürden

IntroductionIn the coming decades, demographic change will dramatically increase health care needs, especially for general practitioners (GPs). However, there is a shortage of young primary care physicians, with signs of (impending) underuse already becoming apparent in rural and structurally weak areas. Innovative care concepts are needed to counteract this development and ensure the future of primary care. In addition to medical assistants (MFA), academically trained physician assistants (PAs) could be considered for more demanding delegation tasks and be involved in direct patient care under the responsibility of a physician in the practice team. In England, the Netherlands and the USA, PAs have been a part of the health care systems for many years. Research questions1) What are the potentials for delegation/possibilities for PAs working in primary care practices in contrast to medical assistants? 2) What structural requirements are necessary to regularly integrate PAs in primary care practices? MethodsAfter preliminary interviews with PA experts and primary care researchers and practitioners (n=29), four expert interviews (n=4) with GPs and PAs were performed in a case analysis in order to elicit experiences with PAs in family practice. Based on this, three focus groups were conducted with GPs and practice staff (n=15) to discuss the extent, the need and the willingness to delegate physician services to PAs, as well as existing barriers. After transcription, analyses were performed using qualitative content analysis according to Mayring. ResultsThe participants acknowledged the potential to reduce physician workloads and showed a high willingness to delegate tasks. Practical examples suggest that a clearly defined delegation of medical tasks to PAs, e.g. participation in infection consultations, is possible after only a few weeks working in family practices. Thus, the cooperation between GPs, PAs and medical assistants can be successful. Uncertainties exist regarding the legal possibilities and limits of delegation as well as the current and future financial reimbursement of PAs. DiscussionThe legal and financial framework for the utilization of PAs in ambulatory care should be reliably clarified as well as transparently communicated so that the considerable potentials of delegating tasks to academically trained staff, e.g. PAs, especially in the GP sector, can be exploited in the future. ConclusionParticipation of PAs in the GP team could be key to overcoming the often threatening or already existing under-provision of medical care in structurally weak regions.

232 A scoping review of Interprofessional collaboration for people over 65 with dementia living in the community

Abstract Background Inter-Professional Collaboration (IPC) has gained prominence for current and future community-based dementia services, as they transition to integrated care. IPC aims to improve patient outcomes by coordinating care across multiple Healthcare Professionals (HCPs) and facilitating informed decision-making. This scoping review examined the nature and extent of evidence on IPC for People with Dementia (PwD) in community settings. Methods The methodology process was guided by the PRISMA-ScR checklist, which aligned with the research question. This involved reviewing eligibility criteria and information sources, establishing a search strategy using PICO, removing duplicates using EndNote, and screening articles in Rayann. The selected articles were then charted in a PRISMA flow chart, critically appraised using CCAT, and synthesised into a data extraction table to complete the process. After screening and evaluation, 15 articles were selected for the scoping review from an initial pool of 1,584 articles. Results Findings were grouped into two main themes: (1) IPC in Community Dementia Care: significance, team building, challenges and opportunities, the role of interprofessional education (IPE) and (2) Community Care Networks: barriers to implementing IPC and region-specific care models and guidelines. Conclusion The scoping review found that IPC in the community can provide high-quality care for PWD, resulting in earlier detection, disease management, and continuity of care. These benefits, however, are contingent upon effective communication, interprofessional coordination and local and national resources. Furthermore, a universal lack of standardised training for HCPs was identified as a key challenge in this. The review also discussed specific roles of IPC teams in dementia care, such as utilising other members of the team to address the shortage of physicians.

Early-Career Compensation Trends Among Family Physicians.

