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Background Rural India has a severe shortage of human resources for health (HRH). The National Rural Health Mission (NRHM) deploys HRH in the rural public health system to tackle shortages. Sanctioning under NRHM does not account for workload resulting in inadequate and inequitable HRH allocation. The Workforce Indicators of Staffing Needs (WISN) approach can identify shortages and inform appropriate sanctioning norms. India currently lacks nationally relevant WISN estimates. We used existing data and modelling techniques to synthesize such estimates. Methods We conducted a retrospective analysis of existing survey data for 93 facilities from 5 states over 8 years to create WISN calculations for HRH cadres at primary and community health centres (PHCs and CHCs) in rural areas. We modelled nationally representative average WISN-based requirements for specialist doctors at CHCs, general doctors and nurses at PHCs and CHCs. For 2019, we calculated national and state-level overall and per-centre WISN differences and ratios to depict shortage and workload pressure. We checked correlations between WISN ratios for cadres at a given centre-type to assess joint workload pressure. We evaluated the gaps between WISN-based requirements and sanctioned posts to investigate suboptimal sanctioning through concordance analysis and difference comparisons. Results In 2019, at the national-level, WISN differences depicted workforce shortages for all considered HRH cadres. WISN ratios showed that nurses at PHCs and CHCs, and all specialist doctors at CHCs had very high workload pressure. States with more workload on PHC-doctors also had more workload on PHC-nurses depicting an augmenting or compounding effect on workload pressure across cadres. A similar result was seen for CHC-specialist pairs—physicians and surgeons, physicians and paediatricians, and paediatricians and obstetricians–gynaecologists. We found poor concordance between current sanctioning norms and WISN-based requirements with all cadres facing under-sanctioning. We also present across-state variations in workforce problems, workload pressure and sanctioning problems. Conclusion We demonstrate the use of WISN calculations based on available data and modelling techniques for national-level estimation. Our findings suggest prioritising nurses and specialists in the rural public health system and updating the existing sanctioning norms based on workload assessments. Workload-based rural HRH deployment can ensure adequate availability and optimal distribution.

The development of highly effective antiretroviral treatment has significantly decreased the disease burden and increased the life expectancy of people living with HIV. As people with HIV live longer, they will require ongoing HIV specialty and primary care, which will increase the demand for specialty-trained nurse practitioners and other health care workers. This report describes the emerging HIV provider shortage and offers models to expand nurse practitioner training in HIV primary care as an approach to addressing the HIV provider shortage.

Autonomous mobile delivery robots are used as a way to improve efficiency in hospitals and reduce staff workload amongst a growing workforce shortage in healthcare. These two case studies investigated the usability, acceptability and functionality of two GoCart delivery robots at two different healthcare settings. The GoCart robots assisted with delivering blood and urine samples at a pathology laboratory and delivering meals at a residential care facility during a two-week period. A total of 50 participants (direct and secondary users, and managers) were interviewed about their experiences with the robot and answered questions about its design and functionality, safety and security, usability and their overall attitudes towards having the robot at their facility. Results showed that the participants from both sites thought the robots could be a good addition to their facilities to improve efficiency and reduce staff workload. The robot was received more positively at the residential care facility than the pathology laboratory. Improvements still need to be made to adapt the robots to each site before implementing the GoCarts long term, including changes to the size and screen. These case studies demonstrate that autonomous mobile delivery robots could be a useful addition to residential care facilities and pathology laboratory sites. Overall, this research adds to the current evidence showing potential uses for delivery robots and highlights important design considerations.

Objective To project the size and demographics of the female urology workforce into 2060. Methods We assessed current urology workforce estimates using 2019 American Urological Association Annual Census data. We used the Accreditation Council for Graduate Medical Education's Data Resource Book from 2007 to 2018 to determine the incoming urology workforce. With these inputs, we calculated urologic workforce projections using two stock and flow models. Results In our continued growth model, the total number of urologists will be lowest in 2025 with 11,600 urologists and recover to baseline by 2040 with 13,377 urologists. The total number of female urologists will grow 3.77-fold from 2020 to 2060 with an absolute increase of 3,792 urologists. Comparatively, the total number of male urologists will grow 1.33-fold with an absolute increase of 3,996 urologists. In our stagnant growth model, the total number of urologists will be lowest in 2030 with 11,354 urologists and will not recover to baseline by the end of our projection. The total number of female urologists will grow 2.18-fold from 2020 to 2060 with an absolute increase of 1,615 urologists. Comparatively, the total number of male urologists will decrease by 21.5% with an absolute decrease of 2,579 urologists. Conclusion In the context of the impending urologic workforce shortage, female urologists make up a significant proportion of the workforce growth over the next four decades in both the continued growth and growth stagnant models. This projection highlights the need for purposeful recruitment, structural changes, and advocacy among urology leadership to support female urologists.

