It's a jungle out there: Understanding physician payment and its role in group dynamics.

Although collaboration between healthcare professionals is essential for the delivery of effective, efficient, and high-quality care, it remains an ongoing and critical challenge across health systems. As a result, many countries are experimenting with innovative payment and employment models. The literature tends to focus on improving collaboration across organizational and sectoral boundaries, and largely ignores potential barriers to collaborative work between members of the same profession within a single organization. Despite intergroup dynamics and professional boundaries having been shown to restrict patient flow and collaboration between specialties, studies have so far tended to overlook the potential effects of differentiated organizational and payment models on physicians' behaviors and intergroup dynamics. In the present study, we seek to unpack the influence of physicians' payment and employment models on their collaborative behaviors and on intergroup dynamics between specialties, adding to the current scholarship on physician payment and employment by considering how physicians' view and act in response to different structural arrangements. The findings suggest that adopting hybrid models, in which physicians are employed or paid differently within the same organization or practice, creates a bifurcation of the profession whereby physicians across different models are perceived to behave differently and have conflicting professional values. These models are perceived to inhibit collaboration between physicians and complicate hospital governance, restricting the ability to move towards new models of care delivery. These findings can be used as a basis for future work that aims to unpack the reality of physician payment and offer important insights for policies surrounding physician employment.

Cost of Training Crisis: Anaesthetics.

The anaesthetic training programme in the United Kingdom (UK) spans over seven years and is overseen by the Royal College of Anaesthetists (RCOA). Junior doctors in England are currently striking amid ongoing pay negotiations with the government, and almost all junior doctors are worried about the cost of living. This article provides an overview of the average financial cost of training for doctors in the anaesthetic training programme. The cost incurred by anaesthetic trainees illustrates the level of financial burden faced by trainees across multiple specialities. The cost includes: student loan repayment (with interest rates), compulsory membership fees (including the Royal College of Anaesthetists and General Medical Council), postgraduate examinations (Fellowship of the Royal College of Anaesthetist exams are compulsory to complete training) and medical indemnity. The average trainee spends between 5.6% and 7.4% of their annual salary on non-reimbursable costs. This article delineates for aforementioned expenses and compares them with the training programs in Australia and New Zealand, given their status as frequent emigration destinations for UK doctors.

Beyond minimum wage: Broader employment policies can significantly affect food insecurity.

Although many have investigated the impacts of minimum wage on a broad array of health outcomes, innovative policies surrounding broader employment policies have largely not been studied. To that end, this paper contributes in three ways. First, it discusses the rise in precarious employment. Then, it turns to the current federal framework of employment policies, namely minimum wage. Finally, it explores what a broader definition of employment policies could include and how future studies could use state, county, and municipal policymaking in this space to investigate ways in which they might contribute to reducing food insecurity and in turn, improve health outcomes.

About 30% of low-income households experienced food insecurity in 2023. Given that food security is strongly tied to employment conditions, there is potential to reduce food insecurity through innovative employment-focused policy changes. Minimum wage is often studied as an indicator of employment quality. However, employment policies now stretch beyond hourly rate, as several jurisdictions have adopted innovative, broader approaches to improving employment. More research is needed to determine whether these broader employment policies, such as secure scheduling, paid leave, and collective bargaining, may mitigate food insecurity.

The Gender Wage Gap Among Early-Career Family Physicians.

PURPOSE: Numerous studies have documented salary differences between male and female physicians. For many specialties, this wage gap has been explored by controlling for measurable factors that influence pay such as productivity, work-life balance, and practice patterns. In family medicine where practice activities differ widely between physicians, it is important to understand what measurable factors may be contributing to the gender wage gap, so that employers and policymakers and can address unjust disparities. METHODS: We used data from the 2017 to 2020 American Board of Family Medicine (ABFM) National Graduate Survey (NGS) which is administered to family physicians 3 years after residency (n = 8608; response rate = 63.9%, 56.2% female). The survey collects clinical income and practice patterns. Multiple linear regression analysis was performed, which included variables on hours worked, degree type, principal professional activity, rural/urban, and region. RESULTS: Although early-career family physician incomes averaged $225,278, female respondents reported incomes that were $43,566 (17%) lower than those of male respondents (P = .001). Generally, female respondents tended toward lower-earning principal professional activities and US regions; worked fewer hours (2.9 per week); and tended to work more frequently in urban settings. However, in adjusted models, this gap in income only fell to $31,804 (13% lower than male respondents, P = .001). CONCLUSION: Even after controlling for measurable factors such as hours worked, degree type, principal professional activity, population density, and region, a significant wage gap persists. Interventions should be taken to eliminate gender bias in wage determinations for family physicians.

Enhancing detection of labor violations in the agricultural sector: A multilevel generalized linear regression model of H-2A violation counts.

