Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.727
Filtrar
5.
Acad Med ; 96(3): 375-380, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33661849

RESUMO

A critical shortage of physicians is looming in the United States. The situation in Kentucky is especially dire, especially in rural areas. Class size constraints have resulted in the University of Kentucky College of Medicine (UK COM) unable to admit over 100 qualified Kentuckians each year. This article describes how leadership at University of Kentucky committed to addressing the state physician shortage while simultaneously strengthening relationships with critical partners through the establishment of two 4-year UK COM regional medical campuses. Based on criteria (such as a commitment to educating physicians, ample patients, sufficient willing physician preceptors, etc.), partners selected were Med Center Health, the leading health care system in southwestern Kentucky, and St. Elizabeth Healthcare, the predominant health care system in northern Kentucky. These regional campuses allow UK COM to expand its class size to 201 and total enrollment to 804, increasing from historically 70 to currently 120 graduates per year expected to practice in Kentucky. Critical to the success of this expansion is the buy-in of leadership and the Admissions Committee to consider students with a wider range of Medical College Admission Test scores. The regional clinical partners have substantially increased their teaching opportunities, with a greater ability to attract physicians. Both partners have made substantial financial contributions in support of the regional campuses. These relationships have energized UK COM engagement with its area alumni and have resulted in fewer Kentuckians referred out of state for advanced specialty care. Partnerships are also occurring with UK COM to increase graduate medical education offerings at the regional sites, fulfilling the vision of "training Kentuckians in Kentucky to practice in Kentucky."


Assuntos
Centros Médicos Acadêmicos/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Política Pública/legislação & jurisprudência , Centros Médicos Acadêmicos/provisão & distribução , Redes Comunitárias , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Kentucky/epidemiologia , Médicos/provisão & distribução , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/tendências , População Rural/estatística & dados numéricos , Especialização/estatística & dados numéricos , Planejamento Estratégico/normas , Estados Unidos/epidemiologia
7.
J Prim Care Community Health ; 12: 2150132721994018, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33567941

RESUMO

OBJECTIVE: To examine the reasons contributing to the physician shortage in the country's medically underserved areas using the state of Delaware as a focus state. METHOD: A literature review regarding the shortage of physicians with data compilation from Delaware Department of Public Health (DPH) and Delaware Health and Social services (DHSS) was performed. A review of the "Conrad 30 J1 VISA waiver program," the most important and primary supplier of physicians to underserved areas of the state was performed. A survey interviewing the physicians recruited through this program to identify any challenges faced by them was designed and conducted. RESULTS: The number of primary care physicians providing direct patient care in Delaware in 2018 had declined about 6% from 2013. The average wait time to see a PCP was 8.2 days in 1998 as compared to 23.5 days in 2018. Forty-six percent of physicians serving in HPSAs in Delaware are IMGs recruited through the J1 VISA waiver program. Eighty percent of these IMGs are actively considering leaving the United States due to anxieties around physician immigration policies, mainly "Immigration backlog." CONCLUSION: The existing programs to recruit physicians to underserved areas seem to be inadequate. The state and the hospital systems should be able to utilize the J1 program to its full potential and focus on retaining these physicians after their assigned services. As the challenges of IMGs continue to worsen every day; the medical societies, hospitals, the state and federal government should advocate for policies that resolve these challenges.


Assuntos
Área Carente de Assistência Médica , Médicos/provisão & distribução , Atenção Primária à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Delaware , Humanos
9.
PLoS One ; 16(1): e0244097, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33434228

RESUMO

Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is temporarily beyond the capacity for which the ED is designed and resourced to manage-a phenomenon called Emergency Department (ED) crowding. ED crowding can impair the quality of care delivered to patients and lead to longer patient waiting times for ED doctor's consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency physicians have to cope with patient volumes above the safe workload. The purpose of this study is to create a virtual ED that closely maps the processes of a hospital-based ED in Singapore using system dynamics, that is, a computer simulation method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i) co-location of primary care services within the ED, (ii) increase in the capacity of doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and (iv) a combination of policies (i) to (iii). Among the tested policies, the co-location of primary care services has the largest impact on patients' average length of stay (ALOS) in the ED. This implies that decanting non-emergency lower acuity patients from the ED to an adjacent primary care clinic significantly relieves the burden on ED operations. Generally, in Singapore, there is a tendency to strengthen primary care and to educate patients to see their general practitioners first in case of non-life threatening, acute illness.