Healthcare systems face various challenges that will persist into the future and must therefore be constantly managed. Three such challenges that have a major effect on healthcare systems globally are organisational culture, workforce shortages and new technological innovations. This article explores the opportunities that exist through strategic and collective leadership, both for addressing these persistent challenges and improving the quality provided by healthcare systems, as well as enhancing team effectiveness and organisational outcomes in healthcare.

Retinopathy of prematurity (ROP) is the leading cause of childhood blindness in very-low-birthweight and very preterm infants in the United States. With improved survival of smaller babies, more infants are at risk for ROP, yet there is an increasing shortage of providers to screen and treat ROP. Through a literature review of new and emerging technologies, screening criteria, and analysis of a national survey of pediatric ophthalmologists and retinal specialists, the authors found the shortage of ophthalmology workforce for ROP a serious and growing concern. When used appropriately, emerging technologies have the potential to mitigate gaps in the ROP workforce.

Behavioral health workforce shortages to provide quality care services for children, adolescents, and transitional age youth are well established. This paper highlights the workforce shortage and t...

The workforce shortage in construction is well known, and demand for construction managers is projected to grow over the next 10 years. These challenges are exacerbated for trade contractors. This ...

Since the development of a Bachelor of Arts in public health, a common question among prospective students, faculty, and community members has been asked: “What will students do after graduation?” While national data on graduates are abundant, community inquiries sought more detailed profiles of local graduates. To address this need, data on 224 graduates of the Bachelors of Arts in Public Health (BAPH) degree at the University of Hawai‘i at Mānoa were collected through alumni outreach efforts and professional online profile searches. Data were compiled into a summary presentation and program “resume”. Findings indicated roughly 30% of BAPH graduates pursued graduate-level education and 43% were employed within a year of graduation. Employment in local NGOs and healthcare organizations was common, while bureaucratic challenges limited hiring at public agencies. A review of job titles suggested graduates were employed in program coordination or support staffing. Local program profiles, such as this one, complement national employment data. Moreover, these efforts may foster interest among prospective students and support from faculty, administrators, and employers.

The sudden and unprecedented increase in seriously ill patients with COVID-19, coupled with both the lack of core palliative care training and expertise among frontline providers and the specialty-trained palliative care workforce shortage, produced immediate challenges to meet the needs of this novel seriously ill patient population. In this article, we describe the rapid expansion and creation of new specialty palliative care services across a health system to meet demands of the COVID-19 surge in New York City. During April 2020, 1019 patients received inpatient specialty palliative care consultations across the Mount Sinai Health System. This overview demonstrates how palliative care services can be titrated up rapidly to meet the acute increase in hospitalized persons with serious illness due to COVID-19, and how these services tailored to the changing needs across a health system.

Providing optimal end-stage kidney disease (ESKD) management requires an adequately trained and sufficiently staffed workforce, including doctors, nurses, and patient care technicians (PCTs). The growing need for ESKD services for a surging population of dialysis-dependent patients has made obvious a workforce crisis affecting nephrology. For a multitude of reasons, the physician workforce supply available to provide dialysis care has failed to expand commensurate with patients need in recent years. Of most importance, fewer US trainees are choosing to enter nephrology, and fewer international medical graduates are available to fill training program rosters. Equally important but less frequently cited are occupational shortages of trained dialysis nurses and PCTs. This article brings attention to this complex workforce shortage and addresses the limited information available regarding how it might constitute a barrier to optimal dialysis care.

The historically constricted forensic pathology workforce pipeline is facing an existential crisis. Pathology residents are exposed to forensic pathology through the American Council of Graduate Medical Education autopsy requirement. In 1950, autopsies were conducted in one half of the patients dying in American hospitals and 90% in teaching hospitals, but they have dwindled to fewer than 5%. Elimination of funding for autopsies is a major contributor to the lack of support for autopsies in departments of pathology. Funding may require reclaiming the autopsy as the practice of medicine. Funding of autopsies would rekindle interest in hospital autopsies and strengthen the forensic pathology workforce pipeline.

