Changes in Employment in the US Health Care Workforce, 2016-2022.

This study examines the rate of employment in US health care in the postpandemic period, through the end of 2022.

Caminhos profissionais dos egressos em um grande hospital de São Paulo / Professional paths of graduates in a large hospital in São Paulo

Este trabalho tem como objetivo avaliar o perfil dos caminhos profissionais após o programa de residência de uma instituição em São Paulo (Hospital do Servidor Público Municipal de São Paulo). Além disso, de forma mais específica, busca-se traçar o perfil de satisfação do egresso com a residência, bem como levantar a produção científica dos egressos durante o programa e correlacionar o perfil do ex aluno e produção científica durante o programa. O trabalho foi realizado com os egressos do Curso de Residência de Clínica Médica no Hospital do Servidor Público Municipal (HSPM), a partir das turmas com ingresso no ano de 2012. Para o levantamento de dados foi disponibilizado um questionário on-line, identificado, através do site Google no modelo Google Forms, este questionário foi composto de sessões que objetivam compreender dados gerais sobre os alunos, informações a respeito dos caminhos traçados após a residência (residência nova ou pós graduação) e compreender o que levou o médico a escolher estes caminhos. O aluno foi convidado a responder o questionário através de links no seu e-mail institucional ou via aplicativo WhatsApp nos números disponibilizados pelo banco de dados da instituição. Os dados foram analisados descritivamente utilizando frequências absolutas e percentuais para as variáveis categóricas e das medidas: média, desvio padrão e mediana. O projeto foi submetido ao Comité de Ética em Pesquisa do HSPM, seguindo a Resolução 466/2012 do Conselho Nacional de Saúde do Ministério de Saúde (CONEP/MS). Os autores do trabalho se comprometem a manter o sigilo das informações coletadas através dos questionários. Palavras-chave: Residência médica. Egresso de residência. Residência em Saúde. Internato e Residência. Hospitais de Ensino.

Use of a Novel Network-Based Linchpin Score to Characterize Accessibility to the Oncology Physician Workforce in the United States.

Importance: Physician headcounts provide useful information about the cancer care delivery workforce; however, efforts to track the oncology workforce would benefit from new measures that capture how essential a physician is for meeting the multidisciplinary cancer care needs of the region. Physicians are considered linchpins when fewer of their peers are connected to other physicians of the same specialty as the focal physician. Because they are locally unique for their specialty, these physicians' networks may be particularly vulnerable to their removal from the network (eg, through relocation or retirement). Objective: To examine a novel network-based physician linchpin score within nationwide cancer patient-sharing networks and explore variation in network vulnerability across hospital referral regions (HRRs). Design, Setting, and Participants: This cross-sectional study analyzed fee-for-service Medicare claims and included Medicare beneficiaries with an incident diagnosis of breast, colorectal, or lung cancer from 2016 to 2018 and their treating physicians. Data were analyzed from March 2022 to October 2022. Exposures: Physician characteristics assessed were specialty, rurality, and Census region. HRR variables assessed include sociodemographic and socioeconomic characteristics and use of cancer services. Main Outcomes and Measures: Oncologist linchpin score, which examined the extent to which a physician's peers were connected to other physicians of the same specialty as the focal physician. Network vulnerability, which distinguished HRRs with more linchpin oncologists than expected based on oncologist density. χ2 and Fisher exact tests were used to examine relationships between oncologist characteristics and linchpin score. Spearman rank correlation coefficient (ρ) was used to measure the strength and direction of relationships between HRR network vulnerability, oncologist density, population sociodemographic and socioeconomic characteristics, and cancer service use. Results: The study cohort comprised 308 714 patients with breast, colorectal, or lung cancer. The study cohort of 308 714 patients included 161 206 (52.2%) patients with breast cancer, 76 604 (24.8%) patients with colorectal cancer, and 70 904 (23.0%) patients with lung cancer. In our sample, 272 425 patients (88%) were White, and 238 603 patients (77%) lived in metropolitan areas. The cancer patient-sharing network included 7221 medical oncologists and 3573 radiation oncologists. HRRs with more vulnerable networks for medical oncology had a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.19; 95% CI, 0.08 to 0.29). HRRs with more vulnerable networks for radiation oncology had a higher percentage of beneficiaries living in poverty (ρ, 0.17; 95% CI, 0.06 to 0.27), and a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.21; 95% CI, 0.09 to 0.31), and lower rates of cohort patients receiving radiation therapy (ρ, -0.18; 95% CI, -0.28 to -0.06; P = .003). The was no association between network vulnerability for medical oncology and percent of cohort patients receiving chemotherapy (ρ, -0.03; 95% CI, -0.15 to 0.08). Conclusions and Relevance: This study found that patient-sharing network vulnerability was associated with poverty and lower rates of radiation therapy. Health policy strategies for addressing network vulnerability may improve access to interdisciplinary care and reduce treatment disparities.

Employment in Office-Based and Intensive Behavioral Health Settings in the US, 2016-2021.

This study uses employment census data to show trends in behavioral health employment during and after the COVID-19 pandemic.

