The allied health rural generalist pathway: a cost consequence analysis.

INTRODUCTION: Rural and remote health workforces face longstanding challenges in Australia. Little is known about the economic effectiveness of workforce initiatives to increase recruitment and retention. A two-level allied health rural generalist pathway was introduced as a workforce strategy in regional local health networks (LHNs) in South Australia in 2019. This research measured the resources and outcomes of the pathway following its introduction. METHODS: A multi-phase, mixed-methods study was conducted with a 3-year follow-up period (2019-2022). A cost-consequence analysis was conducted as part of this study. Resources measured included tuition, time for quarantined study, supervision and support, and program manager salary. Outcomes measured included length of tenure, turnover data, career progression, service development time, confidence and competence. RESULTS: Fifteen allied health professional trainees participated in the pathway between 2019 and 2022 and seven completed during this time. Trainees participated for between 3 and 42 months. The average total cost of supporting a level 1 trainee was $34,875 and level 2 was $70,469. The total return on investment within the evaluation period was $317,610 for the level 1 program and $58,680 for the level 2 program. All seven completing trainees continued to work in regional LHNs at the 6-month follow-up phase and confidence and competence to work as a rural generalist increased. CONCLUSION: This research found that the allied health rural generalist pathway has the potential to generate multiple positive outcomes for a relatively small investment and is therefore likely to be a cost-effective workforce initiative.

Equal pay for equal work: Disparities in compensation in vascular surgery.

Physician compensation varies by specialty, gender, race, years in practice, type of practice, location, and individual productivity. We reviewed the disparities in compensation regarding the variation between medical and surgical specialties, between academic and private practice, between gender, race, and rank, and by practice location. The physician personal debt perspective was also considered to quantify the effect of disparities in compensation. Strategies toward eliminating the pay gap include salary transparency, pay equity audit, paid parental leave, mentoring, sponsorship, leadership, and promotion pathways. Pay parity is important because paying women less than men contributes to the gender pay gap, lowers pension contributions, and results in higher relative poverty in retirement. Pay parity will also affect motivation and relationships at work, ultimately contributing to a diverse workforce and business success. Rewarding all employees fairly is the right thing to do. As surgeons and leaders in medicine, establishing pay equity is a matter of ethical principle and integrity to further elevate our profession.

Analysis of policy interventions to attract and retain nurse midwives in rural areas of Malawi: A discrete choice experiment.

BACKGROUND: Inadequate and unequal distribution of health workers are significant barriers to provision of health services in Malawi, and challenges retaining health workers in rural areas have limited scale-up initiatives. This study therefore aims to estimate cost-effectiveness of monetary and non-monetary strategies in attracting and retaining nurse midwife technicians (NMTs) to rural areas of Malawi. METHODS: The study uses a discrete choice experiment (DCE) methodology to investigate importance of job characteristics, probability of uptake, and intervention costs. Interviews and focus groups were conducted with NMTs and students to identify recruitment and retention motivating factors. Through policymaker consultations, qualitative findings were used to identify job attributes for the DCE questionnaire, administered to 472 respondents. A conditional logit regression model was developed to produce probability of choosing a job with different attributes and an uptake rate was calculated to estimate the percentage of health workers that would prefer jobs with specific intervention packages. Attributes were costed per health worker year. RESULTS: Qualitative results highlighted housing, facility quality, management, and workload as important factors in job selection. Respondents were 2.04 times as likely to choose a rural job if superior housing was provided compared to no housing (CI 1.71-2.44, p<0.01), and 1.70 times as likely to choose a rural job with advanced facility quality (CI 1.47-1.96, p<0.01). At base level 43.9% of respondents would choose a rural job. This increased to 61.5% if superior housing was provided, and 72.5% if all facility-level improvements were provided, compared to an urban job without these improvements. Facility-level interventions had the lowest cost per health worker year. CONCLUSIONS: Our results indicate housing and facility-level improvements have the greatest impact on rural job choice, while also creating longer-term improvements to health workers' living and working environments. These results provide practical evidence for policymakers to support development of workforce recruitment and retention strategies.

