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Objective: This study aimed to examine changes in the demographics and regions of work of Australian doctors over a period of 9 years. Methods: A retrospective study of Australian Health Practitioner Regulation Agency (AHPRA) registration data was performed. Data were sourced from the Health Workforce Dataset Online Data Tool which was derived from annual registration data from AHPRA for 2013–2022. The demographic factors analysed were gender, age, and origin of qualification. Regions of work were defined using the Modified Monash (MM) model. Results: The number of registered doctors increased from 82,408 in 2013 to 111,908 in 2022 but mean hours worked per week decreased from 41 to 39 leading up to 2020. Trends in age and origin of qualification remained stable, but the proportion of female workers increased from 38.5% in 2013 to 44.5% in 2022. While female hours per week (~37) were consistent from 2013 to 2020, male hours per week decreased from 43 to 41. The number of registrations and total full-time equivalent (FTE) outcomes increased consistently in metropolitan (MM1) and rural (MM2–5) regions but did not increase for remote and very remote (MM6–7) regions. Conclusion: The Australian medical workforce both grew and changed between 2013 and 2022. An overall decrease in mean hours worked appears to be driven by a decline in hours worked by male workers and the increased proportion of female workers. While increased gender parity and a decrease in hours worked per week were positive outcomes, a lack of growth in the medical workforce was noted in remote and very remote regions of Australia. What is known about the topic? Changes in the medical workforce over time are likely to impact health service delivery. What does this paper add? This paper examined changes in the gender, age, origin of qualification, and the region of work of Australia's medical workforce from 2013 to 2022. What are the implications for practitioners? An increase in gender parity and a decrease in the mean hours worked suggests improvements in workforce participation and sustainability, but lack of growth in medical workforce was noted in remote and very remote regions of Australia. [ABSTRACT FROM AUTHOR]

Role modelling has powerful impact in medical education, with the potential to shape the professional development, clinical skills and career choices of the medical workforce. In this article we provide twelve tips, some aimed at educators and some at curriculum leaders, to increase the positive potential of role modelling. Our tips are based on theory, evidence, our own research and experience. They include ensuring educators are conscious of their role modelling potential, providing role models to represent the diversity of learners, facilitating reflection in the role modelling process and supporting role modelling to improve recruitment to shortage specialties. [ABSTRACT FROM AUTHOR]

Abstract Background Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England. Methods We accessed electronic health care records (EHRs) for 3.5 million patients from the CPRD GOLD database with linkage to Hospital Episode Statistics from 1st April 2010 to 31st March 2022. We used multi-level mixed effects logistic regression to compare consultations with locum and permanent GPs for several patient outcomes including general practice revisits; prescribing of antibiotics; strong opioids; hypnotics; A&E visits; emergency hospital admissions; admissions for ambulatory care sensitive conditions; test ordering; referrals; and prescribing safety indicators while controlling for patient and practice characteristics. Results Consultations with locum GPs were 22% more likely to involve a prescription for an antibiotic (OR = 1.22 (1.21 to 1.22)), 8% more likely to involve a prescription for a strong opioid (OR = 1.08 (1.06 to 1.09)), 4% more likely to be followed by an A&E visit on the same day (OR = 1.04 (1.01 to 1.08)) and 5% more likely to be followed by an A&E visit within 1 to 7 days (OR = 1.05 (1.02 to 1.08)). Consultations with a locum were 12% less likely to lead to a practice revisit within 7 days (OR = 0.88 (0.87 to 0.88)), 4% less likely to involve a prescription for a hypnotic (OR = 0.96 (0.94 to 0.98)), 15% less likely to involve a referral (OR = 0.85 (0.84 to 0.86)) and 19% less likely to involve a test (OR = 0.81 (0.80 to 0.82)). We found no evidence that emergency admissions, ACSC admissions and eight out of the eleven prescribing safety indicators were different if patients were seen by a locum or a permanent GP. Conclusions Despite existing concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs. The practice and performance of both locum and permanent GPs is likely shaped by the organisational setting and systems within which they work.

Objective: The aim of this study is to evaluate the accessibility of primary care physicians (PCPs) in Eastern Quebec by employing an enhanced two-step floating catchment area (E2SFCA) methodology. This approach will facilitate the identification of patterns in primary care accessibility that may not be readily apparent through the use of regional availability measures. Methods: To evaluate the accessibility of primary care physicians (PCPs), an enhanced two-step floating catchment area methodology was utilized. This approach considers both the population supply of PCPs at the dissemination area level and the travel time between PCPs and dissemination areas. Additionally, a continuous distance decay function (β) was employed. Results: The enhanced two-step floating catchment area (E2SFCA) methodology is effective in identifying possibly underserved areas that could have otherwise appeared to have sufficient access when evaluated using traditional provider-to-population ratios. The availability of primary care services is contingent upon the presence of adequate road infrastructure. Populations residing in areas with limited access to main road networks may experience compromised access to primary care. This issue disproportionately affects vulnerable individuals who lack private transportation options. Conclusions: The application of the enhanced two-step floating catchment area methodology can facilitate the identification of areas experiencing a shortage of primary care physicians. This information can be used to inform the development of regional medical workforce programs, such as "plans régionaux d'effectifs médicaux", and to support the establishment of rural residency initiatives. [ABSTRACT FROM AUTHOR]

