Workforce Supply Research Articles

BN SO60 - Oesophageal physiology studies: Conversion to surgery

Abstract Background This study aims to assess the proportion of patients that proceed to have hiatal surgery after oesophageal physiology studies. The results allow better planning in service development and workforce provision. Approximately 25% of the adult population suffer reflux symptoms (1), however not all patients benefit from surgical intervention. UK data show 1693 anti-reflux operations and 740 hiatal hernia repairs took place 2022-2023 (2). Oesophageal physiology studies, i.e. high resolution pH manometry and 24-hour pH monitoring, are the gold standard investigation in such patients to determine diagnosis and guide management. Method All patients who underwent oesophageal physiology studies between January 2021 and December 2023 were assessed by case note analysis. All patients considered for surgery were discussed in our hiatal MDT. Whilst achalasia is relatively rare, these patients also pass through oesophageal physiology and so are also considered here. Patients with previous hiatal surgery were excluded (20 patients). Results 182 patients attended; 137 underwent the tests, 22 tolerated manometry only, 5 underwent BRAVO. 78 were diagnosed with symptomatic/volume reflux, 3 with hiatus hernia. Mean DeMeester score was 47.63 (range 1.87-228.58) c.f. 20.2 (range 0.2-192.96) in the non-operative group. Ten patients had achalasia; two were referred for POEM, one Botox and one awaits further investigation. Six underwent Heller’s cardiomyotomy and Dor fundoplication. 76 patients were offered surgical intervention for reflux and/or hiatus hernia; 10 of whom declined. 3 patients underwent surgery privately. To date 39 procedures have been completed. 16 patients await further tests. Conclusion 42% of patients undergoing oesophageal studies were offered surgical intervention across a two-year period in our benign unit. A further 9% are awaiting outcome. The data suggest that when planning surgical services, finances and workforce we should anticipate approximately 40% of these patients will go on to require surgery.

Determining skill mix and optimal multidisciplinary team composition: A scoping review.

Holistic care models aligned to population care needs are needed to help leaders shed pre-existing mindsets when determining skill mix and Multidisciplinary Team (MDT) composition. Using a PRISMA flowchart, a narrow eligibility criterion, and a research question, this scoping review resulted in 9 frameworks/models published between January 2000 and September 2023. Analysis showed common methodological elements such as a population needs-based approach, a systematic process, engagement, three or more professions reporting task or competency level analysis, change advocacy, and reliance on population and workforce supply data. Key system enablers were sponsorship, access to population needs-based and workforce supply data, a learning management system for MDT development, and health human resource policies and governance to drive health system redesign to distribute an equitable workforce. This scoping review offers health leaders and policy-makers options and next-step considerations to inspire fresh thinking for making evidence-informed decisions about skill mix and MDT composition.

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

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

The state of primary health care systems in ten high-income countries

Abstract Primary care systems in high-income countries perform comparatively better than the U.S. system in large part due to decades of investment, an adequate workforce supply, and universal healthcare. This research identifies successes and areas of improvement of 10 high-performing primary care systems in four areas of care: 1) access, 2) continuity, 3) comprehensiveness, 4) and coordination. Cross-national comparisons using primary data from the 2022 CMWF International Health Policy Survey of Primary Care Physicians (N ranged from 321-2,092) and the 2023 CMWF International Health Policy Survey on the General Population (N ranged from 750-4,820). Countries included: Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S. • More than 90% of adults in all surveyed countries reported having a regular primary care doctor except Sweden, the U.S., and Canada. • Less than 5% of physicians reported high telehealth use in their patient encounters, except for in the U.K. and New Zealand where over 10% reported high use. • Over a quarter of physicians in the U.S., Germany, and France report screening patients for social needs, compared to just 8% in the Netherlands. • Care coordination with social services was a major challenge in all surveyed countries, with over 75% of physicians in the U.K., Australia, and France reporting major challenges. Primary care systems in 10 other high-income countries outperform the U.S. system, particularly when it comes to access to care and care continuity. Policy options to consider for U.S. policymakers include narrowing the wage gap between generalist and specialist physicians and rewarding and holding providers accountable for continuity of care. On the other hand, countries like Sweden and the Netherlands can learn from the U.S. on how to adequately coordinate care between primary care physicians, specialists, and hospitals. Key messages • Investment in primary care yields better health outcomes, greater equity and lower costs. • Many high-income countries in Europe have high performing primary care systems, something the U.S. system can learn from.