Guam, an unincorporated territory of the United States, is one of the ten (10) US Affiliated Pacific Islands. The geographic location in the western Pacific Ocean, as well as the ties to the US position Guam as a strategic hub between the continental US, Asia, and the Pacific region. Health disparities in Guam and the Micronesian region are significant, and the non-communicable disease crisis is worsening, threatening the existing poor health infrastructure on the islands. Migration of islanders from the Micronesian region, whose countries also suffer health disparities, adds to the burden of the weak health care system on Guam. A critical nursing workforce shortage plagues the health care community, and strong nursing leadership is needed to address the problems. Nurse leaders, through many organizations, are working to implement strategies to address the issues facing the islands. Increased collaboration with partners on the island, on the US mainland, and globally, are necessary to effectively address Guam's health care concerns.

This data article features four figures showing the correlations between the biomass of fish and scallop landed in Okhotsk subprefecture (Hokkaido, Japan) and airfreights from Memanbetsu Airport, a dominant airport in the subprefecture. Total landings of fish and scallop were collected from Hokkaido government office website while the airfreight data were acquired from the Memanbetsu Airport management office. The second and third figures in this data article are in a matrix heatmap format and a line graph, representing the statistical monthly data of airfreights from the airport and fish and scallop landings in the subprefecture; data were gathered from 2009 to 2018. Data were gathered from 2009 to 2018. The airfreight data reflect the increase and decrease in the total fish or scallop landings in the subprefecture. A Pearson's correlation coefficient and cross-correlation statistics between monthly airfreight and monthly fish landings were performed to assess their correlation and annual periodic relationship. This article also provides a data figure that shows an increasing active opening ratio to secure human resources in the motor truck transportation industry in Japan. This may be due to a workforce shortage in this trade. Annual data on the active opening ratio for jobs in Japan from 2001 to 2018 were collected from the open data available on the website of the Japanese Ministry of Health, Labour and Welfare.

The objective of this article is to analyze the governance of migration of health professionals in Switzerland. Owing to a lack of health workers, the growing needs of healthcare, and the limited number of recent graduates, the Swiss health institutions are dependent upon international healthcare professionals. After an analysis of the need for healthcare professionals, this article examines the laws regulating the migration flows, before considering the challenges related to the governance of international migration and recruitment of health professionals in Switzerland. This article confirms Switzerland’s longstanding health workforce shortage, its chronic dependence upon the health professionals from EU neighboring countries, and its difficulty to achieve self-sufficiency against the backdrop of increasing health and demographic challenges, a need to maintain its welfare state, and to strengthen its international competitiveness by attracting talents, and the threat caused by rising restrictionist and anti-migrant political rhetoric, thereby resulting in difficult compromises regarding its migration policy outcomes.

At a time when U.S. policymakers are demonstrating their commitment to CTE established to address particular workforce shortage areas, this mixed methods evaluation study sought to understand the key features and outcomes of an existing healthcare education program (HEP) founded with this intent. Findings demonstrated that the HEP incorporates several unique features that should be considered by other programs including hands-on work using hospital equipment, workplace observations, and a strong emphasis on career decision-making efficacy. Evidence showed that students who continue in a Career and Technical Education (CTE) program for more than one year may exhibit somewhat higher rates of college enrollment.

Background: South Africa suffers from a drastic shortage of anaesthesiologists. This shortage has a major impact on the provision of safe, timeous and appropriate surgery for the population. One factor implicated in this shortage may be the difficulty in appropriate recruitment of trainees.Methods: A questionnaire-based cross-sectional study was conducted among the final-year medical students at the University of KwaZulu-Natal (UKZN), for the year 2013.Results: At total of 112 final-year medical students participated in the study. The majority (93%) of the medical students would like to specialise in the future. Anaesthesiology ranked fourth in popularity among the specialties presented to the students. The students’ opinion of the key positive attributes of anaesthesiology was that it was interesting (26.8%), mentally challenging (22.3%) and afforded good working hours (18.8%). The key negative attributes of anaesthesiology highlighted by the students were that it was boring (21.4%), stressful (20.5%) an...