Agricultural workers are essential to the supply chain for our daily food, and yet, many face harmful work conditions, including garnished wages, and other labor violations. Workers on H-2A visas are particularly vulnerable due to the precarity of their immigration status being tied to their employer. Although worksite inspections are one mechanism to detect such violations, many labor violations affecting agricultural workers go undetected due to limited inspection resources. In this study, we identify multiple state and industry level factors that correlate with H-2A violations identified by the U.S. Department of Labor's Wage and Hour Division using a multilevel zero-inflated negative binomial model. We find that three state-level factors (average farm acreage size, the number of agricultural establishments with less than 20 employees, and higher poverty rates) are correlated with H-2A violations. These findings offer valuable insights into where H-2A violations are being detected at the state and industry levels.

Commitment to inclusion: The importance of collaboration in gender equity work.

Despite decades of faculty professional development programs created to prepare women for leadership, gender inequities persist in salary, promotion, and leadership roles. Indeed, men still earn more than women, are more likely than women to hold the rank of professor, and hold the vast majority of positions of power in academic medicine. Institutions demonstrate commitment to their faculty's growth by investing resources, including creating faculty development programs. These programs are essential to help prepare women to lead and navigate the highly matrixed, complex systems of academic medicine. However, data still show that women persistently lag behind men in their career advancement and salary. Clearly, training women to adapt to existing structures and norms alone is not sufficient. To effectively generate organizational change, leaders with power and resources must commit to gender equity. This article describes several efforts by the Office of Faculty in the Johns Hopkins University School of Medicine to broaden inclusivity in collaborative work for gender equity. The authors are women and men leaders in the Office of Faculty, which is within the Johns Hopkins University School of Medicine dean's office and includes Women in Science and Medicine. Here, we discuss potential methods to advance gender equity using inclusivity based on our institutional experience and on the findings of other studies. Ongoing data collection to evaluate programmatic outcomes in the Johns Hopkins University School of Medicine will be reported in the future.

Managerial (dis)preferences towards employees working from home: Post-pandemic experimental evidence.

Work from home (WFH) has been a part of the professional landscape for over two decades, yet it was the COVID-19 pandemic that has substantially increased its prevalence. The impact of WFH on careers is rather ambiguous, and a question remains open about how this effect is manifested in the current times considering the recent extensive and widespread use of WFH during the pandemic. To answer these questions, this article investigates whether managerial preferences for promotion, salary increase and training allowance depend on employee engagement in WFH. We take into account the employee's gender, parental status as well as the frequency of WFH. Furthermore, we examine whether managers' experience with WFH and its prevalence in the team moderate the effect of WFH on careers. An online survey experiment was run on a sample of over 1,000 managers from the United Kingdom. The experiment was conducted between July and December 2022. The findings indicate that employees who WFH are less likely to be considered for promotion, salary increase and training than on-site workers. The pay and promotion penalties for WFH are particularly true for men (both fathers and non-fathers) and childless women, but not mothers. We also find that employees operating in teams with a higher prevalence of WFH do not experience negative career effects when working from home. Additionally, the more WFH experience the manager has, the lesser the career penalty for engaging in this mode of working. Our study not only provides evidence on WFH and career outcomes in the post-pandemic context but also furthers previous understanding of how WFH impacts careers by showing its effect across different groups of employees, highlighting the importance of familiarisation and social acceptance of flexible working arrangements in their impact on career outcomes.

Welfare effect analysis of pay-as-you-go pension system: Deconstruction from the perspective of relative utility and social equality.

This paper studies the redistributive effects of two major pay-as-you-go pension systems by constructing an intergenerational iterative model which does not only considers standard utility but also relative utility. The study find that the two main pay-as-you-go pension systems are both sustainable. If we consider different preferences, then the choice of pension system should depend on the question of whether individuals are more interested in the absolute level of consumption or in the consumption related to a reference group. If the latter is more important, the Beveridgean system is superior, it provides greater protection for vulnerable groups than the Bismarck pension system, and the pension income after retirement is relatively more balanced, but the price is a lower level of consumption in the long run compared to an economy with Bismarckian system. If individuals prefer instead the absolute level of consumption, the Bismarckian system is better, because it guarantees a comparable higher level of consumption, but the disadvantaged groups face a higher risk of poverty and the degree of social inequality will be relatively higher. However, it is important to note that in the long run, only the level of consumption differs, not the speed of growth or number of children.

Health budget cuts will be paid for by the most vulnerable.

No abstract available.

How our longitudinal employment patterns might shape our health as we approach middle adulthood-US NLSY79 cohort.