Organizational Climate Related to Patient-Perpetrated Sexual Harassment: VA Primary Care Provider Perceptions.

Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment-shared perceptions about an organization's practices, policies, and procedures-is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)'s climate related to patient-perpetrated sexual harassment. Responding providers completed a survey assessing: (1) experiences with patient-perpetrated sexual harassment, (2) beliefs about VA's responses to patient-perpetrated sexual harassment of staff, and (3) perceptions of VA's organizational climate related to sexual harassment for each of 4 perpetrator-target pairings (patient-perpetrated harassment of staff, patient-perpetrated harassment of patients, staff-perpetrated harassment of staff, and staff-perpetrated harassment of patients). Respondents included 105 primary care providers (staff physicians, nurse practitioners, and physician assistants) at 15 facilities in the VA Women's Health Practice-Based Research Network. Seventy-one percent of responding providers reported experiencing patient-perpetrated sexual harassment in the past 6 months. Respondent perceptions of VA's responses to patient-perpetrated harassment of staff were mixed (eg, indicating that VA creates an environment where harassment is safe to discuss but that it fails to offer adequate guidance for responding to harassment). Respondents rated organizational climate related to patient-perpetrated harassment of staff as significantly more negative compared with climate related to other perpetrator-target pairings. Future work with representative samples is needed to corroborate these findings, which have potential ramifications for VA's ongoing efforts to create a safe, inclusive environment of care.

Characterizing hospitalists’ comfort and familiarity with LGBTQ clinical topics

ABSTRACT Objectives Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper’s objective was to understand hospitalists’ comfort with LGBTQ health. Methods A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients. Results Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (p < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients. Conclusions Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists’ ability to more confidently and competently serve LGBTQ patients.

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

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

International perspectives on cultivating high-quality bachelor's degrees in vocational education: Insights, experiences, and practices from overseas universities

Cultivating high-quality technical and skilled professionals is essential for building a modern economic system and ensuring there is a balance between workforce supply and demand. Currently, there are various challenges associated with pilot programs offering undergraduate-level vocational education in China, including unbalanced training structures, limited curricular diversity, and inadequate systemic coordination. To address these issues, in this study, we employed a comparative case study methodology to examine the practices of several esteemed overseas universities in developing high-quality, undergraduate-level programs in vocational education. We systematically analyzed the training objectives, curriculum design, and support systems of these programs and categorized the associated practices as research-oriented, practice-oriented, and integration-oriented models. Drawing on the valuable insights revealed by this study will support China's goal of developing a skilled workforce that meets the demands of a rapidly evolving economy.

Labour Market of Ukraine and Meeting Post-War Workforce Supply Market Demands

Introduction. Full-scale military actions in Ukraine increased the dynamics of changes in the labour market, caused significant uncertainty in influencing factors, and increased the imbalance of supply and demand in the labour market, which was characterised as a crisis even before the invasion. This strengthened the need for a relevant assessment of the needs of the Ukrainian labour market and the possibility of its personnel support and management of labour resources, taking into account the risks for the country's economy and post-war reconstruction. Aim and tasks. The purpose of this article is to evaluate the labour market of Ukraine in the post-war period and substantiate ways of meeting the market's personnel needs using the example of the construction and IT industries. The tasks of this study are to identify the factors affecting the labour market in the post-war period, assess the dynamics of changes in the balance of demand and supply in the labour market in the post-war period, and develop a mathematically formalised approach to the adaptive assessment of the labour market. Results. The developed mathematically formalised approach to assessing the imbalance of the labour market in individual areas allowed the stabilisation of the demand and supply of the IT labour market in 2026 at a level 1.496 times lower than the maximum in 2023. In the construction industry, differentiation in sectoral priorities of post-war reconstruction has been determined, as evidenced by the expected shortage of personnel in this industry, which is 2.15 times higher than the indicator for all industries. This is also indicated by the differentiation in the demand for qualified workers from 20% to 60% for large and small construction enterprises. Conclusions. The identified reasons for the uncertainty of factors affecting the labour market (losses in the quality of labour resources and forced migration) proved that post-war reconstruction would require an adaptive approach to managing labour resources at all levels. The lack of personnel in the post-war period will require a change in the concept of ensuring the competitiveness of domestic enterprises by using cheap labour. It was determined that the demand for qualified personnel in the post-war period for all industries would grow, which is confirmed by the dynamics of the index of change of employees, which is 30% higher for qualified workers than unskilled workers. Significant differentiation by micro-specialty influences the gap between demand and supply, which does not consider the market's needs.

