Health Professions › Emergency Medical Services

Global Health Workforce Issues

Works Count: 94861

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This cluster of papers explores the challenges and solutions related to the rural health workforce, focusing on issues such as geographical imbalances, physician and nurse migration, retention strategies, recruitment programs, and the impact of these factors on global health and health policy. The research delves into the complexities of rural healthcare delivery, workforce shortages, and the implications for primary care in underserved areas.

Keywords

Rural Health; Health Workforce; Physician Migration; Nurse Migration; Retention Strategies; Geographical Imbalances; Health Policy; Recruitment Programs; Global Health; Primary Care Physicians

Implications of the California Nurse Staffing Mandate for Other States

2010-04-09

Linda H. Aiken , Douglas M. Sloane , Jeannie P. Cimiotti +5 more

Objectives. To determine whether nurse staffing in California hospitals, where state‐mandated minimum nurse‐to‐patient ratios are in effect, differs from two states without legislation and whether those differences are associated with … Objectives. To determine whether nurse staffing in California hospitals, where state‐mandated minimum nurse‐to‐patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes. Data Sources. Primary survey data from 22,336 hospital staff nurses in California, Pennsylvania, and New Jersey in 2006 and state hospital discharge databases. Study Design. Nurse workloads are compared across the three states and we examine how nurse and patient outcomes, including patient mortality and failure‐to‐rescue, are affected by the differences in nurse workloads across the hospitals in these states. Principal Findings. California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California‐mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. Conclusions. Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.

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Exposing some important barriers to health care access in the rural USA

2015-05-28

Nathan Douthit , Sakal Kiv , Tzvi Dwolatzky +1 more

Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce

2006-05-27

Gilles Dussault , Maria Cristina Franceschini

Abstract Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community … Abstract Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included.

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Unequal treatment: confronting racial and ethnic disparities in health care

2003-06-01

A. L. Nelson

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even … Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients’ and providers’ attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider–patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Variations in Medical Care among Small Areas

1982-04-01

John E. Wennberg , Alan M. Gittelsohn

The Libby Zion Case

1988-03-24

David A. Asch , Ruth M. Parker

The unexpected death of a young woman at the New York Hospital in 1984 prompted a series of regional investigations that have resulted in recommendations of profound changes in graduate … The unexpected death of a young woman at the New York Hospital in 1984 prompted a series of regional investigations that have resulted in recommendations of profound changes in graduate medical education. An initial proposal included the suggestion that work shifts be imposed to limit the long hours traditionally worked by house officers. Although this proposal was sparked by a single event, it did not occur in isolation; a variety of forces from inside and outside the profession gave it support. We examine the political and social pressures that urged the adoption of work shifts in the medical profession and . . .

The Metrics of the Physician Brain Drain

2005-10-26

Fitzhugh Mullan

There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less … There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians.Data on the countries of origin, based on countries of medical education, of international medical graduates practicing in the United States, the United Kingdom, Canada, and Australia were obtained from sources in the respective countries and analyzed separately and in aggregate. With the use of World Health Organization data, I computed an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration.International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. India, the Philippines, and Pakistan are the leading sources of international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean.Reliance on international medical graduates in the United States, the United Kingdom, Canada, and Australia is reducing the supply of physicians in many lower-income countries.

Global Supply of Health Professionals

2014-03-05

Nigel Crisp , Lincoln Chen

The world's need for and supply of health professionals are in flux. This article reviews the supply in relation to the demand for physicians and nurses around the world. The world's need for and supply of health professionals are in flux. This article reviews the supply in relation to the demand for physicians and nurses around the world.

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Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

2010-11-30

Julio Frenk , Lincoln Chen , Zulfiqar A Bhutta +7 more

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Minority Physicians’ Role in the Care of Underserved Patients

2013-12-30

Lyndonna Marrast , Leah Zallman , Steffie Woolhandler +2 more

Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research?

2008-03-04

Karly B. Smith , John Humphreys , M. G. A. Wilson

We reviewed evidence of any apparently significant 'rural-urban' health status differentials in developed countries, to determine whether such differentials are generic or nation-specific, and to explore the nature and policy … We reviewed evidence of any apparently significant 'rural-urban' health status differentials in developed countries, to determine whether such differentials are generic or nation-specific, and to explore the nature and policy implications of determinants underpinning rural-urban health variations. A comprehensive literature review of rural-urban health status differentials within Australia, New Zealand, Canada, the USA, the UK, and a variety of other western European nations was undertaken to understand the differences in life expectancy and cause-specific morbidity and mortality. While rural location plays a major role in determining the nature and level of access to and provision of health services, it does not always translate into health disadvantage. When controlling for major risk determinants, rurality per se does not necessarily lead to rural-urban disparities, but may exacerbate the effects of socio-economic disadvantage, ethnicity, poorer service availability, higher levels of personal risk and more hazardous environmental, occupational and transportation conditions. Programs to improve rural health will be most effective when based on policies which target all risk determinants collectively contributing to poor rural health outcomes. Focusing solely on 'area-based' explanations and responses to rural health problems may divert attention from more fundamental social and structural processes operating in the broader context to the detriment of rural health policy formulation and remedial effort.

The Burlington Randomized Trial of the Nurse Practitioner

1974-01-31

Walter O. Spitzer , David L. Sackett , John C. Sibley +7 more

Abstract From July, 1971, to July, 1972, in a large suburban Ontario practice of two family physicians, a randomized controlled trial was conducted to assess the effects of substituting nurse … Abstract From July, 1971, to July, 1972, in a large suburban Ontario practice of two family physicians, a randomized controlled trial was conducted to assess the effects of substituting nurse practitioners for physicians in primary-care practice. Before and after the trial, the health status of patients who received conventional care from family physicians was compared with the status of those who received care mainly from nurse practitioners. Both groups of patients had a similar mortality experience, and no differences were found in physical functional capacity, social function or emotional function. The quality of care rendered to the two groups seemed similar, as assessed by a quantitative "indicator-condition" approach. Satisfaction was high among both patients and professional personnel. Although cost effective from society's point of view, the new method of primary care was not financially profitable to doctors because of current restrictions on reimbursement for the nurse-practitioner services. (N Engl J Med 290:251–256, 1974)

Estimate of Current Hospice and Palliative Medicine Physician Workforce Shortage

2010-12-01

Dale Lupu

Trends In International Nurse Migration

2004-05-01

Linda H. Aiken , James Buchan , Julie Sochalski +2 more

Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater … Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.

Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention

2008-01-23

Uta Lehmann , Marjolein Dieleman , Tim Martineau

Many countries in middle- and low-income countries today suffer from severe staff shortages and/or maldistribution of health personnel which has been aggravated more recently by the disintegration of health systems … Many countries in middle- and low-income countries today suffer from severe staff shortages and/or maldistribution of health personnel which has been aggravated more recently by the disintegration of health systems in low-income countries and by the global policy environment. One of the most damaging effects of severely weakened and under-resourced health systems is the difficulty they face in producing, recruiting, and retaining health professionals, particularly in remote areas. Low wages, poor working conditions, lack of supervision, lack of equipment and infrastructure as well as HIV and AIDS, all contribute to the flight of health care personnel from remote areas. In this global context of accelerating inequities health service policy makers and managers are searching for ways to improve the attraction and retention of staff in remote areas. But the development of appropriate strategies first requires an understanding of the factors which influence decisions to accept and/or stay in a remote post, particularly in the context of mid and low income countries (MLICS), and which strategies to improve attraction and retention are therefore likely to be successful. It is the aim of this review article to explore the links between attraction and retention factors and strategies, with a particular focus on the organisational diversity and location of decision-making. This is a narrative literature review which took an iterative approach to finding relevant literature. It focused on English-language material published between 1997 and 2007. The authors conducted Pubmed searches using a range of different search terms relating to attraction and retention of staff in remote areas. Furthermore, a number of relevant journals as well as unpublished literature were systematically searched. While the initial search included articles from high- middle- and low-income countries, the review focuses on middle- and low-income countries. About 600 papers were initially assessed and 55 eventually included in the review. The authors argue that, although factors are multi-facetted and complex, strategies are usually not comprehensive and often limited to addressing a single or limited number of factors. They suggest that because of the complex interaction of factors impacting on attraction and retention, there is a strong argument to be made for bundles of interventions which include attention to living environments, working conditions and environments and development opportunities. They further explore the organisational location of decision-making related to retention issues and suggest that because promising strategies often lie beyond the scope of human resource directorates or ministries of health, planning and decision-making to improve retention requires multi-sectoral collaboration within and beyond government. The paper provides a simple framework for bringing the key decision-makers together to identify factors and develop multi-facetted comprehensive strategies. There are no set answers to the problem of attraction and retention. It is only through learning about what works in terms of fit between problem analysis and strategy and effective navigation through the politics of implementation that any headway will be made against the almost universal challenge of staffing health service in remote rural areas.

