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.

Three Continents, Two Fathers, One Donor: A Non-Puerperal Relactation Case Study

Introduction A woman was able to relactate 7 years after breastfeeding her children. She donated her expressed milk to her friends, a same-sex male couple, who had a child through surrogacy in the United States. She lived in London and shipped her milk to Hong Kong, where they lived. The infant thrived on the donated expressed milk received during the first 3 months of his life. Main issue This case is unusual because the woman was not breastfeeding at the time, which would have made expressing easier, and she was not adopting. She consulted a National Childbirth Trust Breastfeeding Counsellor and an International Board Certified Lactation Consultant® who helped her explore non-puerperal relactation protocols. Management Her plan started 6 months before the birth and included the use of domperidone, frequent expressing by hand and with a hospital-grade pump. A breastfeeding specialist physician made suggestions on the dosage of domperidone. She donated a total of 35.06 L. She had the full support of her partner and family. Conclusion Non-puerperal induced lactation and relactation offer ways to make human milk accessible to all infants, particularly those from LGBTQ+ families in which no parent is lactating, as was the case with the same-sex male couple participating in this study. It is essential to disseminate the knowledge and skills needed to support non-puerperal induced lactation and relactation among all healthcare professionals involved.

Identification and Ranking of the Reasons for not Referring Patients from Level 1 to Level 2 through Electronic Referral System of Golestan Province in 2019

Background: The public sector of the health care system provides justice and access for all people who need more specialized services through the referral system. If the challenges of the referral system are not identified and addressed promptly, the system will not be efficient and effective. The purpose of this study was to rank the reasons for non-referral of outpatient level 1 to level 2 in the electronic referral system of Golestan province in 2019. Methods: In this descriptive and cross-sectional study, 431 outpatients participated from the pilot hospitals of the e-referral system in Golestan province, who did not refer to the level 2 specialist despite that an appointment was set by the system. The participants were selected using a stratified random sampling method. Data were collected using a questionnaire and analyzed by descriptive statistics and Friedman test in SPSS 23 software. Results: The most important reasons for patients who were not referred from level 1 to level 2 in the electronic referral system included the presence of a trusted and familiar physician, inability to pay the visit of a specialist, and high cost of transportation from home to the designated specialist, respectively. The gender of the specialist physician and lack of guidance on referral to the specialist physician were indicated by the referral center. Patients ranked the reasons of not referring to the specialist differently (P < 0.001). Conclusions: The current status can be improved by increasing the public confidence in specialized physicians working in the electronic referral system and making the specialized services free for the poor patients. Furthermore, raising the patient's awareness about using Level 2 specialized services through the mass media can help patients to benefit from these services.

Escolha da medicina como profissão e perspectiva laboral dos estudantes

Introduction: Medicine is a prestigious profession, therefore, although competition for admission is fierce and studies require dedication and sacrifices, thousands of young people face the challenge of becoming doctors every year. Objective: Describe the reasons why medical school students chose Medicine as a profession and their concerns about the job perspective. Method: Quantitative descriptive and documentary research, through the application of a questionnaire with sociodemographic and specific questions. Result: A high percentage of the female gender stood out, with 63.31% of the participants. The main reasons for choosing Medicine as a profession were altruism (71.75%), financial stability (59.42%) and personal accomplishment (58.77%). However, there was a decrease in the preference for altruism during internship (p<0.01). The biggest concern after training was “Doing a good job / Being a good professional” (79.87%) and, in relation to the “job market” and “devaluation of the profession”, there was an increase in the concern during internship (p <0.001). The majority (91.92%) expressed the intention to become a specialist physician, with the specialty of Gynecology and Obstetrics being the most sought after. Regarding the way of working, 51.3% expressed the desire to be a self-employed professional, 55.52% a public or private employee and 7.92% a liberal professional. The greatest difficulty expected in the profession was competition (57.70%) and the most important requirement for professional practice was “Medicine as a means to be useful or help people” (98.38%). Regarding the feelings experienced as a student, the levels of anxiety, stress and feeling of overload were high, respectively 80.52%, 79.55% and 73.38%. Conclusion: At the beginning of the course, there is a more idealized view of Medicine and throughout the development of phases, as contact with medical practice occurs, the students better understand their difficulties and increase their concerns, especially with the job market and the devaluation of the profession, causing, in some, the reduction of the humanistic ideals that motivated the choice of the profession, an aspect to be valued by medical schools during professional training.