Eliminating buyer's remorse: An examination of the sunk cost fallacy in the National Hockey League draft.

The sunk cost effect describes the tendency to escalate one's commitment toward a certain endeavor, despite diminishing returns, as a consequence of irreversible resource expenditure that has already been made (Organ Behav Hum Decis Process. 1985;35:124). This effect has been observed in a number of professional sports leagues, wherein teams escalate their commitment toward players selected early in the draft, regardless of performance outcomes, due to large financial commitments invested in them (J Sports Econom. 2017;18:282; Adm Sci Q. 1995;40:474). This effect, however, has yet to be explored in the National Hockey League (NHL). The purpose of this study was to test for sunk cost effects in the NHL, by examining the relationship between draft order and playing time, while controlling for a myriad of confounding variables. Findings from our analyses provide support for the existence of this effect in the NHL, as first-round draftees were given significantly more playing time than their peers selected in the second round, regardless of injury, player relocation, penalties, or on-ice performance outcomes. We offer some plausible underlying mechanisms driving this effect. Furthermore, we suggest the observed effects have valuable implications for NHL talent development, given the importance of playing time on various aspects of expertise attainment.

Predictive Hiring to Maintain Excellence in Patient Care.

OBJECTIVE: The purpose of this research study was to design and pilot a predictive hiring model to improve the hospital's operational vacancy rate and reduce premium pay expenses. BACKGROUND: According to Purcell, the average nursing turnover rate is at 18.2%, and the new-graduate nurse turnover rate is higher at 35%. With turnover rates high for nurses, the importance of recruiting, hiring, and training the new nurse needs to be completed as soon as possible. Often, a nurse manager cannot interview and hire into a position until it is vacated. Premium pay including overtime is typically used to cover the time from the position being vacated until the next nurse is trained. METHODS: This was a pretest/posttest design with a predictive hiring model intervention. The intervention was a 3-pronged approach that consisted of a strategy for recruiting graduate nurses, hiring to operation vacancy rates, and utilizing a predictive hiring method. Operational vacancy is a calculation to determine if a department has the right amount of hired labor available to work scheduled shifts without having to routinely rely on agency nurses and/or premium pay. These are people ready to work. RESULTS: The hospital significantly decreased premium pay and eliminated the use of agency nurses by implementing a predictive hiring model tailored to the department's operational vacancy. CONCLUSIONS: A predictive model is a useful vehicle in assisting nurse managers to plan and replace positions more quickly. The model needs continued testing to support application beyond the testing site.

Perceptions of the Educational and Institutional Impact of the Orthopaedic Fellowship Interview Process.

INTRODUCTION: The time spent applying and interviewing for an orthopaedic fellowship has notable financial, educational, and workflow consequences on both residents and their respective residency programs. The purpose of this study was to assess the perceptions regarding the fellowship interview process to suggest changes that could be implemented. METHODS: Mixed-response questionnaires were sent to orthopaedic surgery residency program directors (PDs) and PGY-4 to PGY-6 residents at the 164 accredited allopathic orthopaedic surgery residency programs in the United States (August 2017). RESULTS: Significantly more PDs believed that time away for fellowship interviews negatively affected resident education compared with residents (68% versus 25%, 48 of 65 versus 28 of 113; P < 0.001). About half of all PDs and residents noted a specific amount of time granted for interviews (range, 3 to 20 days). Seventy-one percent of residents included in this study would favor regionally coordinated interview dates. CONCLUSIONS: Orthopaedic surgery residents and PDs perceive differences in the impact of the fellowship interview process on resident education and means for improvement of the process. Two-tiered or regionally coordinated interviews are favored as changes that could be implemented.

The gender differences in highly paid wage: a case study of Peruvian physicians.