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Access to Medical Care for Black and White Americans

1989-01-13

Robert J. Blendon

A 1986 national survey of use of health services shows a significant deficit in access to health care among black compared with white Americans. This gap was experienced by all … A 1986 national survey of use of health services shows a significant deficit in access to health care among black compared with white Americans. This gap was experienced by all income levels of black Americans. In addition, the study points to significant underuse by blacks of needed medical care. Moreover, blacks compared with whites are less likely to be satisfied with the qualitative ways their physicians treat them when they are ill, more dissatisfied with the care they receive when hospitalized, and more likely to believe that the duration of their hospitalizations is too short. (<i>JAMA</i>1989;261:278-281)

Human resources for health: overcoming the crisis

2004-11-01

Lincoln Chen , Timothy Evans , Sudhir Anand +7 more

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Physician Race and Care of Minority and Medically Indigent Patients

1995-05-17

Ernest Moy

<h3>Objective.</h3> —To examine the relationship between physician race and care of racial minority and ethnic minority patients and medically indigent patients. <h3>Design.</h3> —Secondary analysis of data from the 1987 National … <h3>Objective.</h3> —To examine the relationship between physician race and care of racial minority and ethnic minority patients and medically indigent patients. <h3>Design.</h3> —Secondary analysis of data from the 1987 National Medical Expenditure Survey, a cross-sectional survey of Americans designed to provide national estimates of health care utilization and expenditures. <h3>Setting.</h3> —A sample representative of the total civilian noninstitutionalized US population with oversampling of minorities and the medically indigent. <h3>Patients.</h3> —Survey respondents aged 18 years or older who identified a specific physician as their usual source of care (n=15081, corresponding to a national population estimate of 116 million Americans). <h3>Main Outcome Measure.</h3> —Identification of a nonwhite physician as usual source of care. <h3>Results.</h3> —Of adult Americans who identified a usual-source-of-care physician, 14.4% identified a nonwhite physician as that source of care. Minority patients were more than four times more likely to receive care from nonwhite physicians than were non-Hispanic white patients. Low-income, Medicaid, and uninsured patients were also more likely to receive care from nonwhite physicians. Individuals who receive care from nonwhite physicians were more likely to report worse health, visit an emergency department, and be hospitalized. Individuals who receive care from nonwhite physicians reported more acute complaints, chronic conditions, functional limitations, and psychological symptoms as well as longer visits. <h3>Conclusions.</h3> —Nonwhite physicians are more likely to care for minority, medically indigent, and sicker patients. Caring for less affluent and sicker patients may financially penalize nonwhite physicians and make them particularly vulnerable to capitation arrangements. (<i>JAMA</i>. 1995;273:1515-1520)

What is a “Health Disparity”?

2002-09-01

Olivia Carter‐Pokras , Claudia R. Baquet

With the launch of Healthy People 2010 in January 2000, the Department of Health and Human Services (DHHS) committed the nation to an overarching goal, to “eliminate health disparities.” Like … With the launch of Healthy People 2010 in January 2000, the Department of Health and Human Services (DHHS) committed the nation to an overarching goal, to “eliminate health disparities.” Like the preceding Healthy People 2000 initiative, Healthy People 2010 outlines a comprehensive disease prevention and health promotion agenda. Although this goal has met with considerable support throughout the nation, upon further examination, it is clear that the term “health disparity” has been used with a number of very different meanings. Since the scope of the eliminating disparities goal for the DHHS Imitative to Eliminate Racial and Ethnic Disparities in Health is narrower than that of Healthy People 2010, discussion of the two goals in the same context can lead to confusion.

The Recent Surge In Nurse Employment: Causes And Implications

2009-01-01

Peter I. Buerhaus , David I. Auerbach , Douglas O. Staiger

Registered nurse (RN) employment has increased during the current recession, and we may soon see an end to the decade-long nurse shortage. This would give hospitals welcome relief and an … Registered nurse (RN) employment has increased during the current recession, and we may soon see an end to the decade-long nurse shortage. This would give hospitals welcome relief and an opportunity to strengthen the nurse workforce by addressing issues associated with an increasingly older and foreign-born workforce. The recent increase in employment is also improving projections of the future supply of RNs, yet large shortages are still expected in the next decade. Until nursing education capacity is increased, future imbalances in the nurse labor market will be unavoidable.

Identifying factors for job motivation of rural health workers in North Viet Nam

2003-11-05

Marjolein Dieleman , Cuong Pham , Le Vu Anh +1 more

BACKGROUND: In Viet Nam, most of the public health staff (84%) currently works in rural areas, where 80% of the people live. To provide good quality health care services, it … BACKGROUND: In Viet Nam, most of the public health staff (84%) currently works in rural areas, where 80% of the people live. To provide good quality health care services, it is important to develop strategies influencing staff motivation for better performance. METHOD: An exploratory qualitative research was carried out among health workers in two provinces in North Viet Nam so as to identify entry points for developing strategies that improve staff performance in rural areas. The study aimed to determine the major motivating factors and it is the first in Viet Nam that looks at health workers' job perception and motivation. Apart from health workers, managers at national and at provincial level were interviewed as well as some community representatives. RESULTS: The study showed that motivation is influenced by both financial and non-financial incentives. The main motivating factors for health workers were appreciation by managers, colleagues and the community, a stable job and income and training. The main discouraging factors were related to low salaries and difficult working conditions. CONCLUSION: Activities associated with appreciation such as performance management are currently not optimally implemented, as health workers perceive supervision as control, selection for training as unclear and unequal, and performance appraisal as not useful. The kind of non-financial incentives identified should be taken into consideration when developing HRM strategies. Areas for further studies are identified.

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Evaluated strategies to increase attraction and retention of health workers in remote and rural areas

2010-05-01

Carmen Dolea , Laura Stormont , Jean-Marc Braichet

The lack of health workers in remote and rural areas is a worldwide concern. Many countries have proposed and implemented interventions to address this issue, but very little is known … The lack of health workers in remote and rural areas is a worldwide concern. Many countries have proposed and implemented interventions to address this issue, but very little is known about the effectiveness of such interventions and their sustainability in the long run. This paper provides an analysis of the effectiveness of interventions to attract and retain health workers in remote and rural areas from an impact evaluation perspective. It reports on a literature review of studies that have conducted evaluations of such interventions. It presents a synthesis of the indicators and methods used to measure the effects of rural retention interventions against several policy dimensions such as: attractiveness of rural or remote areas, deployment/recruitment, retention, and health workforce and health systems performance. It also discusses the quality of the current evidence on evaluation studies and emphasizes the need for more thorough evaluations to support policy-makers in developing, implementing and evaluating effective interventions to increase availability of health workers in underserved areas and ultimately contribute to reaching the United Nations' Millennium Development Goals.

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How to bridge the gap in human resources for health

2004-10-01

Charles Hongoro , Barbara McPake

Migration of health-care workers from developing countries: strategic approaches to its management.

2004-08-01

Barbara Stilwell , Khassoum Diallo , Pascal Zurn +3 more

Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. The rise in the number of people … Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries. Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration.

Primary Care Physicians Who Treat Blacks and Whites

2004-08-04

Peter B. Bach , Hoangmai H. Pham , Deborah Schrag +2 more

In the United States, black patients generally receive lower-quality health care than white patients. Black patients may receive their care from a subgroup of physicians whose qualifications or resources are … In the United States, black patients generally receive lower-quality health care than white patients. Black patients may receive their care from a subgroup of physicians whose qualifications or resources are inferior to those of the physicians who treat white patients.

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A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas

2009-06-12

Nathan Wilson , Ian Couper , Elma De Vries +3 more

Introduction: The shortage of healthcare professionals in rural communities is a global problem that poses a serious challenge to equitable healthcare delivery. Both developed and developing countries report geographically skewed … Introduction: The shortage of healthcare professionals in rural communities is a global problem that poses a serious challenge to equitable healthcare delivery. Both developed and developing countries report geographically skewed distributions of healthcare professionals, favouring urban and wealthy areas, despite the fact that people in rural communities experience more health related problems. This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas. Methods: A comprehensive search of the English literature was conducted using the National Library of Medicine's (PubMed) database and the keywords '(rural OR remote) AND (recruitment OR retention)' on 3 July 2008. In total, 1261 references were identified and screened; all primary studies that reported the outcome of an actual intervention and all relevant review articles were selected. Due to the paucity of prospective primary intervention studies, retrospective observational studies and questionnaire-driven surveys were included as well. The search was extended by scrutinizing the references of selected articles to identify additional studies that may have been missed. In total, 110 articles were included. Results: In order to provide a comprehensive overview in a clear and user-friendly fashion, the available evidence was classified into five intervention categories: Selection, Education, Coercion, Incentives and Support - and the strength of the available evidence was rated as convincing, strong, moderate, weak or absent. The main definitions used to define 'rural and/or remote' in the articles reviewed are summarized, before the evidence in support of each of the five intervention categories is reflected in detail. Conclusion: We argue for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy. Key words: equity, health professionals, inequitable distribution, interventions, recruitment, retention, rural doctors.

