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Objective To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments. Participants and Methods All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary. Results Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties. Conclusion A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.

Objectives, setting and participantsIn July 2011, the EU adopted the Falsified Medicines Directive (FMD) primarily aiming to prevent the infiltration of falsified medicines into the legitimate supply chain. Our aim was to measure the cost elements of FMD implementation and operation using an internationally adaptable tool among Hungarian hospital pharmacies.DesignA 41-item questionnaire was developed to evaluate the implementation process and associated cost consequences leading up to February 2019, and the stabilisation period.ResultsOur representative data are supported by the high response rate, as 44.8% of the Hungarian hospital pharmacies have completed the survey. Human resource requirements related to decommissioning activities were measured as working hours and were expressed in full time equivalent (FTE). We have found an increased workload with extra 0.25 pharmacist and 0.75 technician FTE/institution at the end of the stabilisation period. The entire infrastructural and IT implementation costs were determined as €2173, on average (SD: €3366) and the median was €1506 (range: €0–€20 723). The total IT investment cost per institution was valued at €1410 (SD: €335). We identified a positive correlation (R=0.663) in consideration of the costs, the number of beds and the number of hospital locations with a multivariate linear regression model. At the time of our survey, 76.7% of the respondents experienced drug shortages, 58.1% reported suspected increase in drug costs regarding serialised medications, and 53.5% noticed an increase in packaging size.ConclusionsNotably, our research is the first complex study depicting FMD cost implications in the hospital pharmacy sector in Central Europe, indicating decommissioning significantly impacted workflow referencing human resources and IT.

BACKGROUND: Academic faculty who devote most of their time to clinical work often struggle to engage in meaningful scholarly work. They may be disadvantaged by limited research training and limited time. Simply providing senior mentors and biostatistical support has limited effectiveness. OBJECTIVE: We aimed to increase productivity in scholarly work of hospitalists and internal medicine physicians by integrating an Academic Research Coach into a robust faculty development program. DESIGN: This was a pre-post quality improvement evaluation. SETTING: This was conducted at the University of Washington in faculty across three academic-affiliated hospitals and 10 academic-affiliated clinics. PARTICIPANTS: Participants were hospitalists and internists on faculty in the Division of General Internal Medicine at the University of Washington. INTERVENTION: The coach was a 0.50 full time equivalent health services researcher with strong research methods, project implementation, and interpersonal skills. The coach consulted on research, quality improvement, and other scholarship. MEASUREMENTS: We assessed the number of faculty supported, types of services provided, and numbers of grants, papers, and abstracts submitted and accepted. RESULTS: The coach consulted with 49 general internal medicine faculty including 30 hospitalists who conducted 63 projects. The coach supported 13 publications, 11 abstracts, four grant submissions, and seven manuscript reviews. Forty-eight faculty in other departments benefited as co-authors. CONCLUSION: Employing a dedicated health services researcher as part of a faculty development program is an effective way to engage clinically oriented faculty in meaningful scholarship. Key aspects of the program included an accessible and knowledgeable coach and an ongoing marketing strategy.

Objective: Continuous process improvements enhance accuracy and productivity in a clinical laboratory setting. This study aimed to investigate the accuracy and efficiency of a new autoverification (AV) system designed to improve the consistency and uniformity of reported laboratory test results. Methods: Limit checks, delta checks, and consistency checks were established, and then retrospective data from 500 requested tests were used to evaluate the accuracy of AV rules compared to manual verification, which was performed by five experienced medical technologists. Efficiency was evaluated by comparing turnaround time (TAT), error rates, workload, and staff satisfaction between before and after AV implementation. Results: AV had 100% sensitivity, 77.6% specificity, and a 22% false-positive rate. The AV passing rate was 95%, 85%, 42%, and 39% for chemistry, coagulation, microscopy, and hematology, respectively. The overall passing rate was 65%. After implementation, the mean overall TAT decreased from 54.2±26.6 to 52.4±24.2 min (p

Background: Evidence to support coaching in medical education has grown over the past decade leading educators to search for resources to aid the development of their own coaching programs. A sample of medical schools in the USA were surveyed to describe coaching programs to assist other institutions in the development and implementation of programs. Methods: Participants representing 32 medical schools attending a coaching conference in October 2018 were surveyed via email regarding their undergraduate medical education (UME) coaching programs. The 19-item instrument contained questions on program demographics, program characteristics, coach characteristics, coach training and coach assessment and program evaluation. Results: The response rate was 100% (32/32 programs). Nearly all respondents had a coaching program (53%, 17/32) or were developing one (44%, 14/32) with the majority being implemented in the past five years (82%, 14/17). Professional identity formation (80%, 20/25), professionalism (76%, 19/25), and academic performance (76%, 19/25) were the most commonly identified programmatic goals. The majority of coaches (64%, 16/25) received between 5-25% full time equivalent effort to support their role. Coaches did not formally assess students in any domain at most programs (84%, 21/25) or directly observe their students clinically (76%, 19/25). The majority of programs had formal coach training (88%, 22/25). Conclusion: These results demonstrate that coaching is being used to improve performance, professionalism, and professional identity formation in UME. This sample of coaching programs informs the discussion of coaching in medical education as educators strive to implement effective coaching programs.