Family medicine incomes are often cited as a key reason for shortages of family physicians. The purpose of this study was to identify family physician income trends and to test how income varies among early-career family physicians. We used data from the 2016 to 2020 American Board of Family Medicine National Graduate Survey (NGS) collected from early-career family physicians (n = 9566; response rate = 63.9%). The NGS asked practice income, practice activities, practice site, and setting. We performed an income trend analysis and conducted multivariate regression to test for associations of personal and workplace characteristics with income. Average income across the full sample of early-career family physicians (after inflation adjustments) was $224,292. Overall, income growth outpaced inflation from 2016 to 2020. There are significant differences in income based on personal and work characteristics, and income growth varied dramatically. Notably, women respondents reported earnings of $33,522 below those of men respondents in adjusted models. In addition, the incomes of several groups lagged behind inflation, including those practicing geriatrics (-0.67%), employed by the Indian Health Service (-1.72%), and respondents who identified as Black or African American (-0.85%). Greatest increases in inflation-adjusted incomes were observed among those in palliative care (4.61%) and at nonfederal government clinics (4.46%). Though income is only one factor physicians consider in deciding where and how to work, it is concerning to see lower incomes among groups that traditionally experience shortages (eg, geriatrics and government-associated practice sites). Differences in expected income among family physicians choosing different work may exacerbate workforce challenges.

Factors associated with the attraction and retention of family and community medicine and nursing residents in rural settings: a qualitative study

BackgroundThe current shortage of primary care doctors and nurses is causing difficulties in replacement, and this shortage is expected to increase. This situation is more pronounced in rural environments than in urban ones. Family and community care specialty training is a key component of both the transition to clinical practice and the retention of new professionals. The aim of this study is to explore the attitudes and perceptions of internal medicine residents and internal nurse residents trained in a rural teaching unit on factors associated with recruitment and retention, including the role of the specialty training programme.MethodsA qualitative study was conducted. Purposive sampling was used, and thirteen residents from the central Catalonia teaching unit who were in their final year of training participated in semistructured interviews. The data were collected during 2022 and were subsequently analysed with thematic analysis. The study is reported using the COREQ checklist.ResultsSix themes emerged from data related to perceptions and attitudes about the factors associated with recruitment and retention: training programme, characteristics of the family and community specialty, concept of rural life, family and relational factors, economic and resource factors, and recruitment and job opportunities.ConclusionsFamily and community medicine and nursing residents trained in rural settings expressed satisfaction with the specialty programme and most features of primary care, but they experienced a wide range of uncertainties in deciding on their professional future in terms of living in rural areas, family support, financial support and recruitment. This study identifies individual and structural factors that could be of great use to retain doctors and nurses in rural areas.

Issues of informed consent for non-specialists conducting colorectal cancer screenings.

The United States is currently facing a physician shortage crisis including a lack of specialist providers. Due to this shortage of specialists, some primary care providers offer colorectal cancer screenings in communities with few gastroenterologists, especially in under-resourced areas such as rural regions of the United States. However, discrepancies in training and procedural outcomes raise concerns regarding informed consent for patients. Because osteopathic physicians play a critical role in addressing the physician shortage in these under-resourced communities, this commentary may be especially useful because they are likely to encounter these ethical complexities in their day-to-day practice.

Correlating Access to Primary Medical Care and Veterinary Care Providers: A Novel Application of Spatial Gravity Modelling.

Increasingly, health professionals are recognizing the need for a more holistic, or One Health, approach to wellness. Companion animals share the lives and homes of many Americans, and yet little research exists on the intersection of disparities of access to veterinary care and access to human health care. This research aims to fill that gap by exploring the use of a spatial model that identifies the relationship of supply and demand while also considering reductions as a function of travel time to a care facility. Four counties in Alabama were analyzed at the census tract level to determine the supply of primary care physicians and veterinary care providers. This research provides a unique application of the Enhanced Two-Step Floating Catchment Area model by independently examining access to each type of care and then comparing both access supply values at the census level. Results indicated a statistically significant positive relationship between access to both types of care, implying areas with lower access to primary care have concomitantly low access to veterinary care. Implications for practice include the introduction of this methodological approach, identification of future parameter specification research to improve the approach, and identification of an area of significant concern in the One Health framework. Further, the results can inform solution strategies such as offering integrated care interventions for both humans and their companion animal household members with direct use for policymakers aimed at increasing equitable access to health care across the One Health spectrum.

