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Kurashvili M, Reinhold K, Järvis M. Managing an ageing healthcare workforce: a systematic literature review. J Health Organ Manag 2022; ahead-of-print. [PMID: 36205415 DOI: 10.1108/jhom-11-2021-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this paper is to review research conducted on managing the ageing healthcare workforce and identify gaps for further research. DESIGN/METHODOLOGY/APPROACH A systematic literature search of studies in the English language was carried out in Scopus and Web of Science databases. FINDINGS The study consists of an analysis of 75 published articles. The majority of the papers were published in recent years, indicating a growing interest in the field. The authors specified the following inclusion criteria: all years, articles/reviews, English language and full text in the Web of Science and Scopus databases. The authors of the paper illustrated seven major categories with different topics that were suggested for future research. It included: challenges of labor market in the healthcare field, age-related changes and their influence on work ability, training opportunities and lifelong learning among ageing health workforce, motives of early retirement, ageing and its relationship to Occupational Health and Safety. Longitudinal studies and case study strategy with mixed-methods approaches were suggested for future research by the authors. ORIGINALITY/VALUE The paper summarizes knowledge related to the management of ageing health workforce, describes topics researched and as a result, presents findings on and conclusions about the most important future implications of the ageing workforce for management in the healthcare field providing lines for further research. To the authors' knowledge, no holistic systematic literature reviews have been published in academic journals targeted specifically to ageing healthcare workers.
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Affiliation(s)
- Mari Kurashvili
- Department of Business Administration, Tallinn University of Technology, Tallinn, Estonia
| | - Karin Reinhold
- Department of Business Administration, Tallinn University of Technology, Tallinn, Estonia
| | - Marina Järvis
- Department of Business Administration, Tallinn University of Technology, Tallinn, Estonia
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Francetic I, Gibson J, Spooner S, Checkland K, Sutton M. Skill-mix change and outcomes in primary care: Longitudinal analysis of general practices in England 2015-2019. Soc Sci Med 2022; 308:115224. [PMID: 35872540 DOI: 10.1016/j.socscimed.2022.115224] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Increasing the employment of staff with new clinical roles in primary care has been proposed as a solution to the shortages of GPs and nurses. However, evidence of the impacts this has on practice outcomes is limited. We examine how outcomes changed following changes in skill-mix in general practices in England. METHODS We obtained annual data on staff in 6,296 English general practices between 2015 and 2019 and grouped professionals into four categories: GPs, Nurses, Health Professionals, and Healthcare Associate Professionals. We linked 10 indicators of quality of care covering the dimensions of accessibility, clinical effectiveness, user experiences and health system costs. We used both fixed-effect and first-differences regressions to model changes in staff composition and outcomes, adjusting for practice and population factors. RESULTS Employment increased over time for all four staff groups, with largest increases for Healthcare Professionals (from 0.04 FTE per practice in 2015 to 0.28 in 2019) and smallest for Nurses who experienced a 3.5 percent growth. Increases in numbers of GPs and Nurses were positively associated with changes in practice activity and outcomes. The introduction of new roles was negatively associated with patient satisfaction: a one FTE increase in Health Professionals was associated with decreases of 0.126 [-0.175, -0.078] and 0.116 [-0.161, -0.071] standard deviations in overall patient satisfaction and satisfaction with making an appointment. Pharmacists improved medicine prescribing outcomes. All staff categories were associated with higher health system costs. There was little evidence of direct complementarity or substitution between different staff groups. CONCLUSIONS Introduction of new roles to support GPs does not have straightforward effects on quality or patient satisfaction. Problems can arise from the complex adaptation required to adjust practice organisation and from the novelty of these roles to patients. These findings suggest caution over the implementation of policies encouraging more employment of different professionals in primary care.
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Affiliation(s)
- Igor Francetic
- Centre for Primary Care and Health Services Research, Health Organisation, Policy and Economics (HOPE) Group, University of Manchester, Manchester, UK.