Clinical leadership is necessary to improve the performance of large public hospitals. Trainee medical officers (TMOs) are important stakeholders in organisation-wide initiatives that affect the medical workforce and support clinician engagement. This case study describes the development of a representative body known as the ‘TMO Forum’ within the Central Adelaide Local Health Network as a mechanism to promote engagement between medical trainees and the hospital executive to facilitate escalation and discussion of system-based issues. Over the past 8 years, this group has evolved into a community of practice with steady and sustained growth since inception. Trainees have fostered relationships with the executive, and have engaged in leadership and quality improvement initiatives. Here we explore the evolution, value and barriers to success of the TMO Forum. Our discussion is supplemented with findings from anonymous online evaluation surveys of both the TMO and executive stakeholder groups. We propose that initiatives such as the described may offer reciprocal benefits to both constituent groups regarding communication, and that the development of a dedicated community of practice will enhance engagement of TMOs in health service improvement initiatives and advocacy. However, there are obstacles to overcome in order to attract a greater number of trainees and maximise the benefits from this initiative. [ABSTRACT FROM AUTHOR]

Introduction: Rural medical training along all components of the medical training continuum has been shown to enhance rural workforce outcomes. However, due to the maldistribution of the Australian medical workforce, health services of increased rurality are limited in their ability to fulfil the supervision requirements for all levels of trainees, especially junior doctor training. Although longitudinal program design and pedagogy has flourished in medical school education through the Longitudinal Integrated Clerkship model, this has not yet been widely translated to prevocational training. This study describes how a longitudinal program design was conceptualised and implemented within a rural health service to create a novel internship program. Methods: A descriptive case study methodology was employed to describe and evaluate the longitudinal integrated internship program. Relevant program documents such as rosters and accreditation submissions were reviewed to aid in describing the program. Interviews with participants involved in the program were conducted during the middle (May) and end (November) points of the program's first year (2021) to investigate perspectives and experiences of the internship model. Results: Each week, interns were rostered for 1 day in the hospital's emergency department and 3 days in general surgery or general medicine, swapping disciplines after 6 months. In this way, interns completed core rotations longitudinally, meeting accreditation and supervision requirements. Additionally, 1 day per week was spent parallel consulting in general practice. Participants described program enablers as the organisational vision and staff buy-in, as well as the longitudinal attachments to disciplines. Barriers identified were the tenuous nature of the medical workforce and long-term sustainability of the program. Benefits of the program included value-adding and preparedness for practice, particularly in a rural context. Conclusion: Intern programs that meet the accreditation, supervision and learning requirements can be successfully delivered at rural health services through longitudinal models of medical education. As the intern year is a key component of the rural generalist training pathway, development of similar innovative models provides the opportunity for rural communities to grow their own future medical workforce. [ABSTRACT FROM AUTHOR]

Background/Aims: Clinical fellows support the hospital workforce while gaining experience in different specialities, research, leadership and teaching. The authors aimed to assess the impact of clinical fellow programmes in an acute teaching hospital trust. Methods: An anonymous electronic service evaluation was sent to clinical fellows to investigate their views on whether the programme had improved patient safety, doctors' clinical performance, training and wellbeing. Thematic analysis was used to analyse the free-text responses. Results: A total of 95 out of 144 clinical fellows responded to the evaluation survey. The clinical fellows believed that the programme had improved patient safety, clinical performance (time to manage acute patients), foundation and internal medicine training, undergraduate teaching and junior doctors' wellbeing. Four similar themes emerged from the free-text responses: career development, patient safety, training and doctors' wellbeing. Conclusions: Clinical fellow programmes may improve patient safety, clinical performance, training, undergraduate education and doctors' wellbeing. [ABSTRACT FROM AUTHOR]

Summary: Background: Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests ‘cloning’ (reproduction of sameness) of the existing workforce. Methods: We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002–2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed’s cultural cloning theory. Findings: Female students had higher odds of becoming a physician (OR 1.87 [1.53–2.28], p

Introduction: Rural medical training along all components of the medical training continuum has been shown to enhance rural workforce outcomes. However, due to the maldistribution of the Australian medical workforce, health services of increased rurality are limited in their ability to fulfil the supervision requirements for all levels of trainees, especially junior doctor training. Although longitudinal program design and pedagogy has flourished in medical school education through the Longitudinal Integrated Clerkship model, this has not yet been widely translated to prevocational training. This study describes how a longitudinal program design was conceptualised and implemented within a rural health service to create a novel internship program. Methods: A descriptive case study methodology was employed to describe and evaluate the longitudinal integrated internship program. Relevant program documents such as rosters and accreditation submissions were reviewed to aid in describing the program. Interviews with participants involved in the program were conducted during the middle (May) and end (November) points of the program's first year (2021) to investigate perspectives and experiences of the internship model. Results: Each week, interns were rostered for 1 day in the hospital's emergency department and 3 days in general surgery or general medicine, swapping disciplines after 6 months. In this way, interns completed core rotations longitudinally, meeting accreditation and supervision requirements. Additionally, 1 day per week was spent parallel consulting in general practice. Participants described program enablers as the organisational vision and staff buy-in, as well as the longitudinal attachments to disciplines. Barriers identified were the tenuous nature of the medical workforce and long-term sustainability of the program. Benefits of the program included value-adding and preparedness for practice, particularly in a rural context. Conclusion: Intern programs that meet the accreditation, supervision and learning requirements can be successfully delivered at rural health services through longitudinal models of medical education. As the intern year is a key component of the rural generalist training pathway, development of similar innovative models provides the opportunity for rural communities to grow their own future medical workforce.

