Geographic distribution of the Australian primary health workforce in 1996 and 2001

OBJECTIVE: To analyse the geographic distribution of medical and non-medical primary health professions in 2001, and to compare this with 1996. DESIGN AND SETTING: Census data on the number and characteristics of selected health professionals in Australia by remoteness areas (as measured by the Accessibility Remoteness Index of Australia) were obtained from the Australian Bureau of Statistics. MAIN OUTCOME MEASURES: Number of general medical practitioners, allied health professionals and nurses per capita in Australia by remoteness areas in 2001 and 1996. RESULTS: In 2001, the number of general medical practitioners per capita in major cities was significantly higher than the numbers in inner regional areas, outer regional areas, and remote areas. This was also true of the number of allied health professionals per capita. The number of nurses per capita did not show the same pattern. From 1996 to 2001, the number of general medical practitioners per capita showed the largest increase in outer regional areas (10%) and no change in remote areas. The allied health professional workforce per capita increased significantly in all regions, while the nursing workforce per capita showed no significant increases. CONCLUSIONS AND IMPLICATIONS: Supply of all primary health professionals in remote areas remains low, and distribution patterns changed little from 1996 to 2001. The implementation of numerous government health workforce initiatives has coincided with little observable change in geographic distribution of the health workforce up to 2001.     

A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning

Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -“strife of interests” - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be diverse and dependent on country- or context-specific scenarios.     

Supply Dynamics of the Mental Health Workforce: Implications for Health Policy

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists—psychiatrists, clinical psychologists, and clinical social workers—indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.     

Inequality trends in the demographic and geographic distribution of health care professionals in China: Data from 2002 to 2016

China has long been negatively affected by a shortage and maldistribution of health workers. This study aimed to examine the national and regional trends in the demographic and geographic distribution inequality of health care professionals in China from 2002 to 2016. Based on data from the China Health and Family Planning Statistical and China Statistical Yearbooks, we calculated the Gini coefficient and the Theil T and Theil L indices based on the number of health care professionals per capita and per geographic area to measure the inequalities in their demographic and geographic distribution, respectively. The contributions by intra‐regional and inter‐regional differences on total inequality were explored within and among East, Central, and West China via Theil index decomposition. We found that the national demographic distribution of health care professionals maintained in an absolute equality level, and the inequality indices decreased gradually, whereas the corresponding geographic inequalities were severe and presented a worsening trend. Compared with nurses, physicians not only maintained higher densities but also maintained a more equal distribution. Intra‐regional disparities within the east, central, and western regions were the main cause for overall demographic inequality, whereas both intra‐regional and inter‐regional disparities significantly contributed to overall geographic inequality. To conclude, the distribution equality of health care professionals by population was satisfactory, whereas the corresponding distribution inequality by area was severe. Different types of distribution inequality of health care professionals existed regionally and nationally despite their increasing quantities and densities. Factors beyond population size should be considered when the government introduces health workforce allocation policies.     

The Role of Historically Black Colleges and Universities in Training the Health Care Workforce

