[Income of physicians in private practice in Germany: Results of a micro census]. / Einkommen von niedergelassenen Ärztinnen und Ärzten in Deutschland: Ergebnisse des Mikrozensus.

EINLEITUNG: Daten zum Einkommen von Ärzt:innen in Deutschland sind bisher nur teilweise verfügbar. Die Einkommen der niedergelassenen Ärzteschaft werden vor allem aus den Praxiserträgen abgeleitet, was aber große Interpretationsspielräume eröffnet. Ziel des Artikels ist es, diese Lücke zu schließen. METHODIK: Hierfür werden die Einkommensangaben aus dem Mikrozensus 2017 ausgewertet - mit besonderem Fokus auf niedergelassene Ärzt:innen. Neben dem persönlichen Einkommen erfolgt eine Darstellung der Einkommenssituation auf Haushaltsebene. Die Einkommensziffern werden nach Tätigkeitsumfang, Tätigkeitsgruppe (Allgemein-/Fach-/Zahnärzte), Geschlecht und Stadt/Land differenziert. ERGEBNISSE UND SCHLUSSFOLGERUNG: Das verfügbare persönliche Nettoeinkommen niedergelassener Ärzt:innen beträgt bei Vollzeittätigkeit im Mittel knapp 7.900 € pro Monat. Fachärzt:innen liegen bei 8.250 €, Allgemein- und Zahnärzt:innen bei ca. 7.700 €. Eine finanzielle Benachteiligung von Landärzt:innen lässt sich nicht feststellen, Allgemeinärzt:innen aus Gemeinden<5.000 Einwohnerinnen und Einwohner haben mit 8.700 € sogar das höchste Durchschnittseinkommen - bei einer mittleren Arbeitszeit von 51 Stunden pro Woche. Ärztinnen arbeiten häufiger in Teilzeit als Ärzte. Ein niedrigeres Einkommen resultiert überwiegend aus einem geringeren Tätigkeitsumfang. INTRODUCTION: Data on the income of physicians in Germany are only partially available to date. The income of physicians in private practice is derived primarily from practice income, but this opens up considerable scope for interpretation. The aim of this article is to close this gap. METHODOLOGY: For this purpose, the income data from the 2017 micro census were evaluated, with a special focus on physicians in private practice. In addition to personal income, the income situation was presented at the household level. The income figures were differentiated according to the scope of activity, activity group (general practitioners/specialists/dentists), gender and city/country. RESULTS AND CONCLUSION: The disposable personal income of physicians in private practice was just under € 7,900 per month on average for full-time employment. Specialists earned € 8,250, while general practitioners and dentists earned about € 7,700. Rural physicians were not found to suffer from financial disadvantages; general practitioners from municipalities with<5,000 inhabitants even had the highest average income of € 8,700, with an average working time of 51 hours per week. Female physicians worked part-time more often than did male physicians. A lower income resulted primarily from a lower scope of activity.

A global census of physician assistants and physician associates.

The physician assistant or physician associate (PA) profession is being adopted in many countries. At a time of improved communication and international exchange of educational methods, no central repository of PA numbers exists. The authors set out to consolidate basic information on PAs. The purpose of the project was to support efforts underway that include the global development of PAs. The prevalence of PAs in each country was obtained using an informant methodology strategy and supplemented with reports and internet validation. Eighteen countries have a PA (similar healthcare professionals with different titles were not included), for an estimated total of more than 132,000 clinically active PAs and 366 training programs. In most countries, PA expansion was reported as being underway.

Displacement in new economy labor markets: Post-displacement wage loss in high tech versus low tech cities.

While scholars and politicians tout education as the salve to employment disruptions, we argue that the geography of the new economy, and the social closure mechanisms that geography creates, may be just as important as individuals' characteristics for predicting post-displacement wage loss (or gain). We use data from the 2012 Displaced Workers ement of the Current Population Survey and from the 2010 United States Census to test hypotheses linking local labor markets in different industrial contexts to post-displacement wage loss. Our results point to age as a closure mechanism, and to the partially protective effect of education in high-tech versus low-tech economic sectors. This study is the first to use national level data to examine how employment in high-tech cities influences post-displacement wages. These findings are relevant both for theorizing about the new economy and for public policy.