Information on the employment of patient-care clinicians is needed for policy planning and human resource management. The 2021 Bureau of Labor Statistics (BLS) employment data were probed for occupational settings of 698,700 physicians and surgeons, 246,690 NPs, and 139,100 physician associates/assistants (PAs). These three healthcare professionals accounted for about 1.1 million medical and surgical clinicians serving a US population of 331.5 million. Clinician demographics differ--in 2021, the median age of physicians was 45 years; NPs, 43 years; and PAs, 39 years. The largest employment location is "office of a physician" (physician, 53%; NP, 47%; PA, 51%), followed by hospitals (physician, 25%; NP, 25%; PA, 23%), and outpatient centers (physician, 4%; NP, 9%; PA, 10%). The 10-year job outlook predicts physician growth at 3%, NPs at 46%, and PAs at 28%. NP and PA employment is growing more than that of physicians because of constrained physician postgraduate education funding. Other factors influencing employment changes include medical practice mergers, the rising value of team-based care, the cost of new medical schools, and task shifting. [ABSTRACT FROM AUTHOR]

Background: When the coronavirus disease 2019 (COVID-19) erupted in Yangzhou, China, at the end of July 2021, medical workers in Yangzhou immediately joined the frontline for the fight against the pandemic. This study aimed to identify the mental health and fatigue experienced by the medical workers in Yangzhou during the COVID-19 outbreak. Methods: We included 233 medical workers who participated in the front-line work for more than 1 month through the questionnaire, including doctors, nurses, medical technicians and medical students. The generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), and Fatigue selfassessment scale (FSAS) were administered to the participants and their responses were evaluated. Results: A total of 233 eligible questionnaires were received. Among them, 130 people (57.08%) were probably anxious and 141 (60.52%) people were clinically depressed. Poor sleep was considered an independent risk factor for anxiety (OR = 7.164, 95% CI: 3.365 15.251, p = 0.000) and depression (OR = 6.899, 95% CI: 3.392 14.030, p = 0.000). A high PHQ-9 score was considered an independent risk factor for general fatigue (OR = 1.697, 95% CI: 1.481 1.944, p = 0.000). Mental fatigue (OR = 1.092, 95% CI: 1.027 1.161, p = 0.005) and fatigue response to sleep/rest (OR = 1.043, 95% CI: 1.011 1.076 p = 0.008) were considered independent risk factors for general fatigue. Conclusion: Poor quality of sleep led to probable anxiety, depression, and general fatigue. Mental fatigue and fatigue response to sleep/rest were independent risk factors for depression, which merits attention for battling COVID-19. [ABSTRACT FROM AUTHOR]

Background: The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery., Objective: The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel., Methods: This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants' replies., Results: The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions., Conclusions: The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce., (©Rola Khamisy-Farah, Eden Biras, Rabie Shehadeh, Ruba Tuma, Hisham Atwan, Anna Siri, Manlio Converti, Francesco Chirico, Łukasz Szarpak, Carlo Biz, Raymond Farah, Nicola Bragazzi. Originally published in JMIR Medical Education (https://mededu.jmir.org), 08.10.2024.)

Abstract Background Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province. Methods An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression. Results A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03–11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24–31.1), and have no additional practice (OR 2.78, CI 1.34–5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42–17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09–8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10–0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05–3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06–4.09), currently practising in RR Maluku (OR 8.23, CI 3.27–20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13–0.70). Conclusion This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.

Background Medical workforce scarcity in rural and remote communities is a global problem, severely challenging healthcare delivery and health equity. Both developed and developing countries report geographically uneven distributions of the medical workforce. This scoping review synthesizes evidence from peer-reviewed and grey literature concerning approaches implemented to improve the recruitment, development, and retention of the rural medical workforce in both developed and developing countries. Methods We will utilize the Arksey and O’Malley (2005) framework as the basis for this scoping review. The databases to be searched include Medline, Embase, Global Health, CINAHL Plus, and PubMed for articles from the last decade (2010-2019). Searches for unpublished studies and grey literature will be undertaken using the Google Scholar - Advanced Search tool. Quantitative and qualitative study designs will be included. Two authors will independently screen and extract relevant articles and information, with disagreements resolved by a third. Quantitative and qualitative analyses (thematic) will be conducted to evaluate and categorize the study findings. Discussion The scoping review will aid in mapping the available evidence for approaches implemented to advance the process of recruitment, development, and retention of the medical workforce in the rural and remote areas in developed and developing nations. Registry This protocol has been registered to Open Source Framework (https://osf.io/e83hp/).