Historically Black colleges and universities (HBCUs) continue to be overlooked as a resource to address health care workforce shortages and growing needs for a diverse health workforce, despite our commitment as a nation to health equity and eliminating health disparities.Health workforce graduation rates help illuminate the roles of institutions of higher education in meeting workforce needs. Effective approaches to eliminating disparities invest and leverage resources that address our health workforce and diversity deficits.We must recognize HBCUs as a valuable resource for educating underrepresented groups as health professionals. Increasing resources and enhancing support for building the capacity of HBCUs to produce health professionals is vital to addressing disparities and achieving health equity for our nation.People of color are disproportionately represented in health professional shortage areas. They represent more than 25% of the total population, but only 10% of health professionals.Historically, people of color have been underrepresented in all of the primary health professions. According to one source, between 2000 and 2006 the profession with the highest proportion was pharmacy (9.9%) and with the lowest was dentistry (5.4%). Public health was the only profession studied that had a substantial increase in African Americans during this period. In medicine, dentistry, nursing, and pharmacy, the percentage remained virtually unchanged.1 In 2006, the Association of American Medical Colleges called for a 30% expansion of the total enrollment in medical schools.2In 1996 there was one dentist for every 1700 persons but only one African American dentist for every 6150 African Americans. In 2002, an estimated 27 million persons lacked a dental provider, and 4300 more dentists were needed in the United States.3The Health Resources and Services Administration estimates that the shortage of nurses will reach 29% by 2020. In 2000, only 4.9% of registered nurses were African American.4 The capacity for training nurses is severely inadequate. The National League for Nursing estimates that 99 000 applicants to nursing programs were turned away in 2008 because of inadequate capacity.5In 2000, only 4.7% of pharmacists were African American and 3.2%, Hispanic. The pharmacist shortage decreased in the first decade of this century, and projections of its future magnitude differ.6 Effective July 1, 2007, the Accreditation Council for Pharmacy Education determined that the PharmD degree is the sole professional practice degree for pharmacy in the United States. It is too soon to determine the impact of this major modification in the pharmacy profession.The ratio of public health workers declined from 220 per 100 000 population in 1980 to 158 in 2000.7 This decline is exacerbated by the absence of formal training in public health among four out of five public health workers. Approximately half of all public health workers will be eligible for retirement within the next decade. This looming insufficiency is most dramatic among public health nurses, who were 39% of public health workers in 1980 but were 17.6% in 2000. States report that the shortage of epidemiologists is approximately 50% and that 20 000 more public health laboratory professionals are needed. Although environmental professionals account for only 4.5% of the public health workforce, the need for such expertise is growing.8The Integrated Postsecondary Education Data System comprises interrelated surveys conducted annually by the National Center for Education Statistics that provide demographic data on graduates.9 We reviewed data from this system from 2000 to 2008 and found information relevant to the role historically Black colleges and universities (HBCUs) can play in achieving the goals of health equity and the health professional education of African Americans.     

Retention of allied health professionals in rural new south Wales: a thematic analysis of focus group discussions

ABSTRACT: BACKGROUND: Uneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology. METHODS: Six focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors. RESULTS: Five major themes emerged: personal factors; workload and type of work; continuing professional development (CPD); the impact of management; and career progression. 'Pull factors' favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. 'Push factors' discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel); limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with lack of CPD access was strongly represented by informants. CONCLUSIONS: While personal factors affecting recruitment and retention of allied health study participants were similar to doctors, differences also existed. Allied health professionals were attracted by advanced work roles in a context of generalist practice. Access to CPD and inequitable resource distribution were strong 'push' factors in this group. Health policy based on the assumption of transferability between professions may be misguided.     

Health workforce development: a needs assessment study in French speaking African countries

In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential trainees and training institutions in nine French-speaking African countries. A needs assessment was conducted in the target countries according to four approaches: (1) Review at national level of health challenges. (2) Semi-directed interviews with heads of relevant training institutions. (3) Focus group discussions with key-informants. (4) A questionnaire-based study targeting health professionals identified as potential trainees. A needs assessment showed important public health challenges in the field of health workforce development among the target countries (e.g. unequal HRH distribution in the country, ageing of HRH, lack of adequate training). It also showed a demand for education and training institutions that are able to offer a training programme in health workforce development, and identified training objectives and core competencies useful to potential employers and future trainees (e.g. leadership, planning/evaluation, management, research skill). In combining various approaches our study was able to show a general demand for health managers who are able to plan, develop and manage a nation’s health workforce. It also identified specific competencies that should be developed through an education and training program in public health with a focus on health workforce development.     

Health workforce governance and oral health: Diversity and challenges in Europe

Throughout the life course, oral diseases are some of the most common non-communicable diseases globally, and in Europe. Human resources for oral health are fundamental to healthcare systems in general and dentistry is no exception. As political and healthcare systems change, so do forms of governance. The aim of this paper is to examine human resources for oral health in Europe, against a workforce governance framework, using England as a case study. The findings suggest that neo-liberalist philosophies are leading to multiple forms of soft governance at professional, system, organisational and individual levels, most notably in England, where there is no longer professional self-regulation. Benefits include professional regulation of a wider cadre of human resources for oral health, reorientation of care towards evidence-informed practice including prevention, and consideration of care pathways for patients. Across Europe there has been significant professional collaboration in relation to quality standards in the education of dentists, following transnational policies permitting freedom of movement of health professionals; however, the distribution of dentists is inequitable. Challenges include facilitating employment of graduates to serve the needs and demands of the population in certain countries, together with governance of workforce production and migration across Europe. Integrated trans-European approaches to monitoring mobility and governance are urgently required.     