Current employment characteristics and career intentions of Lithuanian dentists.

BACKGROUND: The present survey explored the current employment profile and future career intentions of Lithuanian general dentists and specialists. METHODS: A census sampling method was employed with data collected by means of a structured questionnaire that inquired about demographics, different employment-related aspects (practice type and location, working hours, perceived lack of patients, etc.), and future career intentions (intent to emigrate, to change profession, or the timing of retirement). The final response rate was 67.6% corresponding to 2,008 respondents. RESULTS: The majority of all dentists work full or part-time in the private dental sector, more than one third of them owns a private practice or rents a dental chair. A minority of dentists works in the public dental sector. According to the survey, 26.6% of general dentists and 39.2% of dental specialists works overtime (> 40 hours per week; P < 0.001) and practice in multiple clinics (1.4 ± 0.6 and 2.0 ± 1.2, respectively; P < 0.001). One third of general dentists (31.3%) and dental specialists (31.4%) stated to have a low number of patients (P > 0.05). The majority (68.9% of general dentists and 65.9% of dental specialists) plans to work after the retirement age (P > 0.05). Emigration as an option for their professional career is being considered by 10.8% of general dentists and 8.3% of dental specialists (P > 0.05). Working either full or part-time in private practices (OR = 4.3) and younger age (≤ 35 years; OR = 2.2) are the two strongest predictors for a perceived insufficient number of patients. CONCLUSIONS: One third of dentists in Lithuania work long hours and lack patients. Many dentists practice in multiple locations and plan to retire after the official retirement age. Some dentists and dental specialists plan to emigrate. The perceived shortcomings within the dental care system and workforce planning of dentists need to be addressed.

Economic returns to occupational closure in the German skilled trades.

Recent sociological studies argue that wage differentials between occupations are partly attributable to occupational closure. Occupations set up barriers which restrict the supply of occupational labor, thereby generating an economic rent. In this article we study occupational closure in the skilled trades of Germany, where the Trade and Crafts code restricts self-employment in 41 occupations to those who are master craftsmen. Newly gathered occupational data about the Trade and Crafts code is mapped on micro data from the German Microcensus of 2006. The central finding of our empirical analyses is that self-employed workers with comparable levels of human capital and demographic characteristics earn structurally more in closed occupations. We argue that this earnings premium is a rent, obtained by self-employed because of the entry restriction that is laid down by the Trade and Crafts code.

Foreign-born health workers in Australia: an analysis of census data.

BACKGROUND: Provide an up-to-date national picture of the medical, midwifery and nursing workforce distribution in Australia with a focus on overseas immigration and on production sustainability challenges. METHODS: Using 2006 and 2011 Australian census data, analysis was conducted on medical practitioners (doctors) and on midwifery and nursing professionals. RESULTS: Of the 70,231 medical practitioners in Australia in 2011, 32,919 (47.3%) were Australian-born, with the next largest groups bring born in South Asia and Southeast Asia. In 2006, 51.9% of medical practitioners were born in Australia. Of the 239,924 midwifery and nursing professionals in Australia, 127,911 (66.8%) were born in Australia, with the next largest groups being born in the United Kingdom and Ireland and in Southeast Asia. In 2006, 69.8% of midwifery and nursing professionals were born in Australia. Western Australia has the highest percentage of foreign-born health workers. There is a higher percentage of Australia-born health workers in rural areas than in urban areas (82% of midwifery and nursing professional in rural areas are Australian-born versus 59% in urban areas). Of the 15,168 additional medical practitioners in Australia between the 2006 and 2011 censuses, 10,452 (68.9%) were foreign-born, including large increases from such countries as India, Nepal, Philippines, and Zimbabwe. We estimate that Australia has saved US$1.7 billion in medical education costs through the arrival of foreign-born medical practitioners over the past five years. CONCLUSIONS: The Australian health system is increasingly reliant on foreign-born health workers. This raises questions of medical education sustainability in Australia and on Australia's recruitment from countries facing critical shortages of health workers.