Background: Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province.Methods: An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression.Results: A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03-11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24-31.1), and have no additional practice (OR 2.78, CI 1.34-5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42-17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09-8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10-0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05-3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06-4.09), currently practising in RR Maluku (OR 8.23, CI 3.27-20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13-0.70).Conclusion: This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors. [ABSTRACT FROM AUTHOR]

Objectives: To highlight the experiences and challenges of international medical graduates (IMGs) living and working in rural and remote Tasmania, and how this informs their acculturation and retention in the state. Design: This paper reports the findings from the Tasmanian IMG questionnaire, which was administered both in hardcopy and online format to all known IMGs within the state. A total of 105 questionnaires were returned, representing a response rate of 30.0%. Results: IMGs were from the 30 countries and the majority were under 49 years of age, had migrated in the past 10 years, with over half having worked in the state for less than 2 years. Many IMGs indicated that they were satisfied with their current employment, the medical facilities, the friendliness of their patients and the friendliness of the community where they lived, and would like to stay much longer in Tasmania. Conclusions: Many IMGs have previously lived and worked in rural areas and are reasonably satisfied with their current employment and lifestyle in Tasmania. However, the following factors play an important part in their views and attitudes: employment satisfaction, access to schools, employment for spouse or partner and access to cultural or religious foods and goods. Nevertheless, beyond employment satisfaction, employment itself, coupled with career pathway and training opportunities, were highlighted as contributory factors for leaving Tasmania. [ABSTRACT FROM AUTHOR]

Abstract Background Despite increasing popularity among health organizations of pay for performance (P4P) for the provision of comprehensive care for chronic non-communicable diseases, evidence of its effectiveness in improving health system outcomes is weak. An important void in the evidence base is whether there are gendered differences in P4P uptake and in related outcomes amenable to healthcare improvement. This study assesses the gender-specific effects of P4P among family physicians on diabetes healthcare costs in a context of universal health coverage. Methods We use population-based linked longitudinal administrative datasets on chronic disease cases, physician billings, hospital discharge abstracts, and physician and resident registries in the province of New Brunswick, Canada. We estimate the effects of introduction of a P4P scheme on excess public healthcare costs among cohorts of adult diabetes patients using propensity score-adjusted difference-in-differences regressions stratified by physician’s gender. Results We observed greater male physician uptake of incentive payments, seemingly exacerbating gender gaps in professional remuneration. Regression results indicated P4P did not lead to improved outcomes in terms of preventing hospitalization costs among patients, only measurable increases in compensation for both the male and female physician workforce. Conclusions While P4P was not attributed in this study to reduced hospital burden and enhanced sustainability of healthcare financing, incentive payments were found to be related to earning gaps by physician’s gender. Decision-makers should consider that benefits of P4P be monitored not only for patient metrics but also for provider metrics in terms of gender equality especially given feminization of primary care medical workforces.

Abstract Background In 2012, the UK introduced medical revalidation, whereby to retain their licence all doctors are required to show periodically that they are up to date and fit to practise medicine. Early reports suggested that some doctors found the process overly onerous and chose to leave practice. This study investigates the effect of medical revalidation on the rate at which consultants (senior hospital doctors) leave NHS practice, and assesses any differences between the performance of consultants who left or remained in practice before and after the introduction of revalidation. Methods We used a retrospective cohort of administrative data from the Hospital Episode Statistics database on all consultants who were working in English NHS hospitals between April 2008 and March 2009 (n = 19,334), followed to March 2015. Proportional hazard models were used to identify the effect of medical revalidation on the time to exit from the NHS workforce, as implied by ceasing NHS clinical activity. The main exposure variable was consultants’ time-varying revalidation status, which differentiates between periods when consultants were (a) not subject to revalidation—before the policy was introduced, (b) awaiting a revalidation recommendation and (c) had received a positive recommendation to be revalidated. Difference-in-differences analysis was used to compare the performance of those who left practice with those who remained in practice before and after the introduction of revalidation, as proxied by case-mix-adjusted 30-day mortality rates. Results After 2012, consultants who had not yet revalidated were at an increased hazard of ceasing NHS clinical practice (HR 2.33, 95% CI 2.12 to 2.57) compared with pre-policy levels. This higher risk remained after a positive recommendation (HR 1.85, 95% CI 1.65 to 2.06) but was statistically significantly reduced (p

This paper compares career expectations and career outcomes of Swiss healthcare assistants (HCA), an occupation created to increase the supply of nurses. We investigate whether HCAs can predict their own professional careers two years ahead by eliciting their expectations for a range of career alternatives, including nursing and other studies. Polytomous choice situations have rarely been analyzed using numerical probabilities in the expectations literature. Our results show that almost all respondents give informative answers to the probabilistic online survey question. Individuals express considerable uncertainty about their future careers, with over 60% attaching positive probabilities to more than one career alternative. The analyses reveal that individuals' numerical expectations have substantial predictive value for their future careers, even after controlling for many variables. This finding confirms that individuals have private information not directly available to researchers, and that eliciting choice probabilities for polytomous choice situations is a viable approach in surveys. However, the mean shares for career alternatives implied by individual probabilities do not fully coincide with actual shares and are more accurate over 4 than over 2 years. The information conveyed in expectations and their deviations from outcomes enables us to derive policy recommendations to increase transitions to nursing. [ABSTRACT FROM AUTHOR]

Background: Medical workforce scarcity in rural and remote communities is a global problem, severely challenging healthcare delivery and health equity. Both developed and developing countries report geographically uneven distributions of the medical workforce. This scoping review synthesizes evidence from peer-reviewed and grey literature concerning approaches implemented to improve the recruitment, development, and retention of the rural medical workforce in both developed and developing countries. Methods: We will utilize the Arksey and O'Malley (2005) framework as the basis for this scoping review. The databases to be searched include Medline, Embase, Global Health, CINAHL Plus, and PubMed for articles from the last decade (2010-2019). Searches for unpublished studies and grey literature will be undertaken using the Google Scholar - Advanced Search tool. Quantitative and qualitative study designs will be included. Two authors will independently screen and extract relevant articles and information, with disagreements resolved by a third. Quantitative and qualitative analyses (thematic) will be conducted to evaluate and categorize the study findings. Discussion: The scoping review will aid in mapping the available evidence for approaches implemented to advance the process of recruitment, development, and retention of the medical workforce in the rural and remote areas in developed and developing nations. [ABSTRACT FROM AUTHOR]