Changes in Unemployment Among Health Care Workers Following the COVID-19 Pandemic.

This study examines changes in unemployment among US health care workers from January 2015 to April 2022, before and after the onset of the COVID-19 pandemic.

Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: A survey was conducted at the 2021 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) to evaluate current practice management strategies among AAHKS members. METHODS: An application was used by AAHKS members to answer both multiple-choice and yes or no questions. Specific questions were asked regarding the impact of COVID-19 pandemic on practice patterns. RESULTS: There was a dramatic acceleration in same day total joint arthroplasty with 85% of AAHKS members performing same day total joint arthroplasty. More AAHKS members remain in private practice (46%) than other practice types, whereas fee for service (34%) and relative value units (26%) are the major form of compensation. At the present time, 93% of practices are experiencing staffing shortages, and these shortages are having an impact on surgical volume. CONCLUSION: This survey elucidates the current practice patterns of AAHKS members. The pandemic has had a significant impact on some aspects of practice activity. Future surveys need to monitor changes in practice patterns over time.

Characterizing the direct care health workforce in the United States, 2010-2019.

BACKGROUND: To describe the growth and characteristics of the direct care health workforce, encompassing home health aides, personal care aides, nursing assistants, and orderlies and psychiatric aides from 2010 to 2019 in the United States. METHODS: Using nationally representative data from the 2010 to 2019 American Community Survey, we described the growth in the direct care health workforce overall and by type of direct care health worker. In addition, we examined the distribution of direct care workers by geographic region of the country, age categories, citizenship, world area of birth, income, health insurance status, and other characteristics. RESULTS: From 2010 to 2019, the number of direct care health workers in the United States per 10,000 individuals decreased slightly from 135.81 in 2010 to 133.78 in 2019. Personal care aides made up 42.1% of the direct care health workforce in 2019, followed by nursing assistants (39.5%) and home health aides (16.3%). In 2019, the number of direct care health workers who were not U.S. citizens accounted for roughly 10% of all workers in each year. The relative percentage of direct care health workers that were not a citizen of the United States was highest among home health aides (16.3%). Among workers born outside of the United States, the majority were from Latin America, followed by Asia. CONCLUSION: From 2010 to 2019, there was little growth in the direct care health workforce despite growing demand for direct care health workers. In the midst of the current and projected shortage of direct care health workers-particularly during the COVID-19 pandemic, longer-term solutions to improve retention of direct care health workers and increase the supply of direct care health workers may be needed.

A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands.

BACKGROUND: We aimed to predict practicing surgeon workforce size across ten specialties to provide an up-to-date, national perspective on future surgical workforce shortages or surpluses. METHODS: Twenty-one years of AMA Masterfile data (1997-2017) were used to predict surgeons practicing from 2030 to 2050. Published ratios of surgeons/100,000 population were used to estimate the number of surgeons needed. MGMA median wRVU/surgeon by specialty (2017) was used to determine wRVU demand and capacity based on projected and needed number of surgeons. RESULTS: By 2030, surgeon shortages across nine specialties: Cardiothoracic, Otolaryngology, General Surgery, Obstetrics-Gynecology, Ophthalmology, Orthopedics, Plastics, Urology, and Vascular, are estimated to increase clinical workload by 10-50% additional wRVU. By 2050, shortages in eight specialties are estimated to increase clinical workload by 7-61% additional wRVU. CONCLUSIONS: If historical trends continue, a majority of surgical specialties are estimated to experience workforce deficits, increasing clinical demands substantially.

An analysis of gender disparities amongst United States medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce.

Gender diversity in medicine continues to be a critical topic, and gender diversity within surgical fields remains an overarching challenge. In the following review, we objectively address the data available in terms of training slots for women in general and vascular surgery and within the vascular surgery workforce. Overall, women comprise 36% of active physicians in the 2019 Association of American Medical Colleges data. The number of women in surgical fields is lower representing 22% in general surgery, 9% in neurosurgery, 6% in orthopedic surgery, 17% in plastic surgery, 8% in thoracic surgery, and 15% in vascular surgery. Also notable is the lower academic ranks held by women in surgery. The proportion of women instructors in surgery in 2020 was 61%, assistant professors 30%, associate professors 23%, and full-time professors only 13.5%. There are multiple opportunities across the divisional/institutional/societal domains in which mentorship and sponsorship can promote gender equity and inclusion. Recruitment and retention of women and minorities into the vascular academic and private practices is essential to ensure best patient outcomes and quality of care for our patients. We hope that by shedding light on this topic, there will be greater awareness and improved strategies to address the disparities within institutions.

COVID-19 Myth Busters: Comparing knowledge and perceptions amongst the dental workforce at an institution in the Eastern Province, Saudi Arabia.

