Association Between Gender and Salary Among Pediatric Hospital Medicine Physicians.

OBJECTIVES: Gender-based disparities in salary exist in multiple fields of medicine. However, there is limited data examining gender inequities in salary in pediatric hospital medicine (PHM). Our primary objective was to assess whether gender-based salary differences exist in PHM. The secondary objective was to assess if, among women, the differences in salary varied on the basis of leadership positions or self-identified race and ethnicity. METHODS: We conducted a survey-based, cross-sectional study of pediatric hospitalists in December 2021. Our primary outcomes were base and total salary, adjusted for the reported number of average weekly work hours. We performed subanalyses by presence of a leadership position, as well as race. We used a weighted t test using inverse probability weighting to compare the outcomes between genders. RESULTS: A total of 559 eligible people responded to our survey (51.0%). After propensity score weighting, women's mean base salary was 87.7% of men's base (95% confidence interval [CI] 79.8%-96.4%, P < .01), and women's total salary was 85.6% of men's total (95% CI 73.2%-100.0%, P = .05) salary. On subgroup analysis of respondents with a leadership position, women's total salary was 80.6% of men's total salary (95% CI 68.7%-94.4%, P < .01). Although women who identified as white had base salaries that were 86.6% of white men's base salary (95% CI 78.5%-95.5%, P < .01), there was no gender-based difference noted between respondents that identified as nonwhite (88.4% [69.9%-111.7%] for base salary, 80.3% [57.2% to 112.7%]). CONCLUSIONS: Gender-based discrepancies in salary exists in PHM, which were increased among those with leadership roles. Continued work and advocacy are required to achieve salary equity within PHM.

[How to manage parental leave as a self-employed physician?] / Comment gérer un congé parental comme médecin indépendant ?

Under Swiss law, the maternity leave (14 weeks) and paternity leave (2 weeks) allowance, for self-employed individuals as well, shall be 80% of salary, to a maximum of 220 CHF a day, i.e. 6600 CHF a month. This amount is generally insufficient to cover the fixed expenses of the Swiss self-employed physician, which are 19'400 CHF per month on average, and only partly reducible during the leave. The use of personal savings excepted, the obvious solution is replacement, which is already implemented in many other countries, but still poorly developed in Switzerland. A project of an internet platform to centralize supply and demand at federal level is under development.

Selon la loi suisse, le montant de l'allocation parentale, également pour les indépendants (maternité : 14 semaines ; paternité : 2 semaines) correspond à 80 % du salaire, et est d'au maximum 220.- CHF par jour, soit 6600.- CHF par mois. Ce montant est généralement insuffisant pour couvrir les charges des médecins indépendants suisses, qui sont en moyenne de 19 400.- CHF par mois, et seulement partiellement réductibles durant le congé. Hormis le recours aux économies personnelles, la solution qui s'impose est celle du remplacement, déjà fonctionnel dans bien d'autres pays, et encore peu développé en Suisse. Un projet de plateforme de remplacement pour centraliser l'offre et la demande au niveau fédéral est en cours de développement.

Effect of financial incentives on the cost and duration of sickness absence.

Sickness absence is a major concern in public health, affecting individuals, businesses, and society. Developing efficient sickness absence policies could help reduce sickness absence. A key aspect of these policies concerns the financial compensation provided to absent employees, including its amount and the length of time it is offered. This study addresses how financial incentives, like salary reductions, might influence sickness absence. For this purpose, we first develop a model to estimate the sensitivity of employees to a financial incentive using a large dataset consisting of approximately six million sickness cases. We then perform a simulation study to determine the effect of similar incentives at different moments and for varying sensitivities. Our findings indicate that financial incentives can notably shorten the duration of sickness absence and decrease its associated costs, particularly when such incentives are implemented early in the absence period. Incentives implemented later have less impact on absence duration, but can still reduce the overall cost. The results of this study can be used by healthcare professionals and employers in the design and evaluation of diverse sickness absence policies.

Wages or Legitimacy? A Qualitative Analysis of Home Care Worker Perspectives in Choosing Work Settings.