Gender Disparities and Differences Among Urologists Included in Top Doctor Lists.

OBJECTIVE: To understand gender trends among urologists included in "Top Doctor" lists as more women practice urology, we (1) Evaluated whether Top Doctor lists reflect a contemporary distribution of urologists by gender; (2) Describe regional differences in gender composition of lists; (3) Report similarities and differences among men and women Top Doctors. METHODS: All urologists in regional Top Doctor Castle Connolly lists published in magazines between January 1, 2020 and June 22, 2021 were included. Physician attributes were abstracted. American Urological Association (AUA) census data was used to compare the number of men and women Top Doctor urologists to the number of practicing men and women urologists within each list's zip codes. Log odds ratios (OR) and (95% confidence intervals) were used to compare likelihood of list inclusion by gender overall and by region. RESULTS: Four hundred and ninety-four Top Doctor urologists from 25 lists were analyzed, of which 42 (8.50%) were women. Women urologists comprised 0%-27.8% of each list, with 7 lists (28.0%) including zero women urologists. Using AUA census data, OR for list inclusion of men urologists compared to women was 1.31 (1.01, 1.70) overall, with OR = 0.78 (0.36, 1.72) in the West, OR = 1.39 (1.03, 1.89) South, OR = 1.46 (0.8, 2.67) Northeast, OR = 1.90 (0.50, 7.18) Midwest. Women top urologists completed fellowship more often than men (66.7%, 55.1%) and were significantly more likely to complete female pelvic medicine and reconstructive surgery (FPMRS) fellowship (P <.001). CONCLUSION: Men urologists were significantly more likely to be included in Top Doctor lists than women urologists. Top women urologists were significantly more likely to complete FPMRS fellowship.

How Female Is the Future of Urology? Projecting Various Trajectories of the United States Urology Workforce.

OBJECTIVE: To project the number and proportion of women in the urology workforce using recent demographic trends and develop an app to explore updated projections using future data. METHODS: Demographic data were obtained from AUA Censuses and ACGME Data Resource Books. The proportion of female graduating urology residents was characterized with a logistic growth model. "Stock and Flow" models were used to project future population numbers and proportions of female practicing urologists, accounting for trainee demographics, retirement trends, and growth in the field. RESULTS: Assuming growth in urology graduate numbers and continued logistic growth in the proportion of women, 10,957 practicing urologists (38%) will be female by 2062. If the rate of women entering urology residency stagnates, 7038 urologists (24%) will be female. If the retirement rates for women in urology change to mirror those of men and the proportion of female residents continues to experience logistic growth, 11,178 urologists (38%) will be female. An interactive app was designed to allow for a range of assumptions and future data: https://stephenrho.shinyapps.io/uro-workforce/. CONCLUSION: Workforce projections should incorporate recent growth in numbers of female residents. If current growth continues, 38% of urologists will be female by 2062. The app allows for exploration of different scenarios and can be updated with new data. The projections demonstrate the need for targeted efforts to recruit women into urology, address disparities within the field, and work toward retaining female urologists. We must continue working toward an equitable future workforce that can address the impending shortage of urologists.

The characteristics of clinically active older physician assistants.

OBJECTIVE: To prepare for future health workforce requirements, planners need an understanding of the clinical activity of physician assistants (PAs) and their career trajectory. We compared the characteristics of clinically active older PAs to younger PAs. METHOD: PAs were identified from all respondents aged 60 years or older at the time they participated in the annual census of the AAPA from 2005 through 2009. The most recent year of census participation was selected for analysis. This cadre of older PAs was compared with PAs younger than 60 years. Variables included age, gender, year of PA graduation, duration of being a PA, and clinical activity by self-identified work location and specialty. RESULT: A total of 48,692 PAs participated in at least one census from 2005 through 2009. Approximately 5% (2,340) met the age criteria and were clinically active. Clinically active older PAs reported working a mean of 39 hours per week and were employed in a rural setting more often than their younger counterparts. Nearly one-half of older respondents reported their specialty to be primary care. CONCLUSION: Although the career span of a PA is only vaguely understood, a small but significant portion of clinicians appear to remain in the workforce into their seventh decade. They distinguish themselves by working proportionally more in primary care and nonurban areas than younger PAs. Older PAs may represent an American trend by remaining employed longer than historically observed. Gaps in the understanding of role behavior of PAs could be improved with longitudinal databases.