In recent decades, the number of women pursuing careers in health has significantly increased. However, the physician labor market is still characterized by gender differences regarding payment. Using a nationally representative Peruvian sample of health providers (3,219 male and 1,063 female physicians), we estimated the gender gap in the likelihood of earning high wages for physicians and decomposed this gap in a proportion related to differences in individual characteristics (e.g. specialty, labor experience), and a residual proportion related to differences in returns to these characteristics. Our main results reveal that male physicians have on average an 81% higher likelihood of earning high salaries (monthly earning level > 5,000 PEN) relative to their female counterparts. Further, the main proportion of this gap is associated to the unexplained component (among 57% and 77%, according to the model specification), which may be associated to unobservable characteristics and discrimination in the Peruvian labor market.

Risk equivalence as an alternative to balancing mean value when trading draft selections and players in major sporting leagues.

In sports leagues that use an annual draft to assign eligible players to clubs, having a value associated with a draft selection can allow clubs to anticipate future growth of players and, if a trading period exists, assist negotiations when exchanging draft selections and players. Typically, mean draft values often decline in either an exponential or geometric manner with increasing draft selection number. Aggregate mean values have been used to compare trade packages. However, clubs may also want to ensure that a trade does not increase the probability of obtaining poor players in the draft. This paper therefore considers equivalence of risk as an alternative trading strategy for club list managers. Here, risk is defined as the probability of the aggregate value of the received draft selections being below a minimum acceptable level. For risk equivalence, a premium over and above mean market value may need to be provided when trading to secure higher draft selections.

For more than money: willingness of health professionals to stay in remote Senegal.

BACKGROUND: Poor distribution of already inadequate numbers of health professionals seriously constrains equitable access to health services in low- and middle-income countries. The Senegalese Government is currently developing policy to encourage health professionals to remain in areas defined as 'difficult'. Understanding health professional's preferences is crucial for this policy development. METHODS: Working with the Senegalese Government, a choice experiment (CE) was developed to elicit the job preferences of physicians and non-physicians. Attributes were defined using a novel mixed-methods approach, combining interviews and best-worst scaling (Case 1). Six attributes were categorised as 'individual (extrinsic) incentive' attributes ('type of contract', 'provision of training opportunities', 'provision of an allowance' and 'provision of accommodation') or 'functioning health system' attributes ('availability of basic equipment in health facilities' and 'provision of supportive supervision by health administrators'). Using face-to-face interviews, the CE was administered to 55 physicians (3909 observations) and 246 non-physicians (17 961 observations) randomly selected from those working in eight 'difficult' regions in Senegal. Conditional logit was used to analyse responses. This is the first CE to both explore the impact of contract type on rural retention and to estimate value of attributes in terms of willingness to stay (WTS) in current rural post. RESULTS: For both physicians and non-physicians, a permanent contract is the most important determinant of rural job retention, followed by availability of equipment and provision of training opportunities. Retention probabilities suggest that policy reform affecting only a single attribute is unlikely to encourage health professionals to remain in 'difficult' regions. The relative importance of an allowance is low; however, the level of such financial incentives requires further investigation. CONCLUSION: Contract type is a key factor impacting on retention. This has led the Senegalese Health Ministry to introduce a new rural assignment policy that recruits permanent staff from the pool of annually contracted healthcare professionals on the condition that they take up rural posts. While this is a useful policy development, further efforts to retain rural health workers, considering both personal incentives and the functioning of health systems, are necessary to ensure health worker numbers are adequate to meet the needs of rural communities.

How Much Do Family Medicine Residency Programs Spend on Resident Recruitment? A CERA Study.

BACKGROUND AND OBJECTIVES: Resident recruitment is one of the most important responsibilities of residency programs. Resource demands are among the principal reasons for calls for recruitment reform. The purpose of this study was to provide a national snapshot of estimated costs of recruitment among US family medicine programs. The aim was to provide data to assist programs in securing and allocating resources to manage the increasingly challenging recruitment process. METHODS: Questions were part of a larger omnibus survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). Specific questions were asked regarding how many interviews each program offered and completed; interview budget; additional funds spent on recruitment; reimbursements; and resident, faculty, and staff hours used per interviewee. RESULTS: The response rate was 53% (277/522). Program directors estimated that residents devoted 6.4 hours (95% CI 6, 7) to each interview, faculty 5.6 hours (95% CI 5, 6), and staff 4.4 hours (95% CI 4, 5). The average budget for interviewing per program was $17,079 (±$19,474) with an additional $8,274 (±$9,615) spent on recruitment activities. The average amount spent per applicant was $213 (±$360), with $111 (±$237) in additional funds used for recruitment. Programs were more likely to pay for interviewee meals (82%) and lodging (59%) than travel (3%). CONCLUSIONS: As individual programs face increasing pressure to demonstrate value for investment in recruiting, data generated by this national survey enables useful comparison to individual programs and sponsoring organizations. Results may also contribute to national discussions about best practices in resident recruitment and ways to improve efficiency of the process.