Biobanks face increasing demands for research materials of consistent quality, which can be used in collaborative studies. Several countries and some international agencies have made formal efforts to standardize biobank operations and outputs. These include the establishment of best practice guidelines for collection management, and certification programs. Such guidelines and programs increase biobanks' opportunities for participation in high impact research and funding. However, they also impose economic and time costs, which may burden biobanks. This study aimed to estimate the costs of gaining certification and maintaining certification (i.e., committing extra resources to continue standards) for three cancer biobanks participating in a biobank certification program in New South Wales, Australia. To gather cost data for a range of cancer biobanks, we recruited three with different full time equivalent (FTE) staff levels (1.0-3.0), recognizing FTE staff level as an indicator of resources and operating scale. In extended interviews with staff, we gathered biobanks' expected costs in obtaining and annually maintaining certification. The biobank with the highest staff level reported the lowest expected costs in gaining certification, due to the strong prealignment of its present operations with certification requirements. The other biobanks expected higher costs as their operations required greater adjustments. Overall, relative costs of gaining certification were between 2% and 6% of current total annual wage costs. To the authors' knowledge, this is the first such costing study of a biobank certification program. Supplementary Data include the interview schedule that other biobanks may use to estimate their own economic certification costs.

More non-GP clinical staff now work in general practice in England than GPs, an analysis has shown.1 The fourth annual NHS workforce report from the Health Foundation shows that the number of non-GP clinical staff has grown more quickly than the number of permanent qualified GPs over the past three years. In March 2016 there were 6% fewer non-GP clinical staff than GPs, the report said. By March 2019, however, non-GP clinical staff had overtaken GPs to outnumber them by 8% (29 459 full time equivalent (FTE) other clinical staff including …

The number of GPs working in England has crept up in the past year, a rise almost entirely accounted for by an increase in GP trainees. In March 2019 England’s GPs totalled 44 847, a rise of 350 (0.8%) on the same month in 2018. The full time equivalent count, which allows for some GPs working only part time, showed a similar increase, rising from 34 424 to 34 736 (0.9%).1 But closer examination of the data released by NHS Digital shows that the headcount of fully qualified GPs fell by 494 year on year, while the number of trainees increased by 760. The great majority of these new recruits to the GP workforce were trained in the UK, lending credence to NHS England’s claim that plans to increase recruitment are working. “Today’s figures highlight the good work being done locally to support GPs through retention …

Objective: To dispense medication in a form of ready to use (RTU) medication was recommended by the standards of Joint Commission International (JCI) and Standard Guidelines of Hospital Pharmacy for preventing the medication error. However, the cost and benefit were questionable. The costs may increase while benefits were unclear. Before making the implementation decision, the cost of investment and benefit between traditional (injectable medication is prepared by nurse) and RTU systems (injectable medication is prepared by pharmacy department) should be evaluated. Methods: This study compared the cost and benefit of injectable medication administration between the traditional system and the RTU system within a large academic hospital. The decision tree was designed to produce comparable data on the hospital's perspective. The t ime horizon was 10 years thus all costs were discounted at 3% annually. Sensitivity analysis was performed to test the stability of the results. Results: The cost of investment at 10-year intervals of the RTU system was lower than the traditional system by about 18,710,160 baht. The benefit was decreased 19.32 full time equivalents (FTEs) of nurse when compared with the traditional system. The result showed that the five most sensitive variables were number of doses, mixing time per dose (prepared by nurse), space for production, salary and fringe benefits of pharmacists, and mixing time per dose (prepared by pharmacist). Conclusion: The RTU system saved 1,871,016 baht per year and 19.32 FTEs of nurse. Moreover, the RTU system enhanced the opportunity of nurses and pharmacists to play more professional role and promoted the efficient health care system.

