Current and future workforce of general internal medicine in Switzerland: a cross-sectional study.

AIM OF THIS STUDY: General internal medicine is a crucial element in healthcare systems. Understanding how many people are and will be working in this field is important to maintain and improve quality for patients in healthcare systems. This can provide a basis for political decisions. METHODS: We conducted a cross-sectional study to analyse the current and future workforce of generalists (general practitioners and internists in hospitals) in Switzerland. The Swiss Society of General Internal Medicine (SSGIM) distributed a survey to all members. Respondents were asked about their current average workload in 2023 and planned workload in 2033. The responses were used to calculate full-time equivalent (FTE) for the current and future workforce of generalists and to extrapolate FTE for all active SSGIM members. To model the demand by 2033, we derived different scenarios. RESULTS: Of all 6,232 active SSGIM members, 2,030 (33%) participated: 46% female, 25% (largest age group) 56-65 years old, 19% still in postgraduate training. The average workload in 2023 was 78% for female and 87% for male generalists; the FTE extrapolated to all active SSGIM members in 2023 was 5,246. By 2033, 1,935 FTEs (36%) will retire, 502 FTEs (10%) will reduce their workload, 116 FTEs (2%) will increase their workload and 2,800 FTEs (53%) will remain in the workforce with the same workload as in 2023. To maintain the same workforce as in 2023, 2,321 new FTEs (44%) will be needed by 2033. To fill this gap of 232 FTE new generalists per year, we modelled different scenarios with assumptions of interest, workload, migration and dropouts. CONCLUSIONS: Within only one decade, 44% of the current workforce of generalists will disappear, mainly due to retirement and decreased workload. To fill this gap, various scenarios need to be incorporated. Politicians are called upon to create the political framework to create attractive training and working conditions for generalists to address the future demand for healthcare services.

Association of part-time clinical work with well-being and mental health in General Internal Medicine: A survey among Swiss hospitalists.

INTRODUCTION: Burnout and low job satisfaction are increasing among the General Internal Medicine (GIM) workforce. Whether part-time compared to full-time clinical employment is associated with better wellbeing, job satisfaction and health among hospitalists remains unclear. MATERIALS AND METHODS: We conducted an anonymized cross-sectional survey among board-certified general internists (i.e. hospitalists) from GIM departments in 14 Swiss hospitals. Part-time clinical work was defined as employment of <100% as a clinician. The primary outcome was well-being, as measured by the extended Physician Well-Being Index (ePWBI), an ePWBI ≥3 indicating poor wellbeing. Secondary outcomes included depressive symptoms, mental and physical health, and job satisfaction. We compared outcomes in part-time and full time workers using propensity score-adjusted multivariate regression models. RESULTS: Of 199 hospitalists invited, 137 (69%) responded to the survey, and 124 were eligible for analysis (57 full-time and 67 part-time clinicians). Full-time clinicians were more likely to have poor wellbeing compared to part-time clinicians (ePWBI ≥3 54% vs. 31%, p = 0.012). Part-time compared to full-time clinical work was associated with a lower risk of poor well-being in adjusted analyses (odds ratio 0.20, 95% confidence interval 0.07-0.59, p = 0.004). Compared to full-time clinicians, there were fewer depressive symptoms (3% vs. 18%, p = 0.006), and mental health was better (mean SF-8 Mental Component Summary score 47.2 vs. 43.2, p = 0.028) in part-time clinicians, without significant differences in physical health and job satisfaction. CONCLUSIONS: Full-time clinical hospitalists in GIM have a high risk of poor well-being. Part-time compared to full-time clinical work is associated with better well-being and mental health, and fewer depressive symptoms.

Relationship between Remote Sensing Data, Plant Biomass and Soil Nitrogen Dynamics in Intensively Managed Grasslands under Controlled Conditions.

The sustainable use of grasslands in intensive farming systems aims to optimize nitrogen (N) inputs to increase crop yields and decrease harmful losses to the environment at the same time. To achieve this, simple optical sensors may provide a non-destructive, time- and cost-effective tool for estimating plant biomass in the field, considering spatial and temporal variability. However, the plant growth and related N uptake is affected by the available N in the soil, and therefore, N mineralization and N losses. These soil N dynamics and N losses are affected by the N input and environmental conditions, and cannot easily be determined non-destructively. Therefore, the question arises: whether a relationship can be depicted between N fertilizer levels, plant biomass and N dynamics as indicated by nitrous oxide (N2O) losses and inorganic N levels. We conducted a standardized greenhouse experiment to explore the potential of spectral measurements for analyzing yield response, N mineralization and N2O emissions in a permanent grassland. Ryegrass was subjected to four mineral fertilizer input levels over 100 days (four harvests) under controlled environmental conditions. The soil temperature and moisture content were automatically monitored, and the emission rates of N2O and carbon dioxide (CO2) were detected frequently. Spectral measurements of the swards were performed directly before harvesting. The normalized difference vegetation index (NDVI) and simple ratio (SR) were moderately correlated with an increasing biomass as affected by fertilization level. Furthermore, we found a non-linear response of increasing N2O emissions to elevated fertilizer levels. Moreover, inorganic N and extractable organic N levels at the end of the experiment tended to increase with the increasing N fertilizer addition. However, microbial biomass C and CO2 efflux showed no significant differences among fertilizer treatments, reflecting no substantial changes in the soil biological pool size and the extent of the C mineralization. Neither the NDVI nor SR, nor the plant biomass, were related to cumulative N2O emissions or inorganic N at harvesting. Our results verify the usefulness of optical sensors for biomass detection, and show the difficulty in linking spectral measurements of plant traits to N processes in the soil, despite that the latter affects the former.

[Neurologic manifestations of an easy to treat illness]. / Neurologische Manifestation einer einfach therapierbaren Erkrankung.

A 34 year-old man from Eritrea presented with gradual onset bilateral loin and leg pain. Clinical examination revealed lower abdominal tenderness, ataxia and a tendency to fall backwards. The imaging and lumbar puncture provided new information. Our differential diagnosis included tuberculosis, lymphoma or other granulomatous illness. He was admitted and started on IV methylprednisolone with subsequent resolution of symptoms. Serum ELISA yielded a diagnosis of Schistosomiasis. Consequently treatment with Praziquantel was initiated and steroid therapy continued.