The need for home care physicians in Japan - 2020 to 2060.

BACKGROUND: Japan faces the most elderly society in the world, and the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060. METHODS: Our estimation is based on modification of major health work force analysis methods using previously reported official data. Two models were developed to estimate the necessary number of full-time equivalent (FTE) home care physicians: one based on home care patient mortality, the other using physician-to-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of patients dying at home. Lastly, we converted estimated FTE physicians to an estimated head count. RESULTS: Results were concordant between our two models. In every instance, there was overlap of high- and low-estimations between the mortality method and the physician-to-patient method, and the estimates show highly similar patterns. Furthermore, our estimation is supported by the current number of physicians, which was calculated using a different method. Approximately 1.7 times (1.6 by head count) the current number of FTE home care physicians will be needed in Japan in the late 2030's, peaking at 33,500 FTE (71,500 head count). However, the need for home care physicians is anticipated to begin decreasing by 2040. CONCLUSION: The results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress future need for physicians. After the late 2030's, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.

What will make a difference? Assessing the impact of policy and non-policy scenarios on estimations of the future GP workforce.

BACKGROUND: Health workforce planning is based on estimates of future needs for and supply of health care services. Given the pipeline time lag for the training of health professionals, inappropriate workforce planning or policies can lead to extended periods of over- or under-supply of health care providers. Often these policy interventions focus on one determinant of supply and do not incorporate other determinants such as changes in population health which impact the need for services. The aim of this study is to examine the effect of the implementation of various workforce policies on the estimated future requirements of the GP workforce, using South Australia as a case study. This is examined in terms of the impact on the workforce gap (excess or shortage), the cost of these workforce policies, and their role in addressing potential non-policy-related future scenarios. METHODS: An integrated simulation model for the general practice workforce in South Australia was developed, which determines the supply and level of services required based on the health of the population over a projection period 2013-2033. The published model is used to assess the effects of various policy and workforce scenarios. For each policy scenario, associated costs were estimated and compared to baseline costs with a 5% discount rate applied. RESULTS: The baseline scenario estimated an excess supply of GPs of 236 full-time equivalent (FTE) in 2013 but this surplus decreased to 28 FTE by 2033. The estimates based on single policy scenarios of role substitution and increased training positions continue the surplus, while a scenario that reduces the number of international medical graduates (IMGs) recruited estimated a move from surplus to shortage by 2033. The best-case outcome where the workforce achieves balance by 2023 and remains balanced to 2033, arose when GP participation rates (a non-policy scenario) were combined with the policy levers of increased GP training positions and reduced IMG recruitment. The cost of each policy varied, with increased role substitution and reduced IMG recruitment resulting in savings (AUD$752,946,586 and AUD$3,783,291 respectively) when compared to baseline costs. Increasing GP training costs over the projection period would cost the government an additional AUD$12,719,798. CONCLUSIONS: Over the next 20 years, South Australia's GP workforce is predicted to remain fairly balanced. However, exogenous changes, such as increased demand for GP services may require policy intervention to address associated workforce shortfalls. The workforce model presented in this paper should be updated at regular intervals to inform the need for policy intervention.

How fast will the registered nurse workforce grow through 2030? Projections in nine regions of the country.

BACKGROUND: After an unprecedented increase in nursing school enrollment and graduates in the past 10 years, projected shortages of nurses have been erased at a national level. However, nursing markets are local, and an uneven distribution of health care providers of all types is a longstanding feature of health care in the United States. PURPOSE: The purpose of this study was to understand how the outlook for future registered nurse (RN) supply varies regionally across the United States. METHODS: We apply our nursing supply model to the nine U.S. Census Divisions to produce separate supply forecasts for each region. DISCUSSION: We find dramatic differences in expected future growth of the nursing workforce across U.S. regions. These range from zero expected growth in the number of RNs per capita in New England and in the Pacific regions between 2015 and 2030 to 40% growth in the East South Central region (Mississippi, Alabama, Tennessee, Kentucky) and in the West South Central region (Texas, Oklahoma, Arkansas, Louisiana). CONCLUSION: Assuming growth in the demand for RNs per population, some regions of the United States are expected to face shortfalls in their nursing workforce if recent trends do not change.

Regional healthcare delivery and demographic change in Germany - scenarios for dermatological care in 2035.