A significant challenge facing the field of rheumatology is the projected gap between the growing demand for rheumatologists and the available workforce. In order to improve access to care, augmenting the rheumatology workforce is required. Herein we discuss potential solutions to the anticipated workforce shortage, including 1) expanding the training of rheumatology physicians; 2) increasing nurse practitioner, physician assistant and pharmacist utilization in rheumatology practice; 3) growing the use of telemedicine; and 4) reducing burnout in order to retain practicing rheumatologists. Building on the existing literature in these areas, we propose a multifaceted approach to addressing the rheumatology workforce shortage.

The authors propose that, through innovative and mutually beneficial partnerships between medical schools and local Emergency Medical Services (EMS) agencies, medical students can help mitigate EMS shortages in areas across the country. These partnerships, which we have seen very early signs of in some places, would create channels by which medical students get their emergency medical technician certifications in the summer before matriculating and volunteer with the agency’s ambulance service, either as an extracurricular clinical experience (which are very popular among medical students) or as a way to fulfill clinical or service requirements or earn elective credit. In the attached piece, the authors (1) establish, using data, that a key factor contributing to current and impending EMS shortages is a lack of certified personnel, and (2) propose why and how medical students could provide a novel source of additional volunteers for understaffed public ambulance services, explore some of the benefits and limitations of this proposal, and provide a road-map for how to form partnerships between medical schools and local EMS agencies.

Introduction The emergency medicine (EM) workforce has been growing at a rapid rate, fueled by a large increase in the number of EM residency programs and growth in the number of Advanced Practice Providers (APPs). Objectives To review current available data on patient volumes and characteristics, the overall physician workforce, the current emergency physician (EP) workforce, and to project emergency physician staffing needs into the future. Methods Data was obtained through review of the current medical literature, reports from certifying organizations and professional societies, Web searches for alternative sources, and published governmental data. Results We conservatively estimate the demand for emergency clinicians to grow by ∼1.8% per year. The actual demand for EPs will likely be lower, considering the higher growth rates seen by APPs, likely offsetting the need for increasing numbers of EPs. We estimate the overall supply of board-certified or board-eligible EPs to increase by at least 4% in the near-term, which includes losses due to attrition. In light of this, we conservatively estimate the supply of board-certified or eligible EPs should exceed demand by at least 2.2% per year. In the intermediate term, it is possible that the supply of board-certified or eligible EPs could exceed demand by 3% or more per year. Using 2.2% growth, we estimate that the number of board-certified or board-eligible EPs should meet the anticipated demand for EPs as early as the start of 2021. Furthermore, extrapolating current trends, we anticipate the EP workforce could be 20–30% oversupplied by 2030. Conclusions Historically, there has been a significant shortage of EPs. We project that this shortage may resolve quickly, and there is the potential for a significant oversupply in the future.

The expansion of genetic and genomic testing across medical specialties and the changing workforce demographics of certified genetic counselors (CGCs) have led to concerns of a workforce shortage. We assessed the number of genetic counselors working in the Southern United States&mdash, a rural and medically underserved region&mdash, using various online and professional resources. We identified 683 practicing genetic counselors across the Southern U.S. and 160 specializing in prenatal genetics. CGCs were concentrated in urban areas, counties with a CGC had a significantly higher proportion of minority residents and median household income than counties without a CGC. There is an average of 2.97 prenatal CGCs per 5000 high-risk births in the South. Alternative delivery models are needed to increase access to counseling services in the Southern U.S., particularly for low income households and those of high risk pregnancies. Increased provider education and patient educational materials can help facilitate informed decision-making in prenatal settings as genetic technologies gain a stronger foothold and bring value to medical practice.

Objective To forecast the size and composition of the urologist and urology advanced care provider (ACP; nurse practitioner, physicians' assistant) workforce over the next 20 years. Methods Current urologist workforce was estimated from the American Board of Urology certification data and the 2014 American Urological Association (AUA) Census. Incoming workforce was estimated from the American Board of Urology and AUA residency match data. Estimates of the ACP workforce were extracted from the 2012 AUA Physician Survey. Full-time equivalent (FTE) calculations were based on a 2014 urology workforce survey. Workforce projections were created using a stock and flow population model with multiple alternative forecast scenarios. Results Slight growth in overall (urologist + ACP) workforce FTEs is expected, from 14,792 in 2015 to 15,160 in 2035. A significant decline in urologist FTEs is likely, from 11,221 in 2015 to 8859 in 2035. ACPs should increase markedly, from 8,710 in 2015 to 15,369 in 2035. Female urologists should increase by 2035, from the current 7.0% to 18.6% of urologist workforce. Alternate scenarios were evaluated, with forecasted FTEs in 2035 ranging from 14,066 to 17,675. In 2035, workforce shortage predictions range from 12% to 46%. Conclusion With a decrease in urologists over the coming decades, urologists and ACPs may not meet future demand. This forecast highlights the need for discussion and planning among leadership in the field to find creative solutions for this impending workforce shortage.