To date, there are no broadly accepted or accurate models to determine appropriate staffing [levels] for clinical engineering departments (CEDs). The purpose of this study is to determine what the determinants of the staffing levels are (total number of full time equivalents (FTEs)) in CEDs in healthcare organisations. In doing so, we used a cross-sectional exploratory approach by using a multivariate regression model over a secondary source of data information from the AAMI Benchmarking Solutions—Healthcare Technology Management database. Two hundred and one healthcare organisations were included in our study. Our study revealed that on average, there are almost 14 biomedical technicians (BMETs) per clinical engineer and one FTE per 1083.72 devices (SD 545.69). The results of this study also revealed that the total number of devices and the total technology management hours devoted to these devices positively affects the number of FTEs in a CED, whereas the hospital complexity, measured by healthcare organisation patient discharges matters inversely. The most important factor that matters in the number of FTEs in CEDs was the total technology management hours devoted to devices. A value of explained variance (i.e. R2) of 85% was obtained, indicating the strong power of the prediction accuracy of our multivariate regression model. © 2016 Informa UK Limited, trading as Taylor and Francis Group.

To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort.Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction.Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months.Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months.

Context The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. Objective To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. Main Outcome Measure(s) The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. Results The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). Conclusions The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured assessment and allocation of staffing and workloads.

The BMA has called for better support for general practice ahead of a potential second wave of covid-19, after figures showed a fall in the number of full time equivalent (FTE) GPs in the past year. Data published by NHS Digital on 27 August1 showed that, from June 2019 to June 2020, …

Background and Aims Crohn’s disease and ulcerative colitis are the most common forms of inflammatory bowel disease affecting 1 in 250 of the population in the UK. It is accepted that access to a specialist nurse service improves patient experience and outcome. National Standards for inflammatory bowel disease care (2013) defined the number of nurse specialists required at 1.5 full time equivalent per 250,000 population. The aim of this study was to determine if these standards were being met and to publish a new, robust validated standard optimising the UK nursing workforce model. Methods Existing national data and specific workload and service data was collected from 164 IBD specialist nurses who completed a questionnaire designed to collect information on activity and complexity of work both done and undone. Results Data was received from all of the UK. Thirty-six percent of respondents were specialist nurses in the field for 3 years or less. A higher caseload than the recommended level was reported by 63% of respondents. Unpaid overtime was regularly carried out by 84%of respondents. The IBD specialist nurse was involved in all areas of the patient pathway. Areas of work left undone were psychological interventions, prescribing medicines and physical assessments. Conclusions Compared to other specialties IBD specialist nurses are less experienced. It is recommended that the current standard be increased to 2.5 full time equivalent specialist nurses per 250,000. patients to mitigate for the increasing complexity of the role, care and the “rookie” factor. Keywords: Inflammatory Bowel Disease, Specialist Nurse, Workforce Modelling

The Royal College of General Practitioners (RCGP) has called for an extra £2.5bn a year for general practice services and an urgent overhaul of the General Practice Forward View , the five year plan launched two years ago by NHS England amid much fanfare.1 The college’s second annual assessment of the Forward View says that the falling number of full time equivalent GPs is a huge concern. Currently, 1000 fewer GPs work in England than when the plan was published with a target of boosting the workforce by 5000 GPs by 2020.2 “Without enough GPs, …

The number of full time equivalent GPs in England has fallen by 1.2% in a year, while the number of GP partners has fallen by 5%, data from NHS Digital show.1 Martin Marshall, chair of the Royal College of General Practitioners, said that “drastic action” needed to be taken to reverse the trend. The figures show that there were 340 fewer full time equivalent GPs in September 2019 than in September 2018 (28 315 versus 28 655). The number of GP partners fell from 19 262 in September 2018 to …

In England, there has been a substantial drop in school nursing numbers, from 2915 full time equivalent (FTE) nurses working in school nursing in Sept 2009 (1135 of whom were qualified school nurses) to 2205 (FTE) nurses working in school nursing in November 2018 (1020 of whom were qualified school nurses) (NHS Digital, 2019).

Hiam and Dorling critique the government’s new prevention plan.1 My colleagues and I have become concerned about difficulties accessing the support of health visitors. A request under the Freedom of Information Act shows that in 2012 there were 76 full time equivalent health visitors in Cornwall, which rose to a peak of 117 in 2015, then fell by 29% to 83 in 2018. …

O’Sullivan and colleagues report on the temporal trends of test use in UK primary care,1 but they focus almost exclusively on general practitioners as if they are synonymous with primary care. This is a common mistake, brought into sharper focus by the rapidly changing composition of the general practice workforce. As at June 2018, there were 27 396 full time equivalent …