Recent labor market transformations brought on by digital and technological advances, together with the rise of the service economy since the 1980s, have subjected more workers to precarious conditions, such as irregular work hours and low or unpredictable wages, threatening their economic well-being and health. This study advances our understanding of the critical role employment plays in our health by examining how employment patterns throughout our working lives, based on work schedules, may shape our health at age 50, paying particular attention to the moderating role of social position. The National Longitudinal Survey of Youth-1979 (NLSY79), which has collected 30+ years of longitudinal information, was used to examine how employment patterns starting at ages 22 (n ≈ 7,336) might be associated with sleep hours and quality, physical and mental functions, and the likelihood of reporting poor health and depressive symptoms at age 50. Sequence analysis found five dominant employment patterns between ages 22 and 49: "mostly not working" (10%), "early standard hours before transitioning into mostly variable hours" (12%), "early standard hours before transitioning into volatile schedules" (early ST-volatile, 17%), "mostly standard hours with some variable hours" (35%), and "stable standard hours" (26%). The multiple regression analyses indicate that having the "early ST-volatile" schedule pattern between ages 22 and 49 was consistently, significantly associated with the poorest health, including the fewest hours of sleep per day, the lowest sleep quality, the lowest physical and mental functions, and the highest likelihood of reporting poor health and depressive symptoms at age 50. In addition, social position plays a significant role in these adverse health consequences. For example, whereas non-Hispanic White women reported the most hours of sleep and non-Hispanic Black men reported the fewest, the opposite was true for sleep quality. In addition, non-Hispanic Black men with less than a high school education had the highest likelihood of reporting poor health at age 50 if they engaged in an employment pattern of "early ST-volatile" between ages 22 and 49. In comparison, non-Hispanic White men with a college degree or above education had the lowest likelihood of reporting poor health if they engaged in an employment pattern of stable standard hours. This analysis underscores the critical role of employment patterns in shaping our daily routines, which matter to sleep and physical and mental health as we approach middle adulthood. Notably, the groups with relatively disadvantaged social positions are also likely to be subject to nonstandard work schedules, including non-Hispanic Blacks and people with low education; hence, they were more likely than others to shoulder the harmful links between nonstandard work schedules and sleep and health, worsening their probability of maintaining and nurturing their health as they approach middle adulthood.

Quantifying fair income distribution in Thailand.

Given a vast concern about high income inequality in Thailand as opposed to empirical findings around the world showing people's preference for fair income inequality over unfair income equality, it is therefore important to examine whether inequality in income distribution in Thailand over the past three decades is fair, and what fair inequality in income distribution in Thailand should be. To quantitatively measure fair income distribution, this study employs the fairness benchmarks that are derived from the distributions of athletes' salaries in professional sports which satisfy the concepts of distributive justice and procedural justice, the no-envy principle of fair allocation, and the general consensus or the international norm criterion of a meaningful benchmark. By using the data on quintile income shares and the income Gini index of Thailand from the National Social and Economic Development Council, this study finds that, throughout the period from 1988 to 2021, the Thai income earners in the bottom 20%, the second 20%, and the top 20% receive income shares more than the fair shares whereas those in the third 20% and the fourth 20% receive income shares less than the fair shares. Provided that there are infinite combinations of quintile income shares that can have the same value of income Gini index but only one of them is regarded as fair, this study demonstrates the use of fairness benchmarks as a practical guideline for designing policies with an aim to achieve fair income distribution in Thailand. Moreover, a comparative analysis is conducted by employing the method for estimating optimal (fair) income distribution representing feasible income equality in order to provide an alternative recommendation on what optimal (fair) income distribution characterizing feasible income equality in Thailand should be.

Foreign outsourcing collaboration within a developing economy's perspective: A case of the Pakistani textile industry.

This paper develops an outsourcing collaboration model from a firm's perspective operating in a developing economy. The model considers that producers of the final goods residing in a developed country, and operators of manufacturing plants in a developing country collaborate with each other. The final goods producer supplies headquarter services for the production of intermediate goods in the developing country. The operators of manufacturing plants also supply their services in the domestic economy. This arrangement leads to foreign outsourcing collaborations (FOC) between firms of developed country and developing country. The operators of manufacturing plant maximize revenue subject to the cost constraint. The first order conditions suggests that an increase in wages of skilled labor, price of domestic inputs, and cost of production deter FOC. On the other hand, an increase in demand for and price of foreign headquarter services increases the FOC. Empirical analysis based on data collected from 217 clothing (textile and apparel) firms in the city of Faisalabad (Pakistan) reveals that an increase in wage to labor-productivity ratio reduces FOC. An improvement in skilled of the labor and foreign headquarter services give rise to FOC, whereas an increase in economies-of-scope enhances FOC. Additionally, an inverted U-shaped relationship is found between the cost of production and FOC, which shows that at the initial stage, the firm's cost of production increases with an increase in the level of FOC, but soon after the tipping point, the firm's cost starts decreasing with a further increase in FOC.

Does the opening of producer services promote the wage growth of the downstream manufacturing industry?-Empirical evidence from Chinese manufacturing listed companies.

Based on the vertical connection between upstream and downstream industries, a unique theoretical model is constructed to analyse the impact mechanism of the opening of producer services on downstream manufacturing wage growth. The empirical tests are carried out using the data of China's manufacturing listed companies from 1999 to 2020. Our findings indicate that the opening of producer services has an inverted-U-shaped impact on downstream manufacturing wage growth, and the average level of the opening of producer services in the sample period is lower than the corresponding threshold. Overall, it is in the stage of promoting the wage growth of the downstream manufacturing industry. The opening of producer services mainly affects the wage growth of the downstream manufacturing industry through two channels: labour productivity and labour income share. The results of heterogeneity analysis show that the wages of capital and technology-intensive and low-competitive manufacturing industries are relatively strongly promoted by the opening of producer services. Therefore, promoting the orderly opening of producer services and strengthening the technological links between industries will help promote the wage growth of downstream manufacturing industries.