Directly-Funded (DF) home care allows users to organize and purchase their own care services and is expanding globally. Little is known about the career pathways of home care workers. Our study asks, what experiences and factors do home care workers consider when choosing a work setting? And, specifically, what influences their decisions to work directly for their clients? Framed with Cranford's (2020) flexibility-security matrix for analyzing home care dynamics, we remotely interviewed 20 home care workers in two Canadian provinces. Three team members conducted axial coding and thematic analysis using Dedoose software. We identified personal and material factors at the intimate and labor market level that workers weigh when choosing whether to work for an agency or directly for a client. At the intimate level, workers value the flexibility, autonomy, and respect facilitated in care relations when working directly for a client. At the labor market level, agencies provide better job security and the benefit of supervisory support but lower wages. Additionally, as care work often serves as a stepping stone for immigration and citizenship agency positions are considered a more "legitimate" option than working directly for a client. Our study shows that workers directly employed by their clients enjoy more flexibility but lack security, whereas agency employed workers risk immediate reductions in working conditions in exchange for limited improvements in safety and supervision and, like other frontline care work, DF home care represents a key career pathway for immigrants with previous experience in health and social care settings.

Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study.

INTRODUCTION: Community health worker (CHW) incentives and remuneration are core issues affecting the performance of CHWs and health programs. There is limited documentation on the implementation details of CHW financial compensation schemes used in sub-Saharan African countries, including their mechanisms of delivery and effectiveness. We aimed to document CHW financial compensation schemes and understand CHW, government, and other stakeholder perceptions of their effectiveness. METHODS: A total of 68 semistructured interviews were conducted with a range of purposefully selected key informants in 7 countries: Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia. Thematic analysis of coded interview data was conducted, and relevant country documentation was reviewed, including any documents referenced by key informants, to provide contextual background for qualitative interpretation. RESULTS: Key informants described compensation schemes as effective when payments are regular, distributions are consistent, and amounts are sufficient to support health worker performance and continuity of service delivery. CHW compensation schemes associated with an employed worker status and government payroll mechanisms were most often perceived as effective by stakeholders. Compensation schemes associated with a volunteer status were found to vary widely in their delivery mechanisms (e.g., cash or mobile phone distribution) and were perceived as less effective. Lessons learned in implementing CHW compensation schemes involved the need for government leadership, ministerial coordination, community engagement, partner harmonization, and realistic transitional financing plans. CONCLUSION: Policymakers should consider these findings in designing compensation schemes for CHWs engaged in routine, continuous health service delivery within the context of their country's health service delivery model. Systematic documentation of the tasks and time commitment of volunteer status CHWs could support more recognition of their health system contributions and better determination of commensurate compensation as recommended by the 2018 World Health Organization Guidelines on Health Policy and System Support to Optimize Community Health Worker Programs.

Physician workload and practice management in pediatric gastroenterology.

OBJECTIVES: The pediatric gastroenterology workforce has grown in the last few decades. The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) formed a task force to understand current pediatric gastroenterology organizations' practice structures. METHODS: 19-item electronic survey was distributed to NASPGHAN members who were clinical or academic division directors. RESULTS: 30% responded to the survey, all directors of academic practices. The median number of clinical sessions per week was seven sessions, and the median individual work relative value unit (wRVU) target for practices was 4000-4500. Healthcare team ratios compared to provider clinical full-time equivalent were reported as the following: Nursing 0.80, medical assistant (MA) 0.29, dietitian 0.29, social worker 0.14, and psychologist 0.13. Regarding compensation, 68.0% were salaried with bonus based on billing or director decision, 28.0% were salaried with no incentive pay, and 4.0% were salaried with a portion at risk if the target was not met, and a bonus was given if the target was met. Most practices participated in a wellness activity with the most common strategies being didactic lectures about physician burnout (80%), annual burnout check-ins (68%), and/or after-hours social activities (60%). CONCLUSIONS: Pediatric gastroenterology practices vary regarding clinical sessions per week and annual wRVU targets with the median at seven sessions per week and an annual goal of 4000-4500 wRVUs, similar to reported national benchmark goals at the 50th percentile. Healthcare teams, including nursing, MAs, dietitians, social workers, and psychologists, had similar ratios of staff to providers for all sizes and types of practices. Most practices are engaging in wellness initiatives.

Willingness to pay for improved working conditions of nurses: Results from a factorial survey experiment in Germany.

