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A study of the workforce in emergency medicine: 1999

ANNALS OF EMERGENCY MEDICINE 2002年第1期40卷 3-15页

作者： Moorhead, JC Gallery, ME Hirshkorn, C Barnaby, DP Barsan, WG Conrad, LC Dalsey, WC Fried, M Herman, SH Hogan, P Mannle, TE Packard, DC Perina, DG Pollack, CV Rapp, MT Rorrie, CC Schafermeyer, RW Oregon Hlth Sci Univ Dept Emergency Med Portland OR 97201 USA Amer Coll Emergency Phys Irvine CA USA Lewin Grp Falls Church VA USA Mt Sinai Sch Med Dept Emergency Med New York NY USA Univ Michigan Dept Emergency Med Ann Arbor MI 48109 USA St Joseph Hosp Dept Emergency Med Denver CO USA Robert Wood Johnson Univ Hosp Dept Emergency Med New Brunswick NJ USA Amer Coll Emergency Phys Washington DC USA Wesley Long Moses Cone Hosp Dept Emergency Med Greensboro NC USA Baylor Univ Med Ctr Dept Emergency Med Dallas TX USA Univ Virginia Hlth Sci Ctr Dept Emergency Med Charlottesville VA USA Penn Hosp Dept Emergency Med Philadelphia PA 19107 USA Washington Univ Sch Med & Hlth Dept Emergency Med Washington DC USA Carolinas Med Ctr Dept Emergency Med Charlotte NC 28203 USA

Study objective: We estimate the total number of physicians practicing clinical emergency medicine during a specified period, describe certain characteristics of those individuals to estimate the total number of full-time equivalents (FTEs) and the total number of individuals needed to staff those FTEs, and compare the data collected with those data collected in 1997. Methods: Data were gathered from a survey of a random sample of 2,153 hospitals drawn from a population of 5,329 hospitals reported by the American Hospital Association as having, or potentially having, an emergency department. The survey instrument addressed items such as descriptive data on the institution, enumeration of physicians in the ED, and the total number of physicians working during the period from June 6 to June 9, 1999. Demographic data on the individuals were also collected. Results: A total of 940 hospitals responded (a 44% return rate). These hospitals reported that a total of 6,719 physicians were working during the specified period, or an average of 7.85 persons scheduled per institution. The physicians were scheduled for a total of 347,702 hours. The average standard for FrE was 40 clinical hours per week. This equates to 4,346 FTEs or 5.29 FTEs per institution. The ratio of persons to FrEs was 1.48:1. With regard to demographics, 83% of the physicians were men, and 82% were white. Their average age was 42.6 years. As for professional credentials, 42% were emergency medicine residency trained, and 58% were board certified in emergency medicine;50% were certified by the American Board of Emergency Medicine. Conclusion: Given that there are 5,064 hospitals with EDs and given that the data indicate that there are 5.35 FTEs per ED, the total number of FTEs is projected to be 27,067 (SE=500). Given further that the data indicate a physician/FTE ratio of 1.47:1, we conclude that there are 39,746 persons (SE=806) needed to staff those FTEs. When adjusted for persons working at more than on

关键词：美国医院协会证明/统计学和数值数据急救医学/教育急诊室医院实习医师和住院医师职务/统计学和数值数据医务人员医院/标准医务人员医院/供应和分配人员配备和时间安排/统计学和数值数据专业场所/统计学和数值数据前瞻性研究薪金和附加福利/统计学和数值数据美国工作负荷量/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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How and why public sector doctors engage in private practice in Portuguese-speaking African countries

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HEALTH POLICY AND PLANNING 1998年第3期13卷 332-338页

作者： Ferrinho, P Van Lerberghe, W Julien, MR Fresta, E Gomes, A Dias, F Gonçalves, A Bäckström, B Univ Nova Lisboa Dept Saude Publ Inst Higiene & Med Trop Unidade Sistemas Saude P-1300 Lisbon Portugal Univ Nova Lisboa Inst Higiene & Med Trop Ctr Malaria & Outras Doencas Tropicais P-1300 Lisbon Portugal Inst Trop Med Prince Leopold Dept Publ Hlth B-2000 Antwerp Belgium Univ Eduardo Mondlane Fac Med Maputo Mozambique Minist de Saude Luanda Angola Minist da Saude Ctr Reg Desenvolvimento Sanitario Maputo Mozambique Minist Saude Lab Saude Publ Bissau Guinea Bissau