Practitioner and academic literature indicate a shortage of young professionals entering logistics, yet limited research exists to understand how to attract more students to the field. To address this gap, we compare survey data of logistics practitioner job characteristics to survey data of expected job values of undergraduate students from seven universities. Based on personality-job fit theory, this study allows us to explore how to better promote the major and field to students as well as to propose recommendations to redesign logistics jobs to better meet student expectations. The results reveal that intrinsic job characteristics desired by students such as learning and seeing the results of their work are prominent in logistics jobs. However, other significant student expectations, specifically long-term job stability and pace of promotions, are not prominent in logistics jobs. The results further reveal that promotional messages about the industry are most effectively communicated to students via family, business professionals, and presence on the Internet more so than by professors and college advisors. Ultimately, this research suggests strategies to increase the number of students both majoring in logistics and entering the professional field to address the workforce shortage.

This chapter presents the state of the current elder care crisis in the United States. According to their analysis and that of their interviewees, less than optimal spending and health outcomes, a geriatric workforce shortage, and the prevalence of chronic disease all contribute to the desperation of a worsening situation. In contrast to that desperation, the authors note that the increased life expectancy in the United States and elsewhere is in fact a triumph of medicine. The chapter nonetheless makes clear that increased length of life cannot be conflated with its quality. The authors describe Aging Well as “a book of solutions” and begin to describe the way those solutions will be unfurled through the course of the coming chapters.

In response to the trends of manufacturing revitalization and workforce shortage in the U.S., this study investigates how Foxconn changes accessibility to industrial employees by automobile and by transit in Southeast Wisconsin. Results suggest that there is a mismatch between the Foxconn site and the areas with high accessibility to industrial employees. With a great demand for labor, Foxconn reduces employee accessibility by automobile throughout the region, while its impact on employee accessibility by transit is more localized. The results inform industrial firm locations, workforce housing development, and transportation service provisions. The analysis framework shifts the angle of accessibility research to focusing on the perspective of employers, and it can be applied to investigate future large-scale economic development projects.

Leading medical authorities advocate for routine integration of palliative care for all major causes of death in the United States. With rapid growth and acceptance, the field of palliative care is tasked with addressing a compelling question of its time: "Who will deliver timely, evidence-based palliative care to all who should benefit?" The current number of palliative care specialists will not suffice to meet the needs of persons with serious illness. In 2010, initial estimates quantified the shortage at 6000 to 18 000 additional palliative care physicians needed to fully staff existing programs. Unfortunately, the predicted number of specialty physicians in 2030 will likely not be larger than the workforce in existence today. These findings result in a physician-to-serious-illness-person ratio of about 1:28 000 in 2030.1 To address the workforce shortage, stronger alignment is needed between intensity of patient needs and provision of palliative care services. Such an alignment better harnesses the talents of those in a position to deliver core palliative care services (such as discussing goals of care with patients or managing their symptoms) while engaging palliative care specialists to address more complex issues. We introduce the concept of "Palliative Care Champions," who sit at the nexus between specialty palliative care and the larger clinical workforce. Acknowledging that the needs of most patients can be met by clinicians who have received basic palliative care training, and that specialty palliative care is not always available for those with more complex needs, there exists an important opportunity for those with additional interest to scale training and quality improvement to fill this void. J Am Geriatr Soc 67:S461-S467, 2019.