Meeting the demand for fertility services: the present and future of reproductive endocrinology and infertility in the United States

The field of reproductive endocrinology and infertility (REI) is at a crossroads; there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services, and availability of care. This document's focus is to provide data justifying the critical need for increased provision of fertility services in the United States now and into the future, offer approaches to rectify the developing physician shortage problem, and suggest a framework for the discussion on how to meet that increase in demand. The Society of REI recommend the following: 1. Our field should aggressively explore and implement courses of action to increase the number of qualified, highly trained REI physicians trained annually. We recommend efforts to increase the number of REI fellowships and the size complement of existing fellowships be prioritized where possible. These courses of action include: a. Increase the number of REI fellowship training programs. b. Increase the number of fellows trained at current REI fellowship programs. c. The pros and cons of a 2-year focused clinical fellowship track for fellows interested primarily in ART practice were extensively explored. We do not recommend shortening the REI fellowship to 2 years at this time, because efforts should be focused on increasing the number of fellowship training slots (1a and b). 2. It is recommended that the field aggressively implements courses of action to increase the number of and appropriate usage of non-REI providers to increase clinical efficiency under appropriate board-certified REI physician supervision. 3. Automating processes through technologic improvements can free providers at all levels to practice at the top of their license.

The US Supreme Court and Affirmative Action: The Negative Impact on the Physician Workforce

PurposeMaintaining admissions of underrepresented students to medical schools is essential to securing a diverse health care workforce. Empirical evidence indicates that minority patients may prefer practitioners of their own race. The recent US Supreme Court decision concerning affirmative action makes this goal more difficult, but medical schools can still work within the language of the law to redouble their efforts to seat a diverse class of medical students. MethodsWe examined the literature correlating the availability of minority physicians and the health outcomes of the patients they serve. We also examined the literature on race-conscious policies of medical schools intended to address the shortage of minority physicians considering the benefits achieved through a diverse field of health care workers. We also examined the law and the recent US Supreme Court opinion, including the application of equal protection principles, to suggest strategies to seat a diverse class of students within the scope of the law. FindingsInstitutions have maintained the status quo of disparate distributions of professions by race through structural biases that also limit access to medical schools. The new US Supreme Court decision is expected to exacerbate this disparity unless medical schools engage in admissions protocols that actively solicit the character and unique abilities that each of the applicants can offer to contribute to the medical school and the health care profession. ImplicationsThe new US Supreme Court mandate is likely to create challenges for medical schools in their efforts to recruit and seat minority applicants. The mandate provides little discussion, suggesting a lack of understanding of the downstream public health consequences to patients if medical school applicants are denied the benefits of race-conscious admissions policies. Nevertheless, the language of the US Supreme Court's opinion may provide a viable path forward, at least with respect to medical schools where the need for a diverse pool of health care practitioners is particularly compelling.

Perlindungan Hukum Ketenagakerjaan Bagi Dokter Dalam Hubungan Kerja Dengan Rumah Sakit

According to the existing legal relationship, there are three groups of doctors working in hospitals, namely doctors with the status of permanent employees (PNS), doctors with contract status and visiting doctors (attending physician). There is a shortage of permanent doctors, in general private hospitals employ civil servant doctors who work in government hospitals as visiting doctors. Research objectives: To find out and analyze the regulation of the medical profession based on the positive law in force in Indonesia and to find out and analyze the labor law protection for doctors in working relations with hospitals. The type of research used is formative juridical, the research approach used is a statute approach and a conceptual approach. Labor law protection for doctors in working relationships with hospitals is regulated in the work agreement. The work agreement is an entry point for the norms of labor law protection for doctors who are bound by a working relationship with a hospital. The working relationship between doctors and hospitals was born from a work agreement. The work agreement stipulates the rights and obligations of each party signing the work agreement. Work agreements between doctors and hospitals are an autonomous source of law in work relations. The work agreement will be a source of law to be considered in the event of a dispute over work relations between a doctor and a hospital, in addition to the applicable labor laws and regulations.

