The Evolution of Board-Certified Emergency Physicians and Staffing of Emergency Departments in Israel.

Introduction: Emergency medicine (EM) was recognized as a specialty in Israel in 1999. Fifty-nine of the 234 (25%) attending physicians working in emergency departments (ED) nationwide in 2002 were board-certified emergency physicians (EP). A 2012 study revealed that 123/270 (45%) of ED attendings were EPs, and that there were 71 EM residents. The EPs primarily worked midweek morning shifts, leaving the EDs mostly staffed by other specialties. Our objective in this study was to re-evaluate the EP workforce in Israeli EDs and their employment status and satisfaction 10 years after the last study, which was conducted in 2012. Methods: We performed a three-part, prospective cross-sectional study: 1) a survey, sent to all EDs in Israel, to assess the numbers, level of training, and specialties of physicians working in EDs; 2) an anonymous questionnaire, sent to EPs in Israel, to assess their demographics, training, employment, and work satisfaction; and 3) interviews of a convenience sample of EPs analyzed by a thematic approach. Results: There were 266 board-certified EPs, 141 (53%) of whom were employed in EDs full-time or part-time. Sixty-two non-EPs also worked in EDs. The EPs were present in the EDs primarily during weekday morning shifts. There were 273 EM residents nationwide. A total of 101 questionnaires were completed and revealed that EPs working part-time in the ED worked fewer hours, received higher salaries, and had more years of experience compared to EPs working full time or not working in the ED. Satisfaction correlated only with working part time. Meaningful work, diversity, and rewarding relationships with patients and colleagues were major positive reasons for working in the ED. Feeling undervalued, carrying a heavy caseload, and having complicated relationships with other hospital departments were reasons against working in the ED. Conclusion: Our study findings showed an increase in the number of trained and in-training EPs, and a decrease in the percentage of board-certified EPs who persevere in the EDs. Emergency medicine in Israel is at a crossroads: more physicians are choosing EM than a decade ago, but retention of board-certified EPs is a major concern, as it is worldwide. We recommend taking measures to maintain trained and experienced EPs working in the ED by allowing part-time ED positions, introducing dedicated academic time, and diversifying EP roles, functioning, and work routine.

"Women's work": Gender and the physician workforce.

Historically, the physician professional identity and the organizational structure of Western medicine have been defined by masculine norms such as authority and assertiveness. The past five decades have seen a rapid shift in the demographics of attendees as medical schools, with equal numbers of women and men matriculants for nearly twenty years. Gender as a social, cultural, and structural variable continues to influence the physician workforce. The entry of women into medicine, has had far reaching effects on the expectations of patients, the interactions of physicians with other members of the healthcare team, and the delivery of care. Redefining the culture of medicine to accommodate the diversity of the modern workforce may benefit all physician and improve the delivery of healthcare.

Are Polish doctors ready to start working right after graduation? The 2023 modification to physicians' postgraduate internship and possible paths forward.

The Polish healthcare system faces many problems, among which the shortage of healthcare professionals is one of the most urgent. In less than ten years, more than twenty Higher Education Institutions (HEIs) have been allowed to add medical programmes to their offer, aiming to increase the number of doctors in Poland. Recently, the healthcare system was faced with a proposal to abolish the mandatory postgraduate internship which has been a mandatory component of medical training for years. Two main reforms were considered. The first one focused on the programme of the internship and aimed to update it. The second one recommended an abolition of the internship. The authors of this article analysed the opinions and positions of key players within the system regarding the postgraduate internship. Opinions in this regard are diverse, leading to the conclusion that additional actions would be required prior to the internship abolition. Undergraduate training has changed and currently students are taught in modern facilities, using new teaching methods. On the other hand, internship allows trainees to improve or even acquire skills they may not have obtained during their studies. The postgraduate internship is an essential part of doctors' training. However, in Poland, there is still a lack of a well-thought, long-term policy or strategy for physicians' workforce development. Our study presents a Polish perspective on common challenges in medical training and workforce policy, highlighting the clash over the growing demand for physicians and the limitations of the existing system.