[Graphic][1] ![Graphic][2] In 2015, the American Society for Clinical Pathology (ASCP) launched “What's My Next” an interactive campaign to address the workforce shortage in laboratory medicine. An important part of “What's My Next” is the Lab Hero program (formerly known as the Career Ambassador program). Since 2009, the Lab Hero program has put laboratory professionals and pathologists in classrooms across the country to teach students about career opportunities in laboratory medicine. Here, Rezvaneh Parsa talks about her experience in the program . My journey to the Lab Hero program began about five years ago, when I was having lunch in the break room of the laboratory where I worked, and I overheard a couple of my histotechnologist colleagues talking about an interesting volunteer opportunity through the Lab Hero program with ASCP. I researched the ASCP website and discovered more about this program, that seemed like a wonderful way to get involved. You can imagine my excitement when I was accepted into the ASCP Lab Hero program for the 20112012 school year. After the program's orientation, I thought about ways to spread the word about my career. I sent a round of emails and letters to the principals, counselors, science teachers, and biology department heads at my daughters' schools in Frisco Independent School District in Frisco, Texas. Those messages … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif

The importance of interprofessional education (IPE) in continuing medical education and professional development has long been recognised by health organisations and academic societies, benefiting not only patient outcomes and interprofessional relationships but also overall health systems and workforce shortage. We report on the outcomes of an Australian IPE activity on medication-overuse headache (MOH) with general practitioners (GPs) and community pharmacists as learners. The design of the activity, which followed the predisposing–enabling–reinforcing instructional framework by Green and Kreuter, aimed to: (1) improve knowledge and foster a willingness in GPs and pharmacists to work collaboratively to enhance the prevention, diagnosis and management of MOH; and (2) address their educational gap by demonstrating the utility of a blended learning IPE strategy on MOH. Integrated into the activity was an assessment of its effectiveness and impact to instil change in the participants’ knowledge of MOH, attitude and willingness to treat, and clinical practice behaviours of GPs and pharmacists to work together. The learners gained knowledge and confidence in diagnosing and managing MOH and in their ability to educate patients. The IPE approach suited the activity and was valued by the participating GPs and pharmacists, who seldom experience such learning formats. However, for educational providers in Australia, developing and deploying an independent medical education (IME) programme can be challenging. Providers of IMEs need to be aware of the potential pitfalls when competing with pharmaceutical-company-sponsored and delivered programmes.

There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance the next generation of palliative care leaders. This report intends to summarize the second cohort of Sojourns Scholars' projects and their reflection on their leadership needs.This report summarizes the second cohort of sojourns scholars' project and their reflection on leadership needs.After providing a written reflection on their own projects, the second cohort participated in a group interview (fireside chat) to elicit their perspectives on barriers and facilitators in providing palliative care, issues facing leadership in palliative care in the United States, and lessons from personal and professional growth as leaders in palliative care. They analyzed the transcript of the group interview using qualitative content analysis methodology.Three themes emerged from descriptions of the scholars' project experience: challenges in palliative care practice, leadership strategies in palliative care, and three lessons learned to be a leader were identified. Challenges included perceptions of palliative care, payment and policy, and workforce development. Educating and collaborating with other clinicians and influencing policy change are important strategies used to advance palliative care. Time management, leading team effort, and inspiring others are important skills that promote effectiveness as a leader.Emerging leaders have a unique view of conceptualizing contemporary palliative care and shaping the future.Providing comprehensive, coordinated care that is high quality, patient and family centered, and readily available depends on strong leadership in palliative care. The Cambia Scholars Program represents a unique opportunity.

Due to an ageing workforce, there is a growing need for greater numbers of nurses to work in areas, such as mental health and alcohol and other drugs (AOD) rehabilitation. These practitioners need to approach their work as ‘recovery-oriented practitioners’. Positive experiences and preceptorship during clinical placement in AOD rehabilitation settings might influence students’ later career choices and address some of the workforce shortage issues. The aim of the present concurrent, mixed-methods study was to explore students’ perceptions of their clinical placement experience in a community-based AOD rehabilitation setting, and to examine attitude, career intention, and satisfaction with the placement. Fifty-eight students completed pre–post-test surveys, with closed and open-ended questions, which included standardized measures. A small sample of survey respondents also agreed to participate in a semistructured interview. The quantitative results revealed two predictors for higher intention to pursue a career in AOD: (i) a high satisfaction with their clinical placement (β = 0.29, P = 0.008); and (ii) a high baseline attitude to recovery-oriented practice (β = 0.28, P = 0.013). The qualitative findings identified five factors influencing placement experience: (i) educational factors; (ii) students’ background factors; (iii) placement factors; (iv) client factors; and (v) staff factors. A model that synthesizes the quantitative and qualitative findings was also developed. In conclusion, clinical placement in a community-based AOD rehabilitation centre improved students’ intention to work in that setting.