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The importance of human resources management in health care: a global context

2006-07-27

Stefane Kabene , Carole Orchard , John M. Howard +2 more

This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care … This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. We explored the published literature and collected data through secondary sources. Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

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Do Patients Choose Physicians Of Their Own Race?

2000-07-01

Somnath Saha , Sara H. Taggart , Miriam Komaromy +1 more

This study seeks to determine whether minority Americans tend to see physicians of their own race as a matter of choice or simply because minority physicians are more conveniently located … This study seeks to determine whether minority Americans tend to see physicians of their own race as a matter of choice or simply because minority physicians are more conveniently located within predominantly minority communities. Using data from the Commonwealth Fund 1994 National Comparative Survey of Minority Health Care, we found that black and Hispanic Americans sought care from physicians of their own race because of personal preference and language, not solely because of geographic accessibility. As minority populations continue to grow, the demand for minority physicians is likely to increase. Keeping up with this demand will require medical school admissions policies and physician workforce planning to include explicit strategies to increase the supply of underrepresented minority physicians.

Health workforce skill mix and task shifting in low income countries: a review of recent evidence

2011-01-11

Brent D. Fulton , Richard M. Scheffler , Susan Sparkes +3 more

Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly … Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda.Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence.First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred.Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.

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Health worker motivation in Africa: the role of non-financial incentives and human resource management tools

2006-08-29

Inke Mathauer , Ingo Imhoff

There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and … There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya.The study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software.The study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM) tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers.The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the professional ethos of doctors and nurses. This entails acknowledging their professionalism and addressing professional goals such as recognition, career development and further qualification. It must be the aim of human resources management/quality management (HRM/QM) to develop the work environment so that health workers are enabled to meet their personal and the organizational goals.

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Rural Definitions for Health Policy and Research

2005-06-28

L. Gary Hart , Eric H. Larson , Denise M. Lishner

The term "rural" suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density.However, defining "rural" for health policy and research purposes requires researchers … The term "rural" suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density.However, defining "rural" for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places-differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of "rural" is required for effectively targeting policy and research aimed at improving the health of rural Americans.

Addressing Nurse Shortages: What can Policy Makers Learn from the Econometric Evidence on Nurse Labour Supply?

2004-10-18

Michael A. Shields

This paper provides a detailed review of the international studies that have used formal econometric models to investigate the labour supply decision of Registered Nurses (RNs). The main finding is … This paper provides a detailed review of the international studies that have used formal econometric models to investigate the labour supply decision of Registered Nurses (RNs). The main finding is that, at least in the short‐run, RN labour supply appears to be fairly unresponsive to wage changes. Consequently, even large wage increases are unlikely to be successful in tackling current and predicted nurse shortages. This finding points to the importance of non‐pecuniary job aspects in influencing labour supply. However, the paper concludes by arguing that these empirical findings should be viewed with some caution given both theoretical and econometric limitations.

The Role of Black and Hispanic Physicians in Providing Health Care for Underserved Populations

1996-05-16

Miriam Komaromy , Kevin Grumbach , Michael V Drake +4 more

Patients who are members of minority groups may be more likely than others to consult physicians of the same race or ethnic group, but little is known about the relation … Patients who are members of minority groups may be more likely than others to consult physicians of the same race or ethnic group, but little is known about the relation between patients' race or ethnic group and the supply of physicians or the likelihood that minority-group physicians will care for poor or black and Hispanic patients.

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Geographic Variation, Speciation, and Clines.

1978-12-01

G. L. Bush , John A. Endler

WHO Statement on caesarean section rates

2015-01-01

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SOCIAL SCIENCE AND MEDICINE

1955-06-01

Manjunatha Vishwanath

Geographic Variation, Speciation and Clines

1978-08-01

Beryl B. Simpson , John A. Endler

Global nurse shortages—the facts, the impact and action for change

2019-04-02

Vari Drennan , Fiona Ross

Nurses comprise half the global health workforce. A nine million shortage estimated in 2014 is predicted to decrease by two million by 2030 but disproportionality effect regions such as Africa. … Nurses comprise half the global health workforce. A nine million shortage estimated in 2014 is predicted to decrease by two million by 2030 but disproportionality effect regions such as Africa. This scoping review investigated: what is known about current nurse workforces and shortages and what can be done to forestall such shortages?Published documents from international organisations with remits for nursing workforces, published reviews with forward citation and key author searches.Addressing nurse shortages requires a data informed, country specific model of the routes of supply and demand. It requires evidence informed policy and resource allocation at national, subnational and organisation levels.The definition in law, type of education, levels and scope of practice of nurses varies between countries raising questions of factors and evidence underpinning such variation. Most policy solutions proposed by international bodies draws on data and research about the medical workforce and applies that to nurses, despite the different demographic profile, the work, the career options, the remuneration and the status.Demand for nurses is increasing in all countries. Better workforce planning in nursing is crucial to reduce health inequalities and ensure sustainable health systems.Research is needed on: the nursing workforce in low income countries and in rural and remote areas; on the impact of scope of practice and task-shifting changes; on the impact over time of implementing system wide policies as well as raising the profile of nursing.

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United States Life Tables, 2019.

2022-03-01

Elizabeth Arias , Jiaquan Xu

This report presents complete period life tables for the United States by Hispanic origin, race, and sex, based on age-specific death rates in 2019. Starting with the 2019 data year, … This report presents complete period life tables for the United States by Hispanic origin, race, and sex, based on age-specific death rates in 2019. Starting with the 2019 data year, this report adds life tables for the non-Hispanic American Indian or Alaska Native (AIAN) and non-Hispanic Asian populations.

Rural and remote health

2009-01-01

Jennene Greenhill

Geographic Variations in Health Care

2014-09-03

Variations in hysterectomy rates are relatively high, in a context of declining use of this intervention.The prevalence of hysterectomy is 75% higher in Canada and Germany (above 350 per 100 … Variations in hysterectomy rates are relatively high, in a context of declining use of this intervention.The prevalence of hysterectomy is 75% higher in Canada and Germany (above 350 per 100 000 females) than in Israel, Spain, Portugal or the Czech Republic.Most countries have two-to three-fold variation across geographic areas.Canada and the Czech Republic have higher levels of variation (close to four-fold), due to some high extreme values in certain areas.Hospital medical admissions rates are twice as high in Israel, Germany or Australia (around 12 000 per 10 000 population) than in Canada.While within-country variations are lower than for other procedures, Canada, Australia, Finland and England display the highest levels of variation (ranging from 2.4 to 3.6-fold), partly due to outlying regions.Caesarean section rates are as much as 50% higher in Italy, Portugal, Australia, Switzerland and Germany (above 300 per 1 000 live births) than in Finland.Withincountry variations are relatively low, except in Italy where caesarean section rates vary by six-fold across regions.Rates of admissions/surgery after hip fracture are about twice as high in Germany and Switzerland (more than 150 per 100 000 population) than in Belgium and Finland.Most countries have low variation across geographic areas (less than two-fold variation), with Australia having the highest levels of within-country variation (five-fold).In Australia, the wide variation is due to an extremely high value in one Medicare Local.Some of the variations observed might be due to differences in health needs, not totally captured by demographic adjustments, or by differences in patient preferences.Others are explained by differences in the supply of services or variations in medical practices.These supply-related variations are deemed to be unwarranted and should be addressed to improve health system performance.1.

Addressing Gaps in Health Care Delivery Among Asian Americans Through Community-Driven Policy Action

2025-06-25

Keith Chan , Emerson Ea , Aparna Kalbag +5 more | American Journal of Public Health

We describe the application of community engagement in addressing priorities and gaps in health care delivery among Asian American populations through community-driven action, resulting in the development of two policy … We describe the application of community engagement in addressing priorities and gaps in health care delivery among Asian American populations through community-driven action, resulting in the development of two policy briefs to be disseminated to policymakers at the local, state, and national levels. The policy briefs highlighted (1) gaps in mental health research and culturally tailored mental health education programs and care and (2) an overall gap in culturally and linguistically tailored evidence-based health care delivery among Asian American populations. ( Am J Public Health. 2025;115(S2):S134–S137. https://doi.org/10.2105/AJPH.2025.308027 )

Collaborators in Health: Redefining Research–Community Partnerships, Chicago, 2022–2024

2025-06-25

Elizabeth B. Lynch , Santosh Basapur , Doriane Miller +7 more | American Journal of Public Health

Effective community-engaged research is critical for designing and testing solutions to decrease the 10-year life expectancy gap between Black and non-Black residents of Chicago, Illinois. In community listening sessions, the … Effective community-engaged research is critical for designing and testing solutions to decrease the 10-year life expectancy gap between Black and non-Black residents of Chicago, Illinois. In community listening sessions, the Chicago Chronic Conditions Engagement Network found that community members’ highest priority health issues were social determinants of health and that there is a strong mistrust of research. Conversations with leaders of community organizations addressing social determinants of health suggest strategies to help researchers overcome mistrust and build effective community–research partnerships. ( Am J Public Health. 2025;115(S2):S130–S133. https://doi.org/10.2105/AJPH.2025.308082 )