BACKGROUND: The 'demand planning guidelines' issued by the Federal Joint Committee are meant to ensure nationwide delivery of healthcare in Germany. The calculatory variable used to reflect the actual care situation in relation to a given geographical entity is referred to as 'adjusted supply rate'. Against the backdrop of demographic change and already existing problems in replacing retiring physicians, the question arises as to how future dermatological care will evolve at the regional level. METHODS: Using current 'demand planning guidelines' as well as nationwide data on the location of dermatologists and current and projected population figures at the county level, the adjusted supply rate - in terms of dermatological care - was calculated for the year 2035 based on three possible scenarios (scenario 1: 100 % replacement of retiring dermatologists; scenario 2: non-replacement of one dermatologist per planning area; and scenario 3: non-replacement of two dermatologists in rural areas). RESULTS: While scenario 1 shows an actual improvement in regional dermatological care in certain areas between 2014 and 2035 (n = 3 no longer undersupplied), the more likely scenarios 2 and 3 are potentially associated with considerable regional undersupply. CONCLUSIONS: Taking demographic change into account, it is safe to assume that the geographical heterogeneity of dermatological care will increase. This requires greater effort not only in terms of demand planning but also with regard to offering alternative methods of delivering healthcare and intercommunal cooperation. In this context, the objective will be to adapt healthcare delivery to changes both in demography as well as in the plans young physicians have for their own lives.

Theory of Constraints: What Can We Learn to Support the Nursing Workforce?

Demand for nurses is influenced by many factors. Labor statistics and health services literature reveal current and predicted supply gaps in meeting this demand. One strategy in response can be drawn from manufacturing industries. This column suggests the application of the Theory of Constraints in efforts to relieve bottlenecks in producing and retaining nurse labor.

Trends in general practitioners/family doctors workload in Croatia in period 1995-2012.

This research aimed to present public data describing the Croatian family doctors (FDs) workload, presented as the average number of patients on the lists, and annual and daily number of consultations per one FD team during the period 1995-2012. Croatian Health Service Yearbook for consecutive years was used as basis for data collection. Impressive increase number of persons on FD lists and significant increase of rate of persons per FD team were observed. Average number of contact to FD team also showed constant increase, starting at level of 5.9 per year in 1995 and reaching 9.6 per year in 2012. However, average number of direct consultation (including physical examination) to FD showed modest increase from level of 4.1 per year in 1995 till level of 5.8 per year in 2005. The number of referrals per one visit remain stable, but the number of referrals per one direct consultation decreased. The data stress problem of discrepancy of increasing number of persons on FD lists and stagnation trend of number of FD teams in Croatian primary health care. Results suggested problem of increasing workload of FD teams, but further research are needed for deeper amylases of the FDs workload.

The medical workforce in 2025: what's in the numbers?

Key trends in Australian medical workforce supply include increasing overall supply levels and an increasing number of medical graduates, but also reduced workforce effort and a large cohort of doctors approaching traditional retirement age. Although prevocational and vocational training programs are beginning to expand, there are significant bottlenecks in the postgraduate training pathway for the sizeable cohorts of new graduates. The primary health care workforce needs continued development, including team-based approaches to care and increased use of technology. Increasing our understanding of system-level and individual-level determinants of doctors' choices and implementing innovative strategies to accommodate the increasingly diverse work patterns of doctors are critical to ensuring that in future there are sufficient doctors, with the right skills, in the right places.

Minnesota's rural health workforce shortages.

With the Affordable Care Act's promise of health insurance coverage for 34 million more Americans comes the question of whether the medical establishment has the capacity to provide care to all who need it. Concern over whether the United States has enough primary care physicians, especially in rural areas, isn't new. Since the end of World War II, the country has been contending with shortages. This article provides an historical perspective on the shortage and efforts to alleviate it in the United States and Minnesota.

General practice - workforce gaps now and in 2020.

BACKGROUND: The general practice workforce required for Australia in the future will depend on many factors, including geographic areas and patient utilisation of general practice services. OBJECTIVE: This article examines the current and future general practice workforce requirements by way of an analysis of geographic areas accounting for differing patient utilisation. DISCUSSION: The results showed that, compared with major cities, inner regional areas had 24.4% higher expected patient general practice utilisation per general practitioner, outer regional 33.2%, and remote/very remote 21.4%. Balanced distribution would mean 1129 fewer GPs in major cities: 639 more in inner regional, 423 more in outer regional and 66 more in remote/very remote. With the population projected to increase 18.6-26.1% by 2020, expected general practice utilisation will increase by 27.0-33.1%. Initiatives addressing general practice workforce shortages should account for increasing general practice utilisation due to the aging population, or risk exacerbating the unequal distribution of general practice services.

Shortage of cardiothoracic surgeons is likely by 2020.