"Everything Possible Is Being Done": Labour, Mobility, and the Organization of Health Services in Mid-20th Century Newfoundland.

This article is the Presidential Address to the 2018 meeting of the Canadian Society for the History of Medicine at the University of Regina. It examines the organization of the nursing service in Newfoundland during the 1950s and 1960s, as well as the recruitment and retention of nurses in cottage hospitals and nursing stations in outport communities. A number of interconnected strategies were used by the Newfoundland government to staff the nursing service, including recruiting internationally educated nurses, adjusting expectations with respect to registration standards, and using both trained and untrained workers to support nurses' labour. Although this article is intended more as a reconnaissance suggesting the possibilities of such research, it does analyze the interconnected issues of geography, funding and pay, the nursing shortage, and the renegotiation of nursing labour that characterized this period. Furthermore, although this is a case study of Newfoundland and Labrador, it is worth considering how, or whether, the linked strategies used in the province were transferable to other communities across rural, remote, or northern Canada.

Public Health Workforce Development Needs: A National Assessment of Executives' Perspectives.

INTRODUCTION: Workforce development is one of the ten essential public health services. Recent studies have better characterized individual worker perceptions regarding workforce interests and needs, but gaps remain around workforce needs from program managers' perspectives. This study characterized management perspectives regarding subordinate's abilities and training needs and perceived challenges to recruitment and retention. METHODS: In 2017, the Directors Assessment of Workforce Needs Survey was sent to 574 managers at state health agencies across the U.S. Respondents were invited based on the positions they held (i.e., to be included, respondents had to be employed as managers and oversee specific program areas). In 2018, descriptive statistics were calculated, including Fisher's exact for inferential comparisons and Tukey's test for multiple comparisons, as appropriate. RESULTS: Response rate was 49% after accounting for undeliverable e-mails; 226 respondents met the inclusion criteria. The largest perceived barriers to staff recruitment were wages or salaries (74%) and private sector competition (56%). Similarly, wages or salaries were identified as the main cause of turnover by 70% of respondents, followed by lack of opportunities for advancement (68%), and opportunities outside the agency (67%). CONCLUSIONS: The Directors Assessment of Workforce Needs Survey fills important knowledge gaps and complements previously identified evidence to guide refinement of workforce development efforts. Although competition from the private sector remains challenging, these findings indicate that recruitment and retention must be top priorities in state health agencies nationwide. Prioritizing individual state health agency workforce gaps and committing to provide specific local-level interventions to those priorities is crucial for individual health agencies.

Standardized Video Interviews Do Not Correlate to United States Medical Licensing Examination Step 1 and Step 2 Scores.

