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1
Jones, Norman L. "A Question of Demand and Supply? Defining the Demand and Providing a Supply of Respirologists." Canadian Respiratory Journal 7, no. 6 (2000): 439–42. http://dx.doi.org/10.1155/2000/745179.
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In this issue of theCanadian Respiratory Journal, we are invited to think about respirology manpower in Canada. I believe it is the first time that theJournalhas published on the topic, perhaps suprisingly, for the issues that are raised are of great importance to all physicians who care for patients with chest problems. Dr Don Cockcroft and Dr David Wensley (pages 451-455) conducted a survey of program directors and obtained data regarding Royal College Fellows, which allowed them to estimate the number of chest specialists currently in practice and to predict what will happen to these numbers in the foreseeable future. Based on the numbers and the waiting times for outpatient appointments, their main conclusions are that there is a shortfall in adult respirologists that may be as high as 50%; that the shortfall is at least as large for pediatric specialists; and that current output from training programs is unlikely to meet the shortfalls. Currently, they estimate a total of 361 adult specialists, or one for every 86,000 population, but with regional differences that account for a variation from one to 69,000 in Alberta to one to 253,000 in New Brunswick.
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Wing, Paul, Gaetano J. Forte, Mark G. Dionne, and James R. Christina. "Projections of the Supply of and Demand for Podiatric Physicians in the United States, 2005 to 2030." Journal of the American Podiatric Medical Association 98, no. 4 (2008): 330–36. http://dx.doi.org/10.7547/0980330.1.
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Background: An unanticipated decrease in applications to podiatric medical schools in the late 1990s has resulted in a decline in the number of podiatric physicians per capita in the United States. This study explores the implications of five possible scenarios for addressing this decline. Methods: With the help of an advisory committee and data from the American Podiatric Medical Association, projections of the supply of podiatric physicians were developed using five different scenarios of the future. Projections of several factors related to the demand for podiatric physicians were also developed based on a review of the literature. Results: The projections reveal that unless the number of graduations of new podiatric physicians increases dramatically, the supply will not keep up with the increasing demand for their services. Conclusion: The growing supply-demand gap revealed by this study will be an important challenge for the podiatric medical profession to overcome during the next couple of decades.
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Yang, B. M. "Supply and Demand Elasticities of Physician Services: Disequilibrium Analysis." Asia Pacific Journal of Public Health 1, no. 2 (1987): 26–31. http://dx.doi.org/10.1177/101053958700100206.
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Numerous empirical works have examined the demand for and supply of physician services during the past 15 years. Almost all simultaneous equation models have used the assumption of an equilibrium condition in the physician services market. The assumption of an equilibrium market for physician services may not be realistic, at least not in the short term, because the cost of physician services is insufficiently flexible or because of the induced demand on the part of physicians. Different market assumptions will result in different model formulations and model estimations, and with different empirical implications of the estimated results. The paper has used the US aggregate time-series data, 1950 to 1980, to estimate the demand and supply relationship of physician services, similar to the model specified in the Martin Feldstein article, 1 under a disequilibrium physician services market assumption. The maximum likelihood method is used for the empirical estimation. Contrary to Feldstein's earlier findings, the price elasticity of the demand for physicians is statistically significant with expected signs under a disequilibrium condition. The elasticity of supply of physician services is also, as expected, positive and statistically significant. Economic and policy implications are discussed based on these findings. This paper should fill empirically the gap that has been noted by previous researchers on the demand for physician services.
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Ahmed, A. A., B. Fateha, and S. Benjamin. "Demand and supply of doctors and dentists in Bahrain, 1998-2005." Eastern Mediterranean Health Journal 6, no. 1 (2000): 6–12. http://dx.doi.org/10.26719/2000.6.1.6.
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We examined the supply and demand of medical doctors and dentists in Bahrain. Demand for physicians and dentists was based on the objective of having a physician-to-population ratio of 1: 650, and a dentist-to-population ratio of 1: 5000. Analysis of the current workforce and projected graduates in the period 1998-2005 indicated that the supply of Bahraini medical doctors and dentists until the year 2005 will not be sufficient to meet the projected demand in these categories. By the year 2005, Bahraini doctors and dentists will provide 82.5% and 75.9% of medical and dental demands respectively. The remaining 17.2% of physicians and 24.1% of dentists will have to be recruited from abroad. Thus, the prospect of oversupply of Bahrainis among these categories until the year 2005 is highly unlikely
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Sullivan, Ashley F., Adit A. Ginde, Janice A. Espinola, and Carlos A. Camargo. "Supply and Demand of Board-certified Emergency Physicians by U.S. State, 2005." Academic Emergency Medicine 16, no. 10 (2009): 1014–18. http://dx.doi.org/10.1111/j.1553-2712.2009.00509.x.
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Bundy, Christopher C., and Betsy White Williams. "Cognitive Screening for Senior Physicians: Are We Minding the Gap?" Journal of Medical Regulation 107, no. 2 (2021): 41–48. http://dx.doi.org/10.30770/2572-1852-107.2.41.
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ABSTRACT Senior physicians are an invaluable community asset that comprise an increasing proportion of the physician workforce. An increase in demand for health care services, with demand exceeding the supply of physicians, has contributed to discussions of the potential benefit of delaying physician retirement to help preserve physician supply. The probable increase in the number of senior physicians has been associated with concerns about their competent practice. Central to this issue are the changes that occur as part of normal aging, how such changes might impact medical practice and what steps need to be taken to ensure the competency of senior physicians. We propose that while age may be an important risk factor for performance issues, it is not the only factor and may not even be the most important. Data on cognitive performance among physicians referred for behavioral and performance concerns reveal that cognitive impairment afflicts physicians across the career span. If the overarching goal is to prevent patient harm through early detection, older physicians may be too narrow a target. Approaches focusing on health screening and promotion across the career span will ultimately be more effective in promoting workforce sustainability and patient safety than age-based solutions.
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Lupu, Dale, Leo Quigley, Nicholas Mehfoud, and Edward S. Salsberg. "The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up?" Journal of Pain and Symptom Management 55, no. 4 (2018): 1216–23. http://dx.doi.org/10.1016/j.jpainsymman.2018.01.011.
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Shih, Ya-Chen Tina, and Ming Tai-Seale. "Physicians' perception of demand-induced supply in the information age: a latent class model analysis." Health Economics 21, no. 3 (2011): 252–69. http://dx.doi.org/10.1002/hec.1710.
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Pylypchuk, Yuriy, and Eric M. Sarpong. "Nurse Practitioners and Their Effects on Visits to Primary Care Physicians." B.E. Journal of Economic Analysis & Policy 15, no. 2 (2015): 837–64. http://dx.doi.org/10.1515/bejeap-2014-0018.
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Abstract The demand for primary care services is expected to increase at a time of persistent shortages of primary care physicians (PCPs) in the United States. A proposed solution is to expand the role of other allied health professions. This study examines the causal effects of visits to nurse practitioners (NPs) on the demand for services from PCPs. We employ a system of simultaneous equations and dynamic panel estimators to control for endogeneity of visits to NPs. Results indicate that patients who visited an NP are significantly less likely to visit PCPs and to receive prescribed medication, medical check-up, and diagnosis from PCPs. Findings were robust to other specification and passed a falsification test. The results suggest that the use of NPs could serve as a potential option to address shortages in supply of primary care services.
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Young, Aaron, Humayun J. Chaudhry, Jon V. Thomas, and Michael Dugan. "A Census of Actively Licensed Physicians in the United States, 2012." Journal of Medical Regulation 99, no. 2 (2013): 11–24. http://dx.doi.org/10.30770/2572-1852-99.2.11.