BACKGROUND: Many countries face substantial shortages of skilled nurses. With an aging population and global demographic changes, developing a skilled workforce of nurses has become one of the central challenges for public health care. The recent COVID-19 pandemic has exacerbated labor shortages, which pose a threat to the quality of publicly provided health care. Improving nurses' working conditions could be a means by which to address the global shortages of nurses. However, in countries with public health care, such improvements may come with additional costs in the form of higher taxes or social security contributions. Therefore, such improvements partly depend on people's willingness to pay (WTP) for them. OBJECTIVE: In this paper, we investigate workers' willingness to pay for improvements in the working conditions of nurses. DESIGN: This study is a factorial survey experiment included as part of an online survey. SETTING(S): The factorial survey experiment was implemented within the high-frequency online panel survey "Life and Employment in Times of Corona" (IAB-HOPP) conducted by the Institute for Employment Research (Germany). PARTICIPANTS: We analyze data from N = 2128 survey participants; our main analysis consists of N = 6384 responses from those participants. METHODS: Our research is based on a factorial survey experiment (vignette analysis) designed to quantitatively measure the willingness to pay for various improvements in the working conditions of nurses. We use random effect models and mixed models to estimate the individual-level willingness to pay for these improvements. RESULTS: Our results show that the survey participants are generally willing to pay for particular policies aimed at improving the working conditions of nurses. However, the amount that respondents are willing to pay varies with the type of policy changes. Survey participants exhibit a high willingness to pay for increases in minimum wages for nurses and wage-related improvements in general. We find, however, a lower willingness to pay for the right to participate in training courses aimed at reducing work-related stress. CONCLUSIONS: The broad support for improvements in the working conditions of nurses provides policymakers with some guidance in implementing policy measures that might address labor shortages in the nursing sector. REGISTRATION: There was no preregistration. TWEETABLE ABSTRACT: Many people are willing to pay extra to improve the working conditions of nurses. Wage-related increases for nurses show the highest willingness to pay.

An exploratory study to identify the factors influencing community pharmacist retention by using COM-B model.

BACKGROUND: Due to multitude of gaps in Pakistan's healthcare system, community pharmacies serve as the" first port of call" for various illnesses. However, the present scarcity of pharmacists in these settings poses significant challenges to healthcare delivery in the country. This scarcity is primarily due to difficulties in retaining pharmacists for community practice. The aim of this study was to explore the factors that influence the retention of community pharmacists by using COM-B model. METHODS: A qualitative methodology employing the COM-|B model was utilized to design this study. In-depth interviews were conducted with pharmacists experienced in community pharmacy practice, at time and place convenient to them. Data were transcribed, translated and analyzed by deductive thematic analysis in accordance with the constructs of COM-B model. RESULTS: A diverse range of factors were identified that negatively influenced the retention of community pharmacists including working conditions and proprietor's demeanor, deficiency in training and intern experience, lack of career planning, low social acceptance, less salary and job satisfaction, less regulatory control and aptitude of renting out category. Conversely, the study also identified the factors that motivate community pharmacists to stay in their roles despite the challenges including strong educational background, abundant job opportunities, flexible schedules, direct patient engagement and positive impact on sales. CONCLUSION: There was an observed discrepancy between the challenges faced by community pharmacists and the motivators that encourage them to continue their job. Due to a disparity and abundance of challenges rather than motivators, retention rates for community pharmacists are low. This imbalance shed light on areas where improvements are needed to enhance pharmacist retention. Various areas for change were highlighted including strict implementation of regulations, integration of practical experience of community pharmacy practice and internships into academic programs, career guidance, and raising patient awareness about the roles of community pharmacists.

[Dual practice in the Spanish health system: problem or solution? SESPAS Report 2024]. / La práctica dual público-privada en la sanidad española. ¿Solución o problema? Informe SESPAS 2024.

The Spanish public health system is overburdened. As a result, heath care professionals are showing symptoms of burnout, while private health services are expanding more than ever. As revealed by numerous strikes in recent years, health care professionals want better pay and work conditions and feel frustrated by their inability to give proper time and care to their patients. The institutional response from regional governments in Spain has been to remove the exclusivity clause that provided a salary bonus for physicians who worked entirely in the public sector; now all physicians receive this bonus, effectively promoting dual (public and private) practice. Although dual practice may increase the income of physicians and other health professionals, it poses several challenges that are analyzed in this paper. We also discuss alternative and more far-reaching policies that we believe should be implemented by the government in order to deal with the current crisis of the health system.

Commitment to inclusion: The importance of collaboration in gender equity work.