Abstract A095: Differences in providers’ perceived preparedness and actual delivery of screening and intervention practices for patients who smoke cigarettes between two types of healthcare centers serving rural and/or medically underserved areas of Texas

Abstract Introduction: Rural populations in the US bear a disproportionate burden of cancer mortality. This is partly due to their elevated tobacco use rates. Best practice guidelines promote tobacco use screening and brief intervention at every patient contact; however, limited literature evaluates compliance in healthcare centers in rural and/or medically underserved areas (MUAs). Here, we examine providers’ use of the 5As (Ask, Advise, Assess, Assist, Arrange) and motivational interventions (for those not ready to quit; e.g., 5Rs: Relevance, Risks, Rewards, Roadblocks, Repetition) with their patients in substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) located in rural and/or MUAs in Texas to identify screening and intervention gaps. Methods: Providers from participating healthcare centers (12 SUTCs, 9 MHCs) responded to a solicitation assessing interest in (later) receiving tobacco use intervention training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 126 counties responded to an anonymized survey about their smoking screening and intervention delivery over the last month, along with their rating of how prepared they thought their healthcare center’s provider workforce was to help patients stop using tobacco (completely or somewhat prepared vs neutral, somewhat unprepared, or not at all prepared). Linear mixed models and generalized linear mixed models were used to assess the differences between SUTCs and MHCs for continuous and binary variables, respectively. Results: Overall, providers Asked 68.31% of their last-month patients whether they smoked cigarettes. Of patients who endorsed smoking (23.94%), providers Advised 58.68% to quit and Assessed 51.90% about their interest in quitting. However, providers only Assisted 35.87% of patients who endorsed smoking in making a quit attempt and 22.79% in Arranging a follow-up. A significantly greater percentage of patients were Asked (p=.0226) and Advised (p=.0025) to quit at MHCs (Ask=77.21%, Advise=72.35%) than at SUTCs (Ask=59.57%, Advise=45.34%). Providers delivered brief motivational interventions to 70.16% of patients who were not ready to quit smoking, with no significant differences between SUTCs and MHCs. Finally, 56.07% of providers at MHCs reported their workforce was prepared to help their patients quit tobacco, significantly greater than the 40.80% reported at SUTCs (p=.0268). Conclusion: Patients at MHCs were more likely to receive comprehensive tobacco cessation care than those at SUTCs in this sample of healthcare centers serving rural and/or MUAs in Texas. However, providers at both types of healthcare centers would benefit from greater workforce preparation to enable the provision of consistent tobacco use screening and brief intervention delivery in line with best practice guidelines. Future work will use these data for intervention and implementation strategy planning to improve centers’ capacity to comprehensively address their patients’ tobacco use. Citation Format: Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Brian J. Carter, Teresa Williams, Kathleen Casey, Kim Skeene, Hector Sanchez, Sriya Kakarla, Lorraine R. Reitzel. Differences in providers’ perceived preparedness and actual delivery of screening and intervention practices for patients who smoke cigarettes between two types of healthcare centers serving rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A095.