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ABSTRACTThe Patient Protection and Affordable Care Act, signed into law in 2010 and upheld by the U.S. Supreme Court last year, is expected to provide health care coverage to as many as 32 million Americans by 2019. As demand for health care expands, the need for accurate data about the current and future physician workforce will remain paramount. This census of actively licensed physicians in the United States and the District of Columbia represents data received from state medical boards in 2012 by the Federation of State Medical Boards. It demonstrates that the total population of licensed physicians (878,194) has expanded by 3% since 2010, is slightly older, has more women, and includes a substantive increase in physicians who graduated from a medical school in the Caribbean. As state medical boards begin to collect a Minimum Data Set about practicing physicians and their practice patterns in the years ahead, this information will inform decisions by policymakers, regulators and health care market participants to better align health care demand with supply.
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Rassman, William R. "The Minigraft Revolution: Can We Keep up Ethically?" American Journal of Cosmetic Surgery 11, no. 2 (1994): 103–4. http://dx.doi.org/10.1177/074880689401100205.
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Hair transplantation is fast becoming a boom industry. It is being fueled by a high demand for service, a short supply of providers, and a high value of product. As millions of bald or balding men and women are becoming more aware of self-improvement options, hair restoration is rapidly gaining more attention. One of the most significant problem confronting physicians entering the field of hair transplantation is the general unavailability of formal or informal training. The high value placed on the service reflects 1) the new technology of Minigrafting in Megasessions; 2) the general unavailability of trained physician in the art and science of modern hair transplantation techniques; and 3) the increasing demand for service. Physicians are rallying to the demand for service disproportionately to their ability to achieve a quality product. Great care must be taken not to allow one's enthusiasm to exceed one's skills and abilities.
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Windmill, Ian M., and Barry A. Freeman. "Demand for Audiology Services: 30-Yr Projections and Impact on Academic Programs." Journal of the American Academy of Audiology 24, no. 05 (2013): 407–16. http://dx.doi.org/10.3766/jaaa.24.5.7.
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Background: Significant growth in the U.S. population over the next 30 yr will likely increase the demand for hearing-care services. In addition, increased accessibility to hearing-care services may be realized due to increased insurance coverage associated with health-care reform efforts. In order to meet this demand, the supply of audiologists will have to keep pace. The U.S. Department of Health and Human Services has developed a Physician Supply Model to predict the necessary number of physicians needed in the future to meet demand. This model is adopted for predicting whether the supply of audiologists will be adequate over the next 30 yr. Purpose: To apply the Physician Supply Model to the audiology profession and then determine if the predicted supply of audiologists will meet the demand for audiologists over the next 30 yr. Data Collection and Analysis: The Physician Supply Model was modified to account for variables unique to the profession of audiology, and the future supply of audiologists is predicted. The predicted demand for audiology was developed based on changes in population demographics over the next 30 yr. The results of the demand calculations and the supply calculations were compared. Results: The current growth rate for audiologists was determined by examining the difference between the number of graduates entering the field and the number leaving. One of the unexpected variables is that the past attrition of graduates, that is, the number of persons who voluntarily leave audiology at some point after graduation, is approximately 40%. The attrition rate combined with the retirement rate results in more persons exiting the profession than entering. Lowering the attrition rate to 20% will result in a positive growth rate. However, even with an attrition rate of 0%, the supply of audiologists will not meet demand. Conclusions: To meet demand, the number of persons entering the field will have to increase by 50% beginning immediately. In addition, the attrition rate will have to be lowered to 20%. Any combination of increased graduation rate and lowered attrition will improve the opportunities to meet demand. Additional strategies could include increasing the capacity of current practitioners or allowing internationally trained audiologists to practice in the United States.
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Basu, Monisha, Tracy Cooper, Kelly Kay, et al. "Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics." Canadian Geriatrics Journal 24, no. 3 (2021): 200–208. http://dx.doi.org/10.5770/cgj.24.538.
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Background 
 The predicted growth of Canadians aged 65+ and the resultant rise in the demand for specialized geriatric services (SGS) requires physician resource planning. We updated the 2011 Canadian Geriatrics Society physician resource inventory and created projections for 2025 and 2030.
 Methods 
 The number and full-time equivalents (FTEs) of geriatricians and Care of the Elderly (COE) physicians working in SGS were determined. FTE counts for 2025 and 2030 were estimated by accounting for retirements and trainees. A ratio of 1.25/10,000 population 65+ was used to predict physician resource requirements.
 Results 
 Between 2011 and 2019 the number of geriatricians and COE physicians increased from 276 (235.8 FTEs) and 128 (89.9 FTEs), respectively, to 376 (319.6 FTEs) and 354 (115.5 FTEs). This increase did not keep pace with the 65+ population growth. The current gap between supply and need is expected to increase.
 Discussion 
 The physician supply gap is projected to widen in 2025 and 2030. Increased recruitment and interdisciplinary team-based care, supported by enhanced funding models, and full integration of COE physicians in SGS could reduce this increasing gap. In contrast to pediatrician supply in Canada, the specialist physician resources available to the population 65+ reflect a disparity.
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Saver, Richard S. "In Tepid Defense of Population Health: Physicians and Antibiotic Resistance." American Journal of Law & Medicine 34, no. 4 (2008): 431–91. http://dx.doi.org/10.1177/009885880803400401.
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AbstractAntibiotic resistance menaces the population as a dire public health threat and costly social problem. Recent proposals to combat antibiotic resistance focus to a large degree on supply side approaches. Suggestions include tinkering with patent rights so that pharmaceutical companies have greater incentives to discover novel antibiotics as well as to resist overselling their newer drugs already on market. This Article argues that a primarily supply side emphasis unfortunately detracts attention from physicians' important demand side influences. Physicians have a vital and unavoidably necessary role to play in ensuring socially optimal access to antibiotics. Dismayingly, physicians' management of the antibiotic supply has been poor and their defense of population health tepid at best. Acting as a prudent steward of the antibiotic supply often seems to be at odds with a physician's commonly understood fiduciary duties, ethical obligations, and professional norms, all of which traditionally emphasize the individual health paradigm as opposed to population health responsibilities. Meanwhile, physicians face limited incentives for antibiotic conservation from other sources, such as malpractice liability, regulatory standards, and reimbursement systems. While multi-faceted efforts are needed to combat antibiotic resistance effectively, physician gatekeeping behavior should become a priority area of focus. This Article considers how health law and policy tools could favorably change the incentives physicians face for antibiotic conservation. A clear lesson from the managed care reform battles of the recent past is that interventions, to have the best chance of success, need to respect physician interest in clinical autonomy and individualized medicine even if, somewhat paradoxically, vigorously promoting population health perspectives. Also, physicians' legal and ethical obligations need to be reconceptualized in the antibiotic context in order to better support gatekeeping in defense of population health. The principal recommendation is for increased use of financial incentives to reward physicians for compliance with recommended guidelines on antibiotic prescribing. Although not a panacea, greater experimentation with financial incentives can provide a much needed jump-start to physician interest in antibiotic conservation and likely best address physicians' legitimate clinical autonomy concerns.
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Pocius, Arūnas. "A Change in the Supply of Professionals in the Health Care Sector and Assessment of the Demand for Physicians and Opportunities for their Integration into the Labour Market." Lietuvos statistikos darbai 52, no. 1 (2013): 45–57. http://dx.doi.org/10.15388/ljs.2013.13924.