| | - Jon Gibson
- Centre for Primary Care and Health Services Research, Health Organisation, Policy and Economics (HOPE) Group, University of Manchester, Manchester, UK
| | - Sharon Spooner
- Centre for Primary Care and Health Services Research, Health Organisation, Policy and Economics (HOPE) Group, University of Manchester, Manchester, UK
| | - Katherine Checkland
- Centre for Primary Care and Health Services Research, Health Organisation, Policy and Economics (HOPE) Group, University of Manchester, Manchester, UK
| | - Matt Sutton
- Centre for Primary Care and Health Services Research, Health Organisation, Policy and Economics (HOPE) Group, University of Manchester, Manchester, UK; Melbourne Institute, Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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Li D, Hu Y, Chen H, Zhu X, Wu X, Li J, Zhang Z, Liu S. Identifying the Subtypes and Characteristics of Mental Workload Among Chinese Physicians in Outpatient Practice: A Latent Profile Analysis. Front Public Health 2021; 9:779262. [PMID: 34900919 PMCID: PMC8653799 DOI: 10.3389/fpubh.2021.779262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: The purpose of this study is to investigate the mental workload level of physicians in outpatient practice since the normalization of prevention and control of the COVID-19 pandemic in China and explore the subtypes of physicians regarding their mental workload. Methods: A cross-sectional survey of 1,934 physicians primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China was conducted from November 2020 to February 2021. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of physician mental workload scale developed by our research team. Chi-square tests were performed to explore the differences in demographic characteristics of the subtypes among the subgroups, and multinomial logistic regression analysis was further conducted to identify the determinants of the subtypes of physicians. Results: Overall, the participating physicians reported high levels of task load but with high self-assessed performance (68.01 ± 14.25) while performing communication work tasks characterized by direct patient interaction in outpatient clinics. About 33.8% of the participating physicians were identified as “high workload and high self-assessment” subtype, compared to 49.7% “medium workload and medium self-assessment” subtype and 16.4% “low workload and low self-assessment” subtype. Physicians in “high workload and high self-assessment” subtype had the highest mean mental workload score. Physicians who were female, younger, married, worse health status, those who had lower educational level and an average monthly income of 5,001–10,000 RMB, those who worked in tertiary A hospitals, more hours per week and more than 40 h per week in outpatient clinics, and those who saw more outpatients per day, and spent more time per patient but with higher outpatient satisfaction were more likely to belong to “high workload and high self-assessment” subtype. Conclusion: Our findings can help provide a solid foundation for developing targeted interventions for individual differences across physicians regarding their mental workload. We suggest the hospital managers should pay more attention to those physicians with characteristics of the “high workload and high self-assessment” subtype and strengthen the management of the workload of this subtype of physicians to reduce the risks of their mental health, and to maintain their high work performance in outpatient clinics.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ximin Zhu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Lenoir AL, Leconte S, Cayn M, Ketterer F, Duchesnes C, Fraipont B, Richelle L. Exploring the diverse career trajectories of general practice graduates in the French-speaking part of Belgium: An interview study. Eur J Gen Pract 2021; 27:111-118. [PMID: 34132619 PMCID: PMC8211135 DOI: 10.1080/13814788.2021.1933938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Several European countries face a shortage of general practitioners (GPs), in part due to GP attrition. Most studies of GP attrition have focussed on why GPs decide to leave. Yet understanding why GPs decide to remain may also elicit potential interventions to reduce attrition. Objectives This study examined GP graduates’ career trajectories and underlying decisions to elucidate the factors influencing GP attrition. Methods We conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant’s career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants’ trajectories. We compared and contrasted trajectories to develop a typology of career trajectories. Results We identified six types of career trajectories: ‘stable’ (never considered leaving general practice), ‘reaffirmed’ (had considered leaving but made substantial changes whilst remaining), ‘reactional reorientations’ (had left to escape the challenges of general practice), ‘inspired reorientations’ (had left to pursue a different job), ‘reorientations out of loyalty’ (had never wanted to practice as GPs and had remained true to their original professional aspirations) and ‘mobiles’ (valued change and did not want to set-up practice). Conclusion Reasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.
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Affiliation(s)
- Anne-Laure Lenoir
- Department of General Practice, Université de Liège, University hospital of Sart-Tilman, Liège, Belgium
| | - Sophie Leconte
- Academic Centre of General Practice, Université catholique de Louvain, Louvain, Belgium
| | - Marion Cayn
- Department of General Practice, Université Libre de Bruxelles, Erasme Campus, Brussels, Belgium
| | - Frédéric Ketterer
- Department of General Practice, Université de Liège, University hospital of Sart-Tilman, Liège, Belgium
| | - Christiane Duchesnes
- Department of General Practice, Université de Liège, University hospital of Sart-Tilman, Liège, Belgium
| | - Béatrice Fraipont
- Academic Centre of General Practice, Université catholique de Louvain, Louvain, Belgium
| | - Lou Richelle
- Department of General Practice, Université Libre de Bruxelles, Erasme Campus, Brussels, Belgium
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Abstract
Although there has been discussion of a shortage of surgical specialties including OB/GYN, consensus is difficult because of the multiple variables involved in estimating both supply and demand. In addition, burnout has become more recognized as a variable that has not been taken into account in estimating a shortage of OB/GYNs. We estimate OB/GYN physician shortages of 17%, 24%, and 31% by 2030, 2040, and 2050, respectively. Here, we examine the impact of burnout on the OB/GYN workforce. Specifically, we address the associations of burnout, reduction in clinical productivity as well as early retirement. We also discuss the implications of the substantial increase of female OB/GYNs to ∼66% of workforce over the next 10 years and how this may impact the impending OB/GYN shortage. Finally, we briefly consider possible solutions to workforce issues causing burnout.