The prevalence of psychiatric and substance use disorders in the United States is rising and of growing concern. Because such behavioral conditions are widespread, one approach is to collaborate with various medical professionals to help offset this demand. To address this issue, the frequency and types of mental health conditions encountered by physician assistants (PAs) were assessed. The National Commission on the Certification of Physician Assistants Practice Analysis was examined for the types of mental health conditions encountered across the spectrum of medical and surgical practices. The findings reveal that, in 2015, at least 62% of PAs saw and evaluated mental health conditions and behavioral disorders at least weekly in their settings. These patient diagnoses were seen with variability based on the specialty of the PA. The highest percentage of cases reported by PAs were in psychiatry, followed by general internal medicine, emergency medicine, family medicine, and hospital medicine. With the profession projected to grow, recruiting, retaining, and integrating more PAs into mental health care is a suggested strategy for addressing national provider shortages. [ABSTRACT FROM AUTHOR]

Although international medical graduates (IMGs) make up a substantial part of the Australian rural general practice workforce, most research on factors associated with rural practice has focused on Australian medical graduates (AMGs). This study aimed to determine whether there were differences between IMGs and AMGs in terms of these factors. Registrars in training and recent fellows (Fellowship of the Royal Australian College of General Practitioners/Fellowship of the Australian College of Rural and Remote Medicine) who participated in training in rural and regional Australia were surveyed about practice models and rural practice. Almost two-thirds of participants were practicing or intending to practice in rural areas, with no difference between AMGs and IMGs. None of the variables associated with rural practice for AMGs was found to be associated with rural practice in IMGs in univariate binary regression analysis. Two key variables that are strongly associated with rural medical practice in the current literature, namely rural background and rural exposure, were not significant predictors of rural practice among IMGs. Due to the significant number of IMGs in regional training programs, any future incentives designed to improve rural recruitment and retention need to address factors relevant to IMGs. Despite the heavy reliance on IMGs, for the rural medical workforce, it is not known what variables are associated with rural practice recruitment and retention. This is one of the first studies to highlight that there are differences between Australian and international medical graduates in terms of the factors associated with rural practice. Neither of the traditional key factors were associated with rural practice in IMGs in this study. Due to the significant numbers of IMGs in regional training programs, future incentives designed to improve rural recruitment and retention need to further explore and address factors associated with rural practice in IMGs. [ABSTRACT FROM AUTHOR]

The Physician Specialty Recruitment Office of the Royal College of Physicians has overseen recruitment into core medical training since 2009. This has allowed trends in recruitment numbers and the experience of applicants to be followed. Current recruitment into core training is not providing a large enough pool of trainees to sustain adequate filling of higher medical specialty training posts and therefore ultimately bridge the consultant vacancy rates in the UK. [ABSTRACT FROM AUTHOR]

Background: Junior doctors experience high rates of psychological distress and burnout. System‐level interventions are one strategy to reduce psychological distress in junior doctors. Unfortunately, few of these interventions have been evaluated. Aim: To evaluate the acceptability and effectiveness of a resilience and well‐being programme designed for junior doctors. Methods: A prospective cohort study of 24 medical interns at a teaching hospital in regional Queensland with a control group of 29 medical interns at a second teaching hospital in regional Queensland. Survey instruments to assess psychological distress, the ProQOL and K10, were completed at baseline, at the completion of the well‐being programme, and 3 months after the completion of the well‐being programme at both sites. Results: The intervention site had an older cohort and fewer participants had a regular general practitioner compared to the control site. Both groups had moderate levels of psychological distress. Insufficient numbers of participants completing the instruments at the two sites meant that it was not possible to demonstrate differences between the groups; however, the trends were promising. Qualitative evaluation data supported these trends, indicating that the Resilience on the Run programme was positively received and provided useful skills to junior doctors. Conclusion: Well‐being programmes benefit medical interns; introducing new knowledge and skills for effectively identifying and managing personal and workplace stressors that can contribute to psychological distress. [ABSTRACT FROM AUTHOR]

Abstract Background In recent years, Ireland has experienced a large-scale, outward migration of doctors. This presents a challenge for national policy makers and workforce planners seeking to build a self-sufficient medical workforce that trains and retains enough doctors to meet demand. Although, traditionally, medical migration has been considered beneficial to the Irish health system, austerity has brought a greater level of uncertainty to the health system and, with it, a need to reappraise the professional culture of migration and its impact on the Irish health system. Methods This paper illustrates how a culture of migration informs career and migration plans. It draws on quantitative data—registration and migration data from source and destination countries—and qualitative data—in-depth interviews with 50 doctors who had undertaken postgraduate medical training in Ireland. Results Of 50 respondents, 42 highlighted the importance of migration. The culture of medical migration rests on two assumptions—that international training/experience is beneficial to all doctors and that those who emigrate will return to Ireland with additional skills and experience. This assumption of return is challenged by a new generation of doctors whose professional lives have been shaped by globalisation and by austerity. Global comparisons reveal the comparatively poor working conditions, training and career opportunities in Ireland and the relative attractiveness of a permanent career abroad. Conclusion In light of these changes, there is a need to critically appraise the culture of medical migration to determine if and in what circumstances migration is appropriate to the needs of the Irish health system. The paper considers the need to reappraise the culture of medical migration and the widespread emigration that it promotes.