Analysis of medical student regional profile data to advance social accountability

2025-06-25

Jordyn N. Linders , Sierra A. Land , Kady Carr +2 more | Education for Health

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Factors Affecting Access to Free Surgical Care in Global Surgical Crisis

2025-06-24

D. Adesida , L. Cheng , Gary Parker | International Journal of Oral and Maxillofacial Surgery

Geographic and Socioeconomic Disparities in Robotic Spine Surgery Access in the Continental United States: A Cross-Sectional Ecological Analysis

2025-06-24

Paul G. Mastrokostas , Leonidas E. Mastrokostas , Ahmed K. Emara +7 more | Global Spine Journal

Study Design Cross-sectional ecological analysis. Objectives This study aims to assess the availability of robotic spine surgery across the United States and identify disparities in access. Methods We utilized provider-finding … Study Design Cross-sectional ecological analysis. Objectives This study aims to assess the availability of robotic spine surgery across the United States and identify disparities in access. Methods We utilized provider-finding functions from major medical equipment manufacturers to identify robotic spine surgeons and categorized affiliated hospitals. Geospatial analyses combined with socioeconomic indicators, Rural-Urban Continuum Codes, and the Area Deprivation Index (ADI) provided insights into access disparities. Multivariate logistic regression and Student’s t-tests were used to identify county-level variables associated with hotspots and coldspots. Statistical significance was set at the P < .05 level. Results Ninety-one robotic spine surgeons were identified. Robotic spine surgeons were predominantly affiliated with nonteaching hospitals (50.55%), followed by minor teaching (38.46%) and major teaching (10.99%) hospitals. Access hotspots are in the Northeast and Southeast, with rural areas showing 22% lower odds of being hotspots (OR = 0.78, P < .001). Factors increasing the odds of being a hotspot include higher disability prevalence (OR = 1.19, P < .001), lack of insurance (OR = 1.18, P < .001), and older median age (OR = 1.17, P < .001). Educational attainment and ADI, despite being significant, had lower predictive values for access. Conclusions Disparities in access to robotic spine surgery are associated with socioeconomic, demographic, and geographic factors. The concentration of surgeons in nonteaching hospitals and higher-income areas may reflect market dynamics. Efforts to improve access should consider regional resources, hospital type, and community disadvantage.

Internationally educated nurses’ experiences of recruitment - An ethical perspective

2025-06-24

Pauliina Oja-Lipasti , Anne Oikarinen , Suleiman Kamau +3 more | Nursing Ethics

Background: International migration among nurses in the healthcare workforce has increased significantly, with the number of internationally educated nurses in higher-income OECD countries doubling since 2000. These nurses frequently encounter … Background: International migration among nurses in the healthcare workforce has increased significantly, with the number of internationally educated nurses in higher-income OECD countries doubling since 2000. These nurses frequently encounter challenges with competence recognition and obtaining local licences, which can hinder their ability to work effectively. Additionally, they often face misleading job information, discrimination, and exploitation, underscoring the urgent need for ethical recruitment and employment practices. Aim: The aim is to describe internationally educated nurses’ experiences of recruitment to Finland, focussing on ethical considerations. Methods: A qualitative study design was employed to explore nurses’ experiences. Data were collected in spring and summer 2024 from 22 internationally educated registered nurses with degrees from outside the EU, who were either working in healthcare or completing a top-up nursing degree in Finland. Content analysis was employed to examine the data, revealing ten key categories associated with ethical recruitment. Ethical considerations: A research permit was obtained from the university overseeing the study. The researchers ensured that all procedures adhered to ethical research standards, including obtaining participants’ informed consent and maintaining the confidentiality of the data. Results: The findings revealed a spectrum of experiences, from supportive practices to notable challenges. Key themes emerged related to the recruitment process, linguistic and cultural adaptation, and workplace integration. Positive encounters included supportive recruitment companies and structured orientation programs, while significant difficulties involved unmet contractual promises, inadequate language support, and cultural barriers. Conclusions: Difficulties with learning Finnish and cultural adaptation impede integration, underscoring the need for employers to provide robust language training and adopt ethical practices. Enhanced support systems are crucial to improving the integration and job satisfaction of internationally educated nurses in Finland.

The Role of Leadership Support for Career-Inclusion in Service-Delivery at Level-6 Hospitals in Kenya

2025-06-24

Christine Mwikali Musee , Paul Kariuki , Magdalene Ndeto | International Journal of Geopolitics and Governance

Work plays a critical role in life satisfaction for employees with disability. Career-inclusion facilitates them in service-delivery through capacity-adjusted deployment, empowerment, and job match. Leadership support for career-inclusion had not … Work plays a critical role in life satisfaction for employees with disability. Career-inclusion facilitates them in service-delivery through capacity-adjusted deployment, empowerment, and job match. Leadership support for career-inclusion had not been researched and its influence on service-delivery from employees with disability in level-6 hospitals in Kenya, thus this research. The objective was to establish the influence of career-inclusion on service-delivery at level-6 hospitals in Kenya. It was cross-sectional research, using two questionnaires and an observation checklist. The target populations were 229 employees with disability and 229 supervisors sampled by census from five purposively selected hospitals. Data analysis was done using SPSS version 29 and N-Vivo version 15 for quantitative and qualitative data, respectively, and Pearson’s correlation coefficients and ANOVA to test associations and hypotheses, with a cut-off of p-value < 0.05 indicating significance. The response rate for employees with disability was 211 (92.1%) and 196 (85.6%) for supervisors. Career-inclusion contributes 46% (R².460) positive change in service-delivery with an F statistic of 151.472 and a significant p-value of 0.000 < 0.05. being greater than the critical value of 3.909 at a significant p-value of 0.000 <0.05. Thus, the null hypothesis, ‘career-inclusion has no significant influence on service-delivery at level-6 hospitals in Kenya,’ was rejected. A respondent with disability said, “…my deployment was adjusted…capacity initially… I have since been transferred…I am not happy…I have not been promoted for a long time…there is no work-adjusted hours or schedules…some tasks allocated are okay, but others cause…strain…” In conclusion, employees with disability are uniquely talented and have potential that can be exploited through leadership support for career-inclusion, backed by evidence to dissipate misconceptions. Career-inclusion has a positive influence on service delivery from employees with disability. Leaders need to improve career-inclusion by addressing the paucity of timely data, barriers to inclusion, and providing evidence to showcase the contributions of employees with disability and the importance of offering them support. Intentional regular creation of awareness is invaluable.

Twenty-five years of Alabama’s Rural Health Leaders Pipeline: what difference has it made?

2025-06-24

John R. Wheat | Frontiers in Medicine

Introduction This community case report describes the Alabama Rural Health Leaders Pipeline operated as a demonstration research project, 1993–2017, tests of its effectiveness, and supportive studies. The purpose was to … Introduction This community case report describes the Alabama Rural Health Leaders Pipeline operated as a demonstration research project, 1993–2017, tests of its effectiveness, and supportive studies. The purpose was to demonstrate production of physicians for Alabama’s diverse rural population. The community-centric conceptual model was operationalized as two precollege summer pipeline programs and a master’s in rural community health/rural medicine track that engaged 1,045 rural Alabama students over 25 years: 651 Rural Health Scholars after 11th grade, 174 Rural Minority Health Scholars after the 12th, and 220 Rural Medical Scholars in the combined MS/MD track. Rural students, rural community-based instruction, family medicine instructors, and community engagement were key components. Method Review of Rural Health Leaders Pipeline publications. Four papers evaluated medical student academic performance, specialty choice, geographic location of practice, and production of other health professionals. Sixteen explored (a) factors associated with limited physician distribution in the Black Belt and (b) circumstances that engaged institutional and community collaborators in program development. Findings Compared to peers in traditional medical education, rural medical track alumni more frequently chose family medicine specialty ( p &lt; 0.001, OR = 15.6) and rural Alabama practice ( p &lt; 0.001, OR = 6.4) with no difference in academic performance ( p &gt; 0.05). Few rural medical track alumni established practice in the Black Belt, with many hypothetical factors identified. RHLP also produced other health professionals. Contextual studies engaged local physicians, institutional colleagues, school systems, the agricultural community, and health care entities in planning, collaboration, and advocacy regarding rural adaptations of admissions, curriculum, pedagogy, and educational context. Discussion The demonstration proved successful across much of rural Alabama, gained continuing state funding, and was institutionalized and expanded in the University of Alabama System. Further expansion is required to meet rural needs. Limited impact in the Black Belt remains a challenge for rural medical education and provides opportunities for future research.