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Campbell JL, Fletcher E, Abel G, Anderson R, Chilvers R, Dean SG, Richards SH, Sansom A, Terry R, Aylward A, Fitzner G, Gomez-Cano M, Long L, Mustafee N, Robinson S, Smart PA, Warren FC, Welsman J, Salisbury C. Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.Main outcome measuresSystematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.ResultsPast research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.LimitationsThe survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.ConclusionsThis research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.Study registrationThis study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- John L Campbell
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Emily Fletcher
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Gary Abel
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Sarah G Dean
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Suzanne H Richards
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anna Sansom
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rohini Terry
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alex Aylward
- ReGROUP project Patient and Public Involvement Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Mayam Gomez-Cano
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Linda Long
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Navonil Mustafee
- University of Exeter Business School, University of Exeter, Exeter, UK
| | - Sophie Robinson
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Philip A Smart
- University of Exeter Business School, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Primary Care Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jo Welsman
- Centre for Biomedical Modelling and Analysis, Living Systems Institute, University of Exeter, Exeter, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Liu HY, Liu CC, Shen TH, Wang YJ, Liu JY, Chen TJ, Chou LF, Hwang SJ. Pattern of Visits to Older Family Physicians in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E499. [PMID: 28481318 PMCID: PMC5451950 DOI: 10.3390/ijerph14050499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
Many family physicians still practice at an old age. Nevertheless, their practice patterns have scarcely been studied. To address this lack of research, the current study analyzed claims data for a total of 2,018,440 visits to 171 family physicians in 2011 sourced from Taiwan's National Health Insurance Research Database. Family physicians aged 65 years and over had fewer patients (mean: 2330, standard deviation (SD): 2019) and visits (mean: 9220, SD: 8600) than younger physicians had. Furthermore, the average age of the patients who visited physicians aged 65 years and over was 51.9 (SD: 21.5) years, significantly higher than that of patients who visited younger physicians. However, the proportions of visits for upper respiratory tract infections, hypertension, diabetes mellitus, and dyslipidemia did not differ significantly among different age groups of physicians. In the future, the manpower planning of physicians should take into consideration the age structure and work profile of physicians.
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Affiliation(s)
- Hao-Yen Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Cheng-Chieh Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Tzu-Hsiang Shen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Yi-Jen Wang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Jui-Yao Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, No. 64, Sec. 2, Zhi-Nan Road, Taipei 116, Taiwan.
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
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Silver MP, Hamilton AD, Biswas A, Warrick NI. A systematic review of physician retirement planning. HUMAN RESOURCES FOR HEALTH 2016; 14:67. [PMID: 27846852 PMCID: PMC5109800 DOI: 10.1186/s12960-016-0166-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Physician retirement planning and timing have important implications for patients, hospitals, and healthcare systems. Unplanned early or late physician retirement can have dire consequences in terms of both patient safety and human resource allocations. This systematic review examined existing evidence on the timing and process of retirement of physicians. Four questions were addressed: (1) When do physicians retire? (2) Why do some physicians retire early? (3) Why do some physicians delay their retirement? (4) What strategies facilitate physician retention and/or retirement planning? METHODS English-language studies were searched in electronic databases MEDLINE, Web of Science, Scopus, CINAHL, AgeLine, Embase, HealthSTAR, ASSA, and PsycINFO, from inception up to and including March 2016. Included studies were peer-reviewed primary journal articles with quantitative and/or qualitative analyses of physicians' plans for, and opinions about, retirement. Three reviewers independently assessed each study for methodological quality using the Newcastle-Ottawa Scale for quantitative studies and Critical Appraisal Tool for qualitative studies, and a fourth reviewer resolved inconsistencies. RESULTS In all, 65 studies were included and analyzed, of which the majority were cross-sectional in design. Qualitative studies were found to be methodologically strong, with credible results deemed relevant to practice. The majority of quantitative studies had adequate sample representativeness, had justified and satisfactory sample size, used appropriate statistical tests, and collected primary data by self-reported survey methods. Physicians commonly reported retiring between 60 and 69 years of age. Excessive workload and burnout were frequently cited reasons for early retirement. Ongoing financial obligations delayed retirement, while strategies to mitigate career dissatisfaction, workplace frustration, and workload pressure supported continuing practice. CONCLUSIONS Knowledge of when physicians plan to retire and how they can transition out of practice has been shown to aid succession planning. Healthcare organizations might consider promoting retirement mentorship programs, resource toolkits, education sessions, and guidance around financial planning for physicians throughout their careers, as well as creating post-retirement opportunities that maintain institutional ties through teaching, mentoring, and peer support.