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The article paper analyses the supply of health care professionals in health care sector in Lithuania in terms of demographic change. On the basis of data from different studies and of the analysis carried out in this work by the author, particular attention is given to the problem of the assessment of the demand for health care professionals (physicians) in health care sector in Lithuania. When analysing the integration of health care professionals into the labour market, in addition to sociological surveys, the data of Lithuanian Statistics Lithuania Department on labour force (employment) was were used. This paper investigates explores the possibility of using different data sources for the analysis of the demand for health care professionals (physicians), as well as analyses their situation in the labour market on the basis of the scientific literature review.
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Rego, Inês, Giuliano Russo, Luzia Gonçalves, Julian Perelman, and Pedro Pita Barros. "A Crise Económica em Médicos do Serviço Nacional de Saúde: Estudo Descritivo das Suas Perceções e Reações em Unidades de Saúde na Região da Grande Lisboa." Acta Médica Portuguesa 30, no. 4 (2017): 263. http://dx.doi.org/10.20344/amp.7690.
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Introduction: In Europe, scant scientific evidence exists on the impact of economic crisis on physicians. This study aims at understanding the adjustments made by public sector physicians to the changing conditions, and their perceptions on the market for medical services in the Lisbon metropolitan area.Material and Methods: A random sample of 484 physicians from São José Hospital and health center groups in Cascais and Amadora, to explore their perceptions of the economic crisis, and the changes brought to their workload. This paper provides a descriptive statistical analysis of physicians’ responses.Results: In connection to the crisis, our surveyed physicians perceived an increase in demand but a decrease of supply of public health services, as well as an increase in the supply of health services by the private sector. Damaging government policies for the public sector, and the rise of private services and insurance providers were identified as game changers for the sector. Physicians reported a decrease in public remuneration (- 30.5%) and a small increase of public sector hours. A general reduction in living standard was identified as the main adaptation strategy to the crisis. Passion for the profession, its independence and flexibility, were the most frequently mentioned compensating factors. A percentage of 15% of physicians declared considering migration as a possibility for the near future.Discussion: The crisis has brought non-negligible changes to physicians’ working conditions and to the wider market for medical services in Portugal.Conclusion: The physicians’ intrinsic motivation for the professions helped counterbalance salary cuts and deteriorating working conditions.
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Alnowibet, Khalid, Adel Abduljabbar, Shafiq Ahmad, et al. "Healthcare Human Resources: Trends and Demand in Saudi Arabia." Healthcare 9, no. 8 (2021): 955. http://dx.doi.org/10.3390/healthcare9080955.
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This paper estimates the impact of policies on the current status of Healthcare Human Resources (HHR) in Saudi Arabia and explores the initiatives that will be adopted to achieve Saudi Vision 2030. Retrospective time-series data from the Ministry of Health (MOH) and statistical yearbooks between 2003 and 2015 are analyzed to identify the impact of these policies on the health sector and the number of Saudi and non-Saudi physicians, nurses and allied health specialists employed by MOH, Other Government Hospitals (OGH) and Private Sector Hospitals (PSH). Moreover, multiple regressions are performed with respect to project data until 2030 and meaningful inferences are drawn. As a local supply of professional medical falls short of demand, either policy to foster an increase in supply are adopted or the Saudization policies must be relaxed. The discrepancies are identified in terms of a high rate of non-compliance of Saudization in the private sector and this is being countered with alternative measures which are discussed in this paper. The study also analyzed the drivers of HHR demand, supply and discussed the research implications on policy and society. The findings suggest that the 2011 national Saudization policy yielded the desired results mostly regarding allied health specialists and nurses. This study will enable decision-makers in the healthcare sector to measure the effectiveness of the new policies and, hence, whether to continue in implementing them or to revise them.
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Mospan, Natalia. "Skills demand and suply in the European Union." Osvitolohiya, no. 6 (2017): 176–80. http://dx.doi.org/10.28925/2226-3012.2017.6.176180.
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The author of the article presents an analysis of the current situation of demand and supply of specialists in the European Union. The basis for the analysis is the reports of the European Commission, which widely cover this issue. It is worth noting that different EU countries feel the problems of supply and demand in different ways. Their conformity is observed only in Germany, where the number of students graduate each year and enter the labor market in search of work coincides with the requirements of employers in terms of the number of specialists. Other EU countries are in demand for specialists in the scientific, engineering and technology sectors and a quantitative shortage of teachers and doctors. The study is devoted to the questions related to factors that affect the matching between the demand and supply of teachers and doctors. Among such factors is the increase in population, health and education costs. The number of school children is the dominant factor in the demand for teachers. Another factor is educational programs that determine the demand for subject teachers. The policies and priorities of the curriculum have a dominant influence in determining the different types of teachers as well. The demand for physicians depends on the health system. The offer of doctors may differ due to differences in the industry, in particular, the accessibility of education and training for doctors, as well as the conditions of medical service. The results of this study can contribute to a deeper understanding of the current state of the regulating process of higher education interaction with the labor market in Ukraine.
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Savage, D., and D. Petrie. "LO77: Assessing the long-term emergency physician resource planning for Nova Scotia, Canada." CJEM 21, S1 (2019): S35—S36. http://dx.doi.org/10.1017/cem.2019.120.
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Introduction: Planning for the future emergency physician (EP) workforce will be a significant challenge for decision makers given the rise in emergency department (ED) visits and no concurrent increase in resident positions. EP workforce planning must incorporate physician supply, as well as current and forecasted patient demand. Nova Scotia has undertaken the process of developing a planning model to support policy decision making. We hypothesize that Nova Scotia will require increased resident positions and recruitment from other provinces to meet future patient demand. Methods: We have developed an age structured population model that tracks the number of clinical full-time equivalent (FTE) EPs by their age and shows the “variance” (i.e., supply – demand = variance) over a 30 year planning horizon. This model represents all Level 1, 2, 3, and 4 EDs in Nova Scotia. Current physician supply was calculated based on FTE staffing levels. The current patient demand was based on historical volume and acuity of patients and converted to an FTE demand estimate. Forecasted demand was predicted to increase at an average rate of 0.5% per year. We varied the number of residents trained and the number of EPs recruited from outside the province to examine the effect on the EP workforce. Our initial model will reflect the current training environment and will be referred to as the “current state”. In our 3 scenarios, we increased the number of residents and recruited physicians by 50%, individually and then together. Our outcome measure will be the variance in FTE. Results: The current state showed that the province will have a deficit of 51 FTE EPs over the next 30 years. In scenario 1, a 50% increase in both resident training streams eliminated all variance, while in scenario 2, the increase in recruitment reduced the FTE variance to 34 FTE positions unfilled. In scenario 3, the variance was 0. Conclusion: We feel that this CTAS weighted volumes perspective is important for clinical services planning but the siting, sizing, and synergizing of EDs in a region will involve other inputs. Its important to recognize that we have made the assumption that all physicians starting to work in Nova Scotia will be a 1 FTE. Future iterations will examine the effect of more realistic FTE definitions that account for administrative, teaching and research activities.
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Erikson, Clese, Edward Salsberg, Gaetano Forte, Suanna Bruinooge, and Michael Goldstein. "Future Supply and Demand for Oncologists : Challenges to Assuring Access to Oncology Services." Journal of Oncology Practice 3, no. 2 (2007): 79–86. http://dx.doi.org/10.1200/jop.0723601.
