A comparative analysis on human resources among the specialized ophthalmic medical institutions in China.

BACKGROUND: This study compares perspectives on specialized ophthalmic medical institutions, identifies the gaps in property and geographic offerings, and explores the ways that ophthalmic medical institutions can better allocate resources. The results of this research will increase patient's access to equitable and high-quality ophthalmic care in China. METHODS: The data for this research was gathered from the Survey of China National Eye Care Capacity and Resource for the year 2015. The paper specified the number, professional level of expertise, and educational background of ophthalmic health personnel. The authors of the paper analyzed and compared the differences in ophthalmic care in public vs. private and urban vs. rural regions in China. Descriptive statistics were used. RESULTS: Of the 395 specialized ophthalmic hospitals surveyed, 332 were private medical institutions (84%), and 63 were public (16%). Of the 26 607 ophthalmic personnel surveyed, working in specialized ophthalmic hospitals, 17 561 were in private hospitals (66%) and 9 046 were in public ones (34%). Furthermore, 22 578 of those personnel worked in urban ophthalmic institutions (85%) and 4 029 worked in rural ones (15%). As for regional differences, 14 090 personnel were located in eastern China (53%), 8 828 in central regions (33%), and 3 689 in the western regions (14%). CONCLUSIONS: Public ophthalmic medical institutions still face challenges in providing equitable and widespread care. The availability of well-staffed health centers varies significantly by region. These variations impact resource allocation and directly lead to inequalities and inaccessibility of health services in certain regions of China.

Shape of allied health: an environmental scan of 27 allied health professions in Victoria.

Objective In 2015, the Victorian Department of Health and Human Services commissioned the Victorian Allied Health Workforce Research Program to provide data on allied health professions in the Victorian public, private and not-for-profit sectors. Herein we present a snapshot of the demographic profiles and distribution of these professions in Victoria and discuss the workforce implications. Methods The program commenced with an environmental scan of 27 allied health professions in Victoria. This substantial scoping exercise identified existing data, resources and contexts for each profession to guide future data collection and research. Each environmental scan reviewed existing data relating to the 27 professions, augmented by an online questionnaire sent to the professional bodies representing each discipline. Results Workforce data were patchy but, based on the evidence available, the allied health professions in Victoria vary greatly in size (ranging from just 17 child life therapists to 6288 psychologists), are predominantly female (83% of professions are more than 50% female) and half the professions report that 30% of their workforce is aged under 30 years. New training programs have increased workforce inflows to many professions, but there is little understanding of attrition rates. Professions reported a lack of senior positions in the public sector and a concomitant lack of senior specialised staff available to support more junior staff. Increasing numbers of allied health graduates are being employed directly in private practice because of a lack of growth in new positions in the public sector and changing funding models. Smaller professions reported that their members are more likely to be professionally isolated within an allied health team or larger organisations. Uneven rural-urban workforce distribution was evident across most professions. Conclusions Workforce planning for allied health is extremely complex because of the lack of data, fragmented funding and regulatory frameworks and diverse employment contexts. What is known about this topic? There is a lack of good-quality workforce data on the allied health professions generally. The allied health workforce is highly feminised and unevenly distributed geographically, but there is little analysis of these issues across professions. What does this paper add? The juxtaposition of the health workforce demographics and distribution of 27 allied health professions in Victoria illustrates some clear trends and identifies several common themes across professions. What are the implications for practitioners? There are opportunities for the allied health professions to collectively address several of the common issues to achieve economies of scale, given the large number of professions and small size of many.

Strengthening the rural dietetics workforce: examining early effects of the Northern Ontario Dietetic Internship Program on recruitment and retention.

INTRODUCTION: As with other allied health professions, recruitment and retention of dietitians to positions in rural and isolated positions is challenging. The aim of this study was to examine the early effects of the Northern Ontario Dietetic Internship Program (NODIP) on recruitment and retention of dietitians to rural and northern dietetics practice. The program is unique in being the only postgraduate dietetics internship program in Canada that actively selects candidates who have a desire to live and work in northern and rural areas. Objectives of the survey were to track the early career experiences of the first five cohorts (2008-2012) of NODIP graduates, with an emphasis on employment in underserviced rural and northern areas of Ontario. METHODS: NODIP graduates (62) were invited to complete a 27-item, self-administered, mailed questionnaire approximately 22 months after graduation. The survey, reflecting issues identified in the rural allied health and dietetics literature, documented their work history, practice locations, employment settings, roles, future career intentions and rural background. Aggregated data were analyzed descriptively to assess their early work experiences, with a focus on their acceptance of positions in rural and northern communities. Items also assessed professional and personal factors influencing their most recent decisions concerning practice locations. RESULTS: Three-quarters of graduates chose organizations serving rural or northern communities for their first employment positions and two-thirds were practicing in rural and underserviced areas when surveyed. Most worked as clinical, community health or public health dietitians, in diverse settings including clinics, hospitals and diabetes care programs. Although most had found permanent positions, working for more than one employer at a time was not uncommon. Factors affecting practice choices included prior awareness of employers, prospects for full-time employment, flexible working conditions, access to interprofessional practice and continuing education, as well as community and family concerns. Intentions to remain in current positions were also shaped by a mixture of professional and personal considerations. Some would relocate in search of opportunities for specialization; a few would leave due to dissatisfaction with employment conditions and disinterest in work; others would move due to personal and family commitments. CONCLUSIONS: This study provides early evidence that the NODIP distributed and community-engaged learning model has been very successful in its goal of augmenting the rural and northern dietetics workforce, with a majority of graduates accepting and remaining in rural positions during their first 2 years of practice. Whether graduates remain in rural practice, however, depends on a number of other factors, including career aspirations, availability of professional supports and personal commitments. This suggests that additional supports, above and beyond the NODIP internship, may be needed to encourage graduate dietitians to stay in rural and northern practice locations over the longer term.