Factors associated with James Cook University medical students experiencing âhigh qualityâ clinical learning on final-year rural placement

2025-06-24

Brooke Mackie , Torres Woolley , Aaron Hollins +1 more | Rural and Remote Health

The James Cook University (JCU) medical school in Australia has a mission to produce graduates committed and competent to practise in local regional, rural and remote areas. As positive rural … The James Cook University (JCU) medical school in Australia has a mission to produce graduates committed and competent to practise in local regional, rural and remote areas. As positive rural placement experiences are known to enhance interest in a rural career and generalist medicine, this study explores key factors contributing to JCU medical students having a 'high quality' rural clinical learning experience during their final-year rural placement. This sequential, explanatory mixed-methods study included four focus groups (n=17) and a one-on-one interview followed by a cross-sectional survey (n=71; response rate=45%) of final-year JCU medical students in 2023. The main outcome variable for the survey was a visual analogue scale question asking students to rate the clinical learning environment on their rural placement, while an open-ended question asked if and how clinical learning received on placement differed depending upon the background training of their supervising doctor. In the focus groups, students were asked to identify on a circle diagram all key components that impacted on having a good or bad clinical learning experience on their placement, and then to explain individually and discuss as a group the contexts around each component. Overall, 46% of students completing the survey reported their rural placement was of high clinical learning value (≥85/100 on the visual analogue scale). Quantitative analysis identified 'high value' clinical learning placements were predicted by students spending >50% of their placement learning in EDs (p=0.005; prevalence odds ratio (POR) 9.4), having 'very high' confidence in knowing how to manage the common presentations of North Queensland patients (p=0.006; POR 8.5) and being placed in small towns more than 100 km from the populated North Queensland coast. Student focus group participants consistently reported they received the best teaching from local doctors who were more permanently based in that community, had significant experience in rural medicine, and were familiar with their competency level as a sixth-year student and their learning objectives on rural placement. Overall, the key areas impacting students' clinical learning on rural placement can be summarized as 'quality teaching/supervision', 'appropriate levels of autonomy', 'appropriate clinical variety and workload' and 'student factors'. The study findings suggest the key to JCU medical students having 'high quality' clinical learning on rural placements is by developing supportive learning relationships with senior, permanently based rural doctors who are willing to teach and know their scope of practice and specific placement learning requirements; and experiencing a diverse roster across hospital, GP and outreach clinics but with significant placement time in the ED. Potentially, these findings may assist rural placement programs coordinators to better plan, develop and support training sites and thus improve future placement experiences for student and junior doctor trainees. These improved learning experiences may in turn lead to more positive rural experiences that may further increase trainees' interest in rural and/or generalist medicine careers.

Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education

2025-06-24

Cheryl L. Holmes , Laura Yvonne Bulk , Naomi Lear +7 more | Academic Medicine

Abstract A socially accountable physician workforce must include disabled learners and providers. However, current Canadian Technical Standards (TS) for medical school admissions create barriers to their inclusion. These standards overlook … Abstract A socially accountable physician workforce must include disabled learners and providers. However, current Canadian Technical Standards (TS) for medical school admissions create barriers to their inclusion. These standards overlook advances in assistive technology, universal design, evolving inclusion practices, and legal protections. Replacing the TS required consensus, but traditional methods of achieving consensus on disability inclusion risk reinforcing ableism in medical education. To address challenges with existing TS, the Association of Faculties of Medicine of Canada (AFMC) formed the “Re-envisioning TS Working Group,” using a novel consensus approach grounded in disability inclusion and critical disability discourse. Guided by transparency, accessibility, and respect for disability as diversity, the group prioritized engagement with disabled physicians, educators, scholars, and learners. The WG followed five stages: (1) identifying key concepts and reviewing literature on TS reform and ableism; (2) examining relevant legislation and case law; (3) drafting functional Core Competencies; (4) consulting partners across the medical education continuum; and (5) presenting outcomes to the AFMC Board, highlighting a commitment to disability inclusion in undergraduate medical education. The AFMC Board unanimously endorsed the “Report on Re-Envisioning Technical Standards,” including the “Desired Outcomes” and the “Core Competencies for Entering Medical Students.” The AFMC’s adoption of functional Core Competencies is a significant step toward inclusion and support for learners with disabilities in Canadian medical education. Medical schools should adopt these competencies, combat ableism, and invest in universal design to promote access. Accommodation support should extend from admission through postgraduate training to independent practice. Finally, efforts to foster an inclusive culture and contribute to a healthy, diverse physician workforce must be evaluated as part of medical schools' social accountability mandate.

Cultural Barriers and Obstruction to Free Surgical Care in West Africa

2025-06-24

D. Adesida , L. Cheng , George A. Parker | International Journal of Oral and Maxillofacial Surgery

Comparing Indian Health Service Sites to Rural Physician Teaching Hospitals

2025-06-23

Matthew Tobey , Mukesh Adhikari , Mark Holmes +3 more | JAMA Internal Medicine

This cross-sectional study compares characteristics of Indian Health Services hospitals and rural hospitals with Graduate Medical Education programs. This cross-sectional study compares characteristics of Indian Health Services hospitals and rural hospitals with Graduate Medical Education programs.

Exploring fellowship programs

2025-06-23

Tracy Jones-Darnell | Nursing

Navigating Dual Roles: Understanding the Experiences of Pregnant Students Juggling Academia and Parenthood at a University in Western Uganda

2025-06-23

Aisha Namubiru , Maliko Kisembo , Dina Kabazira +2 more | East African Journal of Arts and Social Sciences

This study explored the experiences of pregnant students balancing academic responsibilities and impending parenthood at Mountains of the Moon University, a diverse institution with a growing need to promote inclusivity. … This study explored the experiences of pregnant students balancing academic responsibilities and impending parenthood at Mountains of the Moon University, a diverse institution with a growing need to promote inclusivity. Recognising the intersectionality of these dual roles, the research investigated the challenges faced by pregnant students, their coping mechanisms, and the support structures available to them. A qualitative approach was employed, using in-depth interviews and focus group discussions to gather rich data from 10 pregnant students, 5 student mothers (recently delivered within 3 months), the Dean of Students, the university nurse, and the university counsellor, all purposively selected. Findings indicate that pregnant students face academic, social, and emotional challenges, including physical discomfort, stigma, and limited institutional support. Despite these hurdles, they exhibit resilience through peer and family support, personal motivation, and self-care practices. However, the lack of explicit institutional policies such as maternity leave, flexible academic schedules, special examinations, and alternative assessments was cited as a major constraint. Participants stressed the value of informal support systems while revealing gaps in university structures and practices. The study recommends that universities adopt customised policies to accommodate pregnant students' unique needs. It also advocates for faculty and staff training to foster a more empathetic and inclusive academic environment. Furthermore, establishing comprehensive support programs, including counselling services and peer networks, is essential to empower this group. By implementing these measures, institutions can create a more equitable and supportive academic landscape, enabling pregnant students to thrive while managing the responsibilities of motherhood

Regional policy toolkits for the reintegration of war veterans into socio-labor relations

2025-06-23

Olha Levytska , Ольга МУЛЬСКА | Scientific Messenger of LNU of Veterinary Medicine and Biotechnologies

The article identifies the key problems and shortcomings of regional policy for the socio-labor reintegration of war veterans (based on the case of Lviv region). It is established that the … The article identifies the key problems and shortcomings of regional policy for the socio-labor reintegration of war veterans (based on the case of Lviv region). It is established that the main challenges of socio-labor reintegration in the region include: weak cooperation between local governments, businesses, and civil society organizations in ensuring the protection of the rights and freedoms of war veterans and their families; low willingness (motivation) of local employers to adapt workplaces for people with disabilities (including war veterans) or to create new jobs suitable for socially vulnerable groups; a low level of awareness among veterans about available vacancies and in-demand sectors of the labor market; and age-related barriers for servicemen returning to employment. The study substantiates that effective reintegration of war veterans into civilian life requires the implementation of institutional-administrative and economic instruments. These include modernizing information support systems to integrate veterans into regional programs and grant-based initiatives for business start-ups and retraining; motivating employers to create inclusive workplaces and adapt existing jobs for veterans; developing virtual employment options and electronic databases to facilitate veterans’ adaptation; and implementing flexible employment policies, including the ratification of international conventions and the establishment of a social insurance system for veteran freelancers. The article also proves that the transformation of new forms of employment in Ukraine reflects value-oriented changes among employers toward integrating war veterans into socio-labor relations, particularly through practices such as outsourcing, fixed-term contracts, and other non-standard forms of employment.