Objective: To explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public service. Design: cross-sectional qualitative survey. Subjects: In 1996, 28 Angolan doctors, 26 from Guinea-Bissau, 11 from Mozambique and three from S Tome and Principe answered a self-administered questionnaire. Results: All doctors, except one unemployed, were government employees. Forty-three of the 68 doctors that answered the questionnaire reported an income-generating activity other than the one reported as principal. Of all the activities mentioned, the ones of major economic importance were: public sector medical care, private medical care, commercial activities, agricultural activities and university teaching. The two outstanding reasons why they engage in their various side-activities are 'to meet the cost of living' and 'to support the extended family'. Public sector salaries are supplemented by private practice. Interviewees estimated the time a family could survive on their public sector salary at seven days (median value). The public sector salary still provides most of the interviewees income (median 55%) for the rural doctors, but has become marginal for those in the urban areas (median 10%). For the latter, private practice has become of paramount importance (median 65%). For 26 respondents, the median equivalent of one month's public sector salary could be generated by seven hours of private practice. Nevertheless, being a civil servant was important in terms of job security, and credibility as a doctor. The social contacts and public service gave access to power centres and resources, through which other coping strategies could be developed. The expectations regarding the professional future and regarding the health systems future were related mostly to health personnel issues.

关键词：非洲非洲西部安哥拉几内亚比绍卫生保健调查卫生服务研究收入/统计学和数值数据莫桑比克私人开业/经济学私人开业/统计学和数值数据公共卫生管理/人力公共卫生管理/统计学和数值数据问卷调查薪金和附加福利/统计学和数值数据

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Accelerated second degree advanced practice nurses: How do they fare in the job market?

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NURSING OUTLOOK 2000年第5期48卷 218-222页

作者： White, KR Wax, WA Berrey, AL Virginia Commonwealth Univ Dept Hlth Adm Profess Grad Programs Richmond VA 23284 USA Virginia Commonwealth Univ Accelerated Second Degree Nurse Practitioner Prog Richmond VA 23284 USA

Accelerated, nontraditional, advanced practice nursing programs are an alternative way to increase the supply of nurse practitioners. This study profiles demographic and job characteristics of second degree, non-nurse college graduates who pursued graduate degrees in nursing. Graduates' sex, age, income, previous education, nursing experience, factors describing the scope of the advanced practice role, and quality of the educational experience were studied. Data were collected from 29 graduates (57%) from Virginia Commonwealth University's accelerated second-degree nursing program from 1995 through 1999, The findings have implications for nursing educators, health care administrators, employers, and other persons who plan and recruit for this type of nursing education program.

关键词：医务工作者的态度教育护理学士/组织和管理教育护理研究生/组织和管理就业/统计学和数值数据职务说明卫生服务使用研究开业护士/教育开业护士/组织和管理开业护士/心理学护理教育研究职业自主权专业能力方案评价问卷调查薪金和附加福利/统计学和数值数据弗吉尼亚成年人女(雌)性人类男(雄)性中年人

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Returns to nursing education: Rural and nonrural practice

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JOURNAL OF RURAL HEALTH 1997年第1期13卷 78-85页

作者： Pan, SH Straub, L WESTERN ILLINOIS UNIV COLL BUSINESS & TECHNOLDEPT ECON1 UNIV CIRCLESTIPES HALL 442MACOMBIL 61455 USA

This study uses data from a national sample of registered nurses to compare earnings of nurses in rural and nonrural practice. The comparisons, conditioned by the nurses' educational level, are analogous to the concept of ''returns to human capital investment'' used in labor economics. A general linear model is applied within a framework of labor economics analysis. Results show that nurses with more education receive less for their investment if they practice in rural areas. Work experience and employment setting are also related to lower annualized earnings for rural practice. One exception to the otherwise consistent findings is that returns to advanced practice nursing are higher in rural areas. Results and policy implications are discussed.