Sources of health insurance and characteristics of the uninsured: analysis of the March 2012 Current Population Survey.

HEALTH COVERAGE RATE INCREASED, UNINSURED DOWN: The percentage of the nonelderly population (under age 65) with health insurance coverage increased to 82 percent in 2011, notable since increases in health insurance coverage have been recorded in only five years since 1994. EMPLOYMENT-BASED COVERAGE REMAINS DOMINANT SOURCE OF HEALTH COVERAGE, BUT CONTINUES TO ERODE: Employment-based health benefits remain the most common form of health coverage in the United States, though it represents a declining share. In 2011, 58.4 percent of the nonelderly population had employment-based health benefits, down from the peak of 69.3 percent in 2000, during the 1994-2011 period. PUBLIC PROGRAM COVERAGE IS EXPANDING: Public program health coverage expanded as a percentage of the population in 2011, accounting for 22.5 percent of the nonelderly population. Enrollment in Medicaid and the State Children's Health Insurance Program (S-CHIP) also increased to a combined 46.9 million in 2011, covering 17.6 percent of the nonelderly population, significantly above the 10.2 percent level of 1999. INDIVIDUAL COVERAGE STABLE: The percentage represented by individually purchased health coverage was unchanged in 2011 and has basically hovered in the 6-7 percent range since 1994. WHAT TO EXPECT IN 2012: The unemployment rate in 2012 has been about 8 percent since the beginning of the year, and remains high amidst a still-sluggish economy. As a result, the nation is likely to see a corresponding erosion of employment-based health benefits when the data for 2012 are released next year. Until the economy gains enough strength to have a substantial impact on the labor market, a rebound in employment-based coverage is unlikely.

The Latino Resident Physician Shortage: A Challenge and Opportunity for Equity, Diversity, and Inclusion.

PURPOSE: The purpose of this study is to examine the number of Latino physicians in residency training and Latino resident physician trends in the nation's 10 largest medical specialties in the United States and in the 4 states with the largest Latino populations: California, Florida, New York, and Texas. METHOD: The authors used data from the United States Census Bureau's American Community Survey to determine Latino populations and a special report from the Association of American Medical Colleges to determine rates of Latino resident physicians in the United States and in California, Florida, New York, and Texas from 2001 to 2017. Rates of Latino residents in the nation's 10 specialties with the largest number of residents were also determined. RESULTS: From 2001 to 2017, the United States had an average of 37 resident physicians per 100,000 population. At the national level, however, Latino residents were underrepresented, with only 14 per 100,000 Latino population. At the state level, California and Texas, the 2 states with the largest Latino populations (39.4% and 39.7% of their population, respectively), had 5 and 9 Latino residents per 100,000 Latino population, respectively. Latino residents in California, Texas, Florida, and New York were also very underrepresented in the primary care specialties examined. CONCLUSIONS: The findings show a severe shortage of Latino resident physicians. While a similar shortage also exists in primary care specialties, the majority of Latinos in states with large Latino populations are consistently choosing to train in primary care. Investment and greater improvement in the representation of certain population groups in medicine and for combating the inequities existing in the current educational system is needed. The authors offer recommendations to increase the number of Latinos in residency programs and for increasing the number of Spanish-speaking physicians and Latino international medical graduates in residency programs.

Employment-based retirement plan participation: geographic differences and trends, 2010.