Gamification approach to addiction education for internal medicine residents

Background: People with a substance use disorder (SUD) outnumber the trained provider workforce. The Accreditation Council for Graduate Medical Education (ACGME) recognized this gap in 2022 and now requires addiction education for internal medicine (IM) residents. However, traditional lecture formats struggle to deliver education on this stigmatized condition with meaningful retention and changes in attitudes. Gamification is an evidence-based educational strategy with positive outcomes in graduate medical education, but to our knowledge, has not been used for an entire addiction curriculum. Intervention: This six session IM-focused, stigma-free, interactive curriculum used published physician competencies for content selection. Games were matched to topics based on complexity and need for skill practice. Each hourly session included 10 minutes on introduction, 45 minutes on gameplay, and 5 minutes on feedback. This addiction curriculum was incorporated into existing didactics for IM residents where participants’ comfort, psychological safety, and learning expectations were pre-established. Methods: Sixteen IM residents participated in the curriculum. Curriculum evaluation was conducted using Kirkpatrick’s four levels of evaluation. Resident feedback was obtained via online survey software at the conclusion of each session and behavior impact through an anonymous single question prompt. We used descriptive statistics and summative content analysis to evaluate findings, respectively. Results: All residents were highly satisfied with the curriculum design and use of gamification. Residents reported high levels of engagement and learning, despite use of various games. Findings support an increase in medication prescribing and utilization of harm reduction strategies following curriculum implementation. Conclusion: Gamification may be a preferred educational strategy for addiction curriculum for IM residents. We plan to distribute our curriculum widely for further evaluation in health professions’ programs.

How We Solved the Shortage of Cardiothoracic Surgeons: Train More or Work Longer

BackgroundIn the early 2000s, a significant shortage of cardiothoracic surgeons was predicted. We sought to evaluate our specialty’s progress and to update the predicted needs of cardiothoracic surgeons in the coming decades. MethodsTo assess the supply of cardiothoracic surgeons, the evolution of cardiothoracic surgery training was reviewed. The cardiothoracic surgery workforce and future supply and demand were obtained from the National Center for Health Workforce Analysis. Based on these data, predictions from the early 2000s were compared with the current status, and future supply of cardiothoracic surgeons was modeled. ResultsThe number of cardiothoracic surgery trainees increased from 230 in 2008-2009 to 519 in 2022-2023. In 2022-2023, 174 trainees underwent the American Board of Thoracic Surgery Certification Exam, with 129 certificates awarded. From 2005 to 2021, the total number of practicing cardiothoracic surgeons in the United States increased from 4000 to 5200, which contradicts all projections from the early 2000s. The average attrition of 31 cardiothoracic surgeons per year was significantly less than predictive models from the early 2000s. Predictive models project a need of 7000 cardiothoracic surgeons by 2050, which can be met if we continue to fill our available training spots with 173 graduates per year. ConclusionsThe predicted shortage of cardiothoracic surgeons by midcentury has been overcome by training more cardiothoracic surgeons as well as by a reduction in cardiothoracic surgeon attrition. Future increasing demand can be met by filling our available training positions. Continual assessment of cardiothoracic surgeon supply and demand will help achieve the optimal number of cardiothoracic surgery training positions.

Racial and Socioeconomic Disparities in Pediatric Asthma Emergency Care

The aim of this paper is to build a model to compare the relative impact of race and ethnicity and insurance type on pediatric Emergency Department utilization for asthma. A binary logistic regression model using relevant variables from 2022 NHIS survey data was conducted to compare asthma ED visit odds ratios of racial and ethnic minorities and publicly insured children. The results suggest that insurance type has slightly greater influence over asthma ED visits than race and ethnicity. Publicly insured children had the highest unadjusted odds ratio (1.88 [CI 95% 1.09-3.24)]) followed by Non-Hispanic Black children (1.80 [0.92-3.52]) and Hispanic children (1.51 [0.80-2.86]). The data are possibly biased toward exclusion of well-controlled asthmatics that may affect the resulting odds ratios. More socioeconomic variables would provide a more complete analysis. The paper has direct implications for health service providers and policymakers. Providers are encouraged to provide equitable, culturally competent care to asthmatics and policymakers are encouraged to embrace policies that promote better access for Medicaid beneficiaries, improved air quality and housing conditions for low-income children, and better racial representation in the provider workforce. The paper collates many existing sources of research on asthma disparities as a backdrop for examination of recent survey data pertaining to differences in asthma ED utilization between populations. It supports existing theories and work being done to mitigate poor asthma outcomes in children that are exacerbated by biological and systemic factors.