Genesis and prospects of the shortage of specialist physicians in Italy and indicators of the 39 schools of hygiene and preventive medicine.

In Italy, the number of physicians decreased in recent years due to retirements not being replaced by young specialists. To address this shortage of medical personnel, proper planning is needed, taking into consideration the number of accesses in medical schools and residency contracts. The main objective of this study is to deepen the data on the number of physicians, provide a prospective picture and make some suggestions for future planning. Materials and Methods: Estimates of the number of physicians, contracts, assignments, and abandonments for specialist schools are based on data from the General Medical Council, the Ministry of University and Research, Eurostat and the "Associazione Liberi Specializzandi". Results: Estimates of the number of physicians for the period 2023-2032 predict the minimum availability of active doctors between 2028 and 2029. While there has been an increase in the number of contracts for residents in recent years, there are concurrently high dropout rates and non-assignment of contracts, varying across Schools of Specialization. An examination of the available data for the 39 Schools of Specialization in Hygiene and Preventive Medicine shows lower than-average abundance rates. Conclusions: In recent decades, poor planning and early retirement have led to a shortage of doctors, particularly specialists, that will not be resolved until after 2030. Proposed solutions to this 'health emergency' include importing doctors from abroad, delaying the retirement age, recruiting junior doctors to the National Health Service and changing the distribution of junior doctor contracts.

Orthopaedics and Trauma Surgery in Germany in 2023 - Will We Have Sufficient Doctors in the Future?

There has been a growing shortage of physicians in Germany in recent years. In this study, we analyse the situation facing orthopaedic hospitals and trauma centres.Between 22 November and 5 December 2022, a web-based questionnaire was sent out by the Academy of the German Trauma Society (AUC) and by the Society of Leading Orthopaedic and Trauma Surgeons (VLOU).The questionnaire was answered by 185 heads of department. Of the responses, 20% came from university hospitals or major trauma centres, and a third from regional or local clinics. More than half of the hospital departments (55%) had a median of 2.7 vacant doctor positions. Among those hospitals, 47% had a vacant position for a consultant, 33% for a board-certified specialist, and 89% for a junior doctor. Within the university hospitals, only one third had vacant doctor positions. The responding heads of department gave negative feedback regarding the number of applications, the qualifications of young doctors, and their motivation for scientific work (in university hospitals).More than half of the responding hospitals had vacant doctor positions. If we are to counteract the growing shortage of doctors in orthopaedics and trauma surgery, the number of clinical doctors in general and the working conditions in hospitals have to be improved. Teaching hospitals should try to improve the training of medical students with a view to inspiring greater motivation to work in orthopaedics and trauma surgery.

Impact of Beliefs about Local Physician Supply and Self-rated Health on Willingness to See a Nurse Practitioner during the COVID-19 Pandemic: Online Survey and Experiment.

The coronavirus (COVID-19) pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see a NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting they may be willing to see a NP. Evaluate the public's willingness to see a NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Conduct two studies: 1) a survey to identify correlations; and 2) an experiment to assess how willingness is dependent on information about the local supply of physicians. The survey and experiment were conducted online in April and December 2020, respectively. Participants were U.S. adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized five-point scale (Excellent, Very Good, Good vs. Fair, Poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs via altering information the participants read about the local supply of physicians. Willingness to see a NP was assessed as an overall preference over a physician and as a preference given two clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and analysis of variance were used to assess how beliefs as about the local physician supply and self-rated health were associated with overall willingness to see a NP. Bivariate probits simultaneously estimated willingness to see a NP in the two clinically significant scenarios. The survey showed concerns about physician supply was associated with lower willingness to see a NP among respondents with comparatively better health, but a greater willingness among respondents with comparatively worse health. The experiment suggests only the latter is causal. For the two clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. U.S. adults with comparatively worse self-rated health become more willing to see a NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed.