Uneven primary healthcare supply of rural doctors and medical equipment in remote China: community impact and the moderating effect of policy intervention.

BACKGROUND: Unequal access to primary healthcare (PHC) has become a critical issue in global health inequalities, requiring governments to implement policies tailored to communities' needs and abilities. However, the place-based facility dimension of PHCs is oversimplified in current healthcare literature, and formulating the equity-oriented PHC spatial planning remains challenging without understanding the multiple impacts of community socio-spatial dynamics, particularly in remote areas. This study aims to push the boundary of PHC studies one step further by presenting a nuanced and dynamic understanding of the impact of community environments on the uneven primary healthcare supply. METHODS: Focusing on Shuicheng, a remote rural area in southwestern China, multiple data are included in this village-based study, i.e., the facility-level healthcare statistics data (2016-2019), the statistical yearbooks, WorldPop, and Chinese GDP's spatial distribution data. We evaluate villages' PHC service capacity using the number of doctors and essential equipment per capita, which are the major components of China's PHC delivery. The indicators describing community environments are selected based on extant literature and China's planning paradigms, including town- and village-level factors. Gini coefficients and local spatial autocorrelation analysis are used to present the divergences of PHC capacity, and multilevel regression model and (heterogeneous) difference in difference model are used to examine the driving role of community environments and the dynamics under the policy intervention. RESULTS: Despite the general improvement, PHC inequalities remain significant in remote rural areas. The village's location, aging, topography, ethnic autonomy, and economic conditions significantly influence village-level PHC capacity, while demographic characteristics and healthcare delivery at the town level are also important. Although it may improve the hardware setting in village clinics (coef. = 0.350), the recent equity-oriented policy attempts may accelerate the loss of rural doctors (coef. = - 0.517). Notably, the associations between PHC and community environments are affected inconsistently by this round of policy intervention. The town healthcare centers with higher inpatient service capacity (coef. = - 0.514) and more licensed doctors (coef. = - 0.587) and nurses (coef. = - 0.344) may indicate more detrimental policy effects that reduced the number of rural doctors, while the centers with more professional equipment (coef. = 0.504) and nurses (coef. = 0.184) are beneficial for the improvement of hardware setting in clinics. CONCLUSIONS: The findings suggest that the PHC inequalities are increasingly a result of joint social, economic, and institutional forces in recent years, underlining the increased complexity of the PHC resource allocation mechanism. Therefore, we claim the necessity to incorporate a broader understanding of community orientation in PHC delivery, particularly the interdisciplinary knowledge of the spatial lens of community, to support its sustainable development. Our findings also provide timely policy insights for ongoing primary healthcare reform in China.

US County-Level Variation in Availability and Prevalence of Black Physicians in 1906.

Importance: Black physicians are substantially underrepresented in the US health care workforce, with detrimental effects on the health and health care experiences of Black individuals. These contemporary gaps can be traced to the early days of the medical profession using the first edition of the American Medical Directory (AMD). Objective: To identify state- and county-level patterns related to the training and availability of Black physicians relative to their White counterparts in the 1906 AMD. Design, Setting, and Participants: For this cross-sectional study, data for 41 828 physician entries in 18 US states in or adjacent to the South as well as the District of Columbia were extracted from the 1906 AMD and aggregated to 1570 counties. Data analysis was performed between September 2023 and January 2024. Exposures: County-level exposure variables included population density, racial composition, and illiteracy rate among US-born White residents as well as an index of terrain ruggedness and the number of lynchings in the previous decade. Median values of physicians' distance from place of practice to place of medical training (by race of physician) were also used as an exposure variable. Main Outcomes and Measures: There were 4 county-level outcomes: (1) presence of any Black physician, (2) proportion of Black physicians per Black population, (3) proportion of White physicians per White population, and (4) community representativeness (reported as the community representativeness ratio). The cross-sectional analysis used generalized additive mixed models with state-level random effects. Results: Across 1570 counties, Black physicians comprised 746 (1.8%) of the 41 828 physicians in the dataset. Black physicians tended to train further from their place of practice than their White counterparts. The proportion of Black physicians per 1000 Black residents was 0.08 compared with 1.62 for White physicians; these proportions varied substantially by state. At the county level, the presence of any Black physician was associated with percentage Black population (odds ratio [OR], 28.94 [95% CI, 9.77 to 85.76]; P ≤ .001), population density (OR, 2.63 [95% CI, 2.03 to 3.40]; P ≤ .001), and distance to the nearest Black medical school (OR, 0.62 [95% CI, 0.42 to 0.92]; P = .02). Conclusions and Relevance: A variety of structural disadvantages are illustrated in this cross-sectional study of county-level sociodemographic and geographic characteristics associated with the prevalence of Black physicians in the earliest days of the profession. To demonstrate its broader utility for health disparities research, the dataset has been made publicly available with a visualization platform.