Overseas doctors are choosing US and Australia over UK for better pay and quality of life

2025-06-23

Matthew Limb | BMJ

Physicians in Training, Communities in Need—Reimagining GME Policy for the Indian Health Service

2025-06-23

Eve J. Higginbotham , Roy Wade | JAMA Internal Medicine

Understanding the Complexities of Recruitment and Retention of Allied Health Professionals in Rural Health Settings: A qualitative study

2025-06-23

Jane George , Nicola Kayes , Peter Larmer | Research Square (Research Square)

<title>Abstract</title> Background Rural and remote communities in Aotearoa New Zealand face significant challenges in recruiting and retaining Allied Health Professionals (AHPs). While targeted investment exists to increase the numbers of … <title>Abstract</title> Background Rural and remote communities in Aotearoa New Zealand face significant challenges in recruiting and retaining Allied Health Professionals (AHPs). While targeted investment exists to increase the numbers of doctors and nurses entering the rural workforce, comparatively little has been done for the professions that make up the Allied Health Scientific and Technical collective. This study aimed to explore factors that influence AHPs’ decisions to work and remain in rural settings. Methods Drawing on Interpretive Descriptive methodology, semi-structured interviews were conducted with 18 AHPs from diverse professions, ethnicities and geographical locations across Aotearoa who had experience working in rural and/or remote settings. Interviews explored participants’ career journeys, their experiences of rural practice, and factors influencing their employment decisions. Data were analysed using Reflexive Thematic Analysis. Results Three key themes were constructed: (1) Sense of Connection and Belonging, highlighting the importance of feeling connected to teams, community and place; (2) Safe and Supported Practice, emphasising appropriate resources, professional development, and leadership relationships; (3) Creating Roles People Want to Come For, encompassing recruitment experiences, variety of work, growth pathways and scope of practice. These themes were infused with a concept of ‘Fit’, a felt sense of being in the right place, personally and professionally. Conclusion This study provides insights into the perspectives of rural AHPs in Aotearoa New Zealand. Findings suggest that successful recruitment and retention requires attention to both professional and personal factors, with particular emphasis on creating environments where AHPs feel valued, supported to develop their practice, and connected to their communities. These insights can inform the development of targeted strategies to strengthen the rural AHP workforce.

Transitional Reentry Health Act passed in New York

2025-06-20

Alison Knopf | Alcoholism & Drug Abuse Weekly

Last week the New York State Senate passed S.614 sponsored by Senator Gustavo Rivera. The Transitional Reentry Health Act would ensure that people returning to the community from incarceration are … Last week the New York State Senate passed S.614 sponsored by Senator Gustavo Rivera. The Transitional Reentry Health Act would ensure that people returning to the community from incarceration are enrolled in Medicaid prior to their release. Without that care, in the first two weeks after release, formerly incarcerated people are 13 times more likely to die than the general population, and 130 times more likely to die from overdose, according to the Legal Action Center, which has advocated long for this legislation.

Medical studentsâ perceptions of rural clinical placement: a mixed-methods study

2025-06-20

Iwona Kołodziejczyk , Stephanie Maima , Sharon Tobessa +1 more | Rural and Remote Health

A severe shortage and inequitable distribution of doctors between rural and urban populations leave the rural population in Papua New Guinea deprived of medical care. Our medical school adopted strategies … A severe shortage and inequitable distribution of doctors between rural and urban populations leave the rural population in Papua New Guinea deprived of medical care. Our medical school adopted strategies proven in other countries to motivate medical students to undertake rural practice effectively. This study aims to explore medical students' perceptions of rural clinical placement in Papua New Guinea. We adopted a mixed-methods parallel design. We included 41 students who undertook the rural clinical placement. For the data collection instruments, we employed the semi-structured questionnaire for the quantitative strand and focus group discussion for the qualitative strand. Most students reported positive experiences of rural placement evaluating highly rural supervisors. Among the benefits of rural placement are enhanced confidence and competence level in clinical skills, an opportunity to practise several procedures, hands-on diagnosing and managing patients, a wide variety of cases and taking more responsibility for patients' care. For the students with rural upbringings, rural placement influenced them to consider future work in rural areas. For the urban students, it increased their understanding of health issues in the rural population. This study enhances our understanding of factors affecting medical students' opinions on rural clinical placement and how this experience will likely influence their future career choices. Further study is required to assess the association between rural placement and choosing a rural career path.

Consider leadership lessons gleaned from vacation

2025-06-20

Dawn Z. Hodges | Student Affairs Today

During the summer of 2024, my husband spent a week in the hospital. He was extremely ill. I was scared; I asked the doctor if he might die. He simply … During the summer of 2024, my husband spent a week in the hospital. He was extremely ill. I was scared; I asked the doctor if he might die. He simply responded, “He is a very sick man.” Fortunately, he improved, got new forms of treatment, and is healthier now than he has been in a long time.

Correction: Developing a program logic model for evaluation and research of a rural medical training stream

2025-06-20

Lara Fuller , Jessica Beattie , Vivienne Ramsbottom +7 more | BMC Medical Education

Retaining NHS staff from ethnic minority and migrant groups

2025-06-20

Holly Reilly , Manish Pareek , Katherine Woolf | http://isrctn.com/

How Participatory Research Can Inform Antiracism Approaches to Advance Kidney Health Equity

2025-06-20

Abdou Simon Senghor , Godwin Okoye , Chandra L. Ford +2 more | Journal of the American Society of Nephrology

Tackling geographic barriers to primary dental care (dental deserts): a systematic review

2025-06-20

James W. Edwards , Birke Bogale , Jennifer E. Gallagher | BDJ

Abstract Introduction Inequitable distribution of the workforce is a major global challenge, regardless of country income status. England is facing a crisis in access to NHS dental care, with areas … Abstract Introduction Inequitable distribution of the workforce is a major global challenge, regardless of country income status. England is facing a crisis in access to NHS dental care, with areas of the country being designated ‘dental deserts'. Solutions are actively being pursued. Objective To review global literature addressing geographic barriers to dental care and make recommendations for health policy and future research in relation to access. Methods A systematic review was conducted through OVID, searching Medline, Embase and Global Health. Titles and abstracts were screened and full texts reviewed against eligibility criteria with data extraction. Interventions were identified and thematically categorised, then aligned with The Lancet' s ‘High-quality health systems framework'. Results We included 37 papers from 26 countries, reporting on 14 types of interventions across four categories: workforce initiatives (dental team skill mix and non-dental personnel, recruitment and retention strategies); outreach (teledentistry, mobile, outreach and school-based services, new community clinics); in-reach (dental school clinics); and ‘auxiliary access initiatives' (local community engagement, affordability of care, cost-effectiveness and clinician remuneration). All interventions appeared to provide access to care. Every paper addressed between two and seven components of the high-quality health systems framework, with the ‘foundations' domain addressed across all 37 papers, ‘quality impacts' in 30 and ‘processes of care' in 15 papers. Conclusion All identified initiatives demonstrated positive impacts on access to care across the domains of the high-quality health systems framework, indicating the importance of a multi-dimensional health-systems approach to tackling dental deserts. Published evidence, mainly from high- and middle-income countries, supports the co-design and co-production of initiatives with local communities to facilitate sustainable improvements in access.

Phenomenological study of international medical graduates and the supervisory relationship in Canada

2025-06-20

Brenna M. Lynn , Bob Bluman , Vernon Curran | International Journal of Medical Education

This study explored the nature of the supervisory relationship between international medical graduates (IMGs) on temporary practice license and their supervisors, including perceptions of the roles and expectations of IMG … This study explored the nature of the supervisory relationship between international medical graduates (IMGs) on temporary practice license and their supervisors, including perceptions of the roles and expectations of IMG supervisors in Canada. A qualitative phenomenological study comprising six focus group interviews was undertaken. A purposive sample of study participants was recruited via e-mail, and twenty-one supervisors and IMGs on temporary licensure practicing in British Columbia, Canada participated. Focus groups were recorded and transcribed verbatim, and data were analyzed using thematic analysis. Key themes occurring from the focus groups included the Role of Supervisor, Supervisor Interaction, Supervisor Background, Benefits of Supervision, and Supervisor vs Mentor. The supervisor's role was perceived as necessary in supporting the IMG with adjusting, transitioning, and navigating medical practice in Canada. Access and availability of the supervisor were critical, while supervisors with IMG backgrounds were more empathetic to supervisees' needs. Having mentors, in addition to one's supervisor, was seen as valuable in helping with personal and professional adjustments to life in a new country and a novel medical system. Supervisors and IMGs felt the supervisory process was beneficial, but could be enhanced to support IMGs' transition better. Supervisor availability and contact were important to foster engagement throughout the supervisory relationship. Supervisor training was essential to prepare for the supervisory role, and combined supervision and mentorship programs were considered helpful for IMGs as they adjusted to their new practices and life in a new country.

Rural Health Disparities: Contemporary Solutions for Persistent Rural Public Health Challenges

2025-06-19

Karen A. Matthews , Katie Spears , Charkarra Anderson‐Lewis | Preventing Chronic Disease

Mechanisms to build research capacity in the rural health workplace: a realist synthesis

2025-06-19

David Schmidt , Emma Webster , David Lyle | Frontiers in Medicine

Introduction Workplace-based research training contributes to research capability and capacity in rural areas where access to university expertise is limited. Rural health complexities and the diverse approaches previously used to … Introduction Workplace-based research training contributes to research capability and capacity in rural areas where access to university expertise is limited. Rural health complexities and the diverse approaches previously used to build research capacity have led to a lack of clarity about how to build research capacity within rural health services. Methods Using a critical realist foundation, we explored distributed workplace-based rural research training and synthesized five studies centered in rural New South Wales, Australia. Critical realism allowed the exploration of the structural supports and barriers for workplace-based research training activities and the ability of individuals to pursue research activities within rural health workplaces. Results The component studies showed that distributed rural research training programs improve individual research capability by developing research skill, increasing research experience and facilitating research networks across sectors. Rural research activities are characterized by individual agency and partnering or relationships to access support and expertise. Structural barriers including a lack of operational planning for research and few ongoing research opportunities limit translation of capability into research capacity. Discussion Individual workplace-based research training is effective, but not sufficient to build and maintain research capacity. Structural supports such as organizational commitment and careful training design can maximize cooperative partnerships with education partners. Addressing both structural and individual factors is needed to build rural health research capacity and generate real-world health research to drive meaningful improvements in rural health.