Assuntos
Simulação por Computador , Serviço Hospitalar de Emergência/estatística & dados numéricos , Análise Custo-Benefício , Aglomeração , Serviço Hospitalar de Emergência/economia , Humanos , Tempo de Internação , Política Organizacional , Admissão do Paciente , Alta do Paciente , Transferência de Pacientes , Médicos/estatística & dados numéricos , Médicos/provisão & distribução , Atenção Primária à Saúde/economia , Encaminhamento e Consulta , Singapura
10.
Acad Med ; 96(4): 486-489, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33496430

RESUMO

Support of the U.S. health professions investigator workforce is critically important to the continued advancement of health care nationally. Physician-investigators comprise one segment of this health professions investigator workforce, which also includes investigators in the nursing, pharmacy, and dentistry professions, and others. Among physician health professionals in particular, the term "physician-investigator" has been described as encompassing physicians engaged in research in various ways including "clinical researchers" (physicians with clinical duties who do clinical, patient-centered research), "clinician-scientists" (physicians with clinical roles who perform research in laboratories or using computational tools), and "physician-scientists" (physicians focused on research with little or no clinical activity). Broadly defined, physician-investigators are included in various groups of researchers described in several articles recently published in Academic Medicine; these articles provide details on a range of approaches, with supporting outcomes data, being taken to train, support, and retain physicians in the health professions investigator workforce. The authors of this commentary examine selected literature, including several articles in this issue among others, along with Association of American Medical Colleges data, to offer observations about programs that train physician-investigators. Evidence-informed single-program approaches for early-career researchers can sustain continued research interest and foster the career development of the emerging physician-investigator workforce. Collaborative multi-institutional approaches offer the benefit of multisite work to power outcomes studies and to increase generalizability beyond a specific institutional program. System-wide institutional approaches may be particularly critical in supporting physician-investigators across all career stages. Although the articles discussed in this commentary are largely (although not exclusively) focused on various initiatives and programs designed to develop and sustain the physician-investigator workforce, such initiatives and programs may have value in addressing shared challenges of developing, supporting, and retaining the broader investigator workforce across all health professions.


Assuntos
Pesquisa Biomédica/tendências , Escolha da Profissão , Pessoal de Saúde/educação , Médicos/provisão & distribução , Pesquisadores/educação , Pesquisadores/provisão & distribução , Recursos Humanos/tendências , Adulto , Pesquisa Biomédica/estatística & dados numéricos , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Pesquisadores/estatística & dados numéricos , Estados Unidos , Recursos Humanos/estatística & dados numéricos
11.
Psychiatr Serv ; 72(4): 437-443, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33467869

RESUMO

OBJECTIVE: The psychological sequelae of the COVID-19 crisis will increase demands for psychiatric care in already strained emergency and mental health systems. To address the shortage of psychiatrists (and nurse practitioners and physician assistants) in emergency settings (ESs), the American Association for Emergency Psychiatry (AAEP) has established recommendations for utilizing nonprescribing mental health professionals in the evaluation and management of psychiatric patients in these contexts. METHODS: Faced with limited research on the roles and competencies of nonprescribing psychiatric emergency clinicians (PECs), a multidisciplinary committee of members of AAEP was tasked with developing recommendations for use of PECs. RESULTS: The committee developed eight recommendations regarding the role of PECs in evaluation and management of patients who present to ESs with behavioral emergencies. PECs should have the following competencies: conducting independent psychiatric and substance abuse evaluations; managing behavioral emergencies; aiding in the recognition of confounding medical illnesses, intoxication and withdrawal states, and adverse drug reactions; developing appropriate treatment plans; recognizing when consultation from a psychiatrist or emergency physician is indicated; possessing self-awareness and recognizing clinician-patient dynamics; understanding medicolegal issues, such as involuntary holds and decision-making capacity; and collaborating with clinical teams in ESs. PECs are not meant to replace psychiatrists but to extend the psychiatrist's reach. Use of PECs has already been implemented in some areas of the country. CONCLUSIONS: On the basis of the AAEP recommendations, ESs can address staffing shortages while ensuring safe management of patients with behavioral emergencies. With appropriate orientation and training, the PEC can serve effectively and competently in an ES.