Migration and professional mobility: Rural attraction and retention of South African educated physicians.

Rural communities in Alberta, Canada have faced physician shortages for decades. Attracting internationally educated physicians, including many South African physicians, is one way to address this problem. While much of the research on international medical graduates (IMGs) focuses on the push and pull of attraction and retention, I situate the decision to stay as a matter of geographic and professional mobility, all within a life course perspective. More specifically, I explore physicians' decisions to migrate from South Africa to rural Alberta and the impact of professional mobility on their migrations. To understand the processes, I collected data via semi-structured virtual interviews with 29 South African educated generalist/family physicians with experience in rural Alberta. Research was guided by abductive grounded theory and data was analysed using open thematic coding. I found that South African educated physicians made the decision to leave South Africa and to come to Canada to pursue prestige and opportunity they perceived to be inaccessible in South Africa. However, physicians were limited to perceived low prestige work as rural generalists, while they understood that more prestigious work was reserved for Canadian educated physicians. Physicians who remained in rural communities brought their aspirations to life, or achieved upward professional mobility in rural communities, through focused clinical and administrative opportunities. The decision to leave rural communities was often a matter of lifestyle and burnout over prestige.

Ethnic disparities and temporal trends in health resource allocation: a retrospective decadal analysis in Sichuan, a multi-ethnic Province of Southwest China (2009-2019).

BACKGROUND: Research on health resource allocation trends in ethnic minority and impoverished areas in China is limited since the 2009 Medical Reform. This study aimed to investigate the variations and inequalities in health resource distribution among ethnic minority, poverty-stricken, and non-minority regions in Sichuan Province, a multi-ethnic province in Southwest China, from 2009 to 2019. METHODS: The numbers of beds, doctors and nurses were retrospectively sourced from the Sichuan Health Statistics Yearbook between 2009 and 2019. All the 181 counties in Sichuan Province were categorized into five groups: Yi, Zang, other ethnic minority, poverty-stricken, and non-minority county. The Theil index, adjusted for population size, was used to evaluate health resource allocation inequalities. RESULTS: From 2009 to 2019, the number of beds (Bedp1000), doctors (Docp1000), and nurses (Nurp1000) per 1000 individuals in ethnic minority and poverty-stricken counties consistently remained lower than non-minority counties. The growth rates of Bedp1000 in Yi (140%) and other ethnic minority counties (127%) were higher than in non-minority counties (121%), while the growth rates of Docp1000 in Yi (20%) and Zang (11%) counties were lower than non-minority counties (61%). Docp1000 in 33% and 50% of Yi and Zang ethnic counties decreased, respectively. Nurp1000 in Yi (240%) and other ethnic minority (316%) counties increased faster than non-minority counties (198%). The Theil index for beds and nurses declined, while the index for doctors increased. Key factors driving increases in bed allocation include preferential policies and economic development levels, while health practitioner income, economic development levels and geographical environment significantly influence doctor and nurse allocation. CONCLUSIONS: Preferential policies have been successful in increasing the number of beds in health facilities, but not healthcare workers, in ethnic minority regions. The ethnic disparities in doctor allocation increased in Sichuan Province. To increase the number of doctors and nurses in ethnic minority and poverty-stricken regions, particularly in Yi counties, more preferential policies and resources should be introduced.