Introduction: Recent literature calls for initiatives to improve the quality of education studies and support faculty in approaching educational problems in a scholarly manner. Understanding the emergency medicine (EM) educator workforce is a crucial precursor to developing policies to support educators and promote education scholarship in EM. This study aims to illuminate the current workforce model for the academic emergency medicine educator. Methods: Program leadership at EM training programs completed an online survey consisting of multiple choice, completion, and free response type items. Descriptive statistics were calculated and reported. Results: 112 programs participated. Mean number of core faculty/program: 16.02 ± 7.83 [14.53-17.5]. Mean number of faculty full time equivalents (FTEs)/program dedicated to education is 6.92 ± 4.92 [5.87-7.98], including (mean FTE): Vice Chair for education (0.25); Director of Medical Education (0.13); Education Fellowship Director (0.2); Residency Program Director (0.83); Associate Residency Director (0.94); Assistant Residency Director (1.1); Medical Student Clerkship Director (0.8); Assistant/Associate Clerkship Director (0.28); Simulation Fellowship Director (0.11); Simulation Director (0.42); Director of Faculty Development (0.13). Mean number of FTEs/program for education administrative support is 2.34 ± 1.1 [2.13-2.61]. Determination of clinical hours varied. 38.75% of programs had personnel with education research expertise. Conclusion: Education faculty represent about 43% of the core faculty workforce. Many programs do not have the full spectrum of education leadership roles and educational faculty divide their time among multiple important academic roles. Clinical requirements vary. Many departments lack personnel with expertise in education research. This information may inform interventions to promote education scholarship.

To determine the effect of a hospitalist-developed, continuity-centered hospitalist staffing model on patient outcomes and resource use.The Creating Incentives and Continuity Leading to Efficiency (CICLE) staffing model was conceived by a group of hospitalists who sought to improve continuity of inpatient care. Using a retrospective, observational, pre-post study design, we compared patient-level data for all discharges from our hospitalist service from 6 months after implementation of the CICLE staffing model (September 1, 2009, through February 28, 2010; n=1585) with data from those same months in the prior year (September 1, 2008, through February 28, 2009; n=1808). We used the number of unique hospitalists who documented an encounter during the admission as a measure of continuity of care. Length of stay and hospital charges per admission constituted the measures of resource use.The odds of having a single hospitalist for the entire hospitalization nearly doubled under the CICLE model (odds ratio, 1.87; 95% confidence interval, 1.60-2.2; P.001). Mean length of stay decreased 7.5% (from 2.92 before to 2.70 days after initiation of the model; P.001). Mean hospital charge per admission decreased 8.5% (from $7224.33 before to $6607.79 after initiation of the model; P.001). Thirty-day readmission rates were not substantially affected by the CICLE model (15.0% before to 17.3% after initiation of the model; P=.08).Improved continuity of care among hospitalists was associated with reductions in length of stay and lower health care costs. These benefits were realized without substantially affecting readmission rates. The staffing model can be achieved by reorganizing existing hospitalists and may not require the hiring of additional personnel. The CICLE staffing model is a viable option for hospitalist groups that are aiming to diminish resource use and improve quality of care.

Many GPs routinely work 12 hour days, and we still end up having to come in on days off to catch up. There simply aren’t enough GPs to do the work being asked of us, and there’s still no evidence of a magic GP tree. Way back in 2014 the then health secretary promised us an extra 5000 GPs by 2020, but we’ve learnt not to raise our hopes. In June this year, figures from NHS Digital revealed that we now have 1400 fewer full time equivalent GPs than when that target was set. Some commentators suggest that much of what …

The total number of full time equivalent GPs in England fell by 523 in three months this year, from 33 686 in March to 33 163 in June, data from NHS Digital have shown.1 Provisional figures from June and final data from March show that the total number of headcount GPs (full and part time GPs) also fell by almost 500, from 41 848 in March to 41 360 in June. The figures suggest that the government is struggling to …

Paediatric services could become unsafe and put doctors at risk of burnout without extra resources, the Royal College of Paediatrics and Child Health has warned. In its audit report on UK children’s health services, published on 26 April,1 the college called for an increase of 752 full time equivalent (FTE) paediatric consultants. It recommended 520-540 extra consultants in …

NHS England considers only four variables likely to affect consultation length when allocating resources for general practice to clinical commissioning groups, but it should look at more than these, say the authors of a study published in the British Journal of General Practice .1 The current workload formula considers the effects that sex and age group, rurality, deprivation, and the number of new registrations have on consultation length—the proxy variable NHS England uses to measure workload. However, researchers from Oxford, Cambridge, and Bristol looked at six other variables—ethnicity, smoking status, number of full time equivalent (FTE) GPs, number …