Supporting nursing associate and assistant practitioner apprenticeships in health and social care

2025-06-19

Andrew Dainty , Liam Somers , Holly Portia Louise Garrett Anthony +1 more | British Journal of Nursing

Apprenticeships are becoming widespread in healthcare and provide opportunities for development and social mobility that otherwise may not have been possible. This article provides an overview of apprenticeship programmes that … Apprenticeships are becoming widespread in healthcare and provide opportunities for development and social mobility that otherwise may not have been possible. This article provides an overview of apprenticeship programmes that may be of interest to those considering embarking upon an apprenticeship, and to help health professionals new to supporting one of these roles understand the support requirements within the workplace and university. Both roles were developed to provide opportunities for progression and the development of knowledge, skills and behaviours, while building capacity and capability within the healthcare workforce. Apprenticeships necessitate a close working partnership between employer and higher-education institution, which is shown within the proposed conceptual model ‘Forceps’. The authors discuss the end point assessment, which is triggered when apprentices reach the requirements of their occupational standard, and share their experience of preparing apprentices to the point of readiness for the workplace.

Shifting Training Preferences in Emergency Medicine Residency Applicants: A Post Interview Analysis from 2020 to 2024

2025-06-19

C. Mark Woodard , Jennifer Campoli , Stephen E. Lucas | Western Journal of Emergency Medicine

Primary survey: highlights from this issue

2025-06-19

Jason Smith | Emergency Medicine Journal

Fostering the growth and development of the female rural generalist workforce: a mixed methods study

2025-06-19

Emily Anderson , Belinda O’Sullivan , Tiana Gurney +4 more | International Journal for Equity in Health

Medical students’ perspectives of their rural primary care placements

2025-06-19

Nicola Franc , Hugh Alberti | Education for Primary Care

Medical school curricula have seen an expansion of teaching in the community. A rural primary care setting may offer students a variety of patient interactions and opportunities to improve their … Medical school curricula have seen an expansion of teaching in the community. A rural primary care setting may offer students a variety of patient interactions and opportunities to improve their clinical skills within small teams. GP recruitment remains challenging, especially in rural areas but exposure to such settings during training may positively influence career intentions. There is a lack of research into students' perceptions of their rural primary care placements. This study aimed to increase our understanding of medical students'experiences of rural primary care placements. An Interpretative Phenomenological Approach explored students' lived experiences through semi-structured interviews with five final-year medical students. Interview transcripts were analysed to identify multiple Personal ExperientialThemes which led to the development of four higher-level Group Experiential Themes: adjusting to rural living; relationship with GP supervisor and team; autonomy; and developing as a doctor. Students'experiences were significantly influenced by their adjustment to the rural environment. With basic needs met students began to develop a sense of belonging which facilitated learning. Relationships with GP supervisors and team members were crucial, fostering a student's sense of autonomy and professional growth. Rural placements offered students the chance to integrate into small teams, to feel valued and assume 'almost doctor' roles, providing diverse patient consultations, and preparing them for independent practice.

Enhancing Health Policy Administration in LMICs: Dr. LJW Fellowship Program Insights (2021&ndash;2023)

2025-06-18

Bomgyeol Kim , Yejin Kim , Jun Su Park +5 more | Annals of Global Health

Background: The Dr. LEE Jong-wook (LJW) Fellowship Program aims to enhance the capabilities of healthcare personnel in low- and middle-income countries (LMICs) through comprehensive training and education. This study evaluates … Background: The Dr. LEE Jong-wook (LJW) Fellowship Program aims to enhance the capabilities of healthcare personnel in low- and middle-income countries (LMICs) through comprehensive training and education. This study evaluates the satisfaction and effectiveness of the Health Policy Administrator course within the program, focusing on participants from 2021 to 2023. Objective: This study aims to assess the impact of the Dr. LJW Fellowship Program, specifically evaluating participants' satisfaction, knowledge and competency improvement, and the adoption of learned knowledge in the workplace. Methods: A mixed- methods study design was adopted, utilizing Kirkpatrick's four-level evaluation framework to assess the program's impact. A total of 39 public health policymakers from 19 LMICs participated in the training course at an affiliated university. The evaluation focused on training satisfaction, knowledge and competency improvement, competence achievement, and the practical adoption of learned knowledge. Descriptive statistics were used to analyze participant characteristics, while paired t-tests were employed to assess knowledge and competency improvement before and after the program. Results: The program demonstrated high levels of participant satisfaction, with an overall satisfaction score of 92.9. Knowledge scores improved significantly, with an average increase of 61%, particularly in health statistics (77% improvement) and healthcare systems (56.3% improvement). Competency achievement was also high, with an average score of 92.5. However, the job adoption of learned knowledge scored lower, with supervisors and coworkers rating it at 70.9 and 72.1, respectively, indicating challenges in translating training into practical workplace applications. Conclusions: The Dr. LJW Fellowship Program effectively enhanced participants' knowledge and competencies in health policy administration. However, the lower scores in job adoption suggest a need for improved follow-up support and practical application strategies to ensure that the training's benefits are fully realized in participants' work environments.

Naming and Responding to Structural Racism in Health Care

2025-06-18

Chandra L. Ford | NEJM Catalyst

The struggle of preserving self-esteem and professional identity: A grounded theory study of specialists’ experiences serving in the public health system in Rajasthan, India

2025-06-18

Anushree Joshi , Jallavi Panchamia , Dileep Mavalankar +1 more | PLoS ONE

This study aimed to explore and describe the experiences of specialist physicians at rural community health centers (CHCs) and determine the factors accounting for their retention and attrition in Rajasthan, … This study aimed to explore and describe the experiences of specialist physicians at rural community health centers (CHCs) and determine the factors accounting for their retention and attrition in Rajasthan, India. Twenty-one medical professionals from different public health facilities in Rajasthan, selected through purposive sampling, were interviewed in depth. Strauss and Corbin’s grounded theory approach was used to develop a theory/model. Open, axial and selective coding were used to identify the major themes/categories and develop the core category of the model. Strauss and Corbin’s paradigm model was employed to establish linkages among the categories structured in terms of conditions, action-interaction strategies and consequences to explore the experiences of specialist physicians. The central theme of the model, ‘The struggle of preserving Self-esteem and Professional identity’, captures the experiences of specialist physicians working at the rural CHCs in Rajasthan’s public healthcare system. The disadvantages of an underdeveloped rural setting, local political climate and various healthcare system factors challenge the specialists’ self-esteem and professional identity culminating in their decision to remain or quit the system. This further leads to their acute shortage in the system which affects the quality and provision of rural healthcare services in the state. The state government and essential stakeholders must collaborate to enact policies addressing specialist physicians’ personal and professional needs, which include improving developmental infrastructure, healthcare system processes, local governance and accountability. Such policy packages can generate sustainable solutions to mitigate the high attrition rate of specialists in rural CHCs and strengthen rural healthcare services in Rajasthan.

For fellow healthcare workers in the trenches

2025-06-18

Jay Desai | Nursing Outlook

Guiding practice principles for clinicians who work with Indigenous people

2025-06-17

André Schultz , Anne B. Chang , Diana S. Mason +3 more | Frontiers in Pediatrics

Culturally safe healthcare approaches are important to improve outcomes of Indigenous people. Non-Indigenous clinicians are often ill-prepared to provide such healthcare. The NHMRC Centre for Research Excellence (CRE) especially for … Culturally safe healthcare approaches are important to improve outcomes of Indigenous people. Non-Indigenous clinicians are often ill-prepared to provide such healthcare. The NHMRC Centre for Research Excellence (CRE) especially for First Nations Children has been studying for several years how to improve clinical care for Indigenous children with respiratory disease in hospital, clinic, urban, rural and remote settings. At a CRE meeting in 2023 key themes were identified based on what we have learned. Themes were informed by research conducted by the CRE and supplemented by relevant manuscripts known to CRE members. This manuscript provides practical information to aid clinicians in providing culturally safe healthcare to Indigenous people. In brief, the provision of health information that is relevant and understandable to Indigenous patients and their families is critical for ensuring condition-specific health literacy and to allow Indigenous patients to gain autonomy over medical care provided to them and their children. Methods to facilitate effective communication between healthcare providers and patients, and the creation of a culturally safe healthcare environments are discussed. The manuscript will be of practical use to clinicians and translatable to other areas of health care.