Experiencia docente en un programa de formación de Medicina Familiar y General a distancia / Teaching experience in a distance learning program for Family and General Medicine

La distribución inequitativa del talento humano en salud afecta la capacidad de los sistemas de ofrecer servicios esenciales. En la provincia de Córdoba, el primer nivel de atención es responsabilidad de los municipios, pero el nivel provincial procura sostener la rectoría y ser garante del derecho a la salud. En ese marco, se desarrolló un programa para reducir las brechas en la distribución de médicos: el Plan Cordobés de Médicos del Interior. Acompañando ese plan se ejecutó un convenio específico con la Universidad Nacional de Córdoba para garantizar la formación en la especialidad de Medicina Familiar y General. Ingresaron al programa 170 personas, y hoy contamos con 98 médicos en formación o seguimiento. En este artículo damos cuenta de la experiencia docente, los desafíos y dificultades que supuso afrontar una formación en lugares de práctica variados, y con el aporte de las tecnologías de la información y comunicación. Esperamos que la experiencia sirva para transmitir los aprendizajes de nuestra práctica (AU)

The inequitable distribution of human talent in health affects the capacity of systems to offer essential services. In the province of Córdoba, the primary level of care is the responsibility of municipalities, but the provincial level aims to maintain leadership and guarantee the right to health. Within this framework, a program was developed to reduce gaps in the distribution of physicians: the Cordobés Plan for Interior Physicians. Accompanying this plan, a specific agreement was executed with the National University of Córdoba to ensure training in the specialty of Family and General Medicine. 170 individuals entered the program, and today we have 98 physicians in training or under supervision. In this article, we give an account of the teaching experience, the challenges, and difficulties involved in facing training in various practice settings, along with the contribution of information and communication technologies. We hope that this experience serves to transmit the lessons learned from our practice (AU)

Presencia de egresados y egresadas de la Universidad Nacional del Sur en el sistema de residencias médicas de Bahía Blanca / Presence of graduates from the National University of the Sur in the medical residency system of Bahía Blanca

Introducción: La atracción, captación y retención son determinantes de una distribución equitativa de profesionales de la salud. Objetivo: describir las decisiones de formación de posgrado de egresados/as de medicina de la Universidad Nacional del Sur (UNS), y su impacto en el sistema de residencias médicas de Bahía Blanca durante el año 2023. Resultados: el 79,63% de quienes egresaron de esta universidad decidieron realizar una residencia médica, y el 51,12 % adjudicó en especialidades del Primer Nivel de Atención con una adjudicación en pediatría menor a la media nacional. La carrera de medicina local cubrió el 39,24 % de las vacantes de Bahía Blanca, y el 38% de sus graduados/as decidió formarse en otras ciudades. Ocho residencias de la ciudad quedaron sin ingresantes en el 2023. Conclusión: existe una gran proporción de egresados/as de la UNS que eligen especialidades de APS. Hay una baja adjudicación en Pediatría que contrasta con la elección de Medicina Familiar, a diferencia de las elecciones a nivel nacional. En términos generales hay un déficit en la atracción y captación de egresados/as de la UNS por parte del sistema de salud local, lo cual demanda a los sectores docentes y asistenciales nuevas estrategias para captar y atraer profesionales en área prioritarias (AU)

Introduction: Attraction, recruitment and retention are determinants of an equitable distribution of healthcare professionals. Objective: to describe the postgraduate training decisions of medical graduates from the National University of the South (UNS), and their impact on the Bahía Blanca medical residency system during the year 2023. Results: 79.63% of Those who graduated from this university decided to carry out medical residency, and 51.12% were awarded in First Level Care specialties with a pediatric award lower than the national average. The local medical career covered 39.24% of the vacancies in Bahía Blanca, and 38% of its graduates decided to train in other cities. Eight residences in the city were left without entrants in 2023. Conclusion: there is a large proportion of UNS graduates who choose APS specialties. There is a low allocation in Pediatrics that contrasts with the choice of Family Medicine, unlike the elections at the national level. In general terms, there is a deficit in the attraction and recruitment of UNS graduates by the local health system, which demands new strategies from the teaching and healthcare sectors to attract and attract professionals in priority areas (AU)

Mind the implementation gap: a systems analysis of the NHS Long Term Workforce Plan to increase the number of doctors trained in the UK raises many questions.