Health professions development

Health professions development is an integral part of national health plans. It is influenced by various factors and should be continuously updated to meet the changing health situation and related disciplines of the country. There are three forms of establishing a health manpower development plan: a market-oriented form, a goal-achievement form and a normative form. A combination of all forms is best if carried out by a community-oriented team of academic health professions and health care providers. Although countries of the Eastern Mediterranean Region share many demographic, geographic, and sociocultural characterisitics, there are marked differences in resources, health manpower structure and availability in health services. Health professional development plans should be formulated according to existing situations. Other factors influencing health manpower development in the future include political, social and economic trends, changes in morality and disease patterns, industrialization, availability of health services and academic institutions. Perspectives guiding planning for the development of various categories of health professionals are presented.     

Contemporary models of change in the health professions

This article reviews the special position that health professionals have occupied and the ways in which changes threaten the foundations of professional work. The application of modern management principles to health care runs the risk of overriding the "action orientation" that is a defining component of professional work. One goal of health workforce design should be the engineering of opportunities for the preservation of "professional voice" as a countervailing force to ensure high quality health care. Contemporary models of change applied to health care workforce include: (1) the system of professions models in which securing and maintaining jurisdiction are the mechanisms that professions employ to sustain their position, (2) a strategic adaptation model by which professions attempt to adjust to changing environments, (3) a model of redesigning patient care which applies Total Quality Management (TQM) and other "industrial techniques" to the health care workplace, and, (4) model of "consumer sovereignty" in which groups of citizens come together to determine the nature of care services and professional work, with the participation of the organizations and providers.     

The rural-urban distribution of health professionals in Georgia.

In this paper, the rural/urban geographic distribution of licensed health professionals living in the state of Georgia is examined. Using 1983 data from the State Examining Boards, 13 health professions were studied to determine rural and urban differences. Three indicators of ruralness were used to classify county of residence: metropolitan/nonmetropolitan, metropolitan proximity, and size of county population. Results from data analyses indicate a severe geographic maldistribution of health professionals. With all three indicators, 11 of the 13 professions had urban rates of professionals-to-population substantially higher than the corresponding rural rates. A linear configuration seems to illustrate the relationship between the availability of health professionals and the ruralness of the county--as the county becomes more rural, the number of health professionals per population decreases. The percentage increase in physicians since 1968 and nurses since 1979 in nonmetropolitan counties was slightly higher than in metropolitan counties, indicating that this gap is closing somewhat. The most severe rural/urban differences in the number of professionals which per population were found in the more specialized health professions per tended to be the smallest in terms of numbers of members (e.g., occupational therapists, psychologists, speech pathologists/audiologists, podiatrists, opticians and physical therapists). These differences ranged up to a 20 plus-fold difference. Physicians, chiropractors, dentists, physician assistants and registered nurses also had relatively large rural/urban differences but less than the more specialized professions.     

Primary care practice composition in 34 countries

Health care needs in the population change through ageing and increasing multimorbidity. Primary health care might accommodate to this through the composition of practices in terms of the professionals working in them. The aim of this article is to describe the composition of primary care practices in 34 countries and to analyse its relationship to practice circumstances and the organization of the primary care system. The data were collected through a survey among samples of general practitioners (n = 7183) in 34 countries. In some countries, primary care is mainly provided in single-handed practices. Other countries which have larger practices with multiple professional groups. There is no overall relationship between the professional groups in the practice and practice location. Practices that are located further from other primary care practices have more different professions. Practices with a more than average share of socially disadvantaged people and/or ethnic minorities have more different professions. In countries with a stronger pro-primary care workforce development and more comprehensive primary care delivery the number of different professions is higher. In conclusion, primary care practice composition varies strongly. The organizational scale of primary care is largely country dependent, but this is only partly explained by system characteristics.     