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Purpose To conduct a comprehensive analysis of supply of and demand for oncology services through 2020. This study was commissioned by the Board of Directors of ASCO. Methods New data on physician supply gathered from surveys of practicing oncologists, oncology fellows, and fellowship program directors were analyzed, along with 2005 American Medical Association Masterfile data on practicing medical oncologists, hematologists/oncologists, and gynecologic oncologists, to determine the baseline capacity and to forecast visit capacity through 2020. Demand for visits was calculated by applying age-, sex-, and time-from-diagnosis-visit rate data from the National Cancer Institute's analysis of the 1998 to 2002 Surveillance, Epidemiology and End Results (SEER) database to the National Cancer Institute's cancer incidence and prevalence projections. The cancer incidence and prevalence projections were calculated by applying a 3-year average (2000–2002) of age- and sex-specific cancer rates from SEER to the US Census Bureau population projections released on March 2004. The baseline supply and demand forecasts assume no change in cancer care delivery and physician practice patterns. Alternate scenarios were constructed by changing assumptions in the baseline models. Results Demand for oncology services is expected to rise rapidly, driven by the aging and growth of the population and improvements in cancer survival rates, at the same time the oncology workforce is aging and retiring in increasing numbers. Demand is expected to rise 48% between 2005 and 2020. The supply of services provided by oncologists during this time is expected to grow more slowly, approximately 14%, based on the current age distribution and practice patterns of oncologists and the number of oncology fellowship positions. This translates into a shortage of 9.4 to 15.0 million visits, or 2,550 to 4,080 oncologists—roughly one-quarter to one-third of the 2005 supply. The baseline projections do not include any alterations based on changes in practice patterns, service use, or cancer treatments. Various alternate scenarios were also developed to show how supply and demand might change under different assumptions. Conclusions ASCO, policy makers, and the public have major challenges ahead of them to forestall likely shortages in the capacity to meet future demand for oncology services. A multifaceted strategy will be needed to ensure that Americans have access to oncology services in 2020, as no single action will fill the likely gap between supply and demand. Among the options to consider are increasing the number of oncology fellowship positions, increasing use of nonphysician clinicians, increasing the role of primary care physicians in the care of patients in remission, and redesigning service delivery.
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Oh, Young In, Jung Chan Lee, and Jeong Hun Park. "Assessment of the reasonable number of physicians in Korea." Journal of the Korean Medical Association 63, no. 12 (2020): 789–97. http://dx.doi.org/10.5124/jkma.2020.63.12.789.
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The government argues that the expansion of the number of physicians is inevitable due to the absolute lack of practising physicians in Korea compared to members of the Organisation for Economic Co-operation and Development. Further, the government contends that poor medical access and adverse effects on the national health level require such an expansion. This study aimed to verify whether the government’s claims regarding the lack of physician manpower are reasonable by estimating the projected supply and demand of physicians by 2023 based on scenarios involving their productivity and number of working days. As a result, all scenarios indicated a projected oversupply, except for the scenario in which there are 255 working days and physicians’ productivity is the same as that of 2018. Even in scenario three, in which there are 255 working days and physicians’ productivity is the same as that of 2018, an oversupply was projected from 2027. Standards regarding the number of physicians vary from country to country, as they are affected by various factors including medical systems, demographic structures, national health levels, medical infrastructures, accessibility, medical finance and geographical conditions. This issue can be seen as resulting from the unbalanced regional distribution of physicians rather than from an absolute shortage of the number of physicians. The trickle-down effect of expanding the medical student enrollment cannot solve the problem of the unbalanced regional distribution of physicians.
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Chi, I.-Cheng, and Shyam Thapa. "Postpartum tubal sterilisation: an international perspective on some programmatic issues." Journal of Biosocial Science 25, no. 1 (1993): 51–61. http://dx.doi.org/10.1017/s0021932000020290.
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SummaryThe demand for postpartum sterilisation (performed within 42 days after delivery), is increasing both in developed and developing countries. The incidence of regret after postpartum sterilisation is important, but it could be minimised by carefully screening risk factors. Using trained paramedical personnel to perform postpartum sterilisation via minilaparotomy where physicians are in short supply appears to be safe and acceptable, under close medical supervision. Including postpartum sterilisation information in the antenatal counselling services effectively strengthens postpartum services and simultaneously helps to minimise subsequent regret.
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Cheng, Glen. "The National Residency Exchange: A Proposal to Restore Primary Care in an Age of Microspecialization." American Journal of Law & Medicine 38, no. 1 (2012): 158–95. http://dx.doi.org/10.1177/009885881203800103.
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Healthcare deficiencies in the United States have long been perpetuated by a shortage of primary care providers. A core purpose of the Patient Protection and Affordable Care Act (PPACA) is to provide health insurance for America's approximately fifty million uninsured. Implementation of universal health insurance, however, does not mean sufficient healthcare access for all, since the supply of physicians does not and will not meet demand. For reasons reviewed in this Article, the current physician shortage mainly impacts primary care providers. This shortage is particularly troubling because increased provision of primary care relative to specialty care has been associated with improvement in health outcomes, disease prevention, cost effectiveness, and coordination of care. This Article highlights provisions in the PPACA that impact primary care physicians. Finally, this Article proposes the creation of a universal primary care loan repayment program and a national residency exchange designed to alleviate the U.S. primary care crisis by facilitating optimal distribution of resident physicians in each medical specialty based on community need.
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Coleman-Musser, Lori. "The Physician's Perspective: A Survey of Attitudes toward Organ Donor Management." Journal of Transplant Coordination 7, no. 2 (1997): 55–58. http://dx.doi.org/10.1177/090591999700700203.
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The demand for suitable organs in the United States greatly outweighs the supply of transplantable organs. It has been estimated that approximately half of all potential donors do not donate. Preexisting barriers seem to impede donation, and the physician is a vital link in this process. To better understand the physician's perspective and to identify barriers that may produce difficulties in the process, a survey of physicians in northern Ohio was conducted. Respondents identified the following barriers: consensus in tests performed in the diagnosis of death is lacking, ambivalence exists with respect to informing families of the patient's death and offering families the donation option, and physicians do not seem to recognize the importance of decoupling the discussion of brain death from the request for organs. Although physicians surveyed were in favor of donation and transplantation, an effort should be made to increase awareness in personal attitudes that may affect the donation process.
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Ludwick, D. A., and John Doucette. "Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment." International Journal of Telemedicine and Applications 2009 (2009): 1–9. http://dx.doi.org/10.1155/2009/853524.
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Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT). Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation.
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Rizza, Robert A., Robert A. Vigersky, Helena W. Rodbard, et al. "A Model to Determine Workforce Needs for Endocrinologists in the United States Until 20201." Journal of Clinical Endocrinology & Metabolism 88, no. 5 (2003): 1979–87. http://dx.doi.org/10.1210/jc.2002-021288.
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The objective of this study was to define the workforce needs for the specialty of endocrinology, diabetes, and metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 yr was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists. We determined current and projected numbers and demographics of endocrinologists in the United States workforce and the anticipated balance between supply and demand from 1999 to 2020. There were 3,623 adult endocrinologists in the workforce in 1999, of which 2,389 (66%) were in office-based practice. Their median age was 49 yr. Both total office visits and services performed by endocrinologists (particularly for diabetes) increased substantially during the 1990s. Waiting time for an initial appointment is presently longer for endocrinologists than for other physicians. Compared with a balanced, largely closed-staff health maintenance organization, the current national supply of endocrinologists is estimated to be 12% lower than demand. The number of endocrinologists entering the market has continuously fallen over the previous 5 yr, from 200 in 1995 to 171 in 1999. Even if this downward trend were abruptly stopped, the model predicts that demand will exceed supply from now until 2020. Whereas this gap narrows from 2000 to 2008 due to projected growth of managed care, it widens thereafter due to the aging of both the population and the endocrine workforce. Inclusion of other factors such as projected real income growth and increased prevalence of age-related endocrine disorders (e.g. diabetes and osteoporosis) further accentuates the deficit. If the number of endocrinologists entering the workforce remains at 1999 levels, demand will continue to exceed supply from now through 2020 for adult endocrinologists, and the gap will widen progressively from 2010 onward. The present analysis indicates that the number of endocrinologists entering the workforce will not be sufficient to meet future demand. These data suggest that steps should be taken to stop the ongoing decline in the number of endocrinologists in training and consideration should be given to actions designed to increase the number of endocrinologists in practice in the years ahead.