Assuntos
Serviço Hospitalar de Emergência , Serviços de Emergência Psiquiátrica , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Médicos/provisão & distribução , Psiquiatria , Centros Médicos Acadêmicos , Ambulâncias , Conselheiros , Humanos , Enfermeiras e Enfermeiros , Admissão e Escalonamento de Pessoal , Psicologia , Assistentes Sociais
12.
Soc Work Public Health ; 36(2): 178-193, 2021 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-33369535

RESUMO

In the fight against Covid-19, developed countries and developing countries diverge in success. This drew attention to the discussion of how different health systems and different levels of health spending are effective in combating Covid-19. In this study, the role of the health system in the fight against Covid-19 is discussed. In this context, the number of hospital beds, the number of doctors, life expectancy at 60, universal health service and the share of health expenditures in GDP were used as health indicators. In the study, firstly 2020 data was estimated by using the Artificial Neural Networks simulation method and this year was used in the analysis. The model, with the data of 124 countries, was estimated using the cross-sectional OLS regression method. The estimation results show that the number of hospital beds, number of doctors and life expectancy at the age of 60 have statistically significant and positive effects on the ratio of Covid-19 recovered/cases. Universal health service and share of health expenditures in GDP are not significant statistically on the cases and recovered. Hospital bed capacity is the most effective variable on the recovered/case ratio.


Assuntos
Simulação por Computador , Assistência à Saúde , Saúde Global , Redes Neurais de Computação , /mortalidade , Estudos Transversais , Assistência à Saúde/organização & administração , Gastos em Saúde , Número de Leitos em Hospital , Humanos , Expectativa de Vida , Médicos/provisão & distribução , Análise de Regressão
14.
Rev Saude Publica ; 54: 148, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331491

RESUMO

OBJECTIVE: To estimate the flow of professionals and the financial impact of the Programa Mais Médicos para o Brasil (PMMB - More Doctors for Brazil Program) within the More Doctors Program (MDP) for the Brazilian Ministry of Health and the participating municipalities of the state of São Paulo, from January 2019 to March 2022. METHODS: A financial impact study was conducted in the state of São Paulo based on public secondary databases. The number of PMMB vacancies per municipality, of physicians and vulnerability profiles were described to measure the loss of replacement of professionals in the period. RESULTS: In the specified period, the number of PMMB physicians in participating cities will decrease from 2,533 to 320, and the number of participating municipalities from 373 to 86. The municipalities that will need to replace the physicians will have a financial impact of R$ 929,487,904.77 (with sensitivity analysis, ranging from R$ 650,641,533.34 to R$ 1,208,334,276.20). CONCLUSION: The change of vulnerability methodology adopted for the PMMB will represent serious consequences, that is, less population assistance and high financial impact for the municipalities of the state of São Paulo in a scenario of budget limitations.