BACKGROUND: The National Health Service (NHS) in England is facing a workforce crisis. A new Long Term Workforce Plan (LTWP) seeks to address this, setting out ambitious proposals to expand and reform domestic medical education and training in England. However, there are concerns about their feasibility. SOURCES OF DATA: In September 2023, over 60 individuals representing medical education and training in the UK participated in an exercise run by UK Medical Schools Council by using systems theory to identify risks. AREAS OF AGREEMENT: The UK does need more 'home grown' doctors, but the LTWP has important gaps, including lack of attention to postgraduate training, absence of reference to the need for more educators and capital investment and risk of inadequate clinical placement capacity, particularly in primary care settings. AREAS OF CONTROVERSY: There are unresolved differences in the understanding of a proposed medical apprenticeship model and no scheme has, as yet, been approved by the General Medical Council. Participants were unable to determine who the beneficiaries of this scheme will be (apart from the apprentices themselves). GROWING POINTS: While the LTWP represents a welcome, although overdue, commitment to address the NHS workforce crisis, we identified significant gaps that must be resolved. AREAS TIMELY FOR DEVELOPING RESEARCH: First, the development of the LTWP provides a case study that adds to literature on policymaking in the UK. Second, while we only examined the expansion of medical training, the method could be applied to other parts of the LTWP. Third, a prospective evaluation of its implementation is necessary.

[What do we know and what should we know about the imbalances of doctors in Spain? Diagnosis and proposals. SESPAS Report 2024]. / ¿Qué sabemos y qué deberíamos saber sobre los desequilibrios de médicos en España? Diagnóstico y propuestas. Informe SESPAS 2024.

This article characterizes the main features of the supply, demand, and labor markets for physicians in Spain, with an international and territorial perspective. It also presents some of the results of the simulation model for specialist physicians with a 2035 horizon and proposes strategic and short-term lines of action in the planning, regulation, and management of health professionals in Spain, with a focus on specialist physicians. In Spain there are high rates of physicians and medical graduates, but low rates of nurses, compared to other developed countries. Approximately 30% of practicing physicians (not considering residents) practice only in the private network. In the last two decades, competition from the private sector for health professionals has intensified, competing with the public network, which is subject to an excessively rigid regulatory framework. There is currently a shortage of physicians in some specialties, particularly in family medicine, which urgently needs specific incentives to stimulate vocations. Numbers consider only part of the story. The imbalances in the educational and labor markets are not resolved by creating vacancies, but by reforming the regulatory framework, the incentive systems, and the slack in public management to compete with the private sector in attracting and retaining talent.

Gender, flexibility and workforce in the NHS: A qualitative study.

Data from the General Medical Council show that the number of female doctors registered to practise in the UK continues to grow at a faster rate than the number of male doctors. Our research critically discusses the impact of this gender-based shift, considering how models of medical training are still ill-suited to supporting equity and inclusivity within the workforce, with particular impacts for women despite this gender shift. Drawing on data from our research project Mapping underdoctored areas: the impact of medical training pathways on NHS workforce distribution and health inequalities, this paper explores the experiences of doctors working in the NHS, considering how policies around workforce and beyond have impacted people's willingness and ability to continue in their chosen career path. There is clear evidence that women are underrepresented in some specialties such as surgery, and at different career stages including in senior leadership roles, and our research focuses on the structural factors that contribute to reinforcing these under-representations. Medical education and training are known to be formative points in doctors' lives, with long-lasting impacts for NHS service provision. By understanding in detail how these pathways inadvertently shape where doctors live and work, we will be able to consider how best to change existing systems to provide patients with timely and appropriate access to healthcare. We take a cross-disciplinary theoretical approach, bringing historical, spatiotemporal and sociological insights to healthcare problems. Here, we draw on our first 50 interviews with practising doctors employed in the NHS in areas that struggle to recruit and retain doctors, and explore the gendered nature of career biographies. We also pay attention to the ways in which doctors carve their own career pathways out of, or despite of, personal and professional disruptions.