Pre-entry student clinical placement demand: can it be met?

OBJECTIVES: The Clinical Education Workload Management Initiative (the Initiative) is a unique, multiprofessional, jurisdiction-wide approach and reform process enshrined within an industrial agreement. The Initiative enabled significant investment in allied health clinical education across Queensland public health services to address the workload associated with providing pre-entry clinical placements. This paper describes the outcomes of a quality review activity to measure the impact of the Initiative on placement capacity and workload management for five allied health professions. Data related to several key factors impacting on placement supply and demand in addition to qualitative perspectives from workforce surveys are reported. METHODS: Data from a range of quality review actions including collated placement activity data, and workforce and student cohort statistics were appraised. Stakeholder perspectives reported in surveys were analysed for emerging themes. RESULTS: Placement offers showed an upward trend in the context of increased university program and student numbers and in contrast with a downward trend in full-time equivalent (FTE) staffnumbers. Initiative-funded positions were identified as a major factor in individual practitioners taking more students, and staff and managers valued the Initiative-funded positions' support before and during placements, in the coordination of placements, and in building partnerships with universities. CONCLUSIONS: The Initiative enabled a co-ordinated response to meeting placement demand and enhanced collaborations between the health and education sectors. Sustaining pre-entry student placement provision remains a challenge for the future.

Medical students working as health care assistants: an evaluation.

BACKGROUND: The General Medical Council requires that medical students are taught human values and how to work effectively with colleagues. Health care assistants (HCAs) provide fundamental patient care as part of the wider health care team. Reports suggest that medical students gain valuable insights when working as HCAs. METHODS: In 2015, a pilot was developed for medical students to work as and with HCAs. The experience involved 3 days training in preparation for three supervised shifts. The pilot was expanded to involve more students and clinical partners. RESULTS: A total of 131 students completed the HCA project between 2015 and 2018. Students were asked to complete a questionnaire where they scored a set of statements using a 5-point Likert scale, and gave open comments that were analysed thematically. A total of 119 students completed the questionnaire, of which 91% of students rated the experience as good or excellent and 98% of students agreed or completely agreed that they had met the learning outcomes. Themes centred around: feeling empathy; building confidence; appreciating the HCA team role; and how this experience may influence their future practice as doctors. A total of 87% of students said the experience should be mandatory. CONCLUSIONS: Students find the opportunity to work as HCAs meaningful and enjoyable. This brief initiative may help students develop a number of skills and attributes that assist in shaping future doctors. Further to helping medical students understand what values-based practice actually means and why it matters to patients, it also clarifies HCAs' and other professionals' contribution to the wider health care team. A research study is underway to evidence its impact.

Why Is Treatment Urgency Often Overestimated? An Experimental Study on the Phenomenon of Over-triage.

In the 19th century, triage emerged as an administrative concept to overcome the unjust and medically unreasonable consequences of an unsystematic adhoc selection of casualties. Until today, however, triage concepts are often applied incorrectly. High over-triage rates are a well-known phenomenon, which increase mortality rates. In order to examine their frequent occurrences, the article discusses different reasons and presents results of an experimental study. Two triage exercises were conducted: a paper-based triage exercise and a real-world simulation. Both exercises used the same case-vignettes consisting of 5 pairs. Each pair described a patient with the same injury pattern and vital parameters but with differing behaviour (calm/highly excited). Different behavior has a minor but no significant effect on over-triage rates. Over-triage is significantly higher in the real-world simulation than in the paper exercise. This is explained by the characteristics of face-to-face situations themselves: they are more complex and ambiguous, and hold more normative power. Accordingly, over-triage is understood as a means to resolve unclear situations ("better to over- than to under-triage") and to comply with normative demands "within" the strict margins of an administrative concept.