Assuntos
Educação Médica , Médicos , Brasil , Cidades , Educação Médica/economia , Humanos , Médicos/provisão & distribução , Avaliação de Programas e Projetos de Saúde
16.
Intern Med J ; 50(8): 924-930, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32881266

RESUMO

BACKGROUND: Infectious diseases (ID) physicians perform a pivotal role in directing the response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AIM: To assess the impact of SARS-CoV-2 on workload and the perceptions of ID physicians regarding the national response in Australia and New Zealand in the pre-pandemic. METHODS: A survey of ID physicians in Australia and New Zealand was undertaken from 3 to 10 March 2020. Respondents were asked to estimate time spent on SARS-CoV-2-related activities in February and report their agreement with statements on a 5-point Likert scale ranging from 'strongly agree' to 'strongly disagree'. We also asked about the intended use of investigational agents. RESULTS: There were 214 respondents (36% of 600 eligible participants). The median workload due to SARS-CoV-2-related activities was 34% of one full-time equivalent (interquartile range 18-68%). Less than a quarter (50, 23%) of respondents had experience managing cases, while 33% (70) had experience preparing during similar pandemics. Nevertheless, 88% (188/213) believed they were well informed when giving testing and management advice, and 45% (95/212) believed their national response was well coordinated. Additionally, 41% (88/214) were worried about becoming infected through occupational exposure. Over half (116, 54%) the respondents intended to use lopinavir/ritonavir in confirmed cases of COVID-19 with severe disease. CONCLUSIONS: ID physicians spent a large proportion of time on SARS-CoV-2-related activities. Increased staffing is required to avoid burnout. Importantly, ID physicians feel well informed when giving advice. A national body should be established to co-ordinate response. Treatment efficacy trials are needed to clarify the utility of unproven treatments.


Assuntos
Infecções por Coronavirus , Pandemias , Médicos , Pneumonia Viral , Austrália/epidemiologia , Betacoronavirus , Esgotamento Profissional/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Infecções/epidemiologia , Nova Zelândia/epidemiologia , Pandemias/prevenção & controle , Papel do Médico , Médicos/psicologia , Médicos/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Psicologia , Inquéritos e Questionários , Carga de Trabalho
18.
Artigo em Inglês | MEDLINE | ID: mdl-32816942

RESUMO

A narrative review was conducted to examine the current state of the utilisation of telemedicine amid the current COVID-19 pandemic and to evaluate the benefits of continuing telemedicine usage in the future. A literature review was performed for articles related to telemedicine. Databases including PubMed, Google Scholar, Cochrane Library and Ovid MEDLINE were searched. Three reviewers independently performed article selection based on relevance to our topic. We included all articles between 1990 and 2020 related to telemedicine using the following keywords: 'telemedicine', 'telehealth', 'policy', 'COVID-19', 'regulation', 'rural', 'physical examination', 'future'. A total of 60 articles were identified, and through careful selection we narrowed the final number of articles to 42 based on relevance to our topic. Telemedicine has been rapidly evolving over the past several decades. Issues with regulation and reimbursement have prevented its full immersion into the healthcare system. During the current pandemic, Centers for Medicare and Medicaid services have expanded access to telemedicine services. The advantages of telemedicine moving forward include its cost-effectiveness, ability to extend access to specialty services and its potential to help mitigate the looming physician shortage. Disadvantages include lack of available technological resources in certain parts of the country, issues with security of patient data, and challenges in performing the traditional patient examination. It is critically important that changes are made to fully immerse telemedicine services into the healthcare landscape in order to be prepared for future pandemics as well as to reap the benefits of this service in the future.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Telemedicina , Betacoronavirus , Análise Custo-Benefício , Previsões , Acesso aos Serviços de Saúde , Humanos , Pandemias , Médicos/provisão & distribução , Estados Unidos
20.
Tex Med ; 116(6): 42-45, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32645177

RESUMO

Texas' plan to grow and keep more physicians in state is coming to fruition, but it will require constant nurturing to reach harvest. The latest crop will come out of a collaboration between one of the state's newest medical schools, in Fort Worth, and Baylor Scott and White All Saints Medical Center. The program will create as many as 150 new residency positions in the Dallas-Fort Worth area through 2027. Collaborations between medical schools and health care institutions will add to those numbers in coming years.


Assuntos
Educação de Pós-Graduação em Medicina , Internato e Residência/estatística & dados numéricos , Faculdades de Medicina/estatística & dados numéricos , Apoio ao Desenvolvimento de Recursos Humanos , Humanos , Médicos/provisão & distribução , Texas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...