Dificuldades enfrentadas pelos profissionais de saúde no atendimento de emergências em unidades básicas de saúde no Brasil / Difficulties faced by health professionals in emergency care in primary health care units in Brazil / Dificultades enfrentadas por los profesionales de salud en la atención de emergencias en unidades básicas de salud en Brasil

Objetivos: compreender as dificuldades enfrentadas pelos profissionais de saúde para o atendimento de casos de urgências/emergências em unidades básica de saúde e identificar as proposições de resolubilidade. Métodos: Pesquisa qualitativa, realizada com dez profissionais de saúde, em uma unidade básica de saúde do interior paulista. As entrevistas foram transcritas e analisadas utilizando-se a estratégia metodológica do Discurso do Sujeito Coletivo. Resultados: As dificuldades foram atreladas a fatores como despreparo da equipe, falta de infraestrutura, insumos e equipamentos, carência de profissional médico, pouca aproximação das unidades básicas de saúde com o setor de emergência hospitalar e escasso investimento do município para realização desses atendimentos. As proposições de melhorias destacaram a necessidade de capacitação dos profissionais de saúde, investimentos em recursos materiais e equipamentos, permanência de médico em período integral no serviço, implantação de protocolos de atendimento e empenho dos gestores. Conclusão: Os discursos evidenciaram que o serviço não tem condições de atender casos de urgência/emergência, em virtude do despreparo da equipe e da falta de recursos humanos e materiais. Além disso, não é prioridade do município oferecer condições mínimas para a realização deste atendimento nas unidades básicas de saúde, para que sejam integrantes da rede de atenção de Atenção às Urgências no Sistema Único de Saúde.

Objective: understand the difficulties health professionals face in urgency/emergency care at primary health care units and identify the propositions of problem-solving ability. Methods: Qualitative research, conducted with ten health professionals at a primary health care unit in the interior of São Paulo. The interviews were transcribed and analyzed using the methodological strategy of the collective subject discourse. Results: The difficulties were linked to factors such as unpreparedness of the team, lack of infrastructure, supplies and equipment, lack of medical professional, little cooperation between the primary health care units and the hospital emergency sector and scarce investment of the municipality to carry out these services. The proposals for improvements highlighted the need for training of health professionals, investments in material resources and equipment, full-time presence of physician at the service, implementation of care protocols and commitment of managers. Conclusion: The discourse showed that the service is not able to attend urgency/emergency cases, due to the unpreparedness of the team and the lack of human and material resources. In addition, the municipality does not prioritize the supply of minimum conditions for this care in primary health care units to make them part of the emergency care network in the Unified Health System.

Objetivo: comprender las dificultades enfrentadas por los profesionales de salud para la atención de casos de Urgencias/Emergencias en unidades básicas de salud e identificar las proposiciones de resolubilidad. Métodos: Investigación cualitativa, desarrollada con diez profesionales de salud, en una unidad básica de salud del interior paulista. Las entrevistas fueron transcritas y analizadas utilizando la estrategia metodológica del Discurso del Sujeto Colectivo. Resultados: Las dificultades fueron ligadas a factores como la falta de preparación del equipo, falta de infraestructura, insumos y equipamientos, carencia de profesional médico, poca aproximación de las unidades básicas de salud con el sector de emergencia hospitalaria y escasa inversión del municipio para realizar esas atenciones. Las propuestas de mejorías destacaron la necesidad de capacitación de los profesionales de salud, inversiones en recursos materiales y equipamientos, permanencia de médico a tiempo completo en el servicio, implantación de protocolos de atención y empeño de los gestores. Conclusión: Los discursos evidenciaron que el servicio no tiene condiciones de atender casos de urgencia/emergencia, en virtud de la falta de preparación del equipo y de la falta de recursos humanos y materiales. Además, no es prioridad del municipio ofrecer condiciones mínimas para la realización de esta atención en las unidades básicas de salud, para que sean integrantes de la red de atención de atención a las urgencias en el Sistema Único de Salud.