关键词：数据收集人口统计学经济学护理学/统计学和数值数据教育护理继续教育程度模型经济计量学护士/分类护士/统计学和数值数据护士/供应和分配乡村卫生服务/经济学乡村卫生服务/人力薪金和附加福利/统计学和数值数据市区卫生服务/经济学市区卫生服务/人力

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WHO PAYS FOR MANDATED HEALTH-INSURANCE BENEFITS

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JOURNAL OF HEALTH ECONOMICS 1993年第3期12卷 341-348页

作者： FELDMAN, R UNIV MINNESOTA DEPT ECONMINNEAPOLISMN 55455

The great bulk of private health insurance in the US is obtained as a fringe benefit through the worker's place of employment. An analysis of benefits that are mandated on an hourly basis is offered. The analysis concludes that mandated benefits represent a tax at a rate equal to the difference between the employer's cost of providing the benefit and the employee's value of the benefit. Because health insurance is a lump-sum benefit, mandating that it be provided and paid by employers should not affect employees' decisions about working a marginal hour. A problem arises with the analysis because any mandated lump-sum benefit creates an income effect which, by the usual assumptions about employees' preferences, will increase the supply of labor. Using a plausible economic model of worker behavior in competitive labor markets, it is shown that workers may supply more labor and experience a decrease in hourly compensation under a mandated health insurance program.

关键词：雇主承担保健费用/统计学和数值数据雇主承担保健费用/发展趋势就业/经济学保健福利计划雇员/经济学保健福利计划雇员/立法和法学收入/统计学和数值数据工业/经济学工业/立法和法学模型统计学方案评价薪金和附加福利/统计学和数值数据薪金和附加福利/发展趋势美国

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HOSPITAL WAGE GRADIENTS WITHIN UNITED-STATES URBAN AREAS

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JOURNAL OF HEALTH ECONOMICS 1989年第2期8卷 233-246页

作者： HENDRICKS, AM HLTH ECON RES NEEDHAMMA 02194 USA

Average wages from 2,275 general hospitals in metropolitan areas across the U.S. were used to test for a wage gradient descending from hospitals in the central city through those in urbanized and finally non-urbanized areas of each county-defined metropolitan area. Significant gradients were found in MSAs of all sizes. Urbanized-area wages were 3 to 6 percent lower than those in central cities of the same metropolitan area. Non-urbanized suburban wages were 10 to 12 percent lower than those in central cities. The explanations for the gradients differ somewhat between large and small areas. For example, while the relative mix of high-wage and low-wage occupations in each hospital is a significant explanatory variable for wages in all metropolitan area sizes, the relative use of part-time workers is not significant in those metropolitan areas with fewer than 250,000 people. Relative crime in each hospital's city is highly significant in explaining relative wages only for areas with populations of more than one million.

关键词：卫生服务范围数据收集经济学医院医院病床数医院市区/经济学模型统计学人员医院/经济学薪金和附加福利/统计学和数值数据郊区人口美国市区人口

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MUSIC-THERAPY PRACTICES IN GERONTOLOGY

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JOURNAL OF MUSIC THERAPY 1991年第4期28卷 193-210页

作者： SMITH, DS LIPE, AW UNIV MARYLAND COLLEGE PKMD 20742

A national survey was conducted using a representative sample of music therapists who work with older adults. The goals of the survey were: (a) to provide a profile of music therapists working with geriatric clients with respect to professional credentialing, regional membership, age, gender, educational background, salary, and reimbursement practices;(b) to provide a description of assessment practices used by music therapists with geriatric clients;(c) to provide clarification relative to how music therapy practices with elderly clients fit into various settings in which the therapist may be employed;and (d) to identify the types of goals and objectives that are most frequently specified for this population. An 87% response rate yielded 176 usable questionnaires (72% of original sample). Frequency analyses of dichotic and multiple choice responses were conducted and reported as percentages of respondents. Free response items, which were provided as opportunities for clarification and explanation, were presented as a simple frequency count. Comparative analyses between salaried and contractual respondents, and respondents in the eight NAMT regions were not conducted due to unequal sample sizes.