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Diamond, Lisa C., Imran Mujawar, Erik Vickstrom, Margaux Genoff Garzon, and Francesca Gany. "Supply and Demand: Association Between Non-English Language–Speaking First Year Resident Physicians and Areas of Need in the USA." Journal of General Internal Medicine 35, no. 8 (2020): 2289–95. http://dx.doi.org/10.1007/s11606-020-05935-7.
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Rothstein, Mark A. "Currents in Contemporary Ethics." Journal of Law, Medicine & Ethics 38, no. 1 (2010): 149–53. http://dx.doi.org/10.1111/j.1748-720x.2010.00475.x.
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There is widespread concern among public health and emergency response officials that there could be a shortage of health care providers in a public health emergency. At least the following three factors could cause an inadequate supply of physicians, nurses, and other health care providers: (1) the severity of the emergency might greatly increase the demand for health services and outstrip the available supply; (2) health care providers might become unavailable because of their own high rates of illness, as was the case in the SARS epidemic; and (3) many health care providers might not report for duty for personal, family, or professional reasons.One way of addressing the shortage is to encourage health care providers from unaffected areas or parts of the country to volunteer their services. A variety of measures have been enacted to facilitate the use of such volunteers.
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Ansah, John Pastor, Salman Ahmad, Lin Hui Lee, et al. "Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine." PLOS ONE 16, no. 1 (2021): e0244097. http://dx.doi.org/10.1371/journal.pone.0244097.
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Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is temporarily beyond the capacity for which the ED is designed and resourced to manage―a phenomenon called Emergency Department (ED) crowding. ED crowding can impair the quality of care delivered to patients and lead to longer patient waiting times for ED doctor’s consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency physicians have to cope with patient volumes above the safe workload. The purpose of this study is to create a virtual ED that closely maps the processes of a hospital-based ED in Singapore using system dynamics, that is, a computer simulation method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i) co-location of primary care services within the ED, (ii) increase in the capacity of doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and (iv) a combination of policies (i) to (iii). Among the tested policies, the co-location of primary care services has the largest impact on patients’ average length of stay (ALOS) in the ED. This implies that decanting non-emergency lower acuity patients from the ED to an adjacent primary care clinic significantly relieves the burden on ED operations. Generally, in Singapore, there is a tendency to strengthen primary care and to educate patients to see their general practitioners first in case of non-life threatening, acute illness.
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Galbraith, Robert M., and Stephen G. Clyman. "Emerging Trends in the U.S. Physician Workforce: Implications for Licensure and Professional Standards." Journal of Medical Regulation 91, no. 1 (2005): 14–20. http://dx.doi.org/10.30770/2572-1852-91.1.14.
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ABSTRACT During the past quarter century, demand for physicians has dramatically increased, yet the supply of trained allopathic United States medical graduates (USMG) has become fixed. Expansion of funded residency positions has allowed large-scale absorption of international medical graduates (IMG), but there is now growing competition for IMG from other Anglophone countries with developing shortages. Substantive expansion of allopathic USMG enrollment will have to overcome hard fiscal and political realities and an uncertain pool of additional qualified applicants. Although the numbers of osteopathic physicians and non-physician clinicians (NPC) have increased briskly over the last decade, particularly in primary care, their ability to address shortages of specialists appears limited. This conjunction of events could result in serious shortages of physicians, particularly of specialists and in areas that are traditionally victims of maldistribution. Although many corrective actions are theoretically possible, most are impractical, and increasing enrollment of allopathic USMG may be the most feasible immediate approach. There could also be important ripple effects on professional standards, procedures for licensure and the introduction of several important new initiatives in assessment relevant to licensure and certification.
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Virk, Amrit, Mohamed Bella Jalloh, Songor Koedoyoma, et al. "What factors shape surgical access in West Africa? A qualitative study exploring patient and provider experiences of managing injuries in Sierra Leone." BMJ Open 11, no. 3 (2021): e042402. http://dx.doi.org/10.1136/bmjopen-2020-042402.
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IntroductionSurgical access is central to universalising health coverage, yet 5 billion people lack timely access to safe surgical services. Surgical need is particularly acute in post conflict settings like Sierra Leone. There is limited understanding of the barriers and opportunities at the service delivery and community levels. Focusing on fractures and wound care which constitute an enormous disease burden in Sierra Leone as a proxy for general surgical need, we examine provider and patient perceived factors impeding or facilitating surgical care in the post-Ebola context of a weakened health system.MethodsAcross Western Area Urban (Freetown), Bo and Tonkolili districts, 60 participants were involved in 38 semistructured interviews and 22 participants in 5 focus group discussions. Respondents included surgical providers, district-level policy-makers, traditional healers and patients. Data were thematically analysed, combining deductive and inductive techniques to generate codes.ResultsInteracting demand-side and supply-side issues affected user access to surgical services. On the demand side, high cost of care at medical facilities combined with the affordability and convenient mode of payment to the traditional health practitioners hindered access to the medical facilities. On the supply side, capacity shortages and staff motivation were challenges at facilities. Problems were compounded by patients’ delaying care mainly spurred by sociocultural beliefs in traditional practice and economic factors, thereby impeding early intervention for patients with surgical need. In the absence of formal support services, the onus of first aid and frontline trauma care is borne by lay citizens.ConclusionWithin a resource-constrained context, supply-side strengthening need accompanying by demand-side measures involving community and traditional actors. On the supply side, non-specialists could be effectively utilised in surgical delivery. Existing human resource capacity can be enhanced through better incentives for non-physicians. Traditional provider networks can be deployed for community outreach. Developing a lay responder system for first-aid and front-line support could be a useful mechanism for prompt clinical intervention.
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Anagnostiadis, Eleni, and Sangeeta V. Chatterjee. "The Dangers of Buying Prescription Drugs from Rogue Wholesale Distributors." Journal of Medical Regulation 104, no. 1 (2018): 13–16. http://dx.doi.org/10.30770/2572-1852-104.1.13.
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ABSTRACT Counterfeit and unapproved drugs pose serious health risks to patients in the United States. High-profile cases, such as the incident concerning the counterfeit version of the oncology drug Avastin, demonstrate that there are major incentives such as demand, convenience, high profit, and low legal risks for rogue wholesale distributors to sell unapproved and counterfeit drugs. Wholesale drug distributors play a significant role in ensuring prescription medications are delivered safely and efficiently to health care practitioners and pharmacies. While the U.S. drug supply chain is one of the most secure and sophisticated in the world, there are networks of rogue wholesale drug distributors that target physicians and medical practices by advertising prescription drugs for sale at deeply discounted rates. Buying drugs from unlicensed sources puts patients at risk of consuming medications that may be unapproved, counterfeit, contaminated, or ineffective. It is critical that physicians be aware of the patient health risks and potential legal consequences of purchasing drugs from illegal sources. State medical boards can help address this issue given their important role of public protection in the licensing and oversight of the practice of medicine. The regulatory community serves as a key information hub and can provide targeted communication channels to educate physicians.