OBJECTIVE To evaluate patients' expectations of hospital chaplains. PATIENTS AND METHODS From April 6, 2006, through April 25, 2006, we surveyed by mail 1500 consecutive medical and surgical patients within 3 weeks of their discharge from the hospital. The survey included questions related to demographics, duration and area of hospitalization, awareness of chaplain availability, expectations regarding chaplain visits, and reasons for wanting to see a chaplain. Measured characteristics were summarized by calculating means and SDs for continuous variables and proportions for categorical variables. Proportions were statistically compared via Fisher exact tests or Monte Carlo estimates. RESULTS Surveys were returned by 535 of the 1500 patients to whom they were sent. Most of those who returned surveys had been hospitalized for less than 1 week (398/514 [77.4%]) and were male (265/510 [52.0%]), married (396/528 [75.0%]), 56 years or older (382/532 [71.8%]), or affiliated with either the Lutheran (177 [33.3%]) or Catholic (133 [25.0%]) churches. Most (78.9%) were aware of the availability of chaplains, and 62.3% would have appreciated chaplain visitation at least every few days. More than half (52.9%) reported that they were visited, and 86.4% reported that this visit was important to them. The primary reason selected for wanting to see a chaplain was "to be reminded of God's care and presence." Items related to ritual, prayer, and pastoral support were also highly endorsed. Some results were dependent on sex, age, religious affiliation, or duration of stay. CONCLUSION Hospitalized patients value visitation by chaplains and appreciate both religious and supportive interventions. Opportunities for patient care, education, and research are apparent.

Campbell and colleagues note that GP academics comprise just 6.5% of all clinical academics.1 General practice is the biggest branch of medicine. It has a variety of clinical challenges that cross the physical-psychological barrier, it best integrates preventive and therapeutic care, and is best able to ameliorate socioeconomic disadvantage. The ratio of 205 full time equivalent GP academics to 32 628 full time equivalent GPs (1:159) is …

Visible? Viable? Invaluable The report of Higher Education England’s commission on the primary care workforce is timely and welcome.1 The UK has led the way in delivering high quality, effective, accessible, and equitable healthcare at modest cost.2 Getting the right workforce to deliver the strongest possible NHS primary care focus3 is critically important in times of financial constraint, healthcare innovation, and the changing population demographic characterised by complex care needs and multimorbidity. But in parallel, attention must be given to the importance of recruiting, retaining, and developing the primary care academic workforce—an agenda that was beyond the remit of the commission. The UK’s 205 senior academic GPs comprise just 6.5% of all clinical academics, and a tiny fraction of the 64 923 GPs currently registered with the General Medical Council (32 628 established GP full time equivalents). The overall increase in GP academic capacity from 153 full time equivalents in 2000 to 205 in 2014 has been almost exclusively the result of an increase in the numbers of GP professors from 33 to 78; the static number of GP lecturer posts (40) …

OBJECTIVES To determine the provider cost of administering intensive care unit (ICU) services, comparing 3 different staffing models for ICU coverage, and to compare the costs of using house staff vs nonphysician providers (NPPs). METHODS Data were collected on total staff composition and number of beds in ICUs from January 1, 2004, through December 31, 2004, at the 3 Mayo Clinic sites: Rochester, Minn; Jacksonville, Fla; and Scottsdale, Ariz. Institutional or national average staff salaries were used to determine total staffing costs per ICU bed per year at each site. Medicare medical education reimbursements were also taken into account. RESULTS Costs per ICU bed for physician staffing were $18,630 in Rochester, $37,515 in Jacksonville, and $38,010 in Scottsdale. When NPPs were substituted for house staff, the costs per bed were $72,466 in Rochester, $61,291 in Jacksonville, and $49,909 in Scottsdale. Incremental costs per ICU bed using NPPs were $53,836 in Rochester, $23,776 in Jacksonville, and $11,899 in Scottsdale. CONCLUSION Use of residents and fellows in ICU staffing at a major tertiary health center is more cost-efficient than use of NPPs. This finding could have implications for the cost of physician services in nonteaching community hospitals and the methods by which care is provided.

Purpose: A survey was taken by NRG Oncology to assess Full Time Equivalent (FTE) contributions to multi institutional clinical trials by medical physicists.No current quantification of physicists’ efforts in FTE units associated with clinical trials is available. The complexity of multi-institutional trials increases with new technologies and techniques. Proper staffing may directly impact the quality of trial data and outcomes. The demands on physics time supporting clinical trials needs to be assessed. Methods: The NRG Oncology Medical Physicist Subcommittee created a sixteen question survey to obtain this FTE data. IROC Houston distributed the survey to their list of 1802 contact physicists. Results: After three weeks, 363 responded (20.1% response). 187 (51.5%) institutions reporting external beam participation were processed. There was a wide range in number of protocols active and supported at each institution. Of the 187 clinics, 134 (71.7%) participate in 0 to 10 trials, 28 (15%) in 11 to 20 trials, 10 (5.3%) in 21 to 30 trials, 9 (4.8%) had 40 to 75 trials. On average, physicist spent 2.7 hours (SD: 6.0) per week supervising or interacting with clinical trial staff. 1.25 hours (SD: 3.37), 1.83 hours (SD: 4.13), and 0.64 hours(SD: 1.13) per week were spent on patient simulation, reviewing treatment plans, and maintaining a DICOM server, respectively. For all protocol credentialing activities, physicist spent an average of 37.05 hours (SD: 96.94) yearly. To support dosimetrists, clinicians, and therapists, physicist spend on average 2.07 hours (SD: 3.52) per week just reading protocols. Physicist attended clinical trial meetings for on average 1.13 hours (SD: 1.85) per month. Conclusion: Responding physicists spend a nontrivial amount of time: 8.8 hours per week (0.22 FTE) supporting, on average, 9 active multi-institutional clinical trials.

