Equity among physicians and the wish to reallocate time

Objective: To examine the relationship between perceptions of equity among physicians and the wish to reallocate time by creating a fitted, multistage model of the equity distress- wish to reallocate time pathway using structural equation modelling (SEM). Background: The reorganizing of work among various health care professionals and better management of scarce resources are seen as necessary for the delivery of effective and efficient health care. Physicians play a key role in the health care system, and any substantive changes in their work will require their cooperation. Gaining support from physicians for changes in the allocation of their time will depend, in part, on the degree to which these changes are seen to promote their professional and personal objectives. Whether physicians perceive their practice conditions to be equitable, and how they choose to respond to efforts by others to make changes in the work they do and the rewards they receive, has important implications for the successful reform of health care in Canada. Design: A modified panel study using questionnaires mailed to a stratified random sample of 840 physicians in Saskatchewan and British Columbia. A total of 384 physicians responded at baseline (110 from Saskatchewan and 274 from British Columbia). At follow-up, 240 usable questionnaires were returned from the remaining 371 eligible respondents for a response rate of 64.7% (72 from Saskatchewan and 168 from British Columbia). Measures: Reliable constructs were developed for: intrinsic and extrinsic equity; distress; coping with practice demands; and the four components of professional activity (patient care, teaching and research, continuing education, and administration). Latent variables were created for: local health care conditions; distributive equity; wish to reallocate professional time; and wish to reallocate administrative time. Results: SEM produced a well-fitted model (P = 0.112; NFI = 0.991; RMSEA = 0.029; P for Test of Close Fit =0.965; and Hoelter 0.05 Index =255) that explained a substantial amount of variance at each stage of the model, and supported the hypotheses of the main pathway. The contributions of practice condition variables to the model, however, were shown to relate almost exclusively to the equity stage of the model. Discussion/Conclusions: Inequity was significantly associated with distress. In turn, distress was significantly associated with the wish to reallocate time. The state of local health care contributed substantially to perceptions of equity among physicians. The physician's ability to cope with time demands was associated with the equity, distress, and wish to reallocate professional time (patient care, teaching & research, and continuing education). Wish to reallocate administrative time was associated with time already allocated to administrative duties, but was not associated with ability to cope with time demands. The impact of inequity on the allocation of time and the organization of the work of physicians and other health care practitioners over time should be examined in a larger study of a longitudinal design

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

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

An Evaluation of the Determinants of Job Satisfaction in Canadian Family Physicians

Physicians as a group appear to be satisfied with their work. However, there are some gaps in our current understanding of the determinants that impact the job satisfaction of Canadian family physicians. This thesis examined determinants of family physician job satisfaction using in-depth interviews with family physicians to achieve a broad perspective on their job satisfaction. This was complemented by a multivariate analysis that examined the professional and work-life balance satisfaction of physicians across this country. The findings from this research confirm the significance of a number of factors to the professional and work-life balance satisfaction of family physicians. Novel findings included an overall dissatisfaction with electronic medical record use and increased satisfaction of focused practice family physicians. Addressing the factors that contribute to family physician satisfaction can have a significant impact on physician recruitment, retention and on patient outcomes

Breaking down barriers: towards the development of a low-cost community dental clinic in Prince George, British Columbia

Access to dental care for all population groups in Canada is inequitable. While the overall dental health of Canadians is very good, there are disparities that primarily affect the financially disadvantaged in society. Current methods for delivering dental care demonstrate an economic gradient favoring more affluent members of society. An examination of the methods for financing dental care, both public and private, will be conducted to better understand the challenges to solving this dilemma. The role of government and dental professionals in providing access to dental care will be explored. The existing gaps in dental care delivery will be illustrated, and the current methods for providing dental care in northern British Columbia will be identified. While continued government support for disadvantaged groups is necessary, an investigation of alternative models of low-cost dental care delivery will be undertaken to determine the feasibility of these models in Prince George, British Columbia. Solutions that are being used in other nations will be considered to determine their applicability to our local situation in northern British Columbia. A preferred model will be proposed for implementation in Prince George. Ultimately, two questionnaires will be developed to assess the attitudes and preferences of dental professionals and social agencies in coming to a consensus on the best model for bridging the existing gaps in dental care. --Leaf i.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b194713

An Analysis of the interventions to improve the geographic distribution of physicians in OECD countries