Despite decades of faculty professional development programs created to prepare women for leadership, gender inequities persist in salary, promotion, and leadership roles. Indeed, men still earn more than women, are more likely than women to hold the rank of professor, and hold the vast majority of positions of power in academic medicine. Institutions demonstrate commitment to their faculty's growth by investing resources, including creating faculty development programs. These programs are essential to help prepare women to lead and navigate the highly matrixed, complex systems of academic medicine. However, data still show that women persistently lag behind men in their career advancement and salary. Clearly, training women to adapt to existing structures and norms alone is not sufficient. To effectively generate organizational change, leaders with power and resources must commit to gender equity. This article describes several efforts by the Office of Faculty in the Johns Hopkins University School of Medicine to broaden inclusivity in collaborative work for gender equity. The authors are women and men leaders in the Office of Faculty, which is within the Johns Hopkins University School of Medicine dean's office and includes Women in Science and Medicine. Here, we discuss potential methods to advance gender equity using inclusivity based on our institutional experience and on the findings of other studies. Ongoing data collection to evaluate programmatic outcomes in the Johns Hopkins University School of Medicine will be reported in the future.

Enhancing detection of labor violations in the agricultural sector: A multilevel generalized linear regression model of H-2A violation counts.

Agricultural workers are essential to the supply chain for our daily food, and yet, many face harmful work conditions, including garnished wages, and other labor violations. Workers on H-2A visas are particularly vulnerable due to the precarity of their immigration status being tied to their employer. Although worksite inspections are one mechanism to detect such violations, many labor violations affecting agricultural workers go undetected due to limited inspection resources. In this study, we identify multiple state and industry level factors that correlate with H-2A violations identified by the U.S. Department of Labor's Wage and Hour Division using a multilevel zero-inflated negative binomial model. We find that three state-level factors (average farm acreage size, the number of agricultural establishments with less than 20 employees, and higher poverty rates) are correlated with H-2A violations. These findings offer valuable insights into where H-2A violations are being detected at the state and industry levels.

Managerial (dis)preferences towards employees working from home: Post-pandemic experimental evidence.

Work from home (WFH) has been a part of the professional landscape for over two decades, yet it was the COVID-19 pandemic that has substantially increased its prevalence. The impact of WFH on careers is rather ambiguous, and a question remains open about how this effect is manifested in the current times considering the recent extensive and widespread use of WFH during the pandemic. To answer these questions, this article investigates whether managerial preferences for promotion, salary increase and training allowance depend on employee engagement in WFH. We take into account the employee's gender, parental status as well as the frequency of WFH. Furthermore, we examine whether managers' experience with WFH and its prevalence in the team moderate the effect of WFH on careers. An online survey experiment was run on a sample of over 1,000 managers from the United Kingdom. The experiment was conducted between July and December 2022. The findings indicate that employees who WFH are less likely to be considered for promotion, salary increase and training than on-site workers. The pay and promotion penalties for WFH are particularly true for men (both fathers and non-fathers) and childless women, but not mothers. We also find that employees operating in teams with a higher prevalence of WFH do not experience negative career effects when working from home. Additionally, the more WFH experience the manager has, the lesser the career penalty for engaging in this mode of working. Our study not only provides evidence on WFH and career outcomes in the post-pandemic context but also furthers previous understanding of how WFH impacts careers by showing its effect across different groups of employees, highlighting the importance of familiarisation and social acceptance of flexible working arrangements in their impact on career outcomes.

It's a jungle out there: Understanding physician payment and its role in group dynamics.

Although collaboration between healthcare professionals is essential for the delivery of effective, efficient, and high-quality care, it remains an ongoing and critical challenge across health systems. As a result, many countries are experimenting with innovative payment and employment models. The literature tends to focus on improving collaboration across organizational and sectoral boundaries, and largely ignores potential barriers to collaborative work between members of the same profession within a single organization. Despite intergroup dynamics and professional boundaries having been shown to restrict patient flow and collaboration between specialties, studies have so far tended to overlook the potential effects of differentiated organizational and payment models on physicians' behaviors and intergroup dynamics. In the present study, we seek to unpack the influence of physicians' payment and employment models on their collaborative behaviors and on intergroup dynamics between specialties, adding to the current scholarship on physician payment and employment by considering how physicians' view and act in response to different structural arrangements. The findings suggest that adopting hybrid models, in which physicians are employed or paid differently within the same organization or practice, creates a bifurcation of the profession whereby physicians across different models are perceived to behave differently and have conflicting professional values. These models are perceived to inhibit collaboration between physicians and complicate hospital governance, restricting the ability to move towards new models of care delivery. These findings can be used as a basis for future work that aims to unpack the reality of physician payment and offer important insights for policies surrounding physician employment.