LATEST DATA: This Issue Brief examines the level of participation by workers in public- and private-sector employment-based pension or retirement plans, based on the U.S. Census Bureau's March 2011 Current Population Survey (CPS), the most recent data currently available (for year-end 2010). SPONSORSHIP RATE: Among all working-age (21-64) wage and salary employees, 54.2 percent worked for an employer or union that sponsored a retirement plan in 2010. Among full-time, full-year wage and salary workers ages 21-64 (those with the strongest connection to the work force), 61.6 percent worked for an employer or union that sponsors a plan. PARTICIPATION LEVEL: Among full-time, full-year wage and salary workers ages 21-64, 54.5 percent participated in a retirement plan. TREND: This is virtually unchanged from 54.4 percent in 2009. Participation trends increased significantly in the late 1990s, and decreased in 2001 and 2002. In 2003 and 2004, the participation trend flattened out. The retirement plan participation level subsequently declined in 2005 and 2006, before a significant increase in 2007. Slight declines occurred in 2008 and 2009, followed by a flattening out of the trend in 2010. AGE: Participation increased with age (61.4 percent for wage and salary workers ages 55-64, compared with 29.2 percent for those ages 21-24). GENDER: Among wage and salary workers ages 21-64, men had a higher participation level than women, but among full-time, full-year workers, women had a higher percentage participating than men (55.5 percent for women, compared with 53.8 percent for men). Female workers' lower probability of participation among wage and salary workers results from their overall lower earnings and lower rates of full-time work in comparison with males. RACE: Hispanic wage and salary workers were significantly less likely than both white and black workers to participate in a retirement plan. The gap between the percentages of black and white plan participants that exists overall narrows when compared across earnings levels. GEOGRAPHIC DIFFERENCES: Wage and salary workers in the South and West had the lowest participation levels (Florida had the lowest percentage, at 43.7 percent) while the upper Midwest, Mid-Atlantic, and Northeast had the highest levels (West Virginia had the highest participation level, at 64.2 percent). OTHER FACTORS: White, more highly educated, higher-income, and married workers are more likely to participate than their counterparts.

Sources of health insurance and characteristics of the uninsured: analysis of the March 2011 current population survey.

LATEST CENSUS DATA: This Issue Brief provides historical data through 2010 on the number and percentage of nonelderly individuals with and without health insurance. Based on EBRI estimates from the U.S. Census Bureau's March 2011 Current Population Survey (CPS), it reflects 2010 data. It also discusses trends in coverage for the 1994-2010 period and highlights characteristics that typically indicate whether an individual is insured. HEALTH COVERAGE RATE CONTINUES TO DECREASE, UNINSURED INCREASE: The percentage of the nonelderly population (under age 65) with health insurance coverage decreased to 81.5 percent in 2010. Increases in health insurance coverage have been recorded in only three years since 1994, when 36.5 million nonelderly individuals were uninsured. The percentage of nonelderly individuals without health insurance coverage was 18.5 percent in 2010, up from 18.3 percent in 2009, and its highest level during the 1994-2010 period. EMPLOYMENT-BASED COVERAGE REMAINS DOMINANT SOURCE OF HEALTH COVERAGE, BUT CONTINUES TO ERODE: Employment-based health benefits remain the most common form of health coverage in the United States. In 2010, 58.7 percent of the nonelderly population had employment-based health benefits, down from 69.3 percent in 2000. SHIFTING COMPOSITION OF EMPLOYMENT-BASED COVERAGE: Between 2007 and 2010, the percentage of individuals under age 65 with employment-based coverage in their own name has dropped. In 2007, 54.2 percent had coverage in their own name. By 2010, it was down to 51.5 percent. Dependent coverage during this time period fell slightly from 17.5 percent to 17.1 percent, and increased slightly from 16.8 percent to 17.1 percent between 2009 and 2010. PUBLIC PROGRAM COVERAGE IS GROWING: Public program health coverage expanded as a percentage of the population in 2010, accounting for 21.6 percent of the nonelderly population. Enrollment in Medicaid and the State Children's Health Insurance Program increased, reaching a combined 45 million in 2010, and covering 16.9 percent of the nonelderly population, significantly above the 10.2 percent level of 1999. INDIVIDUAL COVERAGE STABLE: Individually purchased health coverage was unchanged in 2010 and has basically hovered in the 6-7 percent range since 1994. WHAT TO EXPECT IN 2011: 2010 is the most recent year for data on sources of health coverage. Unemployment in 2011 has been about 9 percent since the beginning of the year. While down from the 2010 average of 9.6 percent, it remains high and there is a continued threat of a double-dip recession increasing it even further. As a result, the nation is likely to see continued erosion of employment-based health benefits when the data for 2011 are released in 2012. Fewer working individuals translates into fewer individuals with access to health benefits in the work place, especially after COBRA subsidies have been exhausted.