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HOSPITAL EXPENDITURES IN THE UNITED-STATES AND CANADA - DO HOSPITAL WORKER WAGES EXPLAIN THE DIFFERENCES

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 453-465页

作者： HABER, SG ZWANZIGER, J ANDERSON, JGM THORPE, KE NEWHOUSE, JP UNIV N CAROLINA SCH PUBL HLTHDEPT HLTH POLICY & ADMCHAPEL HILLNC 27514 HARVARD UNIV SCH MEDDEPT HLTH CARE POLICYBOSTONMA 02115 HARVARD UNIV KENNEDY SCH GOVTCAMBRIDGEMA 02138 HARVARD UNIV SCH PUBL HLTHDEPT HLTH POLICY & MANAGEMENTBOSTONMA 02115 UNIV ROCHESTER DEPT COMMUNITY MEDROCHESTERNY 14627 UNIV BRITISH COLUMBIA CTR HLTH SERV & POLICY RESVANCOUVER V6T 1W5BCCANADA

An analysis indicates that higher wages cannot explain the substantially higher hospital expenditure rates in the US compared to Canada. On the contrary, hospital worker wage rates are lower in the US than in Canada, and it appears that they reflect differences between the countries in the markets for hospital labor, particularly among the less skilled occupations. It is not known why hospital labor markets might differ across countries. One explanation might be that collectively bargained wage levels are higher and that unionization is more widespread in Canadian hospitals. The finding that wages are lower in the US than in Canada strongly suggests that the difference in hospital costs between the 2 countries is primarily in the quantity of factor outputs, as well as in output differences, rather than in factor prices. Furthermore, it appears that greater amounts of both labor and non-labor inputs are used in US hospitals.

关键词：加拿大成本及成本分析/统计学和数值数据数据收集卫生经费支出/统计学和数值数据卫生服务研究模型经济计量学人员医院/经济学人员医院/统计学和数值数据薪金和附加福利/经济学薪金和附加福利/统计学和数值数据美国

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The declining significance of race among American men during the latter half of the twentieth century

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DEMOGRAPHY 2000年第1期37卷 41-51页

作者： Sakamoto, A Wu, HH Tzeng, JM Univ Texas Dept Sociol Austin TX 78712 USA Univ Texas Dept Sociol Austin TX 78712 USA McGill Univ Dept Sociol Montreal PQ H3A 2T5 Canada

The extent to which racial minority groups face discrimination in the labor market is the subject of considerable debate. Using William J. Wilson's thesis of the declining significance of race as our theoretical context, we provide further empirical evidence about labor market discrimination by investigating wages among African American, American Indian, Chinese American, Hispanic white, Japanese American, and non-Hispanic white men. We find, during the period before the civil rights movement, that a substantively significant wage disadvantage is evident for these minority groups with controls for observed labor force characteristics. In recent data, these net disadvantages are reduced substantially for each of these groups except Hispanics. With the exception of Hispanics, the results support Wilson's thesis.

关键词：公民权利大陆人口群就业少数民族/统计学和数值数据回归分析薪金和附加福利/统计学和数值数据薪金和附加福利/发展趋势美国人类男(雄)性

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The relationship between heavy alcohol use and work productivity loss in active duty military personnel: A secondary analysis of the 1995 Department of Defense Worldwide Survey

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MILITARY MEDICINE 2000年第5期165卷 355-361页

作者： Fisher, CA Hoffman, KJ Austin-Lane, J Kao, TC Uniformed Serv Univ Hlth Sci Dept Prevent Med & Biometr Div Epidemiol & Biostat Bethesda MD 20814 USA

This cross-sectional study examines the association between heavy alcohol use among active duty military personnel and five work productivity loss events that may have an adverse effect on military performance and readiness, Data for light [N = 3,147) and heavy (N = 2,242) drinkers, categorized by gender and pay grade, were obtained from the 1995 Department of Defense Worldwide Survey. Drinking classification was predefined using a standard algorithm that factored quantity and frequency of wine, beer, and liquor consumed. The relative risks of experiencing a productivity loss event at a particular level and 95% confidence intervals were calculated by applying the Mantel-Haenszel method after adjusting for age, The relative risks for increased self-reported lateness, leaving early, low performance, and on-the-job injury were all higher for heavy drinkers than for light drinkers. This association between the heavy-drinking population and four of five work productivity loss events indicates that prevention programs should target all personnel.

关键词：算法横断面研究效率组织/统计学和数值数据健康调查军事人员/统计学和数值数据需求估价危险因素薪金和附加福利/统计学和数值数据疾病严重程度指数性别分布吸烟/流行病学社会经济因素美国/流行病学女(雌)性人类男(雄)性

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