Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics

Background The predicted growth of Canadians aged 65+ and the resultant rise in the demand for specialized geriatric services (SGS) requires physician resource planning. We updated the 2011 Canadian Geriatrics Society physician resource inventory and created projections for 2025 and 2030. Methods The number and full-time equivalents (FTEs) of geriatri­cians and Care of the Elderly (COE) physicians working in SGS were determined. FTE counts for 2025 and 2030 were estimated by accounting for retirements and trainees. A ratio of 1.25/10,000 population 65+ was used to predict physician resource requirements. Results Between 2011 and 2019 the number of geriatricians and COE physicians increased from 276 (235.8 FTEs) and 128 (89.9 FTEs), respectively, to 376 (319.6 FTEs) and 354 (115.5 FTEs). This increase did not keep pace with the 65+ population growth. The current gap between supply and need is expected to increase. Discussion The physician supply gap is projected to widen in 2025 and 2030. Increased recruitment and interdisciplinary team-based care, supported by enhanced funding models, and full integra­tion of COE physicians in SGS could reduce this increasing gap. In contrast to pediatrician supply in Canada, the specialist physician resources available to the population 65+ reflect a disparity.

Cognitive Screening for Senior Physicians: Are We Minding the Gap?

ABSTRACT Senior physicians are an invaluable community asset that comprise an increasing proportion of the physician workforce. An increase in demand for health care services, with demand exceeding the supply of physicians, has contributed to discussions of the potential benefit of delaying physician retirement to help preserve physician supply. The probable increase in the number of senior physicians has been associated with concerns about their competent practice. Central to this issue are the changes that occur as part of normal aging, how such changes might impact medical practice and what steps need to be taken to ensure the competency of senior physicians. We propose that while age may be an important risk factor for performance issues, it is not the only factor and may not even be the most important. Data on cognitive performance among physicians referred for behavioral and performance concerns reveal that cognitive impairment afflicts physicians across the career span. If the overarching goal is to prevent patient harm through early detection, older physicians may be too narrow a target. Approaches focusing on health screening and promotion across the career span will ultimately be more effective in promoting workforce sustainability and patient safety than age-based solutions.

The Maldistribution of Pediatric Providers as a Potential Driver of Reduced Educational Outcomes

Objective Despite evidence of a strong bidirectional connection between educational achievement and health, few studies have examined the link between these intertwining forces on a national level. This study takes advantage of a new population-level dataset to explicitly link child health access to academic outcomes in nearly every U.S. school district. Methods National data were used to construct and link district-level measures of child health access to district-level measures of third-grade achievement. Specifically, location data for over 256,000 practicing pediatricians and family physicians were linked to achievement data from 12,296 school districts. We include district-level rates of uninsured children as an additional measure of child health access. Results First, physician supply is unequally distributed across districts and their student populations. Second, districts that had higher physician supply tended to have higher test scores. This relationship is most pronounced for districts with relatively few pediatricians and family physicians. While the rate of uninsured children is largely correlated with community socioeconomic status, physician supply appears to operate independently of this measure. Conclusion Early childhood health and wellbeing are linked to cognitive performance and achievement in school. We provide evidence to illustrate an aspect of this relationship: children with less access to healthcare providers also do less well in school. The specific patterning of this finding suggests a need to reconsider how availability and access to pediatricians and family physicians is currently configured. Future research should examine whether a redistribution of the existing physician workforce could result in a net academic benefit for students.

Public Service Quality under Permanent and Fixed-term Employment Contracts: Evidence from Physician Supply of Primary Care

A key feature of public sector employment in many countries is rigid civil service rules that effectively limit manager autonomy over hiring, firing, promotion, and compensation decisions. We study the effect of these rules by comparing the quality of healthcare provided by physicians employed as civil servants with physicians hired in the same facilities on fixed-term contracts that give managers more autonomy over personnel decisions. Using data from interactions with unannounced standardized patients, we find that fixed-term contracts motivate greater diagnostic effort without increasing unnecessary treatments. Lower effort among civil servants appears due to both weaker career and wage incentives.

What Lies Ahead: Northwest Florida’s Healthcare Workforce Supply

Studies describing healthcare workforce distribution are myriad. Little space, however, has been devoted to regional and local workforce issues. This literature review sought to first review national factors affecting healthcare supply, then progressively focus on the state and regional levels. The analysis concluded that, while healthcare workforce shortages are not present in Florida in terms of nursing, there is a significant gap between physician supply and demand. The results concluded that nearly all of the factors presented can be addressed through educational and health policy initiatives. Strategies were suggested to better meet the needs of Florida’s underserved populations through primary care providers.

The Impact of Medical Malpractice Reforms

This article evaluates the effects of medical malpractice reform on claiming, malpractice premiums, physician supply, and defensive medicine. We conclude that damage caps materially reduce claim frequency, payouts per claim, and total payouts. The effects of damage caps on malpractice premiums, physician supply, and defensive medicine are more modest. It is difficult to quantify the impact of reforms other than damage caps—partly because reforms are typically adopted as a package deal, and partly because of the limitations of the available data. We close by identifying three areas that would benefit from more research.