Medical manpower

Geographic imbalances of physician supply: an international comparison

This study was undertaken to compare geographic imbalances of physician manpower in developed and developing countries and to evaluate the success of policies designed to alleviate the imbalances. Data were drawn from a mail survey of countries conducted by the World Health Organization, from national statistical summaries, and from published information on national policies and programs. Information was available from 26 developing countries and 15 developed countries. Among developing countries, the degree of urbanization and rural economic development appeared to be the most important determinants of the level of geographic imbalance. Among developed countries, those with very high overall physician/population ratios tended to have the least degree of imbalance, but this effect was not consistent. At the national level in most countries, the effect of policies or programs specifically designed to redistribute physician manpower appeared to be limited.

The future of obstetrics and gynaecology in Europe

There is a general recognition that the health of women in Europe can be improved by collaboration between obstetricians and gynaecologists in EU and EFTA countries. The way in which collaborative approaches are developing are discussed, including the problems that have to be addressed if such an initiative is to be successful.

An analysis of medical workload--evidence of patient to specialist mismatch

The National Health Service has employed physicians since its inception, yet 46 years later there are few data on the day-to-day work done by physicians. This paper describes the case mix of general medicine in one region using data for general medical admissions to one specialty (respiratory medicine) as a working example. The pattern of general medical inpatient admissions is consistent across the 10 districts in the Mersey region: 26% have a respiratory diagnosis, 22% cardiac, and 15% gastrointestinal. For medical day cases, 60% are gastrointestinal. The average length of stay for particular conditions varies little between hospitals, and the average consultant 'cares' for 949 consultant inpatient episodes per year. In only half the Mersey districts is the respiratory consultant provision appropriate for the case mix admitted to the hospital. A simple algorithm applied to data collected routinely by regional health authorities can yield much information upon which to plan medical manpower. Applied to a specialty, it has identified mismatches between workload and consultant type. For respiratory medicine, at least six more respiratory physicians (a 30% increase) are needed to correct the underprovision in Mersey region.

A survey of undergraduate and continuing medical education about antimicrobial chemotherapy in the United Kingdom. British Society of Antimicrobial Chemotherapy Working Party on Antimicrobial Use

1 A questionnaire about undergraduate teaching on antimicrobial chemotherapy was sent to academic Departments of Clinical Pharmacology, Pharmacology and Medical Microbiology throughout the UK. 2 Questionnaires about postgraduate lectures and information circulated to doctors about antimicrobial chemotherapy were sent to Drug Information Centres and Postgraduate Tutors throughout the UK. Review articles and editorials in general medical journals were assessed. 3 The median amount of core undergraduate teaching on antimicrobial chemotherapy was 13.5 h but the range was from 9.0 h to 102.0 h. Content was predominantly oriented towards drugs rather than diseases and towards prescribing in hospital rather than in the community. Most teaching was by formal lecture as part of a core programme. On a scale from 0 to 5 the median emphasis given to individual topics ranged from 2.50 to 3.75 but the range of emphasis given by individual medical schools was wide, for example from 1.00 to 4.50 for teaching on pharmacokinetics. 4 Postgraduate tutors identified advice from local specialists and requests from local practitioners as the most important determinants of content of continuing medical education. Material from drug information centres was predominantly oriented towards discussion of individual drugs rather than management of specific diseases and even this limited survey found evidence of duplication. The UK general medical literature contained a total of 112 reviews or editorials on antimicrobial chemotherapy covering a wide range of topics but these were not, and should not be assumed to be comprehensive. 5 Almost all doctors regularly prescribe antimicrobials and require education about the subject. Wide variations in current medical practice should be addressed explicitly through more extensive use of problem solving. The literature suggests that knowledge is most effectively disseminated through local networks of practitioners. There should be more national co-ordination of the content of information to be disseminated through the existing drug information networks.