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HIGUCHI, KAZUKO, EIJI MUKAI, TOYOHISA TSUKAMOTO, and SHUSHI MORITA. "Studies of Drug Information for the Proper Use of Medicine. (1). The Demand and Supply of Drug Information for Physicians in Hospital." Japanese Journal of Hospital Pharmacy 24, no. 1 (1998): 86–95. http://dx.doi.org/10.5649/jjphcs1975.24.86.
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Sharma, MBBS, MD, B. R. "Disaster management following explosion." American Journal of Disaster Medicine 3, no. 2 (2008): 113–19. http://dx.doi.org/10.5055/ajdm.2008.0015.
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Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making.
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Ratanachina, Jate, and Pornchai Sithisarankul. "Two decades’ contribution of occupational medicine training in Thailand: experience from the foundation with a view toward the future." Asian Biomedicine 11, no. 4 (2018): 387–92. http://dx.doi.org/10.1515/abm-2018-0012.
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AbstractFor 2 decades, the Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, has served the Occupational Medicine Residency training program in Thailand. Graduates of this program undertake to work in occupational medicine to promote health and prevent morbidity and mortality in the workplace and provide occupational medical services for the working population in Thailand. Qualifying for a Postgraduate Diploma in Occupational Medicine in Thailand can be achieved in 2 ways: through a 3-year residency training or 5 years of working experience in the field of occupational medicine combined with an elective 2-month short course. There are currently 159 Thai board-certified occupational medicine physicians. Occupational medicine physicians in Thailand work in both public and private healthcare facilities. A number of certified occupational physicians occupy leading national health positions in various government and academic organizations. Knowledge of occupational medicine is currently essential for undergraduate medical students as specified in the medical competency assessment criteria of the Thai Medical Council. Updating content and incorporating needs of employers are keys to success for Thailand, as a country with an occupational medicine training program in its initial stages. In Thailand, the supply of occupational medicine physicians is still less than the increasing demand. Advancement of health research schemes would contribute to the curriculum. Occupational medicine development in Thailand needs to address challenges in local issues including work in the informal sector, particularly in agriculture, and incorporate standardization and international consistency into the training curriculum and qualifying management.
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Bishop, John H., and Shani Carter. "Response to Kutscher’s Comment." Educational Evaluation and Policy Analysis 13, no. 3 (1991): 253–55. http://dx.doi.org/10.3102/01623737013003253.
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Recent studies of trends in relative wage rates and unemployment rates are reviewed. These studies conclude that real wages of recent college graduates rose substantially during the 1980s while the wages of recent high school graduates fell, contradicting the Bureau of Labor Statistics (BLS) claim that college graduates were oversupplied during the 1980s. The BLS approach to measuring the supply–demand balance for college graduates by counting the number of college graduates who say they are working in “nontraditional” occupations is dismissed as invalid because of the unreliability of Current Population Survey coding of occupation and education and the lack of attention to mismatches of the opposite kind such as the more than 5% of physicians, lawyers, and high school teachers who report having fewer than 16 years of schooling.
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Devereaux, P. J., and Wojciech Szczeklik. "Myocardial injury after non-cardiac surgery: diagnosis and management." European Heart Journal 41, no. 32 (2019): 3083–91. http://dx.doi.org/10.1093/eurheartj/ehz301.
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Abstract Myocardial injury after non-cardiac surgery (MINS) is due to myocardial ischaemia (i.e. supply-demand mismatch or thrombus) and is associated with an increased risk of mortality and major vascular complications at 30 days and up to 2 years after non-cardiac surgery. The diagnostic criteria for MINS includes an elevated post-operative troponin measurement judged as resulting from myocardial ischaemia (i.e. no evidence of a non-ischaemic aetiology), during or within 30 days after non-cardiac surgery, and without the requirement of an ischaemic feature (e.g. ischaemic symptom, ischaemic electrocardiography finding). For patients with MINS who are not at high risk of bleeding, physicians should consider initiating dabigatran 110 mg twice daily and low-dose aspirin. Physicians should also consider initiating statin therapy in patients with MINS. Most MINS patients should only be referred to cardiac catheterization if they demonstrate recurrent instability (e.g. cardiac ischaemia, heart failure). Patients ≥65 years of age or with known atherosclerotic disease should have troponin measurements on days 1, 2, and 3 after surgery while the patient is in hospital to avoid missing >90% of MINS and the opportunity to initiate secondary prophylactic measures and follow-up.
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Edwards, Asher, and Samuel Nam. "Palliative Care Exposure in Internal Medicine Residency Education: A Survey of ACGME Internal Medicine Program Directors." American Journal of Hospice and Palliative Medicine® 35, no. 1 (2017): 41–44. http://dx.doi.org/10.1177/1049909116687986.
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As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education–accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was “very important” (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.
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Halpern, Michael T., Heather Kane, Stephanie Teixeira-Poit, et al. "Projecting the Adequacy of the Multiple Sclerosis Neurologist Workforce." International Journal of MS Care 20, no. 1 (2018): 35–43. http://dx.doi.org/10.7224/1537-2073.2016-044.
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Abstract Background: Anecdotal reports suggest shortages among neurologists who provide multiple sclerosis (MS) patient care. However, little information is available regarding the current and future supply of and demand for this neurologist workforce. Methods: We used information from neurologist and neurology resident surveys, professional organizations, and previously reported studies to develop a model assessing the projected supply and demand (ie, expected physician visits) of neurologists providing MS patient care. Model projections extended through 2035. Results: The capacity for MS patient visits among the overall neurologist workforce is projected to increase by approximately 1% by 2025 and by 12% by 2035. However, the number of individuals with MS may increase at a greater rate, potentially resulting in decreased access to timely and high-quality care for this patient population. Shortages in the MS neurologist workforce may be particularly acute in small cities and rural areas. Based on model sensitivity analyses, potential strategies to substantially increase the capacity for MS physicians include increasing the number of patients with MS seen per neurologist, offering incentives to decrease neurologist retirement rates, and increasing the number of MS fellowship program positions. Conclusions: The neurologist workforce may be adequate for providing MS care currently, but shortages are projected over the next 2 decades. To help ensure access to needed care and support optimal outcomes among individuals with MS, policies and strategies to enhance the MS neurologist workforce must be explored now.
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Gaughan, James, Panagiotis Kasteridis, Anne Mason, and Andrew Street. "Why are there long waits at English emergency departments?" European Journal of Health Economics 21, no. 2 (2019): 209–18. http://dx.doi.org/10.1007/s10198-019-01121-7.
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Abstract A core performance target for the English National Health Service (NHS) concerns waiting times at Emergency Departments (EDs), with the aim of minimising long waits. We investigate the drivers of long waits. We analyse weekly data for all major EDs in England from April 2011 to March 2016. A Poisson model with ED fixed effects is used to explore the impact on long (> 4 h) waits of variations in demand (population need and patient case-mix) and supply (emergency physicians, introduction of a Minor Injury Unit (MIU), inpatient bed occupancy, delayed discharges and long-term care). We assess overall ED waits and waits on a trolley (gurney) before admission. We also investigate variation in performance among EDs. The rate of long overall waits is higher in EDs serving older patients (4.2%), where a higher proportion of attendees leave without being treated (15.1%), in EDs with a higher death rate (3.3%) and in those located in hospitals with greater bed occupancy (1.5%). These factors are also significantly associated with higher rates of long trolley waits. The introduction of a co-located MIU is significantly and positively associated with long overall waits, but not with trolley waits. There is substantial variation in waits among EDs that cannot be explained by observed demand and supply characteristics. The drivers of long waits are only partially understood but addressing them is likely to require a multi-faceted approach. EDs with high rates of unexplained long waits would repay further investigation to ascertain how they might improve.