Optimising junior doctor rosters is a common subject of debate both in Australia and overseas. While total work hours are recognised to increase the risk of fatigue-related complications for both junior doctors and their patients, patterns of work are less commonly described. Multiple low quality evidence recommendations exist to guide rostering practices to reduce predominantly the risk of fatigue-associated error and burnout, but also to avoid disruptions to continuity of care and provide adequate training opportunities. Given available evidence is poor, further centre and specialty specific studies are required to delineate optimal rostering patterns for Australian junior doctors. [ABSTRACT FROM AUTHOR]

Objective: Increased exposure to post‐graduate rural medical training is associated with increased likelihood of future rural practice. Training rotations in rural emergency departments provide a possible avenue for such exposure, but have been under‐investigated. This study aimed to compare junior medical officers' emergency department experiences in a metropolitan and a rural hospital to inform rural health workforce initiatives. Design: Mixed‐method case‐study design. Setting: Two 10‐week periods in the respective emergency departments. Participants: Four junior medical officers at the rural site and 22 junior medical officers at the metropolitan hospital. Main outcome measures: Caseloads extracted from electronic medical records and training experience. Results: Data were collected over 142 days. The average number of patients seen per day, per junior medical officer, was significantly higher at the rural hospital emergency department (7.2 patients per day) in comparison with the metropolitan hospital (4.3 patients per day). Junior medical officers at the rural hospital saw relatively more lower acuity patients. The seven junior medical officers who were interviewed provided consistently positive responses regarding their training experiences in both locations. This was particularly evident in the rural hospital and was attributed to one‐on‐one supervision. Conclusions: Most junior medical officers agreed that their expectations for support and learning opportunities were met and/or exceeded. However, junior medical officers reported feeling more supported at the rural hospital due to direct contact and communication with senior medical officers. Placement in a smaller hospital emergency department did not disadvantage the junior medical officers' training in this case‐study and provided a positive rural training experience. These findings support workforce policies which encourage rural hospital emergency department training. [ABSTRACT FROM AUTHOR]

Objective: The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Methods: Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Results: Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance. Conclusion: There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs. What is known about the topic?: MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same. What does this paper add?: The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness. What are the implications to practitioners?: A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress. [ABSTRACT FROM AUTHOR]

Worldwide there is a call for diversifying the healthcare workforce through widening participation (WP) necessitating a significant change in current recruitment and selection policies and practices. However this is advocated without a well understood conceptualisation of WP or consensus between stakeholders about its purposes. Employers, and patients, require a medical workforce that is both caring and competent but also accessible. This presents a significant challenge for most countries, especially in some areas of healthcare, for both common and varying reasons. For example Australia and NZ have long struggled to recruit healthcare workers to remote and rural parts of their countries, whilst currently general practice within the UK, is in crisis due to under recruitment and low morale. Higher Education institutions wish to recruit the best students but it is not clear who the "best students" are and who will progress to fulfil future workforce requirements. Globally universities are concerned by market forces and face significant financial constraints often directly competing with WP policies. Furthermore an established culture of meritocracy, schemes to "top-up" perceived deficits within certain student groups, and fears surrounding the performance of non-traditional students once at university, deter both would be students and the institutions themselves from increasing diversity. Whilst medical schools may aspire to the aims of social justice and fair opportunities such a trajectory is plagued with difficulties, such as university tariff leagues tables, and concerns with student attrition and differential attainment. However considering the aforementioned workforce issues it is timely to look afresh at what our priorities are in selecting for the future medical workforce. Better understanding the available evidence and the inherent tensions within WP would help us make the required step change that facilitates selecting a more appropriate medical workforce.

Background: The factors that influence physicians to establish and maintain their practice in a region are variable. The presence of a regional medical campus (RMC) could influence physicians’ choice. The objective of this study was to explore the factors influencing physician recruitment and retention, and in particular the role of a RMC, in a region of Quebec. Methods: A literature review of factors influencing physicians to stay in a rural area was conducted in order to create an interview guide. Questions were divided into sections: general information, family situation, medical training, career choice, current practice, intent to stay in the region, and impact of the RMC. Thirteen semi-structured individual interviews were conducted with practicing physicians. Data were analyzed using QDAMiner. Results: Recruitment factors were divided into six major themes: type of practice, spousal interest, opportunity for teaching, training in a region, workforce planning, and quality of life. Participants identified positive and negative factors associated with retention. In both cases, family and quality of work environment were mentioned. The RMC was perceived as having important impacts on the quality of professional life, research, medical practice, and regional development. Conclusion: This study highlights the role of RMCs in physician recruitment and retention via multiple impacts on the quality of practice of physicians working in the same area. _______ Contexte: Les facteurs influençant les médecins à s’établir et à rester dans une région sont variables. La présence d’un campus médical régional (CMR) pourrait influencer ce choix. L’objectif de cette étude était d’explorer les facteurs de recrutement et de rétention influençant les médecins ayant choisi de pratiquer dans la région du Saguenay-Lac-Saint-Jean au Québec, en particulier le rôle du CMR. Méthodes: Une synthèse de la littérature a permis d’identifier différents facteurs influençant les médecins dans leur choix de lieu de pratique. Un guide d’entrevue a été élaboré à partir de ces facteurs. Les questions étaient séparées selon les sections suivantes: informations générales, situation familiale, études médicales, choix de carrière, pratique actuelle, intention de rester dans la région, impact du CMR. Treize entrevues semi-dirigées individuelles ont été réalisées avec des médecins en pratique. Les données ont été analysées avec QDA Miner. Résultats: Les facteurs influençant le recrutement étaient séparés en six thèmes majeurs : type de pratique, intérêt du conjoint, opportunité d’enseigner, formation en région, planification gouvernementale des effectifs médicaux et qualité de vie. Les participants ont identifié des facteurs de rétention négatifs et positifs. Ceux-ci concernaient la famille et la qualité de l’environnement de travail. D’après les participants, le CMR avait un impact direct sur la qualité de la vie professionnelle, la recherche, la pratique médicale et le développement régional. Conclusion: Cette étude a permis de mettre en évidence le rôle des CMRs dans le recrutement et la rétention via de multiples impacts sur la qualité de pratique des médecins exerçant dans la même région.