INTRODUCTION: In 2017, the Standardized Video Interview (SVI) was required for applicants to emergency medicine (EM). The SVI contains six questions highlighting professionalism and interpersonal communication skills. The responses were scored (6-30). As it is a new metric, no information is available on correlation between SVI scores and other application data. This study was to determine if a correlation exists between applicants' United States Medical Licensing Examination (USMLE) and SVI scores. We hypothesized that numeric USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores would not correlate with the SVI score, but that performance on the Step 2 Clinical Skills (CS) portion may correlate with the SVI since both test communication skills. METHODS: Nine EM residency sites participated in the study with data exported from an Electronic Residency Application Service (ERAS®) report. All applicants with both SVI and USMLE scores were included. We studied the correlation between SVI scores and USMLE scores. Predetermined subgroup analysis was performed based on applicants' USMLE Step 1 and Step 2 CK scores as follows: (≥ 200, 201-220, 221-240, 241-260, >260). We used linear regression, the Kruskal-Wallis test and Mann-Whitney U test for statistical analyses. RESULTS: 1,325 applicants had both Step 1 and SVI scores available, with no correlation between the overall scores (p=0.58) and no correlation between the scores across all Step 1 score ranges, (p=0.29). Both Step 2 CK and SVI scores were available for 1,275 applicants, with no correlation between the overall scores (p=0.56) and no correlation across all ranges, (p=0.10). The USMLE Step 2 CS and SVI scores were available for 1,000 applicants. Four applicants failed the CS test without any correlation to the SVI score (p=0.08). CONCLUSION: We found no correlation between the scores on any portion of the USMLE and the SVI; therefore, the SVI provides new information to application screeners.

The gender differences in highly paid wage: a case study of Peruvian physicians / Las diferencias de género en los sueldos de mejor remuneración: el estudio de caso de los médicos peruanos / Diferenças de gênero em salários altos: um estudo de caso de médicos peruanos

Abstract: In recent decades, the number of women pursuing careers in health has significantly increased. However, the physician labor market is still characterized by gender differences regarding payment. Using a nationally representative Peruvian sample of health providers (3,219 male and 1,063 female physicians), we estimated the gender gap in the likelihood of earning high wages for physicians and decomposed this gap in a proportion related to differences in individual characteristics (e.g. specialty, labor experience), and a residual proportion related to differences in returns to these characteristics. Our main results reveal that male physicians have on average an 81% higher likelihood of earning high salaries (monthly earning level > 5,000 PEN) relative to their female counterparts. Further, the main proportion of this gap is associated to the unexplained component (among 57% and 77%, according to the model specification), which may be associated to unobservable characteristics and discrimination in the Peruvian labor market.

Resumen: En décadas recientes, el número de mujeres realizando su carrera en el ámbito de salud se ha incrementado significativamente. No obstante, el mercado laboral de los médicos está todavía caracterizado por diferencias de género respecto a los salarios. Utilizando una muestra peruana nacionalmente representativa de proveedores de salud (3.219 hombres y 1.063 mujeres médicos), estimamos la brecha de género en la probabilidad para los médicos de ganar sueldos altos y la desglosamos según los porcentajes vinculados a las diferencias relacionadas con las características individuales (p.ej. especialidad, experiencia laboral) y un porcentaje residual vinculado a las diferencias relacionadas con estas características. Nuestros resultados principales revelaron que los médicos hombres contaban en promedio con un 81% mayor probabilidad de ganar sueldos más altos (nivel mensual de renta > 5.000 PEN) frente a sus compañeras mujeres. Asimismo, gran parte del porcentaje de esta brecha está asociado a un componente inexplicable (entre un 57% y un 77%, según la especificación del modelo), lo que tal vez esté relacionado con las características no observables y la discriminación en el mercado laboral peruano.

Resumo: Nas últimas décadas, o número de mulheres atuando em carreiras da saúde aumentou significativamente. Contudo, o mercado de trabalho médico continua caracterizado por diferenças de gênero nos salários. Usando uma amostra nacional representativa de profissionais da saúde peruanos (3.219 médicos e 1.063 médicas), nós estimamos a diferença de gênero na probabilidade de receber altos salários para médicos e decompomos essa diferença em uma proporção relacionada a diferenças em características individuais (p.ex.: especialidade, experiência profissional) e uma proporção residual relacionada a diferenças de retornos dessas características. Nossos resultados principais revelam que os médicos têm, em média, uma probabilidade 81% maior de receber salários altos (nível de rendimentos mensais > 5.000 PEN) em relação às médicas. Adicionalmente, a principal proporção dessa diferença está associada ao componente não-explicado (entre 57% e 77%, de acordo com a especificação do modelo), o que pode estar associado a características não-observadas e discriminação no mercado de trabalho peruano.