Job satisfaction and moral distress of nurses working as physician assistants: focusing on moderating role of moral distress in effects of professional identity and work environment on job satisfaction

BackgroundPhysician assistant was created in response to a shortage of physicians. However, this profession is not officially recognized in Korea. Many nurses are working as physician assistants. Their job satisfaction was low due to role conflict. Job satisfaction plays a major role in providing high quality nursing. This study aimed to investigate effects of work environment and professional identity on job satisfaction and identify the mediating role of moral distress in such effects.MethodsParticipants were 112 nurses working as physician assistants. They were recruited from three General Hospitals. A questionnaire scale was used to collect data. Data were analyzed using frequency, descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation, and Macro Model 4 with SPSS Statistics.ResultsJob satisfaction of nurses working as physician assistants had a score of 3.08 out of 5. It showed significant associations with work environment and professional identity. Moral distress had a partial mediating role in relationships of job satisfaction with work environment and professional identity.ConclusionMany nurses are working as physician assistants, although physician assistant as a profession is not officially recognized in Korea. Nurses working as physician assistants experience confusion about their professional identity and moral distress. For better nursing outcomes, physician assistant policy should be improved, and various strategies should be provided to improve their job satisfaction.

Shortages of Medical Doctors in Indonesia, Is It True?

All parts of Indonesia need medical doctors, but it is not a simple thing to be solved. The world of medicine in Indonesia faces many internal problems, specifically regarding medical doctor distribution. Where do the medical doctors in Indonesia reside? Recently many areas in Indonesia experienced a ratio between doctors and population of more than 1 : 1000. Data From the Indonesia Medical Council (KKI) and Indonesia Medical doctor association (IDI) in the year 2023 total number of medical doctors are 214,878 doctors, dominated by general physician 165,453 doctors, and followed by doctors specialist 49,425. Total dentists are 41,940, and dentist specialists are 5,201. The fundamental problems, according to population ratios, is related to geographical and demographic handicap because Indonesia is an archipelago country with more than 17,000 islands with more than 280 million populations, with many specific problems in access, communication, transportation system, socio-economic, cultural, and leadership.

Assessing medical student satisfaction with rural placement: The Australian Rural Clinical School Support Survey.

Australia has a doctor shortage in rural settings, and rural placements for medical students have an important role in increasing the likelihood of students staying in rural settings throughout their careers. However, to date there is limited research regarding medical student perceptions of rural placement quality. We aimed to determine factors that impact the overall medical student experience during rural placements. Cross-sectional survey. Rural/remote clinical schools across Australia. Medical students on rural/remote clinical placements for at least 6 months. To assess factors impacting student experience on rural placements, we conducted a cross-sectional survey, known as the Australian Rural Clinical School Support Survey (ARCSSS) which was completed online by medical students across Australia. Demographic data were collected in addition to responses regarding academic teaching, extracurricular activities, and support services. Multiple choice and Likert scale questions were utilised. A total of 107 responses to our survey were analysed. The majority of participants were female (66.4%), and in their middle years of clinical education (55.1%). Overall, respondents showed high levels of satisfaction with clinical school supervisors, and clinical education. A high proportion of respondents indicated minimal accessibility of health and other support services. While a large proportion of participants indicated satisfaction with the rural placements, it was demonstrated that students were generally dissatisfied with school wellness activities and extracurricular activities. Financial insecurity was noted. The findings from our survey indicate there are numerous areas in which rural placements have been effective for medical students, and others in which improvement is needed. Furthermore, more research is required to better develop well-being initiatives that are effective in improving overall experience.