Enumerating the preventive youth health care workforce: Size,composition and regional variation in the Netherlands

The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region.A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n = 3220) were recruited through organisations involved in YHC (participation: 88%).The YHC workforce is multi-disciplinary, 62% had >10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range 688–1007). All essential public health operations were provided and could be clustered in an operational or policy profile. The operational profile prevailed in all regions. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need.The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries.     

A rural-urban comparison of allied health professionals' average hourly wage

Nationwide, demand for allied health services is projected to grow significantly in the next several decades, and there is evidence that allied health shortages already exist in many states. Given the longstanding history of health professional shortages in rural areas, the existing and impending shortages in allied health professions may be particularly acute in these areas. To assess whether rural areas are potentially at a recruiting disadvantage because of relative wages, this report uses data from the Bureau of Labor Statistics to describe the extent to which rural-urban differentials exist in wages for eight allied health professions, focusing on professions that are both likely to be found in rural communities and have adequate data to support hourly wage estimates. Overall the data show that the national average wage of each of the eight allied health professions is higher in metropolitan than nonmetropolitan areas. On average, the unadjusted rural hourly wage is 10.3% less than the urban wage, although the extent of the difference varies by profession and by geographic area. Adjustment for the cost of living narrows the discrepancy, but does not eliminate it. It is likely that rural providers in areas with the greatest wage discrepancies find it more difficult to recruit allied health professionals, but the extent to which this is the case needs to be assessed through further research with data on workforce vacancy rates.     

Die Professionalisierung der Zahnmedizin in Deutschland

Within a century dentistry stepped from the bottom of the healing professions to a socially and economically successfull profession with its own organizational body. The theory of the professions and a comparative analysis mark important factors of the German professionalization. Here the main professional characteristics were gained much later than in the USA and Great Britain, as the control of education and admission to the profession and especially the control of occupation. The “Kurierfreiheit” and later the dualism of dentists and unexamined dental workers, encouraged by the state and social insurance system, formed a profession with a high inter- and intraprofessional closure. The professional process in Germany puts many questions on the gendered structure and the politics of dentistry, especially prevention and dental public health.     

The precarious supply of physical therapists across Canada: exploring national trends in health human resources (1991 to 2005)

Background  

Health Human Resource (HHR) ratios are one measure of workforce supply, and are often expressed as a ratio in the number of health professionals to a sub-set of the population. In this study, we explore national trends in HHR among physical therapists (PTs) across Canada.     

2002-2006年广东省卫生资源配置公平性的趋势研究

目的:通过调查2002-2006年广东省卫生资源(卫技术员,医生数,病床数)配置情况,并进行公平性评价分析,为卫生资源合理配置评价方法提供实践依据。方法:计算每年每个城市每个卫技人员负担人口数(PHW)、每个医生负担人口数(PP)及每张病床负担人口数(PHB)来反映各城市资源配置平均水平的高低。并通过基尼系数和洛伦茨曲线来反应5年全省卫生资源配置的变化趋势。结果:2002-2006年,全省每个卫技人员、每个医生、每张病床负担人口数都有下降。全省卫技人员在人口配置上其基尼系数为由0.297上升到0.382,医生数基尼系数由0.314上升到0.393,病床数基尼系数由0.345上升到0.367。结论:尽管全省每万人口卫生资源不断增加,资源配置不公平性却有进一步恶化的趋势。     

Rural Illinois Hospital Chief Executive Officers'' Perceptions of Provider Shortages and Issues in Rural Recruitment and Retention

BACKGROUND: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. PURPOSE: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. METHODS: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. FINDINGS: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. CONCLUSIONS: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention.     

基于世界卫生组织WISN方法的社区卫生服务机构人员需求分析

目的:引入世界卫生组织开发的基于工作量指标的卫生人力需求分析工具(WISN),对社区卫生服务机构人员进行工作量和需求分析。方法:以宁夏银川和固原两市的5家社区卫生服务机构为样本,应用WISN方法和软件工具进行分析。结果:样本社区卫生服务机构人员短缺与分布不均衡现象比较严重,工作量压力差异也较大。结论:应用WISN工具很有前景,有助于机构卫生人力需求规划和提高卫生人力利用效率。