Non-physician clinicians in 47 sub-Saharan African countries.

Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3-4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.

Social Security Disability Insurance Enrollment and Health Care Employment.

OBJECTIVE: To examine the relationship between Social Security Disability Insurance (SSDI) enrollment and health care employment. DATA SOURCES: State-year level data from government and other publicly available sources for all states (2000-2014). STUDY DESIGN: Population-weighted linear regression analyses model associations between each health care employment measure and each SSDI enrollment measure (i.e., SSDI overall, physical, or mental health enrollment rates), controlling for factors associated with health care employment, state fixed effects, and secular time trends. DATA COLLECTION: Data are gathered from publicly available sources. PRINCIPAL FINDINGS: A one standard deviation increase in SSDI enrollment per 100,000 population is associated with a statistically significant 2.6 and 4.5 percent increase in the mean employment rate per 100,000 population for health care practitioner and technical occupations and health care support occupations, respectively. The size of this relationship varies by the type of disabling condition for SSDI enrollment (physical versus mental health). CONCLUSIONS: Social Security Disability Insurance enrollment is significantly associated with health care employment at the state level. Quantifying the magnitude of this relationship is important given high SSDI enrollment rates as well as evolving policy and demographic shifts related to the SSDI program.

Community Paramedicine Initiative: Transforming Paramedicine in British Columbia.

British Columbia's health care system is facing challenges related to rural access to care and an ever increasing demand for services. These variables are compounded by the anticipated needs of an aging population that can expect to live several of their golden years with a chronic illness. The introduction of community paramedicine in BC allows for a care delivery model that expands the role of qualified paramedics to include the delivery of prevention, health promotion and primary care services in the community. The implementation of the Community Paramedicine Initiative in rural and remote BC highlights a transformational approach to health care delivery empowered by a technology enabled perspective of community needs.

Peripheral health workers are central to primary health care: lessons from Papua New Guinea's aid posts.

This paper examines the nature of the service offered by Papua New Guinea's primary health workers and analyses the factors that influence their performance. The structural position of these peripheral health workers in the health care system set limits to the effectiveness of current Health Department policy in determining the quality and availability of local services. Instead a variety of factors are found to be important. These include the individual attributes of health workers, the expectations that their clients have of them, local priorities in health, the relationship between attitudes to health and illness and the perceived value of Western medicine, and aspects of local social organization. The implications for policy of the findings are discussed.

Determinants of the delegation of healthcare aboard ships with women assigned.

The purpose of this study was to identify the potential determinants and distribution of shipboard patient delegation decisions. During a 1-month period, physicians aboard five U.S. Navy ships with women assigned estimated the minimum numbers of healthcare providers needed to diagnose and treat each patient (N = 2,725). Results indicated the following distribution of potential patient assignment: consultation 1.4%, medical officer 18.6%, physician assistant/nurse practitioner 8.7%, corpsman with additional OB/GYN training 2.2%, and corpsman 69.2%. Diagnosis was the best predictor of the indicated level of healthcare required. The patient's sex and pay grade were unrelated to the potential levels of care provided.

Primary care and physician extenders in affluent countries.

The worldwide growth of specialization in medicine has led to a perceived shortage of primary care. A major response in the United States has been the training of physician extenders (both physician assistants and nurse practitioners). Other industrialized countries have rejected this approach, in favor of strengthening general medical practice through continuing education, provision of ancillary personnel, use of health centers, and by other methods. Developing countries use doctor-substitutes as a reasonable adjustment to their lack of economic resources. All countries use ancillary personnel for selected procedures, such as midwifery, which involve only limited judgment and decision making. The American strategy on use of doctor-substitutes for primary care, however, follows from unwillingness to train greater numbers of primary care physicians and to require them to serve in places of need. This results in an inequitable concentration of doctor-substitutes on service to the poor in both urban and rural areas.

A study of tenure among allied health faculty.

Most allied health faculty are practitioners who hold a master's degree. Consequently, they may not be prepared to face the rigorous criteria of the tenure system. A study was conducted to identify the demographic characteristics of allied health units, their tenure policies, the criteria for tenure, and any trends in tenure. Deans and directors of 310 allied health units were surveyed and 47.0% responded. In general, allied health tenure policy is drafted by faculty, then sent to the administration for approval. The availability of alternatives to tenure, tenure fractions, and requirements for tenure vary with institutional type. Allied health units reported a tenure fraction of 35.5%, compared to 58.2% for campuses in general. Most of the survey respondents agreed that there is a trend toward increasing the rigor of tenure criteria, and that this trend will come from both within and outside of allied health. As allied health faculty become more involved with research, their tenure fraction will increase and their policies for tenure will more closely conform to those of other units within the parent institution.