Objective: The objective of this study was to quantify the subspecialist workforce involved in the clinical education of Obstetrics and Gynecology (OBGYN) residents and to provide an overview of the subspecialist faculty workforce geographic distribution and demographics., Methods: This cross-sectional, observational study used public data collected from July 1, 2022, through August 31, 2022. A list of Obstetrics and Gynecology residency programs, their sponsoring institutions/locations, and affiliated locations was compiled from the American Medical Association's Fellowship and Residency Electronic Interactive Database. Faculty subspecialists' names were collected by manually searching each program's website. Demographics were collected from the National Plan and Provider Enumeration System. Subspecialty faculty who had completed an Obstetrics and Gynecology residency, were fellowship trained, and/or had board certification in the subspecialty were included in the study., Results: A total of 4,659 subspecialist faculty were identified from 278 residency programs, representing 81.5% of the total subspecialist workforce in Obstetrics and Gynecology (n=5,716). Of the subspecialists identified, 2,838 were faculty at sponsoring institutions, representing 49.7% of the entire subspecialist workforce; the remainder worked with residents at affiliate locations. Our results showed 59.9% of subspecialists were female and 40.1% were male; 97.0% were allopathic subspecialists. The largest proportion of subspecialists were in the age group of 40-49 years (36.6%). Subspecialists were present in 45 states, with the exception of Alaska, Idaho, Montana, North Dakota, South Dakota, and Wyoming., Conclusion: Most of the Obstetrics and Gynecology subspecialty workforce is involved in the clinical education of OBGYN residents, with half of the workforce on faculty at the residency program sponsor site. The subspecialty faculty workforce is primarily female, has an allopathic degree, is mid-career, and is geographically diverse., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Steffen et al.)

Background: Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests 'cloning' (reproduction of sameness) of the existing workforce., Methods: We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002-2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory., Findings: Female students had higher odds of becoming a physician (OR 1.87 [1.53-2.28], p < 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43-0.71], p < 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54-1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist., Interpretation: In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce., Funding: ODISSEI., Competing Interests: The authors declare that they have no competing interests., (© 2023 The Author(s).)

The medical workforce shortfall in rural areas is a major issue influencing the nature of undergraduate medical education in Australia. Exposing undergraduates to rural life through rural clinical school (RCS) placements is seen as a key strategy to address workforce imbalances. We investigated the influence of an extended RCS placement and rural origin on the rural principal place of practice (PPP) of the first 3 graduate cohorts (2012-2014) from a Joint Medical Program offered by two universities based in northern New SouthWales. Data was available for 426 eligible graduates. Participation in an extended RCS placement (odds ratio (OR), 6.075, 95% confidence interval (CI) 2.716-13.591), rural background (OR 3.613, 95% CI 1.752-7.450) and being 25 years or older at completion of a medical degree (OR 2.550, 95% CI 1.252-5.194) were all independently associated with rural PPP. Being bonded into a program to practice rurally was not associated with rural PPP. Participation in an extended RCS placement is strongly associated with rural practice in the first 3 to 5 years of practice for graduates from both rural and metropolitan backgrounds. This finding indicates that strategies to improve the rural workforce should focus on the promotion of rural placements, in addition to rural background. [ABSTRACT FROM AUTHOR]

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Introduction: Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. Results: Thirty-one percent of ADZU-SOM medical graduates practised in communities <100 000 population versus 7% of graduates from the conventional school in the Zamboanga region (p<0.001), while 61% of SHS-Palo medical graduates practised in communities <100 000 population versus 12% of graduates from the conventional school in the Visayas region (p<0.001). Twenty-seven percent of ADZU-SOM graduates practised in lower income category communities (categories 2--6) versus 8% of graduates from the conventional school in the same region (p<0.001), while 49% of SHS-Palo graduates practised in lower income category communities (categories 2--6) versus 11% of graduates from the conventional school in the same region (p<0.001). Conclusions: SAHPE has contributed to increased medical coverage across rural and/or economically disadvantaged areas in two Philippines regions. The extensive community-based medical student placements associated with SAHPE likely play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas. [ABSTRACT FROM AUTHOR]

