Relative remoteness and wage differentials in the Canadian allied health professional workforce.

INTRODUCTION: Health workforces around the world are characterized with geographic maldistribution, often leading to inequalities in rural health outcomes. Monetary incentives are frequently raised as a policy option to bolster recruitment of healthcare practitioners to rural and underserved communities; however, few rural health workforce studies focus on allied health professionals (AHPs), include urban comparators, integrate gender considerations, or measure rural diversity. This population-based observational study examines trends in the geographic and gender distribution and earnings of AHPs in Canada across the rural-urban continuum. METHODS: Nationally representative data from the 2006 and 2016 Canadian population censuses were pooled and linked with the geocoded Index of Remoteness for all inhabited communities. Five groups of university-educated AHPs providing prevention, diagnostic evaluation, therapy, and rehabilitation services were identified by occupation. Multiple linear regression models were used to estimate the associations between relative remoteness and annual earnings of AHPs aged 25-54 years, controlling for gender and other personal and professional characteristics. RESULTS: The density of AHPs was found to be 15 times higher in more urbanized and accessible parts of the country (23.6-25.6 per 10 000 population in 2016) compared to the most rural and remote areas (1.6 per 10 000 population), a pattern that changed little over the previous decade. A positive correlation was seen across occupations in terms of the degree of feminization and their geographic dispersion by relative remoteness. While pharmacists residing in more rural and remote communities earned 9% (95% confidence interval 4-15%) more than those in core urban centers, relative remoteness contributed little to wage differentials among dentists, physiotherapists and occupational therapists, or other AHPs in therapy and assessment (no significant difference at p<0.05). Women earned significantly less than men in dentistry, pharmacy, and physical or occupational therapy, after adjusting for remoteness and other characteristics. CONCLUSION: This study did not find consistent wage disparities by relative remoteness as characterizing allied health professions in Canada. The evidence base to support financial incentives to AHPs to reduce perceived opportunity costs associated with working and living in rural and underserved areas remains limited. More research is needed on the intersections of rurality, gender, and wage differentials among AHPs in different national contexts.

Gender composition and wage gaps in the Canadian health policy research workforce in comparative perspective.

BACKGROUND: Gendered challenges have been shown to persist among health practitioners in countries at all levels of development. Less is known about non-clinical professionals, that is, those who do not deliver services directly but are essential to health systems performance, such as health policy researchers. This national observational study examined gender occupational segregation and wage gaps in the Canadian health policy research workforce using a cross-domain comparative labour market analysis approach. METHODS: Sourcing data from the 2016 population census, we applied linear regression and Oaxaca-Blinder decomposition techniques to assess wage differentials by sex, traditional human capital measures (e.g., age, education, place of work), and social identity variables intersecting with gender (household head, childcare, migrant status) among health policy researchers aged 25-54. We compared the gender composition and wage gap with seven non-health policy and programme domains, as mapped under the national occupational classification by similarity in the types of work performed. RESULTS: The health policy research workforce (N = 19 955) was characterized by gender segregation: 74% women, compared with 58% women among non-health policy research occupations (N = 102 555). Women health policy researchers earned on average 4.8% (95% CI 1.5‒8.0%) less than men after adjusting for other professional and personal variables. This gap was wider than among education policy researchers with similar gender composition (75% women; adjusted wage gap of 2.6%). Wages among health policy researchers were 21.1% (95% CI 19.4‒22.8%) lower than their counterparts in the male-dominated economics policy domain, all else being equal. Overall, women's earnings averaged 3.2% lower than men's due to factors that remained unexplained by policy domain or other measured predictors. CONCLUSIONS: This investigation found that the gender inequalities already widely seen among clinical practitioners are replicated among health policy researchers, potentially hindering the competitiveness of the health sector for attracting and retaining talent. Our findings suggest intersectoral actions are necessary to tackle wage gaps and devaluation of female-dominated health professions. Accountability for gender equity in health must extend to the professionals tasked with conducting equity-informative health policy research.

A case report of sciatic hernia as a cause of sciatica and lower back pain: Diagnostic dilemma for family physicians.

Degenerative changes in lumbosacral spine or disc bulges impinging on the thecal sac are the usual causes of sciatica. However peripheral compression of sciatic nerve in pelvis or lower limb presenting as sciatica is an uncommon entity. The sciatic hernia is a rare type of hernia. Due to the deep location of this pathology, the clinical examination would add little and imaging plays a pivotal role in diagnosis. We present a case of sciatica diagnosed with giant gluteal lipoma presenting as sciatic notch hernia and compressing sciatic nerve in the greater sciatic notch. Less than 100 cases are reported in the literature so far. The possibility of this rare diagnosis should be kept in mind by family physicians while evaluating patients of sciatica with no significant imaging findings in lumbosacral spine.

Why COVID-19 pandemic builds a convincing case for investing in 'Young Physician Leaders (YPL)'.

There are pressing issues that are plaguing healthcare systems across the world (especially in the lower-middle-income countries), which comprise low-quality care, affordability, accessibility, poor infrastructure, violence against healthcare personnel, deficiency of physicians and healthcare staff. COVID-19 has put an immense physical and mental strain on the young physicians who are at the forefront in fighting this pandemic. This has lead to an increase in incidences of burnout among young doctors, which adversely impacts the quality of healthcare, patient well-being and satisfaction. The present-day medical training typically creates solo medical experts; but, modern-day management of patients and organisations require team-work and leadership. To profoundly alter the way the young physicians work and for creating physician leaders for the future, leadership training ought to commence during the medical school.