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Riegert, Monica, Monica Nandwani, Bonny Thul, et al. "Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients." Endoscopy International Open 08, no. 10 (2020): E1423—E1428. http://dx.doi.org/10.1055/a-1221-4546.
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Abstract Background and study aims The demand for screening colonoscopy has continued to rise over the past two decades. As a result, the current workforce of gastroenterologists is unable to meet the needs for colorectal cancer (CRC) screening. Therefore, solutions are needed to improve this disparity, with non-physician endoscopists being a potential option. However, current literature on the performance of non-physicians in endoscopy is limited. The aim of this study was to assess the quality of colonoscopy performed by three gastrointestinal fellowship-trained nurse practitioners (NPs). Methods This was a retrospective study performed at a single tertiary academic medical center. Colonoscopies performed by three gastrointestinal-specialized NPs after having completed training of at least 140 supervised colonoscopies were reviewed for analysis. Inclusion criteria were patients undergoing colonoscopy for colorectal cancer screening purposes. Outcomes included colonoscopy quality indicators as defined by the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Taskforce (ASGE/ACG) Taskforce. Results The study included 1,012 subjects (mean age 56.2 years, female 51.5 %, African American 73.9 %) who underwent screening colonoscopies by three NPs. Cecal intubation was successful in 997 subjects (98.5 %). Mean adenoma detection rate was 35.6 %. Mean withdrawal time was 18.9 minutes. There were no adverse events including colonic perforations or delayed post-polypectomy bleeding. Conclusions Three fellowship-trained NPs in colonoscopy in the United States satisfied the quality indicators proposed by the ASGE/ACG Task force, demonstrating that adequately trained NPs can perform colonoscopy safely and effectively. With the demand for colonoscopy exceeding the supply, non-physicians could be part of the solution to meet the demands for CRC screening.
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Gard, Anton, Bertil Lindahl, Gorav Batra, et al. "Interphysician agreement on subclassification of myocardial infarction." Heart 104, no. 15 (2018): 1284–91. http://dx.doi.org/10.1136/heartjnl-2017-312409.
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ObjectiveThe universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how often physicians agree in this classification and what factors lead to agreement or disagreement.MethodsA total of 1328 patients diagnosed with MI at eight different Swedish hospitals 2011 were included. All patients were retrospectively reclassified into different MI or myocardial injury subtypes by two independent specially trained physicians, strictly adhering to the third universal definition of MI.ResultsOverall, there was a moderate interobserver agreement with a kappa coefficient (κ) of 0.55 in this classification. There was substantial agreement when distinguishing type 1 MI (κ: 0.61), compared with moderate agreement when distinguishing type 2 MI (κ: 0.54). In multivariate logistic regression analyses, ST elevation MI (P<0.001), performed coronary angiography (P<0.001) and larger changes in troponin levels (P=0.023) independently made the physicians agree significantly more often, while they disagreed more often with symptoms of dyspnoea (P<0.001), higher systolic blood pressure (P=0.001) and higher C reactive protein levels on admission (P=0.016).ConclusionDistinguishing MI types is challenging also for trained adjudicators. Although strictly adhering to the third universal definition of MI, differentiation between type 1 MI, type 2 MI and myocardial injury only gave a moderate rate of interobserver agreement. More precise and clinically applicable criteria for the current classification, particularly for type 2 MI diagnosis, are urgently needed.
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Billah, Md Mostarshid, Hafiza Farzana, Abdul Latif, et al. "Knowledge and Attitude of Bangladeshi Physicians towards Organ Donation and Transplantation." Bangladesh Critical Care Journal 4, no. 1 (2016): 23–27. http://dx.doi.org/10.3329/bccj.v4i1.27975.
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Background: Organ transplantation saves thousands of lives worldwide. There is discrepancy between organ demand and supply which demands cadaveric donation. Knowledge and attitudes of physicians towards organ donation and transplantation can increase the rate of organ and tissue donation by motivating general population.Methodology: This cross-sectional survey was done on 150 Bangladeshi physicians including specialist and post-graduate students on four teaching hospitals in Dhaka, Bangladesh over a period of six months. After taking informed consent, the participants were given a self-administered questionnaire which includes socio-demographic data, knowledge and attitude about organ donation and transplantation.Results: Male and female were almost equal (Total 102, Male 54, female 48) with mean age was 34.6±5.0 years and 54.9% were specialists and 45.1% were post graduate students. More than 32% respondents were from Medicine, followed by Nephrology (26.5%), Critical Care Medicine (CCM) (25.5%) and Urology (15.6%). Fifty-six (54.9%) physicians agreed with organ donation after death. The most important reason of agreement was to help others (78.4%) and disagreement was religious fear (54.3%). More than 40% respondents agreed and 59.8% completely disagreed with living kidney donation. The most common reason for agreement of living kidney donation was to donate to help family member (82.93%) and disagreement was probable damage to donors (52.46%). More than three-fourth (76.4%) respondents had knowledge about theoretical basis of transplantation, 50% know about cost and 43% about organ transplant Act, Bangladesh. Significant positive correlation was found between physicians attitudes towards organ and tissue donation after death and knowledge about theoretical basis of transplantation (p =0.02, r= 0.43) and cost of transplantation in Bangladesh (p= 0.02, r= 0.22) but no statistically significant correlation with knowledge about organ transplant Act, Bangladesh (p value= 0. 19, r= 0.13) whereas significant positive correlation between physicians knowledge about transplant Act (p= 0.008, r= 0.28), cost (p = 0.04, r= 0.23) and theoretical basis of transplantation (p= 0.04, r= 0.20) was found in living kidney donation.Conclusion: Physicians had a good attitude towards organ donation and transplantation although less than half of them had knowledge of transplantation rules and financial issues; therefore, additional awareness and education of physicians is needed in all areas of the organ transplant process in Bangladesh to make organ donation and transplantation successful.Bangladesh Crit Care J March 2016; 4 (1): 23-27
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Schlag, Anne Katrin, David S. Baldwin, Michael Barnes, et al. "Medical cannabis in the UK: From principle to practice." Journal of Psychopharmacology 34, no. 9 (2020): 931–37. http://dx.doi.org/10.1177/0269881120926677.
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Background: In the UK, medical cannabis was approved in November 2018, leading many patients to believe that the medicine would now be available on the NHS. Yet, to date, there have been only 12 NHS prescriptions and less than 60 prescriptions in total. In marked contrast, a recent patient survey by the Centre for Medical Cannabis (Couch, 2020) found 1.4 m people are using illicit cannabis for medical problems. Aims: Such a mismatch between demand and supply is rare in medicine. This article outlines some of the current controversies about medical cannabis that underpin this disparity, beginning by contrasting current medical evidence from research studies with patient-reported outcomes. Outcomes: Although definite scientific evidence is scarce for most conditions, there is significant patient demand for access to medical cannabis. This disparity poses a challenge for prescribers, and there are many concerns of physicians when deciding if, and how, to prescribe medical cannabis which still need to be addressed. Potential solutions are outlined as to how the medical profession and regulators could respond to the strong demand from patients and families for access to medical cannabis to treat chronic illnesses when there is often a limited scientific evidence base on whether and how to use it in many of these conditions. Conclusions: There is a need to maximise both clinical research and patient benefit, in a safe, cautious and ethical manner, so that those patients for whom cannabis is shown to be effective can access it. We hope our discussion and outlines for future progress offer a contribution to this process.