In April 2013, local authorities gained responsibility for commissioning sexual health services in England. With many services going out to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. The aim of this study was to evaluate the impact of tendering on GUM trainees. An electronic survey designed by the British Association for Sexual Health and HIV Trainees' Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Eighty-two individuals responded (74% GUM trainees, 25% newly appointed consultants, 1% locum appointed for service). Sixty-three per cent (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered during the tendering process and 20% (8/41) felt that it was. Forty-four per cent (18/41) felt adequately supported. Thirty per cent (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated: other than management experience the overall impact on all parameters was negative, namely morale, senior support and education. In conclusion, this survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering. [ABSTRACT FROM AUTHOR]

Background: In recent years, Ireland has experienced a large-scale, outward migration of doctors. This presents a challenge for national policy makers and workforce planners seeking to build a self-sufficient medical workforce that trains and retains enough doctors to meet demand. Although, traditionally, medical migration has been considered beneficial to the Irish health system, austerity has brought a greater level of uncertainty to the health system and, with it, a need to reappraise the professional culture of migration and its impact on the Irish health system.Methods: This paper illustrates how a culture of migration informs career and migration plans. It draws on quantitative data-registration and migration data from source and destination countries-and qualitative data-in-depth interviews with 50 doctors who had undertaken postgraduate medical training in Ireland.Results: Of 50 respondents, 42 highlighted the importance of migration. The culture of medical migration rests on two assumptions-that international training/experience is beneficial to all doctors and that those who emigrate will return to Ireland with additional skills and experience. This assumption of return is challenged by a new generation of doctors whose professional lives have been shaped by globalisation and by austerity. Global comparisons reveal the comparatively poor working conditions, training and career opportunities in Ireland and the relative attractiveness of a permanent career abroad.Conclusion: In light of these changes, there is a need to critically appraise the culture of medical migration to determine if and in what circumstances migration is appropriate to the needs of the Irish health system. The paper considers the need to reappraise the culture of medical migration and the widespread emigration that it promotes. [ABSTRACT FROM AUTHOR]

Background People with an intellectual disability (ID) have complex healthcare needs yet experience barriers to participation in primary care. Further research is required to examine if the characteristics of general practitioners (GPs) and their practices influence their delivery of care to people with ID. Methods Data from the Bettering the Evaluation and Care of Health program was used to determine if there are significant differences in the ID-GP and Non ID-GP group. Analysis included characteristic-specific rates, chi-square, and odds ratios. Results This study found that GPs who were Australian medical graduates, practising in rural areas, in accredited practices, and in some states of Australia were significantly more likely to be classified to the ID-GP than the Non ID-GP group. Conclusions This research suggests that certain GP and practice characteristics may present barriers to primary care participation for people with ID and supports the need for a comprehensive national action framework. [ABSTRACT FROM AUTHOR]

Context: A relatively new specialty, hospice and palliative medicine (HPM), is unusual in that physicians can enter from 10 different specialties. This study sought to understand where HPM physicians were coming from, where they were going to practice, and the job market for HPM physicians.Objectives: Describe characteristics of the incoming supply of HPM physicians, their practice plans, and experience finding initial jobs.Methods: In October 2015, we conducted an online survey of physicians who completed accredited HPM fellowships the previous June. We had electronic mail addresses for 195 of the 243 graduating fellows.Results: About 112 HPM fellows responded (58% of those invited). The most common prior training was internal medicine (45%), followed by family medicine (23%), pediatrics (12%), and emergency medicine (10%). More than 40% had practiced medicine before their HPM training. After graduation, 97% were providing 20 or more hours per week of patient care, with most hours in palliative care. About 72% devoted more than 20 hours per week to palliative care, whereas only 13% worked that much in hospice care. About 81% reported no difficulty finding a satisfactory practice position. About 98% said that they would recommend HPM to others, and 63% took the time to provide written comments that were highly positive about the specialty.Conclusion: New HPM physicians are finding satisfying jobs. They are enthusiastic in recommending the specialty to others. Most are going into palliative medicine, leaving questions about how the need for hospice physicians will be filled. Although jobs appear to be numerous, there are practice areas with more limited opportunities. [ABSTRACT FROM AUTHOR]

Introduction: Medical schools are in general over-epresented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage. Methods: The current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economi deciles versus the top 2 socio-economic deciles. Results: Those who were categorised in the lower 8 socio- conomic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001). Conclusion: Widening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum. [ABSTRACT FROM AUTHOR]

Background: In many high-income countries, there is a regional or indication-specific shortage of physicians. One way to alleviate these shortages is to recruit physicians from abroad. However, the high turnover rate of foreign-trained physicians (FTPs) makes it difficult to maintain stable medical care. The purpose of this scoping review was to analyze recent studies on turnover intentions and retention in order to, first, understand how they are assessed and, second, to identify the parameters that contribute to reducing turnover and improving the retention of FTPs., Method: A total of six articles were included, and a thematic analysis was conducted. The literature search was limited to English-language articles from bibliographic databases related to public health and health services research (MEDLINE, CINAHL, Web of Science, PsycINFO) between 2010 and 2022., Results: The topis identified were: (1) the quality of working relationships, (2) the quality of the work environment, (3) personal life and migration issues, (4) employment-related issues, and (5) career and training opportunities. Three approaches were considered in examining the retention and turnover intentions of FTPs: satisfaction, motivation for migration, and professional integration. Underrepresented fields are discrimination and social integration., Conclusions: The processes of turnover intention and retention are still poorly understood. Standardizing definitions and certain parts of the methodology would help researchers navigate the process with more accuracy. Further studies should look at the causal relationships that can be collected in the form of qualitative data, as these are currently lacking., (Copyright © 2023. Published by Elsevier GmbH.)