Purpose To examine the supply of physician anesthesia providers necessary to accommodate the previously described clinical and non-clinical service volume needs throughout Canada

A survey of the food service departments in 93 hospitals throughout NSW Australia (covering 51% of hospital beds in the state) was conducted using a mailed questionnaire and the results compared with those from similar surveys conducted in 1986 and 1993. Over the past eight years there has been a significant increase in the proportion of hospitals using cook-chill food service production systems, from 18% in 1993 to 42% in 2001 (P < 0.001). Hospitals with cook-chill systems had better staff ratios than those with cook-fresh systems (8.3 vs. 6.4 beds/full time equivalent staff; p < 0.05), but there was no significant difference in the ratio of meals served per FTE. There was no difference between public and private hospitals in terms of ratios of beds or meals to food service staff. Managers using cook-chill systems reported significantly lower levels of satisfaction with the food service system compared to those using cook-fresh. Two aspects of the services have not changed since the last survey: approximately a quarter of food service departments are still managed by staff without formal qualifications and meal times remain the same, with more than 90% of hospitals serving the evening meal before 5.30 p.m. and a median of 14.25 h gap between the evening meal and breakfast.

This project evaluated the roles and workload of Registered Nurses (RNs) within an outpatient Cancer Care Centre (CCC) of a tertiary referral hospital in Sydney, Australia. The research incorporated the two distinct areas of radiation oncology and haematology oncology. Patient throughput (incorporating clinic attendance and treatments) was known to have increased substantially since the centre opened in 1994. The nursing Full Time Equivalents (FTEs) for the CCC were determined when the centre opened with minimal change to the nursing establishment since then. Nursing staff perceived that their workload had increased substantially and that their roles had become more complex. Work sampling was conducted over a 3-month period and identified the range of nursing activities performed by the oncology outpatient nurse. The nurses were found to have a large administrative role while their nursing activities ranged from basic nursing tasks to more specialist activities including patient counseling and complex chemotherapy regimes.

The number of full time equivalent GPs in England increased by less than 1% in the past three months, show new figures the BMA has described as “disappointing.” The figures, from NHS Digital, show that there were 34 242 full time equivalent GPs in England as at 30 June 2017, an increase of 321 (0.9%) from 33 921 in March 2017.1 Excluding locum GPs, the number of full time equivalent GPs increased by 263 (0.8%) to 33 235 in June from 32 972 in March. But from March 2016 to March 2017 the number of full time GPs, excluding locums, fell by 1252 …

NHS trusts are increasing their recruitment efforts to fill vacancies, posting 8% more advertisements for medical jobs on NHS Jobs in 2016-17 than in the previous year. In the year to March 2017, NHS trusts in England advertised to fill 32 153 full time equivalent medical jobs, up from 29 776 in the year to March 2016. The increase in the number of posts advertised was greatest among foundation doctors and specialty doctors. The …

The UK Medical Schools Council recently published the findings of its survey of clinical academic staffing.1 The council gathered data from all 33 publicly funded UK medical schools on 31 July 2016. The survey did not include the newly established private medical schools. The survey found that UK medical schools employed 3041 full time equivalent clinical academic staff …

The rise in outpatient appointment numbers is outstripping the growth in the number of hospital doctors, data from NHS Digital show. Between 2005 and 2015, the number of full time equivalent consultants increased by 45%, from 29 613 to 42 903. Over the same period, outpatient appointment attendances increased by 79%, from 50 038 667 in …

GP numbers in England fell from September 2016 to March 2017 despite a multibillion pound rescue plan to ease shortages in general practice, figures from NHS Digital show.1 The Royal College of GPs said that a depleted GP workforce was unacceptable when the workload was “soaring.” Provisional estimates (figures exclude locums) showed 33 423 full time equivalent (FTE) GPs at 31 March this year—down 381 from September 2016 (33 804). In the most recent quarter to March 2017, however, a small rise of 36 GPs was recorded, up from 33 387 FTEs at 31 December 2016. In April 2016 NHS England announced extra annual investment, rising to an …