BACKGROUND: Even as the burden of cardiovascular disease in the United States is increasing as the population grows and ages, the number of active cardiothoracic surgeons has fallen for the first time in 20 years. Meanwhile, the treatment of patients with coronary artery disease continues to evolve amid uncertain changes in technology. This study evaluates current and future requirements for cardiothoracic surgeons in light of decreasing rates of coronary artery bypass grafting procedures. METHODS AND RESULTS: Projections of supply and demand for cardiothoracic surgeons are based on analysis of population, physician office, hospital, and physician data sets to estimate current patterns of healthcare use and delivery. Using a simulation model, we project the future supply of cardiothoracic surgeons under alternative assumptions about the number of new fellows trained each year. Future demand is modeled, taking into account patient demographics, under current and alternative use rates that include the elimination of open revascularization. By 2025, the demand for cardiothoracic surgeons could increase by 46% on the basis of population growth and aging if current healthcare use and service delivery patterns continue. Even with complete elimination of coronary artery bypass grafting, there is a projected shortfall of cardiothoracic surgeons because the active supply is projected to decrease 21% over the same time period as a result of retirement and declining entrants. CONCLUSIONS: The United States is facing a shortage of cardiothoracic surgeons within the next 10 years, which could diminish quality of care if non-board-certified physicians expand their role in cardiothoracic surgery or if patients must delay appropriate care because of a shortage of well-trained surgeons.

Report of the 2019-2020 AACP Academic Affairs Committee: Developing the Pharmacist Workforce for Society's Medication Use Needs in 2030.

The 2019-2020 Academic Affairs Committee was charged with identifying promising practices in academic-practice partnerships and professional pharmacy organization initiatives that are accelerating the transformation of a workforce prepared to assume responsibility for society's medication use needs in 2030 and determining the role AACP can plan in supporting these partnerships and initiatives. The committee identified a set of ideal principles, characteristics, and design elements of a high-quality, large-scale workforce development program. The committee also categorized current mechanisms for professional workforce development, in addition to identifying their strengths and weaknesses, with the realization that novel approaches are needed to accomplish the goal of large-scale workforce transformation. This report also highlights two existing initiatives aligned with accelerating the transformation of the workforce (ie, the Community Pharmacy Enhanced Services Network (CPESN) ACT (Academia-CPESN Transformation) Pharmacy Collaborative and the American Pharmacists Association ADVANCE platform) and is proposing a policy statement affirming AACP's support. Furthermore, the committee is proposing another policy statement supporting colleges and schools of pharmacy taking an active role in implementing innovative and novel approaches for the development of the current workforce. In order to truly understand the many factors influencing large-scale workforce transformation, the committee is also proposing a stakeholder conference with a wide range of participants and a targeted set of questions focused on current and future needs.

Trends in Unmet Need for Physician and Preventive Services in the United States, 1998-2017.

Importance: Improvements in insurance coverage and access to care have resulted from the Affordable Care Act (ACA). However, a focus on short-term pre- to post-ACA changes may distract attention from longer-term trends in unmet health needs, and the problems that persist. Objective: To identify changes from 1998 to 2017 in unmet need for physician services among insured and uninsured adults aged 18 to 64 years in the United States. Design, Setting, and Participants: Survey study using 20 years of data, from January 1, 1998, to December 31, 2017, from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System to identify trends in unmet need for physician and preventive services. Main Outcomes and Measures: The proportion of persons unable to see a physician when needed owing to cost (in the past year), having no routine checkup for those in whom a routine checkup was likely indicated (within 2 years), or failing to receive clinically indicated preventive services (in the recommended timeframe), overall and among subgroups defined by the presence of chronic illnesses and by self-reported health status. We estimated changes over time using logistic regression controlling for age, sex, race, Census region, employment status, and income. Results: Among the adults aged 18 to 64 years in 1998 (n = 117 392) and in 2017 (n = 282 378) who responded to the Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System (mean age was 39.2 [95% CI, 39.0-39.3]; 50.3% were female; 65.9% were white), uninsurance decreased by 2.1 (95% CI, 1.6-2.5) percentage points (from 16.9% to 14.8%). However, the adjusted proportion unable to see a physician owing to cost increased by 2.7 (95% CI, 2.2-3.8) percentage points overall (from 11.4% to 15.7%, unadjusted); by 5.9 (95% CI, 4.1-7.8) percentage points among the uninsured (32.9% to 39.6%, unadjusted) and 3.6 (95% CI, 3.2-4.0) percentage points among the insured (from 7.1% to 11.5%, unadjusted). The adjusted proportion of persons with chronic medical conditions who were unable to see a physician because of cost also increased for most conditions. For example, an increase in the inability to see a physician because of cost for patients with cardiovascular disease was 5.9% (95% CI, 1.7%-10.1%), for patients with elevated cholesterol was 3.5% (95% CI, 2.5%-4.5%), and for patients with binge drinking was 3.1% (95% CI, 2.3%-3.3%). The adjusted proportion of chronically ill adults receiving checkups did not change. While the adjusted share of people receiving guideline-recommended cholesterol tests (16.8% [95% CI, 16.1%-17.4%]) and flu shots (13.2% [95% CI, 12.7%-13.8%]) increased, the proportion of women receiving mammograms decreased (-6.7% [95% CI, -7.8 to -5.5]). Conclusions and Relevance: Despite coverage gains since 1998, most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased.