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Rahman F, Bhat V, Ozair A, Detchou DKE, Ahluwalia MS. Financial barriers and inequity in medical education in India: challenges to training a diverse and representative healthcare workforce. MEDICAL EDUCATION ONLINE 2024; 29:2302232. [PMID: 38194431 PMCID: PMC10778416 DOI: 10.1080/10872981.2024.2302232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.
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Affiliation(s)
- Faique Rahman
- Faculty of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University (AMU), Aligarh, UP, India
| | - Vivek Bhat
- St. John’s Medical College, Bangalore, KA, India
| | - Ahmad Ozair
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Faculty of Medicine, King George’s Medical University, Lucknow, UP, India
| | - Donald K. E. Detchou
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Manmeet S. Ahluwalia
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
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Tozduman B, Sözmen MK. Assessing the job preferences of senior medical students for mandatory service: a discrete choice experiment. Prim Health Care Res Dev 2024; 25:e31. [PMID: 38818776 DOI: 10.1017/s1463423624000252] [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: 06/01/2024] Open
Abstract
AIM To investigate the job preferences of senior medical students for mandatory service as general practitioners using discrete choice experiment. INTRODUCTION Health workforce is directly associated with health service coverage and health outcomes. However, there is a global shortage of healthcare workers (HCWs) in rural areas. Discrete choice experiments can guide the policy and decision-makers to increase recruitment and retention of HCWs in remote and rural areas by determining their job preferences. The aim of this study is to investigate job preferences of senior medical students for mandatory service as general practitioners. METHODS This cross-sectional survey was conducted among 144 medical students. To estimate students' preferences for different levels of job attributes, a mixed logit model was utilised. Simulations of job uptake rates and willingness to pay (WTP) estimates were computed. FINDINGS All attributes had an impact on the job preferences of students with the following order of priority: salary, workload, proximity to family/friends, working environment, facility and developmental status. For a normal workload and a workplace closed to family/friends which were the most valued attributes after salary, WTPs were 2818.8 Turkish lira (TRY) ($398.7) and 2287.5 TRY ($323.6), respectively. The preference weights of various job characteristics were modified by gender, the presence of a HCW parent and willingness to perform mandatory service. To recruit young physicians where they are most needed, monetary incentives appear to be the most efficient intervention. Non-pecuniary job characteristics also affected job preferences. Packages of both monetary and non-monetary incentives tailored to individual characteristics would be the most efficient approach.
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Affiliation(s)
- Buşra Tozduman
- Dokuz Eylul University, Faculty of Medicine, Department of Public Health, Epidemiology Subsection, Izmir, Turkey
| | - Melih Kaan Sözmen
- Izmir Katip Çelebi University, Faculty of Medicine, Department of Public Health, Izmir, Turkey
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA02115, USA
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Kurniati A, Efendi F, Ismawiningsih I, Mulyani N, Zakaria Z, Ambarwati R, Prasetyo HT, Muljandari E, Damayanti I, Noor AYM, McKenna L, Nurlinawati I. Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment. J Multidiscip Healthc 2024; 17:2215-2225. [PMID: 38741922 PMCID: PMC11090117 DOI: 10.2147/jmdh.s459158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Retaining doctors and dentists in remote areas of Indonesia remains a national priority of the Indonesian government. The purpose of this study was to analyze the interventions for retention of doctors and dentists in remote areas using the discrete choice experiment (DCE) approach. Materials and Methods A DCE was conducted to investigate preferences of doctors and dentists for retention in remote areas. This research was conducted in 78 primary healthcare settings across 15 provinces in Indonesia. The conditional logit model was used to explore stated preferences for each attribute. Results The total number of respondents was 158, including 113 doctors and 45 dentists. In general, doctors placed the highest preference on getting priority for government scholarships to facilitate retention in remote areas (OR=5.65, p<0.001). Specifically, dentists preferred security guarantees from local government (OR = 4.87, p<0.001). Both groups valued having an official residence (OR=3.6, p<0.001) as a factor for retention in remote areas. Conclusion Scholarship, security guarantees, housing facilities, and medical facilities were the most considered factors for retaining doctors and dentists in a remote area. This study confirms the importance of a combination of interventions in maintaining doctors and dentists in remote areas. Policy options in the form of non-financial and financial intervention packages can be combined to improve their retention.
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Affiliation(s)
- Anna Kurniati
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Ismawiningsih Ismawiningsih
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Nila Mulyani
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Zakaria Zakaria
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Retno Ambarwati
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Hutomo Tuhu Prasetyo
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Endro Muljandari
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Irni Damayanti
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Arif Yustian Maulana Noor
- Agriculture Socio-Economic Department, Faculty of Agriculture, Brawijaya University, Malang, Indonesia
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Rahman KMT, Rayna SE, Khan FA, Khan MMH, Rahman F, Ether ST, Islam MZ, Sarkar S, Islam SS, Khalequzzaman M. Challenges faced by medical officers in providing healthcare services at upazila health complexes and district hospitals in Bangladesh - a qualitative study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 24:100398. [PMID: 38665890 PMCID: PMC11043881 DOI: 10.1016/j.lansea.2024.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/03/2023] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
Background Upazila Health Complexes (UHCs) and District Hospitals (DHs) play a crucial role in the healthcare delivery system of Bangladesh. But very few research has been conducted to find out the prevailing challenges of the medical officers working in these tiers. The objective of the study was to identify the challenges faced by medical officers in providing healthcare services at UHCs and DHs. Methods In-depth interviews of 51 medical officers from 17 UHCs and nine DHs were done between March and April 2021. All participants were purposively sampled. Data were transcribed verbatim and analysed using thematic analysis. Findings Inadequate service rooms, unavailability of proper medical equipment, poor housing conditions, lack of public amenities, shortage of health workforce, lack of laboratory services, and excessive workload were the common challenges mentioned by the medical officers in providing healthcare services in UHCs and DHs. Lack of workplace safety, security, and undue pressure from local political leaders and journalists made the work environment fearful. The absence of proper implementation of policy related to higher education, posting, transfer, and promotion was also stated as challenge for the medical officers. Interpretation Infrastructural improvements along with increased safety and security of the doctors at their workplace and transparent implementation of reformed policies are essential to reduce the workplace challenges of medical officers in UHCs and DHs of Bangladesh. Funding The study was funded by Hospital Services Management, Directorate General Of Health Services (DGHS), Mohakhali, Dhaka, and Bangabandhu Sheikh Mujib Medical University.
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Affiliation(s)
- Khan Mohammad Thouhidur Rahman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Shahrin Emdad Rayna
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Fahmida Afroz Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Md. Maruf Haque Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | | | | | - Md. Zahidul Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Supriya Sarkar
- Hospital Services Management, Directorate General of Health Services, Mohakhali, Dhaka, 1212, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Md. Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
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Li Q, Zhao Z, Yang C, Lu B, Yang C, Qiao J, Huang D, Chen Z, Yin W. Comparative analysis of village doctors' relative deprivation: based on two cross-sectional surveys. BMC PRIMARY CARE 2024; 25:133. [PMID: 38664696 PMCID: PMC11044418 DOI: 10.1186/s12875-024-02385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Village doctors are the main health service providers in China's rural areas. Compared with other rural groups, they will have a sense of relative deprivation, which has an impact on their practice mentality and job stability. This study aims to analyze the changes and causes of relative deprivation among village doctors, so as to improve the stability of them. METHODS The data were collected from two surveys conducted in Shandong Province in 2015 and 2021. In 2015, 322 village doctors were surveyed and 307 questionnaires were collected, with a recovery rate of 95.3%. In 2021, 394 village doctors were surveyed and 366 questionnaires were collected, with a recovery rate of 92.9%. Descriptive and univariate analysis were used to compare the changes before and after the survey. RESULTS The scores of vertical deprivation of village doctors increased from 2.77 ± 0.81 in 2015 to 3.04 ± 0.83 in 2021, with a statistically significant difference (P < 0.001). The reference group selected by village doctors changed from village teachers to ordinary villagers. Compared to village teachers, the horizontal deprivation score of village doctors increased from 3.47 ± 0.87 to 3.97 ± 0.77, with a statistically significant difference (P < 0.001). Compared to villagers, only the professional reputation deprivation score increased, from 2.38 ± 0.93 to 2.68 ± 0.76, with a statistically significant difference (P < 0.05). CONCLUSIONS As time goes by, village doctors fail to reach the expected level in terms of economic income, social status, professional reputation and living standards, resulting in a sense of relative deprivation. This may have a negative impact on village doctors' work motivation and behavior, and will fail to guarantee the sustainability of the team. We should pay attention to this unbalanced mentality of village doctors.
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Affiliation(s)
- Qiusha Li
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Zixuan Zhao
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Chunxiao Yang
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Bei Lu
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Chenxiao Yang
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Jiahui Qiao
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Dongmei Huang
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Weifang, Shandong, China.
| | - Wenqiang Yin
- School of Management, Shandong Second Medical University, Weifang, Shandong, China.
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Jobalayeva B, Khismetova Z, Glushkova N, Kozhekenova Z, Abzaliyeva A, Berikuly D, Semenova Y. The impact of incentive scheme on rural healthcare workforce availability: a case study of Kazakhstan. HUMAN RESOURCES FOR HEALTH 2024; 22:23. [PMID: 38605387 PMCID: PMC11010400 DOI: 10.1186/s12960-024-00905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND During the 1990-2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme. METHODS Interrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020. RESULTS There was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals. CONCLUSION Future research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas.
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Affiliation(s)
- Bagym Jobalayeva
- Department of Public Health, JSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Zaituna Khismetova
- Department of Public Health, JSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Natalya Glushkova
- Department of Epidemiology, Biostatistics & Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan
| | - Zhanat Kozhekenova
- Department of Public Health, JSC "Asfendiyarov Kazakh National Medical University", Almaty, Republic of Kazakhstan
| | - Akerke Abzaliyeva
- Department of Public Health and Social Sciences, "Kazakhstan School of Public Health", Kazakhstan's Medical University, Almaty, Republic of Kazakhstan
| | - Duman Berikuly
- Deputy Chairperson of the Board for Clinic and Postgraduate Education, JSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Yuliya Semenova
- Nazarbayev University School of Medicine, Astana, Republic of Kazakhstan.
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Lukaschek K, Sporkert A, Blank WA. [How to Motivate Medical Students to Practice in Rural Areas]. DAS GESUNDHEITSWESEN 2024; 86:274-280. [PMID: 38224695 PMCID: PMC11003249 DOI: 10.1055/a-2206-1684] [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: 01/17/2024]
Abstract
BACKGROUND The excellent project "LandArztMacher" is an attempt to work against the predicted shortage of rural doctors in Germany with diverse approaches. METHOD "LandArztMacher" is a clinical traineeship with four weeks of practical training in general practices and clinics in the Bavarian countryside, accompanied by joint professional teaching. Participants were asked before and after the internship about the topics "importance of an internship in rural areas"; "attractiveness of rural areas" (scale: 0/no agreement to 10/full agreement). Ideas about the tasks of a general practitioner were assessed (scale: 0/no idea at all to 100/exact idea). The present study is a repeated cross-sectional study. The median is reported as the location measure and the interquartile range as the dispersion measure. RESULTS Participants (n=363, 74% female, n=267, age: range 19-46 years, mean: 23.2 years, SD: 2.41 years) from the clinical section of the medical studies considered an internship in the rural area before and after the internship very important (median: 8 and 9, respectively) and could well imagine working in the countryside (median: 7 and 8, respectively). Their attitude towards the cultural offerings or the infrastructure did not change (median: 6 in each case). After the internship, the students had a more precise idea of what a general practitioner tasks are (median: 65 and 90, respectively). SUMMARY A well-structured four-week rural internship can enhance the appeal of future rural employment through individual supervision and collaborative training.
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Affiliation(s)
| | - Anna Sporkert
- Allgemeinmedizin, Gemeinschaftspraxis im Bayerwald, Kirchberg im Wald,
Germany
| | - Wolfgang A Blank
- Allgemeinmedizin, Gemeinschaftspraxis im Bayerwald, Kirchberg im Wald,
Germany
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Dumesnil H, Lutaud R, Bellon-Curutchet J, Deffontaines A, Verger P. Dealing with the doctor shortage: a qualitative study exploring French general practitioners' lived experiences, difficulties, and adaptive behaviours. Fam Pract 2024:cmae017. [PMID: 38521970 DOI: 10.1093/fampra/cmae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
CONTEXT The shortage of general practitioners (GPs) is a growing concern in Europe, especially in France. This problem is likely to continue until the end of the 2020s. OBJECTIVES To study the GPs' perceptions of access to care in medically underserved areas (i.e. with low physician density), its consequences on their working conditions, and how they cope with the resulting difficulties. METHODS Semi-structured individual interviews were conducted between May and August 2021 of 29 GPs practising in areas of southeastern France with a low physician density or at risk of a doctor shortage. Purposive sampling was used to include profiles of diverse physicians and diverse rural and urban areas. The interviews, conducted with an interview guide, were transcribed and analysed thematically. RESULTS The participants described a serious degradation of access to care in their areas. These issues also concerned urban areas, where they were, according to the participants, underrecognized. The participants' workloads were rising, at a rate often perceived as unsustainable: many participants, including the youngest group, reported they were exhausted. Their principal source of dissatisfaction was their impression that they could not do their work correctly. Participants reported that these difficulties required them to improvise and adapt without any official or formal method to keep their practice manageable. CONCLUSION These GPs were worried about the future of their profession and their patients. They expected strong measures by public policymakers and officials, but paradoxically seemed to have little interest in the solutions these officials are promoting.
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Affiliation(s)
- Hélène Dumesnil
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Romain Lutaud
- Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Julien Bellon-Curutchet
- Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Aliénor Deffontaines
- Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Barnawi NA, Al-Otaibi H, Alkhudairy AI, Alajlan MA, Alajlan RA, Alay SM, Alqahtani SM, Bushnak IA, Abolfotouh MA. Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers. Int J Gen Med 2024; 17:1047-1058. [PMID: 38532847 PMCID: PMC10964027 DOI: 10.2147/ijgm.s452641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Background This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.
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Affiliation(s)
- Najla A Barnawi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Hazza Al-Otaibi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz I Alkhudairy
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Mohammed A Alajlan
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Renad A Alajlan
- College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Saeed M Alay
- College of Pharmacy, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | | | - Ibraheem A Bushnak
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Salerno PRVO, Chen Z, Vieira de Oliveira Salerno J, Motairek I, Dazard JE, Deo S, Rajagopalan S, Al-Kindi S. Thoracic Surgery Deserts in the United States: A Geospatial Analysis. Chest 2024:S0012-3692(24)00137-5. [PMID: 38301743 DOI: 10.1016/j.chest.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Salil Deo
- Surgical Services, Louis Stokes VA Medical Center, Cleveland, OH; Western Reserve University School of Medicine, Cleveland, OH
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Western Reserve University School of Medicine, Cleveland, OH.
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Marcec R, Seils LA, Gonzalez AI, Dubas-Jakobczyk K, Domagała A, Dan S, Flinterman L, Likic R, Batenburg R. Tackling medical deserts: unearthing factors that influence medical students' attitudes and the path forward. Postgrad Med J 2023; 99:1205-1206. [PMID: 37280152 DOI: 10.1093/postmj/qgad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Robert Marcec
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | | | - Ana Isabel Gonzalez
- Avedis Donabedian Research Institute (FAD), Barcelona 08016, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid 28022, Spain
| | | | - Alicja Domagała
- Institute of Public Health, Jagiellonian University Medical College, Krakow 30-010, Poland
| | - Sorin Dan
- School of Management, University of Vaasa, Vaasa 65100, Finland
| | - Linda Flinterman
- Netherlands Institute for Health Services Research (NIVEL), Utrecht 3553, The Netherlands
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht 3553, The Netherlands
- Department of Sociology, Radboud University, Nijmegen 6524, The Netherlands
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12
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Jin R, Chen Y. Job satisfaction of village doctors in a rural-oriented tuition-waived medical education program in China. Front Psychol 2023; 14:1184430. [PMID: 37560095 PMCID: PMC10408449 DOI: 10.3389/fpsyg.2023.1184430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/22/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION To address health inequity and relieve shortage of rural doctors, China initiated Rural-oriented Tuition-waived Medical Education (RTME) to train doctors in rural areas for free since 2010. Little is known about job satisfaction of this particular group of rural doctors. METHODS Job Satisfaction Questionnaires for Village Doctors were distributed to 240 village doctors with RTME program in China, and 40 received in-depth semi-structured interviews. Descriptive analysis, chi-square test, univariate and multivariate logistic regressions in SPSS23.0 were conducted, and thematic analysis was applied to interviews. RESULTS Job satisfaction rate of village doctors with RTME program was 56.50%. Full understanding of RTME policy, recognition of rural medical work, relevance of RTME curriculum with present job, education background, rural origin and renumeration were positively correlated with job satisfaction. Preferential policies of RTME program, relaxing working atmosphere, more promotion opportunity, and easier access to higher technical titles were the key factors to retain rural doctors. CONCLUSION Our findings may interest healthcare authorities, medical colleges and primary healthcare establishments. Studying the job satisfaction of village doctors in China may also be beneficial in developing community and rural health services, and provide valuable insights into the training and retention of primary healthcare providers in other countries.
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Affiliation(s)
- Renmin Jin
- Party School of Anhui Provincial Committee of C.P.C, Hefei, China
| | - Yan Chen
- Anhui Medical College, Hefei, China
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Sbaffi L, Zamani E, Kalua K. Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach. J Med Internet Res 2023; 25:e45440. [PMID: 37166971 DOI: 10.2196/45440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. OBJECTIVE This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. METHODS We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. RESULTS The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. CONCLUSIONS This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role.
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Affiliation(s)
- Laura Sbaffi
- Information School, University of Sheffield, Sheffield, United Kingdom
| | - Efpraxia Zamani
- Information School, University of Sheffield, Sheffield, United Kingdom
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
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Park K, Kim H, Lee J, Shin J, Park A. Determinants of Working Practice Location for Clinicians According to High School, Medical School, and Resident Training Locations in Korea. Healthcare (Basel) 2023; 11:healthcare11091203. [PMID: 37174745 PMCID: PMC10178582 DOI: 10.3390/healthcare11091203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Although several regulations have been implemented for medical school admission, such as a quota system, the uneven distribution of healthcare personnel across regions is an unresolved problem in Korea. This study explores the distribution and retention rate of clinicians across regions according to the degree of experience staying in the current clinical area during high school/medical school/resident training using 2016 Korean Physician Survey data. Both in metropolitan and non-metropolitan areas, clinicians who completed high school, medical school, and resident training in the current practice region (Subgroup D) accounted for the largest proportion (Metro, n = 1611, 46.1%; non-metro, n = 1917, 52.9%). The retention rate was the highest in Subgroup D both in metropolitan (84.3%) and non-metropolitan areas (Chungcheong 86.2%, Jeolla 79.9%, Daegu/Gyeongbuk 81.6%, Busan/Ulsan/Gyeongnam 93.3%) except Gangwon and Jeju. The second, third, and fourth highest retention rates were observed in cases where clinicians completed their high school and resident training, medical school and resident training, and resident training only, respectively, in all regions, although the ranking differs by region. To increase the retention rate of physicians, this study shows that it is necessary for a student to seek ways to continue training in the same region in which they graduated from medical school.
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Affiliation(s)
- Kyungah Park
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of Korea
| | - Jeehye Lee
- National Emergency Medical Center, National Medical Center, Seoul 04564, Republic of Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of Korea
| | - AhHyun Park
- Expert Group on Health Promotion for Seoul Metropolitan Government, Konkuk University, Seoul 05029, Republic of Korea
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Yani M, Ruby M, Puspandari DA, Munawar M, Fachrurrozi K, Isfanda I, Candra A, Ilzana TM, Khaled TM, Rahmi CR. Implementation of Aceh Health Insurance ( Jaminan Kesehatan Aceh) 2013-2021: Has health equity been achieved for all Acehnese after armed conflict? NARRA J 2023; 3:e160. [PMID: 38450037 PMCID: PMC10914141 DOI: 10.52225/narraj.v3i1.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/29/2023] [Indexed: 03/08/2024]
Abstract
Aceh Health Insurance (Jaminan Kesehatan Aceh-JKA) has been implemented since 2010 to increase the health equity by covering the health expenses and guaranteeing that all Acehnese are covered regardless of their economic, educational, and social statuses. However, since its implementation, there has been no study on its impact on health quality, particularly regarding the utilization of the main referral hospital (Dr Zainoel Abidin Hospital located in Banda Aceh) and the effects of the geographic accessibility and the number of specialist doctors in each regency/city on hospital utilization. This retrospective study assessed the equity factors during the Aceh Health Insurance implementation and during its integration to National Health Insurance (Jaminan Kesehatan Nasional-JKN) from 2013 to 2021 using data of travel time (time spent for travelling from the origin regency/city of referred patients to the main referral center) and healthcare resources (number of specialist doctors). The data were analyzed using Student's t-tests, Kolmogorov-Smirnov or Mann-Whitney U test when appropriate. Williamson Index was calculated to determine the disparities of health equity between regencies. Our data indicated the noticeably increase of health facilities utilization since the implantation of Aceh Health Insurance. However, there was no equity in the use of main referral facility by the residents in Aceh - was dominated by residents who lived closer and from more populated regencies/cities. In conclusion, there are accessibility and financial hardship barriers in accessing the health care facilities during the implementation of Aceh Health Insurance that need to be addressed by the government to achieve the health equity for all Acehnese.
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Affiliation(s)
- Muhammad Yani
- Department of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Mahlil Ruby
- Planning and Development of BPJS Kesehatan, Jakarta, Indonesia
| | - Diah A Puspandari
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Munawar Munawar
- Department of Statistics, Faculty of Mathematics and Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Kamal Fachrurrozi
- Faculty of Economics and Business, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Isfanda Isfanda
- Faculty of Medicine, Universitas Abulyatama, Aceh Besar, Indonesia
| | - Aditya Candra
- Faculty of Medicine, Universitas Abulyatama, Aceh Besar, Indonesia
| | - Teuku M Ilzana
- Faculty of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia
| | - Teuku M Khaled
- Department of Radiology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Dr Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Cut R Rahmi
- Medical Education Unit, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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Ghavami V, Tabatabaee SS. A survival analysis approach to determine factors associated with non-retention of newly hired health workers in Iran. BMC Health Serv Res 2023; 23:265. [PMID: 36927509 PMCID: PMC10022210 DOI: 10.1186/s12913-023-09262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND AND AIM One of the main tasks of the healthcare human resource management is to maintain and retain professional staff. The high level turnover of professional staff may reduce the quality of healthcare service delivery. Therefore, this study investigated the factors associated with the turnover of the newly recruited healthcare professionals using survival analysis method in Iran. MATERIALS AND METHODS This historical cohort analysis comprised 6811 employees who began working at Mashhad University of Medical Sciences between 2005 and 2020. Employees recruited at any of the university's units between the years 2005 to 2019 were included. We used appropriate descriptive indices and Log-rank test and the Cox proportional-hazards model to assess the staff turnover. A significance level of 0.05 was used for all tests. RESULTS The findings of the survival analysis showed that the probability of turnover in one year, two years, and five years of employment were 0.12, 0.16, and 0.27. Based on the findings of the Log-rank test, the probability of turnover in entire of the study period was not statistically different between male and female (p = 0.573), and likewise between employees with healthcare occupations and non-healthcare occupations (p = 0.351). Employees whose current workplace and birthplace were not similar had a significantly higher probability of turnover (p < 0.001). Accordingly, the Cox regression result showed, the risk of turnover for the singles was 1.22 times higher than the married. For the Ph.D degree was 3.23 times higher compared to those with a diploma or an associate degree, and for a bachelor's or master's degree was 2.06 times more likely to change their workplace than those with a diploma or an associate degree. CONCLUSION Policies promoting the recruitment of native-born professionals, given priority to the married candidates than single ones, and/or recurring candidates to pledge to stay in the locality of recruitment site can increase the staff retention and reduce the costs of staff turnover including re-hiring, initial and on-the-job training, accommodation, and other extra living consumptions away from home and family.
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Affiliation(s)
- Vahid Ghavami
- Department of Epidemiology & Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Daneshgah avenue, between 16 -18, Faculty of Health, Mashhad, 9137673119, Iran.
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Chatterjee S, Kar SK, Singh A. Solutions for health care enigma in Indian villages - author's reply. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 9:100114. [PMID: 37383045 PMCID: PMC10305937 DOI: 10.1016/j.lansea.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/30/2023]
Affiliation(s)
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow 226003, UP, India
| | - Amit Singh
- Department of Psychiatry, King George's Medical University, Lucknow 226003, UP, India
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18
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Zhao Y, Mbuthia D, Blacklock C, Gathara D, Nicodemo C, Molyneux S, English M. How do foundation year and internship experience shape doctors' career intentions and decisions? A meta-ethnography. MEDICAL TEACHER 2023; 45:97-110. [PMID: 35944557 PMCID: PMC7615548 DOI: 10.1080/0142159x.2022.2106839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Foundation years or internships are an important period for junior doctors to apply their knowledge and gain clinical competency. Experiences gained during the foundation years or internships are likely to inform newly qualified doctors' opinions about how they want to continue their career. We aimed to understand how medical doctors' internship experiences influence their career intention/decision. METHODS We conducted qualitative evidence synthesis using meta-ethnography. We searched six electronic bibliographic databases for papers published between 2000-2020 and included papers exploring how foundation years or internship experiences shape doctors' career intention/decisions, including in relation to migration, public/private/dual practice preference, rural/urban preference, and specialty choice. We used the GRADE-CERQual framework to rate confidence in review findings. RESULTS We examined 23 papers out of 6085 citations screened. We abstracted three high-level inter-related themes across 14 conceptual categories: (1) Deciding the personal best fit both clinically and in general (which option is 'more me'?) through hands-on and real-life experiences (2) Exploring, experiencing and witnessing workplace norms; and (3) Worrying about the future in terms of job market policies, future training and professional development opportunities. Confidence in findings varied but was rated high in 8 conceptual categories. CONCLUSIONS Our meta-ethnographic review revealed a range of ways in which internship experience shapes medical doctors' career intentions/decisions allowing us to produce a broad conceptual model of this phenomenon. The results highlight the importance of ensuring sufficient, positive and inspiring clinical exposure, improving workplace environment, relationship and culture, refraining from undermining specific specialities and communicating contractual and job market policies early on to young doctors, in order to attract doctors to less popular specialties or work locations where they are most needed. We propose our conceptual model should be further tested in new research across a range of contexts.
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Affiliation(s)
- Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Claire Blacklock
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Catia Nicodemo
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Economics, Verona University, Verona, Italy
| | - Sassy Molyneux
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Siripanumas C, Suphanchaimat R, Nittayasoot N, Sawaengdee K. Distribution of Physicians to Public Health Facilities and Factors Contributing to New Medical Graduates Serving in Public Facilities, 2016-2020, Thailand. Risk Manag Healthc Policy 2022; 15:1975-1985. [PMID: 36325046 PMCID: PMC9621218 DOI: 10.2147/rmhp.s384507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In Thailand, the shortage and maldistribution of physicians in the public sector is a critical public health problem. The aims of this study are to describe the retention situation of new physicians and to determine factors associated with new physicians' decision to serve in public facilities. METHODS Data of new physicians from the Human Resource Office of the Permanent Secretary System (HROPS) were analysed in order to describe the retention situation of new physicians. A retrospective cohort study was conducted to determine factors associated with new physicians' decision to remain in public service. The data were collected between Oct 2021 and Jan 2022. Cox regression was performed. RESULTS According to the HROPS database, most new physicians remained in hospitals affiliated to the Office of the Permanent Secretary (OPS) of the Ministry of Public Health (MOPH) (83.5%). Among the physicians resigning from MOPH hospitals, 80.6% resigned due to career factors. From a retrospective cohort study, physicians in the special recruitment track had the lowest incidence rate of resigning. In terms of satisfaction, most physicians were least satisfied with salary levels and workload. The majority of physicians felt satisfied with being close to their families. The Cox regression revealed that physicians graduating from private medical schools or from abroad had a higher risk of leaving public facilities. CONCLUSION To lessen the burden of physician shortage and maldistribution, the proportion of students recruited in the special track should be enhanced. High workload and inappropriate income should be addressed. Allocating new physicians to work in their hometown is recommended.
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Affiliation(s)
- Chutima Siripanumas
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand,Correspondence: Chutima Siripanumas, Email
| | - Rapeepong Suphanchaimat
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand,International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Natthaprang Nittayasoot
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Krisada Sawaengdee
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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20
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Attitudes of medical students and junior physicians towards working self-employed in private practice in Northern and Western Europe: a systematic review. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01760-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
Abstract
Abstract
Aim
A shortage in primary care physicians has been a well-known challenge in many Western countries for several years. In addition, we currently see a trend in primary care, where an increasing number of physicians work as employees instead of being self-employed, even among general practitioners. To address this shortage, knowledge of the future specialists’ attitudes toward working self-employed is needed. This qualitative systematic review aims to explore the attitudes of future specialists towards self-employment in private practice, and what factors influence these attitudes.
Subject and methods
We conducted a systematic search using PubMed, Embase, and Web of Science. We developed a search strategy that collected terms for future specialists, career choices, and self-employment and linked these with the Boolean operator “AND”. We analysed the results using a qualitative content analysis, as both qualitative and quantitative studies were included in the research.
Results
Self-employment is less attractive to future specialists. In particular, women prefer to be employed and receive a fixed salary. The main factors that influence the decision as to whether to become self-employed or not are financial conditions, bureaucracy and non-medical tasks, organisation, job satisfaction during residency, personal responsibility, career opportunities, specialty-dependent factors, personal environment, and education.
Conclusion
Among future specialists, being self-employed is less attractive than being an employee. Students should be better informed about future career opportunities to make an informed decision. However, it should be examined whether other forms of organisation are more in line with the wishes of future specialists.
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21
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Peterman N, Smith EJ, Liang E, Yeo E, Kaptur B, Naik A, Arnold PM, Hassaneen W. Geospatial evaluation of disparities in neurosurgical access in the United States. J Clin Neurosci 2022; 105:109-114. [PMID: 36148727 DOI: 10.1016/j.jocn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/15/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022]
Abstract
When neurosurgical care is needed, the distance to a facility staffed with a neurosurgeon is critical. This work utilizes geospatial analysis to analyze access to neurosurgery in the Medicare population and relevant socioeconomic factors. Medicare billing and demographic data from 2015 to 2019 were combined with national National Provider Identifier (NPI) registry data to identify the average travel distance to reach a neurosurgeon as well as the number of neurosurgeons in each county. This was merged with U.S. Census data to capture 23 socioeconomic attributes. Moran's I statistic was calculated across counties. Socioeconomic variables were compared using ANOVA. Hotspots with the highest neurosurgeon access were predominantly located in the Mid-Atlantic region, central Texas, and southern Montana. Coldspots were found in the Great Plains, Midwest, and Southern Texas. There were statistically significant differences (p < 0.05) between high- and low-access counties, including: stroke prevalence, poverty, median household income, and total population density. There were no statistically significant differences in most races or ethnicities. Overall, there exist statistically significant clusters of decreased neurosurgery access within the United States, with varying sociodemographic characteristics between access hotspots and coldspots.
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Affiliation(s)
| | | | - Edward Liang
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Eunhae Yeo
- Carle Illinois College of Medicine, Urbana, IL, USA
| | | | - Anant Naik
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Paul M Arnold
- Carle Illinois College of Medicine, Urbana, IL, USA; Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Wael Hassaneen
- Carle Illinois College of Medicine, Urbana, IL, USA; Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA.
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Schnack H, Uthoff SAK, Ansmann L. The perceived impact of physician shortages on human resource strategies in German hospitals - a resource dependency perspective. J Health Organ Manag 2022; 36:196-211. [PMID: 36098505 DOI: 10.1108/jhom-05-2021-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen. DESIGN/METHODOLOGY/APPROACH The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis. FINDINGS The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad. PRACTICAL IMPLICATIONS Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages. ORIGINALITY/VALUE This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.
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Affiliation(s)
- Helge Schnack
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Sarah Anna Katharina Uthoff
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Tang XY, Cheng M, Geater A, Deng QY, Zhong G, Lin YD, Chen N, Lan T, Jiang LY, Zhu MT, Li Q. Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study. Infect Dis Poverty 2021; 10:102. [PMID: 34294157 PMCID: PMC8296749 DOI: 10.1186/s40249-021-00885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/12/2021] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Measles outbreaks re-emerged in 2013-2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi. METHODS A multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18-54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models. RESULTS A total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28-4.58; MCV2, OR = 1.42-3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48). CONCLUSIONS Guardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China.
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Affiliation(s)
- Xian-Yan Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
| | - Man Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Qiu-Yun Deng
- Institute of Vaccination, Guangxi Centre for Disease Control and Prevention, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Ge Zhong
- Institute of Vaccination, Guangxi Centre for Disease Control and Prevention, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yue-Dong Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Ning Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Tao Lan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Long-Yan Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Man-Tong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Qiao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
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