Nursing in Brazil: socioeconomic analysis with a focus on the racial composition.

OBJECTIVES: to analyze the socioeconomic characteristics of nurses and nursing technicians living in Brazil according to color/race. METHODS: based on the 2010 Demographic Census sample, 62,451 nursing professionals (nurses and technicians) living in Brazil were selected. Differences in monthly income were estimated by multivariate models, stratified by color or race groups (white, brown, and black). RESULTS: the majority were technicians (61.9%) of white color (54.3%). The income of white nurses exceeded that of brown and black nurses by more than a quarter; among technicians, white professionals had an income approximately 11% higher than brown and black nurses. CONCLUSIONS: differences between incomes of nursing workers were associated with ethnic/racial background, revealing situations in which white professionals systematically presented more favorable job and income conditions than black and brown professionals.

China should emphasize key issues inherent in rational medication management for the elderly.

According to China's Seventh National Census, 18.70% of a total of 1.41 billion people were 60 or older and 13.50% were 65 or older, so China's population is increasingly aging. In conjunction with China's socioeconomic and scientific and technological development and its promotion of medical insurance-related policies, rational medication management for the elderly is a concern in order to control the risk of polypharmacy. This paper summarizes and discusses the following five key issues inherent in rational medication management: i) an increase in serious polypharmacy and the potential risks of medication; ii) a lack of medication consultation service and medication withdraw without healthcare providers' supervision; iii) poor medication compliance among the elderly; iv) insufficient quantity and incompetence of pharmaceutical staffing; and v) limited awareness of pharmaceutical services and lack of trust in the ability of pharmacists. Based on a discussion of factors influencing these issues, suggestions have been put forward in the hopes that China emphasizes rational medication management in order to reduce the risk of polypharmacy and the disease burden of the elderly in China.

[Necessary number of dedicated industrial physicians in Japan: evaluated from the establishment and enterprise census].

The required number of dedicated industrial physicians has been enacted by the Ministry of Health, Labour and Welfare in Japan. However, the number of workplaces requiring an appointment of industrial physicians is unknown, because of the lack of official publication from the Ministry of Health, Labor and Welfare. The Bureau of Statistics in the Ministry of Internal Affairs and Communications has published the Establishment and Enterprise Census. Based on this statistical data, we estimated the minimal necessary number of dedicated industrial physicians in Japan. There are 1,228 workplaces where 1,000 workers or more are regularly employed. Considering that the number of hazardous workplaces where 500-999 workers are regularly employed is around 1,500, it is estimated that at least 2,000-2,500 dedicated industrial physicians are required in Japan.

Users and suppliers of physician services: a tale of two populations.

Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, especially in the light of the widespread phenomenon of population aging. To determine the extent to which shortages exist, one needs to study the population of users of physician services as well as that of the physicians themselves. The authors study both, using the province of Ontario, Canada, as an example. The user population is projected and the implications for requirements calculated, conditional on given utilization rates. On the supplier side, the age and other characteristics of the (active) physician population are examined and patterns of withdrawal investigated. The necessary future growth of supply is calculated, assuming alternative levels of present shortages. The effects of population change on requirements are found to be smaller in the future than in the decade 1981-1991, in the aggregate, not far from the effects in 1991-2001, but highly variable among different categories of physicians.