Un déséquilibre dans la répartition géographique des médecins a été observé dans la plupart des pays membres de l'OCDE. Le nombre de médecins praticiens, par rapport à la densité de population générale, est nettement plus faible dans les régions rurales et éloignées que dans les zones urbaines. Plusieurs interventions ont été mises en œuvre pour tenter de corriger le déséquilibre, mais les rapports indiquent que les solutions durables n'ont pas été identifiées. L'objectif de cette étude est de comprendre la persistance d'une pénurie de médecins dans les régions rurales, malgré la mise en œuvre des interventions. Deux approches évaluatives fondées sur la théorie sont utilisées pour évaluer la pertinence et la plausibilité des interventions. Une analyse stratégique permet de hiérarchiser les causes des pénuries de médecins et de classer les interventions en fonction de leur capacité à cibler ces causes. Une analyse logique permet d'évaluer le fondement théorique des interventions afin de déterminer si les interventions peuvent atteindre leurs résultats escomptés. Les résultats de cette recherche démontrent que les interventions mises en œuvre dans les pays de l'OCDE pour réduire la pénurie de médecins sont conçues pour cibler les causes du problème et sont donc pertinentes pour la répartition géographique des médecins. Les résultats démontrent également qu’à l'exception des stratégies réglementaires, selon les théories de la motivation au travail, les interventions peuvent inciter les médecins à choisir une pratique médicale rurale. La persistance d'une pénurie de médecins dans les régions rurales n'est pas due à la faiblesse théorique des interventions. D'autres recherches sont nécessaires pour évaluer le processus de production et la mise en œuvre des interventions.An imbalance in the geographic distribution of physicians has been observed in most member countries of the OECD. The number of practicing physicians, in relation to the general population density, is significantly lower in rural and remote regions, than in urban areas. Several interventions have been implemented to rectify the geographic maldistribution of physicians, however, reports indicate that sustainable solutions have not been identified. The purpose of this study is to understand the persistence of physician shortages in rural regions of OECD countries, despite the implementation of interventions. Two, theory-based evaluative approaches are used to evaluate the relevance and the plausibility of interventions. A strategic analysis allows for the prioritization of the causes of physician shortages, and the ranking of the interventions, based on their ability to target these causes. A logic analysis allows for the evaluation of the theoretical foundation of the interventions, to determine whether the interventions can achieve their intended outcome. The results of this research demonstrate that the interventions implemented in OECD countries to reduce physician shortages, are designed to target the causes of the problem, and are therefore relevant to the geographic maldistribution of physicians. Results also demonstrate that, with the exception of regulatory strategies, according to the theories of work motivation, the interventions can plausibly encourage physicians to choose rural medical practice. The persistence of physician shortages in rural regions is not due to the theoretical weakness of the interventions. Further research is required to evaluate the production process, and the implementation of the interventions

Improving primary healthcare workforce retention: in small rural and remote health communities: How important is ongoing education and training?

The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Human resources for health interventions in high- and middle-income countries: Findings of an evidence review

Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013–2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others—there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals’ characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.This work was supported by the Saudi Health Council and World Bank.https://doi.org/10.1186/s12960-020-00484-w18pubpu

Patient Safety Law: Regulatory Change in Britain and Canada

Did governments in different countries regulate common concerns about patient safety differently? If so how and why did they do this? This thesis undertakes a historical comparison of the regulation of patient safety in Britain and Canada between 1980 and 2005. These jurisdictions began the period with very similar regulatory frameworks, but by 2005 there were distinct differences in each jurisdiction‘s regulatory response to patient safety. Britain was very actively regulating all aspects of service provision within its health system in the name of patient safety, whereas Canada‘s regulatory direction showed adherence to the 1980s model with only scattered incremental developments. This thesis assesses the broader sociopolitical context and the structure of the health systems in each jurisdiction and concludes there are differences in the logics of these systems that established a foundation for future regulatory divergence. It is argued that between 1980 and 2005 there were two factors that influenced regulatory directionality in each jurisdiction: changing political norms associated with the development of neoliberalism and the New Public Management; and events or scandals associated with the provision of health services. The differing levels of penetration of both the changing political norms into governance cultures and of scandals into the public and political consciousness are critical to explaining regulatory differences between jurisdictions. The thesis concludes that what and how governments chose to regulate is a function of the perceived need for action and the dominant social and political norms within that society. Context is everything in the formulation of regulatory approaches to address pressing social problems