This paper contributed to the pool of studies about agricultural surplus labor in China, also acted as the root to the imminent settlement of the issues concerning agriculture, countryside and farmers. Using data from survey of agricultural surplus labor in 2012, which covered three provinces in northern, midwestern and southern parts of China, this paper analyzed the influential factors on agricultural surplus labor professionalization by adoption of a logistic regression model. It showed that agricultural surplus labor shortage could be explained by low-quality professionalization. It was a feasible and effective way to solve the issue of workforce shortage during economic downturn by improving agricultural surplus labor's professionalization.

e18335 Background: Urology workforce shortage in rural areas limits access to surveillance cystoscopy for bladder cancer. Tele-cystoscopy is a novel solution whereby an advanced practice provider (APP) performs cystoscopy at a satellite location with real-time interpretation and guidance by an off-site urologist via transmitted video. We hypothesized that tele-cystoscopy videos would be comparable to traditional cystoscopy videos in diagnostic utility. Methods: Our IRB approved tele-cystoscopy protocol utilizes a dual-cystoscopy model. Two sequential cystoscopies are performed first by an APP with off-site urologist guidance (tele-cystoscopy) then by a urologist onsite (traditional cystoscopy) without removal of the cystoscope from the urethra. Both cystoscopies are video-captured. Twelve de-identified videos were reviewed via electronic survey (Qualtrics) by board-certified urologists who were blinded as to whom performed the cystoscopy. Survey questions centered on completeness of exam and diagnostic level of suspicion. A random effects logistic regression model was used to account for multiple reviews of the same video. Results: Diagnostic utility, defined as visibility sufficient for diagnosis, was 83% for both tele-cystoscopy and traditional cystoscopy. There were no statistically significant differences in completeness of exam between the two techniques (tele 83.3%, traditional 91.7%, p = 0.308). When asked about action taken based on cystoscopic findings, reviewers recommended action other than planned surveillance (i.e., biopsy, operative resection, etc.) for 58.3% of tele-cystoscopy videos vs. 66.7% for traditional cystoscopy videos (p = 0.300). Conclusions: Tele-cystoscopy provides high quality bladder surveillance with diagnostic capacity comparable to that of traditional cystoscopy. These results support continued expansion of the tele-cystoscopy platform as a means to amplify the care provided by a single urologist. [Table: see text]

Background Multiple studies have documented a significant decrease in the general surgery workforce in the United States, both rural and urban, for the past 3 decades. This 11-year study evaluates the Texas general surgery workforce at both the state and local level in 2002 and 2012. Methods Data were obtained from the Texas Medical Board, the United States Census Bureau/Texas State Library and Archives Commission, and the Texas Department of State Health Services for 2002 and 2012. A benchmark target of 7 general surgeons per 100,000 population was used. Results During the study period, the Texas population increased 21%, and actively practicing physicians increased 44%. All surgical specialists increased by 26%. General surgeons increased 4%; however, the number of general surgeons per 100,000 population decreased 14% (from 6.7 to 5.8/10 5 ). Using the total Texas population for 2012, an additional 329 general surgeons are needed by benchmark standards. However, when analyzed by individual county population, 449 additional general surgeons are needed in the individual counties. These effects were greater in the nonmetropolitan areas of Texas where per capita general surgeons decreased by 21%. Conclusions The absolute increase in Texas general surgeons over the past decade has not kept pace with an increase in the Texas population. The general surgery workforce deficit based on the Texas state population underestimates the local workforce shortage, particularly in the nonmetropolitan areas of Texas.

In this study, we evaluated the efficacy of virtual microscopy as the primary mode of laboratory instruction in undergraduate level clinical hematology teaching. Distance education (DE) has become a popular option for expanding education and optimizing expenses but continues to be controversial. The challenge of delivering an equitable curriculum to distant locations along with the need to preserve our slide collection directed our effort to digitize the slide sets used in our teaching laboratories. Students enrolled at two performance sites were randomly assigned to either traditional microscopy (TM) or virtual microscopy (VM) instruction. The VM group performed significantly better than the TM group. We anticipate that this approach will play a central role in the distributed delivery of hematology through distance education as new programs are initiated to address workforce shortage needs. ABBREVIATIONS: TM - traditional microscopy, VM - virtual microscopy, DE - distance education, CLS - clinical laboratory sciences, CI - classroom instruction, F2F - face to face, GPA - grade point average, RBC - red blood cell, WBC, white blood cell

As part of an effort to address shortages in the cancer workforce, C-Change developed competency standards and logic model-driven implementation tools for strengthening the cancer knowledge and skills of non-oncology health professionals. These standards and tools were applied by four diverse grant programs to yield gains in the management of pain and palliative care, thereby improving the quality of care for individuals experiencing or recovering from cancer treatment. The results from the four grant sites and tools used to achieve them are described in this article.