The Role of Medical Education in Community Hospital Sustainability: A Case for Increasing Models of Integration

U.S. hospitals are facing unprecedented margin compression and experiencing ongoing staffing issues, not only with nursing and ancillary services but with physicians as well. Looming physician shortages add to the vulnerabilities of acute care facilities to maintain normal operations. The traditional model of physician recruitment and retention may be inadequate to fill gaps, and novel approaches are needed. Vertical integration of medical education into health systems ecosystems may provide benefit to future stability. A recent uptick in proposed (and accredited) medical schools in the United States, particularly in Osteopathic Medicine, has seen many of these schools collaborating with community hospitals to provide the clinical training experiences required. Early reflection on this rapid growth (at least in one region) suggests that nascent physician education and training programs can have a significant synergy with community health/hospital systems that have not had such programming heretofore. Criticisms of such patterns are also addressed with a discussion of rebuttals and potential solutions. Hospitals that currently do not have medical education programs should consider the benefits of collaborating with medical education programs and seek to integrate their mission with local and regional providers of such programming.

Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan

BackgroundAccording to the World Stroke Organization, there was a significant increase in stroke cases, stroke deaths, and the DALY rate in low- and middle-income countries in 2022. The number of stroke cases rose by 70.0%, stroke deaths reached 86.0%, and the DALY rate reached 89.0%. Among cerebrovascular diseases, ischemic stroke accounts for 62.0% of all strokes, with more than 7.6 million cases reported annually.Kazakhstan, with a population of 19,832,737, is the largest country in Central Asia in terms of territory. In Kazakhstan, the incidence of cerebrovascular disease has risen from 258.4 cases per 100,000 population in 2015 to 433.7 cases per 100,000 population in 2020. Official statistics indicate that the average inpatient mortality rate from stroke in the country is 16.2%, and the average time for patients to be delivered to the hospital after an ambulance call is 40 min (83.2%).Our study findings reveal that in the regions of Kazakhstan, the main contributors to the high morbidity and mortality rates in stroke are a shortage of doctors, inadequate primary healthcare, insufficient follow-up and treatment, and delayed hospitalization. Consequently, this study has helped fill knowledge gaps regarding the epidemiological situation in these regions and underscores the need for training doctors in managing high-risk patients, establishing multidisciplinary home visit teams, and establishing “Stroke Schools” to enhance public awareness of early stroke signs and the fundamentals of a healthy lifestyle. Future research endeavors should consider these study results as valuable contributions towards addressing the existing problems. AimTo study the prevalence and mortality of acute cerebral circulation impairment in the population within multidisciplinary hospitals in the cities of Nur-Sultan and Almaty, Republic of Kazakhstan, for the period of 2018–2020.This retrospective study was conducted in two stages. In the first stage, an analysis of morbidity, prevalence, and mortality was conducted for the population of Nur-Sultan and Almaty cities, as well as for the overall population of Kazakhstan. This analysis was based on data from the “Electronic Register of Discharged Patients” (IS ERDB) and the annual collection “Health of the Population of the Republic of Kazakhstan and the Activities of Health Organizations in 2015–2020". In the second stage, we examined the care provided to patients with acute impaired cerebral circulation in a multidisciplinary hospital in these two cities. The analysis was based on data regarding the sex and age composition of treated patients in hospitals across the Republic of Kazakhstan, categorized according to the ICD-10 code “Acute Impaired Cerebral Circulation” (I60–I64). We investigated the methods of patients' delivery to medical organizations, types of hospitalization, and outcomes of treated patients. The sample of patients was selected using data from the “Electronic Register of Dispensary Patients” of the Ministry of Health of the Republic of Kazakhstan, along with the statistical collection “Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations”. Between January 1, 2018, and December 31, 2020, a total of 5965 patients were diagnosed with a cerebrovascular event and admitted to a general hospital in Nur-Sultan city, while 13,498 patients were diagnosed and admitted in Almaty city.