The government has made “no progress” on increasing the number of GPs in England one year after it committed to recruit 5000 more by 2020, a report by MPs has said. The Public Accounts Committee issued a progress report on 27 April on its inquiry into access to general practice.2 It said that GP numbers had actually fallen in the past year—from 34 592 full time equivalent doctors in September 2015 to 34 495 in September 2016.1 The committee said that more trainee GPs were being recruited, but the latest recruitment target was missed and the NHS was still having problems retaining existing staff. “Health Education England still lacks a credible plan for ensuring that …

General practice leaders have expressed alarm at new figures showing that the number of full time equivalent GPs in England fell by more than 400 in the last three months of 2016. The new figures, from NHS Digital,1 also show a decrease in the overall GP head count in England between September and December 2016, despite pledges from government and NHS England to increase the workforce by 5000 GPs by 2020.2 GP leaders said that policymakers must start turning promises into action if the chronic decline in GP numbers is to be reversed. The figures show that there were 34 050 full time equivalent (FTE) GPs, including registrars, locums, and retainers, as at …

Latest figures for England show that the number of full time GPs fell by 97 last year, despite government promises to expand the workforce by 5000 by 2020.1 The report by NHS Digital shows that there were 34 495 full time equivalent GPs in September 2016, down from 34 592 a year earlier (a drop of 0.3%). The latest data show that the overall headcount fell by 12 from 41 877 to 41 865. Just over half (57%) of GPs were partners, the …

Phased dentistry (PD) is a philosophy of managed oral health care that emphasizes an orderly approach to dental risk assessment, prevention, and disease management. PD is divided into two stages. Phase 1 (PH1) care is intended to eliminate all conditions that may produce a dental emergency within 12 months. PH1 care is directed primarily to recruits and apprentice training students. Phase 2 (PH2) care strives to attain and maintain optimal oral health for Navy and Marine Corps personnel after their initial training period and throughout their military career. The purpose of this study was to evaluate the feasibility of introducing PH1 into a recruit dental treatment facility. Data were obtained at Naval Dental Center (NDC), Orlando from 4,571 recruit dental patients who were in-processed and completed recruit training between May 27 and October 1, 1993. The incoming operational dental readiness (ODR) of recruits during the PD trial was 28.5%, whereas the ODR of graduating recruits was 85.8%. During this same period there was a 34% increase in completed dental treatments per provider full time equivalent. Although dramatic increases in ODR and productivity were noticed during PD, other variables may have contributed to these results.

The purpose of this study were to describe research involvement, identify barriers to research and factors that encourage research, and determine which department and therapist characteristics are associated with research involvement in pediatric physical therapy(PT) and occupational therapy (OT) patient care settings. A survey was sent to the director of PT and to the director of OT of 106 facilities listed with the National Association of Children's Hospitals and Related Institutions ( NACHRI). The response rate was 65%. Of the respondents, 41.4% PT and 45.5% OT department were involved in research. The top three ranked barriers to performing research were: productivity. Requirements, inadequate staffing levels, and lack of financial support. The top three ranked factors that encourage research were: employee retention, adequate knowledge, and assistance. Those departments with 10 or more full time equivalents (FTE's) and those with research in their mission statement were more likely to be involved in ...

More women but fewer young people are choosing to become clinical academics, a survey of medical academic staffing levels has found.1 The Medical Schools Council has published its 14th survey of clinical academic staffing levels in UK medical schools, setting out how things stood at 31 July 2015. In 2015 there were 13% fewer clinical academics aged under 46 compared with a decade ago, and 38% more aged over 46. There were now 593 full time equivalent (FTE) clinical lecturers—more than in any year since 2003. This represented around a 50% increase since 2006 when there were 396 FTEs. …

I was dismayed by Walshe’s phrase “improving the organisation of primary care and its integration with secondary care.”1 My surgery (six full time equivalent partners, 12 500 patients) has as much wish or need to be integrated with any of our district general hospitals …

In response to Upton, the Clinical Practice Research Datalink (CPRD) includes limited anonymised information on the characteristics of health professionals.1 2 Sex and role are available and information on consultation volumes can be extracted. Data on GP density, full time equivalents, or other staff characteristics are unavailable. Such data are available nationally but cannot be linked to the practices in CPRD, which are anonymous. In …