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McCabe, Mary S., and Todd Alan Pickard. "Planning for the Future: The Role of Nurse Practitioners and Physician Assistants in Survivorship Care." American Society of Clinical Oncology Educational Book, no. 32 (June 2012): e56-e61. http://dx.doi.org/10.14694/edbook_am.2012.32.107.
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Overview: The number of cancer survivors in the United States now approaches 12 million individuals, with an estimated 7.2% of the general population aged 18 years or older reporting a previous cancer diagnosis. These figures highlight a number of questions about the care of survivors—how patients at risk for a known set of health problems should be followed, by whom, and for how long. At the same time that oncologists are developing strategies to provide services to this growing population, there are economic and systems challenges that have relevance to the previous questions, including a predicted national shortage of physicians to provide oncology services. Nurse practitioners (NPs) and physician assistants (PAs) have been identified as members of the health care team who can help reduce the oncology supply and demand gap in a number of ways. The ASCO Study of Collaborative Practice Arrangements (SCPA) in 2011 concluded that oncology patients were aware and satisfied when their care was provided by NPs and PAs; there was an increase in productivity in practices that utilized NPs and PAs; utilizing the full scope of practice of NPs and PAs was financially advantageous; and, physicians, NPs, and PAs are highly satisfied with their collaborative practices. Increasingly, the oncology and health policy literature contains evidence supporting innovative provider models. There is still much work to be done to move beyond pilot data to establish the true value of these models.
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Baggiano, Andrea, Marco Guglielmo, Giuseppe Muscogiuri, Andrea Igoren Guaricci, Alberico Del Torto, and Gianluca Pontone. "(Epicardial and microvascular) angina or atypical chest pain: differential diagnoses with cardiovascular magnetic resonance." European Heart Journal Supplements 22, Supplement_E (2020): E116—E120. http://dx.doi.org/10.1093/eurheartj/suaa075.
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Abstract Angina pectoris is a chest discomfort caused by myocardial ischaemia, and it is classified as ‘typical’ or ‘atypical’ if specific features are present. Unfortunately, there is a heterogeneous list of cardiac diseases characterized by this symptom as onset sign. Mostly, angina is due to significant epicardial coronary artery stenosis, which causes inadequate oxygen supply increase after raised myocardial oxygen demand. In the absence of significant epicardial stenoses, another potential cause of angina is microvascular dysfunction, related to inadequate response of resistance coronary vessels to vasodilator stimuli. The unique capability of cardiovascular magnetic resonance (CMR) in providing extremely detailed morphological and functional information, along with precise stress perfusion defects and wall motion abnormalities depiction, translates it into the test with one of the best diagnostic performance and prognostic stratification among non-invasive cardiac imaging modality. Moreover, CMR is also extremely accurate in detecting non-ischaemic cardiac causes of chest pain (such as myocardial and pericardial inflammation, or stress-related cardiomyopathy), and is very useful in helping physicians to correctly approach patients affected by chest pain.
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Martin, Stephen A., Scott H. Podolsky, and Jeremy A. Greene. "Overdiagnosis and overtreatment over time." Diagnosis 2, no. 2 (2015): 105–9. http://dx.doi.org/10.1515/dx-2014-0072.
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AbstractOverdiagnosis and overtreatment are often thought of as relatively recent phenomena, influenced by a contemporary combination of technology, specialization, payment models, marketing, and supply-related demand. Yet a quick glance at the historical record reveals that physicians and medical manufacturers have been accused of iatrogenic excess for centuries, if not millennia. Medicine has long had therapeutic solutions that search for ever-increasing diagnostic problems. Whether the intervention at hand has been leeches and lancets, calomel and cathartics, aspirins and amphetamines, or statins and SSRIs, medical history is replete with skeptical critiques of diagnostic and therapeutic enthusiasm. The opportunity cost of this profusion shapes the other side of the coin: chronic persistence of underdiagnosis and undertreatment. Drawing from key controversies of the 19th and 20th centuries, we chart the enduring challenges of inter-related diagnostic and therapeutic excess. As the present critique of overdiagnosis and overtreatment seeks to mobilize resources from inside and outside of medicine to rein in these impulses, we provide an instructive historical context from which to act.
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Holahan, A., J. Irwin, C. Honeywell, S. Kortstee, and P. Anderson. "P.132 Redesign of a neuropsychology service in a tertiary pediatric hospital (CHEO)." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, s2 (2018): S51. http://dx.doi.org/10.1017/cjn.2018.234.
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Background: Neuropsychological assessments are used in hospitals to examine brain-behaviour relationships, and are an integral part of care for medically complex patients. Unfortunately, waitlists can be lengthy. We gathered information regarding best-practice guidelines and physician referral patterns in an effort to better manage the neuropsychology waitlist at a pediatric hospital. Methods: We conducted: 1) A semi-structured telephone survey with 4 Canadian, pediatric, hospital-based neuropsychology services; 2) An electronic survey distributed to referring physicians at CHEO; 3) A focus group for CHEO neurologists and neurosurgeons. Results: The telephone survey indicated that there are no clear, best-practice guidelines for pediatric neuropsychologists working in a tertiary, pediatric hospital. The electronic survey revealed some confusion about neuropsychology services and indicated the need for better communication between neuropsychology and referral sources. The focus group revealed that demand for neuropsychology services far outstrips supply and confirmed the need for better communication. Conclusions: The results confirmed the need for best-practice guidelines to be developed around delivering neuropsychology services within a pediatric tertiary care setting, as well as continuing to work closely with neurology and neurosurgery to ensure that the neuropsychological needs of their patients are met.
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DAS, VEENA, and RANENDRA K. DAS. "URBAN HEALTH AND PHARMACEUTICAL CONSUMPTION IN DELHI, INDIA." Journal of Biosocial Science 38, no. 1 (2005): 69–82. http://dx.doi.org/10.1017/s002193200500091x.
Full textAbstract:
This paper interrogates the routine and unproblematic use of terms such as ‘self-medication’ in biomedical and anthropological discourse. A typical depiction of the social factors that explain the practice of ‘self-medication’ in India is to put together the supply side factors (such as protection offered by the government for the production of generic drugs, especially in the small scale sector, and expansion of the number of drug store outlets), with the increasing demand for allopathic drugs. The paper provides an ethnographic account of the intricate connections between households and biomedical practitioners in urban neighbourhoods in Delhi. It breaks away from the conventional opposition drawn between the practices of physicians and the beliefs of their patients, and suggests that what constitutes the medical environments of these neighbourhoods is the product of medical practices, household economies and concepts of disease. Thus pharmaceutical use is determined as much by practices of dispensation and by how practitioners understand what constitutes therapy as by household understanding of the normal and the pathological. This paper uses both quantitative data and narrative interviews to provide an in-depth understanding of the circulation of pharmaceuticals within the life worlds of the urban poor.
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Suh, Edward Hyun, David J. Bodnar, Laura D. Melville, Manish Sharma, and Brenna M. Farmer. "Crisis clinical pathway for COVID-19." Emergency Medicine Journal 37, no. 11 (2020): 700–704. http://dx.doi.org/10.1136/emermed-2020-209933.
Full textAbstract:
The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic. Relatively less has been given to the issue that precedes it: the demand on resources posed by patients who are not yet critically ill but are unwell enough to seek care in the ED. We describe here how at one institution, a cross-campus ED physician working group produced a care pathway to guide clinicians and ensure the fair and effective allocation of resources in the setting of the developing public health crisis. This ‘crisis clinical pathway’ focused on using clinical evaluation for medical decision making and maximising benefit to patients throughout the system.