“I Know I Can Do Anything I Set my Mind to Now.” From the Invictus Pathways Program to Representing Australia Competitively: A Qualitative Analysis of the Perceptions and Experiences of Veterans and Their Family Support Networks About the Impact of Participation

2025-06-17

Dannielle Post , Amy Baker , Steve Milanese +2 more | Deleted Journal

Long Term Quality of Life, Health Status, and Residential Destination after Emergency Abdominal Aortic Aneurysm Repair

2025-06-17

Tijmen F C M Nederstigt , Daphne van der Veen , Jan-Willem Lardenoije +7 more | Journal of Vascular Surgery

“Maybe I should just risk tetanus”: The experiences of post-secondary international students accessing healthcare services in Ontario, Canada

2025-06-17

Mariam Omilabu , Elena Neiterman | Journal of American College Health

International students (IS) experience both post-secondary school stress and the stress of adjusting to a new culture. However, they are less likely to access healthcare services. This study examines the … International students (IS) experience both post-secondary school stress and the stress of adjusting to a new culture. However, they are less likely to access healthcare services. This study examines the experiences of IS in accessing healthcare services at a university in Southwestern Ontario, Canada. Semi-structured, qualitative interviews were conducted with eight undergraduate and two graduate IS. Interviews were analyzed using a thematic analysis. Although participants shared positive experiences, they expressed confusion about using their health insurance and the services they could access. Participants desired information sessions on healthcare services and proposed that upper year IS act as healthcare system guides. While this research focused on Ontario, Canada, the information may be applicable to other jurisdictions by offering insights on international students' knowledge and use of their health insurance. Given the growth of IS, educational institutions must ensure their healthcare needs are met.

Fostering advocacy of physician health and accessibility from training into practice

2025-06-17

Michael Quon , Mamta Gautam | Canadian Medical Education Journal

Understanding Rural Patients’ Perspectives on Patient Care Teams

2025-06-16

Amy Tite , Brynn Magner , Elaine Pierce +1 more | PRiMER

Introduction: With a critical primary care clinician shortage, team-based care (TBC) is under development to enhance access, especially in rural regions. However, there has been limited discussion about TBC from … Introduction: With a critical primary care clinician shortage, team-based care (TBC) is under development to enhance access, especially in rural regions. However, there has been limited discussion about TBC from the patient’s perspective. We explored rural patient preferences for composition of their current and ideal primary health care team. Methods: An anonymous online survey of rural residents was conducted within the Kootenay-Boundary region of British Columbia. The survey included demographic information and current and ideal health care team composition. Descriptive statistics were used. Results: Four hundred ninety individuals responded to the survey. Most respondents self-identified as female, were over age 40 years, White, and had a postsecondary school diploma. Those with a health care provider (n=362, 74%) included a primary care doctor (86.5%), alternative medicine practitioner (52.2%), allied health professional (35.4%), friends/family/support people (35.1%), specialist physician (30.1%) and nurse practitioner (18.5%) on their team. Ideal health care teams included a primary care physician (92.2%) followed by an alternative medicine practitioner (64.1%), allied health professionals (61.2%), specialist physician (59.8%), and nurse practitioner (54.8%). Almost half of all respondents (46.6%) chose five or more categories of team members and 43.7% chose 3-4 categories of members. Respondents (81.1%) were highly likely (49.6%) or likely (31.6%) to affiliate with a primary health care team clinic. Conclusion: Both current and ideal health care team membership included many types of caregivers, with most respondents including three or more team-member categories. As many people in rural BC are without primary care providers, incorporating alternative medical practitioners and allied health professions into clinical teams within multidisciplinary settings could improve health care access.

‘When I Migrated, I Faced Challenges but Gained Much More…’ Challenges and Support Needs of Internationally Educated Nurses—A Qualitative Study

2025-06-16

Turgay Yalcinkaya , Erkan Ünsal | Journal of Advanced Nursing

ABSTRACT Aim This study aims to examine the experiences and support needs of internationally educated nurses (IENs) who migrated from Türkiye to different countries. Background With the impact of globalisation … ABSTRACT Aim This study aims to examine the experiences and support needs of internationally educated nurses (IENs) who migrated from Türkiye to different countries. Background With the impact of globalisation and changes in the healthcare sector, the migration of IENs is on the rise. The global shortage of nurses has prompted high‐income countries to increase their recruitment of nurses from low‐ and middle‐income countries. Methods This descriptive qualitative study included 16 nurses who had migrated to seven different countries: Germany ( n = 3), England ( n = 3), the USA ( n = 3), Canada ( n = 2), Sweden ( n = 2), Ireland ( n = 2) and Switzerland ( n = 1). Data were collected between August and November 2024 using Google Meet. The data were analysed using content analysis. The COREQ Checklist was utilised for data analysis and reporting. Results Content analysis identified four main themes: (1) challenges encountered, (2) professional and personal development gains, (3) support needs and (4) recommendations for development and adaptation. Conclusions This study revealed that IENs face challenges such as professional adjustment, language barriers and cultural differences, while also experiencing gains such as professional skill development and enhanced intercultural nursing competencies. Implications for Nursing Practice and Policies The findings highlight the critical role of orientation and mentoring programmes that include language training, cultural awareness and psychological support and emphasise the need for more inclusive and sustainable health policies that support the integration of IENs. Reporting Method The Consolidated Criteria for Reporting Qualitative Studies (COREQ). Patient or Public Contribution No patient or public contribution.

Back to the future: A call to generalism in psychiatry

2025-06-16

Mathew Coleman , Beatriz Cuesta‐Briand | Australasian Psychiatry

Introduction Providing a sustainably resourced medical workforce to meet the healthcare needs of a population is a significant challenge. Drivers of medical workforce issues include an ageing population, increasing chronic … Introduction Providing a sustainably resourced medical workforce to meet the healthcare needs of a population is a significant challenge. Drivers of medical workforce issues include an ageing population, increasing chronic disease, skill shortages and workforce maldistribution. In this paper, we consider the imbalance between generalism and specialism in Australia, arguing that generalist positions may better address the current healthcare gaps. Analysis and evidence We describe generalism in the broad Australian healthcare system before exploring generalism within psychiatry and reflect on how lessons learned in rural generalist psychiatry can be applied to broader medical workforce reform. Discussion The imbalance between specialism and generalism within the mental health workforce across settings must be re-examined given the increased burden of disease and patient complexity. An explicit articulation and recognition of generalism within psychiatry may yield positive results on workforce development and ultimately accessibility of psychiatric services across geographical and service delivery settings. Conclusion Advocating for generalist psychiatry, alongside general practice, to be at the centre of workforce solutions into the future is more critical than ever. The profession must give generalist psychiatry the recognition it deserves, lift its professional status and prioritise its training before we lose our authority and our social licence.

Factors of registered nurse vacancies in the United States

2025-06-14

Nicholas Yell , Elizabeth Crouch , Nabil Natafgi +2 more | Nursing Outlook

Widening access to medical school: students need ongoing focused support

2025-06-13

Harj K Kaul | BMJ

Milestones Progression of International Medical Graduates in Family Medicine

2025-06-13

Varshaben M. Songara , Regina Bray-Brown , Sarah Fleischer +1 more | Family Medicine

Background and Objectives: International medical graduates (IMGs) are a quarter of US practicing physicians and residents, with higher numbers in family medicine. Our objective was to determine whether the progression … Background and Objectives: International medical graduates (IMGs) are a quarter of US practicing physicians and residents, with higher numbers in family medicine. Our objective was to determine whether the progression of milestone ratings varies between IMGs and US medical graduates based on a residency’s historical percentage of IMGs. Methods: Data, which were all from the American Board of Family Medicine, included milestone ratings of each family medicine graduate from 2018 to 2020. We calculated the mean milestone rating for each core competency at each assessment. The main exposure was the 10-year percentage of residency graduates who were IMGs: very low (&lt;10%), low (10%–33%), medium (34%–66%), and high (67%–100%). We used repeated measures multilevel regression to test for adjusted associations of resident and residency characteristics with milestone performance. Interactions between IMG status and historical percentage of IMGs tested for differential milestone growth. Results: Our sample included 12,302 residents from 538 residencies. Of the family medicine residencies, 41.8% had less than 10% IMGs. Across milestones, mean growth between rating periods ranged from 0.46 to 0.54. In adjusted regression analysis, both being an IMG (β=–0.003 to –0.07) and training in a higher historical IMG residency (β=–0.01 to –0.08) were associated with lower milestone ratings. IMGs in high IMG programs had higher ratings for medical knowledge and professionalism (β=0.07). Conclusions: We found comparable milestone ratings between IMGs and US medical graduates, with IMGs getting a small boost if they were trained in a program with a higher percentage of IMGs. Our results demonstrate that the performance of IMGs may be enhanced in residencies with a history of acculturating them.