A doctor's performance is measured by the relative value unit (RVU), originally considered to be the fairest method to measure productivity. However, there is a category of clinician, the clinician/educator, who dedicates himself or herself to graduate medical education, and for which the RVU system does not take into account that most important element: teaching. There are no RVUs for spending 10 minutes at a bedside teaching medical interns how to differentiate systolic from diastolic murmurs, or how to measure jugular venous pressure. There are no RVUs for spending an hour with a large group of residents for clinical reasoning seminars. And there are no RVUs for inspiring a perplexed medical student who was drawn to the medical profession for its humanistic core. Generating a rational differential diagnosis requires meticulous history taking and thorough physical examination, yet in the 21st century some of this is being replaced by excessive ancillary testing. Despite the fact that this “new” method seems to be more efficient in looking for a definitive diagnosis, is it more cost effective than teaching the physician-in-training to generate a sound differential diagnosis based on clinical reasoning before exposing patients to unnecessary radiation? We do not know. A thriving clinician/educator—a master teacher—is someone who has the passion to inspire residents and who possesses a unique teaching style that commands their attention. Someone who can demonstrate to students how to elicit the right information from their patients, and how to use that to attain exceptional medical knowledge and develop sound clinical judgment. Unfortunately, these master teachers must work harder than anyone else, and, on paper, they receive lower RVUs than their peers who have not spent much time teaching. Perhaps, instead of developing new ways to pay these master teachers, the RVU system should be modified to account for their value, allowing institutions to recognize the true master teacher. This would be an incentive for doctors to provide the type of care that is truly important to patients and graduate medical education. A while ago, I attended the Society of Critical Care Medicine conference where Dr Paul Rogers, the vice chair of education at the University of Pittsburgh, was the honorary lecture speaker. He proposed giving out education credit units to allocate monetary resources to the medical educational department. Academic RVU to measure academic productivity also has been proposed in academic radiology departments. I believe that each academic institution should both identify a number of master teachers according to the size of the residency training program and provide them with full time equivalent (FTEs)/education credit units/academic RVUs that are proportionate to their time spent teaching and mentoring junior clinicians/educators. These master teachers are a valuable asset for the institution in attracting medical students during residency recruitment, as well as in reassuring those students that they will receive an excellent graduate medical education. Obviously, they are the academic leaders that nurture independent, competent, and skilled future physicians. To offer them the appropriate education credit units is an investment for the department that will pay dividends in the future.

International audience; 1. In this study, we compared a conventional broiler production system keeping fast growing broilers with an organic broiler production system keeping slow growing broilers in the Netherlands, both managed by one person working a full time year (Full Time Equivalent, FTE). This comparison was based on a quantification of economic, ecological and social indicators. Indicators were quantified using scientific literature and national data sets. 2. The organic system performed better for the economic indicator net farm income per FTE than the conventional system. 3. Regarding ecological indicators, calculations showed a higher on-farm emission of ammonia per kg live weight for the organic system. Moreover, an organic system includes a higher risk for eutrophication per ha due to outdoor access. Emission of green house gasses, use of fossil fuels and use of land required for the production of one kg of live weight is higher for an organic than for a conventional system. This is mainly due to a lower feed conversion in organic production and use of organic feed. 4. The organic system performed better than the conventional system for the social indicators related to animal welfare time spent on walking, footpad lesions, mortality, and sound legs. Regarding the social indicator food safety was found that meat from an organic system contained less antibiotic residues and Salmonella contaminations but more Campylobacter contaminations than meat from a conventional system. 5. Changing from a conventional to an organic broiler production system, therefore, not only affects animal welfare, but also affects economic, ecological and other social issues. In this study, we ran into the situation that some information needed was lacking in literature and quantifications had to be based upon several sources. Therefore, an integrated on-farm assessment is needed, which can be used to develop a broiler production system that is economically profitable, ecologically sound, and acceptable for society.

Objective Patient care experience survey data might be useful for managing individual physician malpractice risk, but available evidence is limited. This study assesses whether patients' experiences with individual physicians, as measured by a validated survey, are associated with patient complaints and malpractice lawsuits. Design Random samples of active patients in physicians' panels, with sample sizes adequate to provide highly reliable, stable information about patients' experiences with each physician ( n = 19 202, average respondents per physician = 119) were used to assess the relation of patient survey measures to malpractice risk. Setting A large multi-specialty physician organization in eastern Massachusetts, USA. Participants Physicians providing care for at least 5 years in adult primary care and select high-risk specialty departments between January 1996 and December 2005 ( n = 161). Main outcome meausure(s) Patient complaints (2001–05) and malpractice lawsuits (1996–2005). Results Compared to primary care physicians, high-risk specialists had a lower patient complaint rate (0.34 vs. 1.36 complaints per patient care full time equivalent; P < 0.001), but a higher lawsuit rate (0.09 vs. 0.05 lawsuits per patient care full time equivalent; P = 0.02). Irrespective of physician specialty, the quality of physician–patient interactions (IRR = 0.61; P < 0.001) and care coordination (IRR = 0.65; P < 0.001) were inversely associated with patient complaints. Patient survey measures were not associated with malpractice lawsuits. Conclusions The results underscore the challenges organizations face when attempting to use patient survey data to manage individual physician medical malpractice risk. Because lawsuits are infrequent events, calibrating these validated patient survey measures to malpractice lawsuit risk will require large physician samples from diverse practices.