Revitalizing Urologists' Role in Transplantation as a Novel Strategy to Address Surgeon Shortage: Results from a Cross-Sectional Survey.

OBJECTIVES: Urologists represent functional alternatives for transplant surgeons, but their involvement is minimal. Evaluating urologists' interests in transplant and identifying associated factors may help to determine whether recruitment of more urological providers is a viable strategy to address transplant surgeon shortages in the United States. MATERIALS AND METHODS: We emailed a 10-question survey to individuals pursuing urology in the United States and collected demographic data, education and training backgrounds, and preferences for proposed integrated residency programs and abbreviated transplant fellowships. We stratified respondents based on transplant interest (yes/no); we made comparisons by using t-tests for continuous variables and Fisher exact tests for categorical variables. We used multivariable logistic regression to identify factors associated with interest in transplant surgery. RESULTS: Of 104 respondents, 98 were included in the final analysis, with 47% indicating a current or prior interest in transplantation. Male respondents were 3.7 times more likely than female respondents to be interested (odds ratio = 4.675; 95% CI, 1.411-15.495; P = .012). Participants aged <30 years were 93% less likely than older participants to be interested in transplantation (odds ratio = 0.071; 95% CI, 0.006-0.779; P = .03). International medical graduates reported higher enthusiasm for transplantation compared with US-trained counterparts (89% vs 42%), with a trend toward significance (P = .06). Nearly all (93%, 43/46) who expressed interest endorsed having an integrated training pathway. Only 70% (32/46) supported an abbreviated fellowship (<24 mo). Lifestyle concerns and insufficient exposure during residency were the most frequently cited reasons for lack of interest. CONCLUSIONS: Compared with male and older urology trainees, female and younger urology trainees were less inclined to pursue transplant surgery. Nonetheless, urologists represent an untapped pool of transplant surgeons. Proposing an integrated training program for urologists and increasing exposure to transplantation during urology residency represent potential strategies to decrease transplant surgeon shortages.

What happens when the tasks dry up? Exploring the impact of medical technology on workforce planning.

Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour.

The Supply of Surgical Specialists and Subspecialists to the U.S. Medicare Population: National Trends from 2013 to 2019.

PURPOSE: The U.S. population is rapidly aging. The supply of surgeons needed to meet this demand should be evaluated. This study evaluated the trends in supply of Medicare surgeons by specialty and by U.S. state and region. METHOD: All surgeons associated with a National Provider Identifier for cardiothoracic surgery, colorectal surgery, general surgery, gynecologic oncology, hand surgery, neurosurgery, obstetrics-gynecology, ophthalmology, oral and maxillofacial surgery, orthopedic surgery, otolaryngology, plastic and reconstructive surgery, surgical oncology, urology, and vascular surgery from 2013 to 2019 on the Centers for Medicare & Medicaid Services website were included. The absolute number of physicians was adjusted per 100,000 Medicare beneficiaries. Annual change was calculated by linear regression model, and the compound annual growth rate (CAGR) was calculated per specialty. RESULTS: The absolute number of physicians per 100,000 beneficiaries increased in 6 of 15 specialties during the study period. Vascular surgery had the largest annual increase (+0.23; CAGR, +2.75%), and obstetrics-gynecology had the largest annual decrease (-1.08; CAGR, -1.44%). Surgical oncology showed the largest positive CAGR (+4.20%). Oral and maxillofacial surgery had the largest negative CAGR (-2.86%). The Northeast was above the national average in supply for each specialty. The Midwest had the most specialties with positive CAGRs. The South did not meet the national average for physicians in any specialty. CONCLUSIONS: This analysis of 15 surgical specialties provides important context to predicted physician shortages to the Medicare population. The study found geographic variation by region across specialty, which has important implications for health care planning from the level of undergraduate medical education to provision of hospital resources. Overall, the supply of surgeons across all specialties may not be sufficient to meet the demand of the rapidly aging U.S. population. Future study is needed to evaluate why surgeons are leaving the Medicare program.

A Odontologia hospitalar nos hospitais públicos vinculados a secretaria do estado da saúde de São Paulo / Hospital dentistry in public hospitals linked the state secretary of health of São Paulo

A atenção odontológica tem sido tradicionalmente realizada em consultórios. Aos hospitais a prática mais comum é reservada ao atendimento cirúrgico bucomaxilofacial ou procedimentos que necessitam de anestesia geral. Entretanto, a atuação do Cirurgião-Dentista em âmbito hospitalar vai além. O Odontólogo deve ter foco no cuidado ao paciente cuja doença sistêmica possa ser fator de risco para agravamento e ou instalação de doença bucal, ou cuja doença bucal possa ser fator de risco para agravamento e ou instalação de doença sistêmica. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). O Estado de São Paulo conta com uma ampla rede de serviços hospitalares próprios. Embora os resultados dos últimos anos comprovem o maior acesso da população a rede hospitalar pública do Estado de São Paulo, com aumento no número de atendimentos a pacientes internados, maior quantidade de cirurgias e de procedimentos complexos realizados (Mendes, Bittar, 2010), não há dados públicos concretos comprovando a atuação do Cirurgião- Dentista nesse contexto. Por outro lado, estudos e experiências em hospitais têm mostrado que a inserção do Cirurgião-Dentista na equipe multiprofissional de atendimento ao paciente sob internação contribui para minimizar o risco de infecção, melhorar a qualidade de vida, reduzir o tempo de internação, diminuir a quantidade de prescrição de medicamentos e a indicação de nutrição parenteral, além de promover um atendimento completo ao paciente. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007...

Dental care has traditionally been performed in dental offices. It is more common practice for oral and maxillofacial surgery care or procedures that require general anesthesia to be reserved for treatment at hospitals. However, the work of the Dental Surgeon in the hospital environment goes beyond this. The Dentist must be focused on care of the patient whose systemic disease may be a risk for aggravation and or onset of oral disease, or whose oral disease may be a risk factor for aggravation or onset of systemic disease. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). The State of São Paulo has a wide network of its own hospital services. Although the results of the last few years have proved that there is greater access by the population to the public hospital network of the State of São Paulo, with an increasing number of attendances of hospitalized patients, larger number of surgeries and complex procedures performed (Mendes, Bittar, 2010), there are no concrete public data proving the activities of the Dental Surgeon in this context. On the other hand, studies and experiences in hospitals have shown that the inclusion of the Dental Surgeon in the multiprofessional team of hospitalized patient care contributes to minimizing the risk of infection, improving quality of life, reducing time of hospitalization, diminishing the amount of medication prescribed and indication of parenteral nutrition, in addition to promoting complete care of the patient. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007; Eduardo et al., 2008; Bezinelli et al., 2013). Ours is a cross-sectional study with the aim of characterizing the Dental Service within public hospitals linked to the State Secretary of Health of São Paulo...