The choice of Medicine as a profession and the students’ labor perspective

Introduction: Medicine is a prestigious profession, therefore, although competition for admission is fierce and studies require dedication and sacrifices, thousands of young people face the challenge of becoming doctors every year. Objective: Describe the reasons why medical school students chose Medicine as a profession and their concerns about the job perspective. Method: Quantitative descriptive and documentary research, through the application of a questionnaire with sociodemographic and specific questions. Result: A high percentage of the female gender stood out, with 63.31% of the participants. The main reasons for choosing Medicine as a profession were altruism (71.75%), financial stability (59.42%) and personal accomplishment (58.77%). However, there was a decrease in the preference for altruism during internship (p<0.01). The biggest concern after training was “Doing a good job / Being a good professional” (79.87%) and, in relation to the “job market” and “devaluation of the profession”, there was an increase in the concern during internship (p <0.001). The majority (91.92%) expressed the intention to become a specialist physician, with the specialty of Gynecology and Obstetrics being the most sought after. Regarding the way of working, 51.3% expressed the desire to be a self-employed professional, 55.52% a public or private employee and 7.92% a liberal professional. The greatest difficulty expected in the profession was competition (57.70%) and the most important requirement for professional practice was “Medicine as a means to be useful or help people” (98.38%). Regarding the feelings experienced as a student, the levels of anxiety, stress and feeling of overload were high, respectively 80.52%, 79.55% and 73.38%. Conclusion: At the beginning of the course, there is a more idealized view of Medicine and throughout the development of phases, as contact with medical practice occurs, the students better understand their difficulties and increase their concerns, especially with the job market and the devaluation of the profession, causing, in some, the reduction of the humanistic ideals that motivated the choice of the profession, an aspect to be valued by medical schools during professional training.

Primary breast MALT lymphoma: a case report

A 42-year-old woman, with no history of autoimmune diseases or risk factors for cancer, sought a private medical clinic for undergoing breast imaging tests, noticing the presence of a solid nodule with indistinct margins — BI-RADS 4 — in the left breast. An ultrasound-guided core biopsy was performed and complemented by histopathological and immunohistochemical studies, confirming the diagnosis of primary small B-cell MALT lymphoma. After treatment with radiotherapy, the patient evolved with remission, maintaining annual follow-up with a specialist physician. The importance of routine screening for pathologies that affect the breasts is highlighted, aiming at their early diagnosis. In addition, radiotherapy has good prognostic results at the expense of surgical treatment.

Using Machine Learning to Measure Specialist Wait Times from Family Physicians’ Electronic Medical Records Linked to Ontario Health Administrative Data

IntroductionReliable information about the time spent waiting for health care services is a critical metric for measuring health system performance. Wait times are a useful measure of access to various health care sectors. Alongside the increased adoption of electronic medical records (EMR) by Canadian family physicians (FP), is the secondary use of FP EMR data for research. However, using FP EMR data can be challenging in its unstructured, free-text format. Objectives and ApproachOur objective was to identify the target specialist physician type from the EMR FP referral note and then calculate wait times from a FP referral to a specialist physician visit. We used FP EMR data and linked to Ontario, Canada health administrative data (called EMRPC). EMRPC collects the entire clinical record from patients including the content of FP referral notes. We used machine learning (ML) methods to identify the type of specialist physician in which the referral was intended. Labels to test the ML methods were created from physicians’ claims data. Wait times were calculated from the FP EMR referral note date to the specialist physician claim date in administrative data. ResultsOur ML models’ ability to classify 2016 FP EMR referral notes to selected medical and surgical specialists achieved sensitivity and positive predictive values ranging from the high 70s to low 80s.Compared to earlier analyses from 2008, we observed a similar relative ordering to see specific specialist physicians. Overall, the median wait times have increased by 14 days on average, with a maximum increase of 28 days to see a gastroenterologist. Conclusion / ImplicationsThe accuracy of ML on unstructured FP EMR data is high, thereby providing a mechanism to “codifying” information in a timely manner. This information can help inform decision makers and providers about which patients or FP practices are experiencing long wait times in seeing specialist physicians.