Peran Asosiasi Pengusaha Indonesia (APINDO) Memanfaatkan kebijakan Sistem Informasi Pasar Kerja (SIPK) 2024

The Indonesian Employers Association (APINDO) plays a crucial role in addressing the gap between workforce supply and industrial demand. This study explores how APINDO leverages the Labor Market Information System (SIPK) to align human resources with industry needs, thereby enhancing employment rates and improving the efficiency of the labor market. The SIPK provides comprehensive data on labor market trends, job vacancies, and skill requirements, enabling employers to make informed decisions about hiring and training. Through interviews with key stakeholders and analysis of SIPK data, this research highlights the effectiveness of APINDO's strategies in optimizing human resource absorption. The findings indicate that APINDO's utilization of SIPK not only bridges the gap between job seekers and employers but also contributes to the development of a more responsive and adaptive workforce, meeting the evolving needs of industries in Indonesia. The study concludes with recommendations for enhancing the SIPK platform and expanding APINDO's initiatives to further support the alignment of labor supply and demand.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

BackgroundAdvanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.MethodsWe conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).ResultsWe identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations’ decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs’ backgrounds and characteristics, clinical team members’ perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.ConclusionsWe summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Closing the Chasm: Understanding and Addressing the Anesthesia Workforce Supply and Demand Imbalance.

The imbalance in anesthesia workforce supply and demand has been exacerbated post-COVID due to a surge in demand for anesthesia care, especially in non-operating room anesthetizing sites, at a faster rate than the increase in anesthesia clinicians. The consequences of this imbalance or labor shortage compromise healthcare facilities, adversely affect the cost of care, worsen anesthesia workforce burnout, disrupt procedural and surgical schedules, and threaten academic missions and the ability to educate future anesthesiologists. In developing possible solutions, one must examine emerging trends that are affecting the anesthesia workforce, new technologies that will transform anesthesia care and the workforce, and financial considerations, including governmental payment policies. Possible practice solutions to this imbalance will require both short- and long-term multifactorial approaches that include increasing training positions and retention policies, improving capacity through innovations, leveraging technology, and addressing financial constraints.

Do HIV Care Outcomes Differ by Provider Type?

We compared HIV care outcomes by HIV provider type to inform efforts to strengthen the HIV provider workforce. United States. We analyzed data from Center for Disease Control and Prevention's Medical Monitoring Project collected during June, 2019-May, 2021 from 6323 adults receiving HIV medical care. Provider types include infectious disease physicians only (ID physicians), non-ID physicians only, nurse practitioners only, physician assistants only, and ID physicians plus nurse practitioners and/or physician assistants (mixed providers). We measured patient characteristics, social determinants of health, and clinical outcomes, including retention in care; antiretroviral therapy prescription; antiretroviral therapy adherence; viral suppression; gonorrhea, chlamydia, and syphilis testing; satisfaction with HIV care; and HIV provider trust. Compared with patients of ID physicians, higher percentages of patients of other provider types had characteristics and social determinants of health associated with poor health outcomes and received HIV care at Ryan White HIV/AIDS Program-funded facilities. After accounting for these differences, most outcomes were not meaningfully different; however, higher percentages of patients of non-ID physicians, nurse practitioners, and mixed providers were retained in care (6.5, 5.6, and 12.7 percentage points, respectively) and had sexually transmitted infection testing in the past 12 months, if sexually active (6.9, 7.4, and 13.5 percentage points, respectively). Most HIV outcomes were equivalent across provider types. However, patients of non-ID physicians, nurse practitioners, and mixed providers were more likely to be retained in care and have recommended sexually transmitted infection testing. Increasing delivery of comprehensive primary care by ID physicians and including primary care providers in ID practices could improve HIV primary care outcomes.

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

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

Dermatology workforce projections in the United States, 2021 to 2036.

There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

Private practice dietetics: A scoping review of the literature.

Private practice is one of the most rapidly growing, but under-researched employment sectors for graduate dietitians in Australia, limiting evidence-based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities. The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports,statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research. A total of 72 peer-reviewed and grey literature sources were included, with 65% of the studies being Australian-based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners. The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced-based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.