BACKGROUND: Currently, world is suffering from a respiratory disease names as COVID-19. This is a novel coronavirus (n-CoV), a new strain which has not been previously identified in humans and it has spread in more than 100 locations internationally due to which it is termed as "public health emergency of international concern" (PHEIC) by the World Health Organization So far, no study done as yet to assess whether the dental workforce is aware about the facts and myths related to Covid-19 awareness. OBJECTIVE: This study aims to analyze and compare the level of awareness about the facts and myths related to COVID-19 amongst faculty, dental students and prep year students of the College of Dentistry (COD) as part of an awareness campaign. METHODS: An awareness test about COVID-19 was designed using information from the World Health Organization's (WHO) Myth Busters Awareness webpage. The questionnaire was administrated online to faculty and students, of the College of Dentistry and preparatory year students who had applied for the admission to the dental college using a secure enterprise online assessment platform (Blackboard). The tests were administered over a period of three months from March to June 2020. A written informed consent was obtained. RESULTS: The online COVID-19 awareness test was administered to 810 participants, out of which 325 (40%) were prep year students, 429(53%%) were dental students, and 56 (7%) were faculty members. Analysis of the results showed that 86% of the Faculty were able to correctly identify the facts and the myths related to COVID-19 followed by 81% of the prep year students and 74% of the dental students. Preparatory year student's knowledge related to COVID-19 was found to be high when compared to dental students (26.47±4.27, 23.67±6.2). Student to faculty knowledge score did not differ significantly (p = 0.808). CONCLUSION: This study reports about a successful pilot test conducted to assess the perceived knowledge about facts and myths related to corona virus amongst the dental workforce.

Modelo dinámico para proyectar la necesidad de recursos humanos en salud: anestesistas en Uruguay / Anesthesiologists in Uruguay: dynamic model to project the need of human resources in healthcare

Objetivo Desarrollar un modelo dinámico para simular la oferta de médicos especialistas y estimar la brecha especto a la demanda/necesidad en anestesiología en el sistema de salud del Uruguay. Métodos Se desarrolló un modelo de simulación dinámico determinístico implementado en el programa libre R. Se analizaron las proyecciones en el período 2011-2050 y se estimó la brecha a partir de la situación de equilibrio o desequilibrio entre oferta y demanda/necesidad. Se evaluó la calidad del modelo comparando los valores simulados con los datos históricos, con indicadores de bondad de ajuste, como la raíz del error cuadrático medio relativo (rRMSE). Se realizó un análisis de sensibilidad con respecto a los cupos de ingreso a la especialidady la tasa de crecimiento de la necesidad de especialistas. Resultados Se proyectó la oferta y demanda de anestesistas para el período considerado. Se obtuvo un rRMSE menor a 0,1, lo que sugiere que el modelo propuesto reproduce adecuadamente la dinámica de la oferta real. Para el período proyectado la situación a mediano y largo plazo es de equilibrio. Conclusión El modelo simulado presenta buen ajuste, por lo que la proyección de la oferta de Recursos Humanos (RR. HH.) representa de forma precisa la disponibilidad futura de la fuerza de trabajo. Además, el modelo representa un insumo de interés para la gestión informada sobre la necesidad de recursos humanos y las políticas de salud, dado que permite evaluar las proyecciones bajo diferentes escenarios.

Objectives The aim of this study is to develop a dynamic model to simulate the supply of specialized physicians in Anesthesiology and estimate the gap with its demand, within Uruguay healthcare system. Methods A deterministic dynamic simulation model was developed and implemented using R software. Projections for the 2011-2050 period were analyzed, and the gap was estimated based on the equilibrium state of supply and demand. The quality of the model was evaluated comparing the simulated data with historical empirical data using goodness of fit indicators, such as the relative root mean square error (rRMSE). Results The demand and supply of anesthesiologists was projected for the period under analysis. A rRMSE<0,1 was obtained, which suggests the proposed model adequately reproduces the real offer dynamics. Based on the defined gap criteria, in the medium and long-term the situation is in equilibrium state. Conclusions The simulated model presents a good fit so that the human resources (HR) supply projection represents in a precise way the future availability of the work-force. Given that the model allows to evaluate the projection dynamics under different management scenarios, the model also represents an input of the utmost interest for management knowledgeable about human resource demands and healthcare policy.

Exploring Challenges to COVID-19 Vaccination in the Darfur Region of Sudan.

The current COVID-19 pandemic has affected the ability of health systems to provide essential services globally. The Darfur region, located in the western part of Sudan, has been largely devastated by the war that began in 2003 and has been drawing considerable attention from the international community. The war, which erupted as a result of environmental, political, and economic factors, has led to tragic outcomes. Collapsing health-care infrastructures, health workforce shortages, lack of storage facilities for medicines and medical products, and inadequate access to health services are some of the effects of the war. After Sudan received the AstraZeneca COVID-19 vaccine through the COVID-19 Vaccines Global Access facility, significant challenges have been implicated in the delivery, storage, and use of the vaccine in the Darfur region. Lack of vaccine storage and transportation facilities, vaccination hesitancy, inequity in the distribution to health facilities, and shortage of health-care professionals resulting from insecurity and instability have added an extra layer of burden on local authorities and their ability to manage COVID-19 vaccinations in the region adequately. Addressing the impact of COVID-19 requires an effectively managed vaccination program. In the face of current challenges in Darfur, ensuring a fully vaccinated population might remain far-fetched and improbable if meaningful efforts are not put in place by all stakeholders and actors to address some of the challenges identified.