Hematopoietic cell transplantation (HCT) is the only known curative therapy for many patients with life-threatening hematologic and oncologic diseases. It is estimated that the National Marrow Donor Program(®) (NMDP) will facilitate 10,000 transplants by 2015, double the current number. To better understand the existing personnel and center infrastructure for HCT in the country and to address system capacity challenges to the future growth of HCT, the NMDP convened a diverse group of stakeholders and thought leaders representing HCT physicians, physician assistants, nurse practitioners, nurses, pharmacists, other healthcare providers, HCT program directors, hospital administrators, payors, and professional organizations. Working groups were formed to identify: capacity issues because of shortages in human resources, structural constraints, and patient access barriers including diversity and healthcare disparity challenges; recommendations to address challenges; and stakeholders to engage. This report details the deliberations and recommendations of a national symposium, "Hematopoietic Cell Transplantation in 2020: A Health Care Resource and Infrastructure Assessment," held in September 2010.

ASCO projects a shortfall of oncologists in the next decade. The study was designed to address the workforce shortage by exploring collaborative oncology practice models that include nonphysician practitioners (NPPs).ASCO contracted with Oncology Metrics, a division of Altos Solutions, to conduct a national survey of NPP integration and identify collaborative practice models and services provided by NPPs, as the first phase of the ASCO Study of Collaborative Practice Arrangements. Results of the national survey were used to identify practices for the next phase, in which selected practices participated in a more detailed data survey and satisfaction surveys. Focus groups or interviews were conducted with NPPs to collect additional subjective information to inform the project.The incident-to practice model was the predominant model. Satisfaction was universally high for patients and generally high for physicians and NPPs. In virtually all cases (98%), patients recognized they were seeing an NPP rather than a physician. Practices in which the NPP worked with all practice physicians showed significantly higher productivity than those practices in which the NPP worked exclusively with a specific physician or group of physicians.The use of NPPs in oncology practices increases productivity for the practice and provides high physician and NPP satisfaction. Patients were aware when care was provided by an NPP and were very satisfied with all aspects of the collaborative care that they received. The integration of nonphysician practitioners into oncology practice offers a reliable means to address increased demand for oncology services without adding physicians.

This article describes a community-based mentoring program, Partners in Nursing (PIN), which was developed as a collaborative effort to address the nursing workforce shortage. While the primary goal was to increase retention rates of new nurse graduates, the program also produced secondary benefits of professional development and outreach opportunities. Furthermore, through the creation of PIN, local resources were identified to support new graduates and cultivate leadership potential. While the program was deemed effective, continued research is needed to quantify the benefits of such programs so that similar initiatives can be successfully replicated.

Rural Australia continues to experience a chronic medical workforce shortage. For a variety of reasons, recruiting to and retaining medical professionals in many rural communities remain difficult. A place's amenity is often cited as a significant contributing factor towards the differential attractiveness of different rural and remote practice locations for doctors. This study investigates the extent to which there is an association between medical workforce shortage across rural Australia and a selection of place characteristics descriptive of their isolation, climate, and overall rural amenity. Our main outcome measure, District of Workforce Shortage (DWS) designation, has been employed for over a decade to identify areas eligible for incentive measures designed to overcome the chronic rural medical workforce shortage. Somewhat surprisingly, our study found only a weak association between DWS and our measure of rural amenity. In contrast, alternative measures of medical workforce shortage showed a moderate-to-strong association with rural amenity. The weak explanatory value of rural amenity may reflect the limitations of the DWS measure or the lesser significance of rural amenity compared with other professional aspects relating to where doctors take up practice. Findings from this study also suggest that the current DWS measure provides an inadequate basis for targeting recruitment and retention incentives. © 2011 The Authors. Geographical Research