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Affiliation(s)
- Michelle Pannor Silver
- Department of Anthropology/Health Studies, University of Toronto Scarborough Campus, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Angela D Hamilton
- Department of Anthropology/Health Studies, University of Toronto Scarborough Campus, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
| | - Aviroop Biswas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Irene Warrick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
OBJECTIVE To investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50-60 years. DESIGN AND SETTING Qualitative study based on semistructured interviews with GPs in the South West region of England. Transcribed interviews were analysed thematically. PARTICIPANTS 23 GPs aged 50-60 years: 3 who had retired from direct patient care before age 60, and 20 who intended to quit direct patient care within the next 5 years. RESULTS The analysis identified four key themes: early retirement is a viable option for many GPs; GPs have employment options other than undertaking direct patient care; GPs report feeling they are doing an (almost) undoable job; and GPs may have other aspirations that pull them away from practice. Findings from this study confirmed those from earlier research, with high workload, ageing and health, family and domestic life, and organisational change all influencing GPs' decisions about when to retire/quit direct patient care. However, in addition, GPs expressed feelings of insecurity and uncertainty regarding the future of general practice, low morale, and issues regarding accountability (appraisal and revalidation) and governance. Suggestions about how to help retain GPs within the active clinical workforce were offered, covering individual, practice and organisational levels. CONCLUSIONS This research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions. Any future changes to policy or practice to help retain experienced GPs will benefit from this informed understanding of GPs' views. Key factors to take into account include: making the GP workload more manageable; managing change sympathetically; paying attention to GPs' own health; improving confidence in the future of general practice; and improving GP morale.
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Affiliation(s)
- Anna Sansom
- University of Exeter Medical School, Exeter, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
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10
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Lost to the NHS: a mixed methods study of why GPs leave practice early in England. Br J Gen Pract 2016; 66:e128-35. [PMID: 26740606 PMCID: PMC4723211 DOI: 10.3399/bjgp16x683425] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022] Open
Abstract
Background The loss of GPs in the early stages of their careers is contributing to the GP workforce crisis. Recruitment in the UK remains below the numbers needed to support the demand for GP care. Aim To explore the reasons why GPs leave general practice early. Design and setting A mixed methods study using online survey data triangulated with qualitative interviews. Method Participants were GPs aged <50 years who had left the English Medical Performers List in the last 5 years (2009–2014). A total of 143 early GP leavers participated in an online survey, of which 21 took part in recorded telephone interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis techniques. Results Reasons for leaving were cumulative and multifactorial. Organisational changes to the NHS have led to an increase in administrative tasks and overall workload that is perceived by GP participants to have fundamentally changed the doctor–patient relationship. Lack of time with patients has compromised the ability to practise more patient-centred care, and, with it, GPs’ sense of professional autonomy and values, resulting in diminished job satisfaction. In this context, the additional pressures of increased patient demand and the negative media portrayal left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice. Conclusion To improve retention of young GPs, the pace of administrative change needs to be minimised and the time spent by GPs on work that is not face-to-face patient care reduced.
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Xu H, Zhang W, Gu L, Qu Z, Sa Z, Zhang X, Tian D. Aging village doctors in five counties in rural China: situation and implications. HUMAN RESOURCES FOR HEALTH 2014; 12:36. [PMID: 24973946 PMCID: PMC4094459 DOI: 10.1186/1478-4491-12-36] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 05/25/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND The aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former "barefoot doctors") who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors' aging situation and its implications in rural China. METHODS The data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0. RESULTS The average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts. CONCLUSIONS Aging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.
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Affiliation(s)
- Huiwen Xu
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China
| | - Weijun Zhang
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China
| | - Linni Gu
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China
| | - Zhiyong Qu
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China
| | - Zhihong Sa
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China
| | - Xiulan Zhang
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China
| | - Donghua Tian
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, China
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