Medical directors of long-term care facilities: preventing another physician shortage?
Notice bibliographique
Résumé
OBJECTIVE: The long-term care (LTC) sector in Canada is expanding, but little attention has been given to medical human resources in this area. Our objective was to seek LTC medical directors' opinions about medical services in LTC and about strategies for recruitment and retention. DESIGN: Mailed survey. SETTING: Long-term care facilities and nursing homes. PARTICIPANTS: Seven hundred five medical directors of LTC facilities across Canada were identified from the Canadian Healthcare Association database. MAIN OUTCOME MEASURES: Responses to open- and closed-ended questions and to Likert-type scales. RESULTS: The response rate was 55%. The average age of medical directors was 54 years. Most had started work in LTC because of a vacant position, as opposed to self-perceived skills or training. Most (75.3%) reported satisfaction with their role as medical directors, but 82.7% believed that there was a significant shortage of physicians working in LTC, and 42% had seriously considered leaving their positions. Major sources of satisfaction identified were clinical, especially working with older patients and improving care. Important sources of dissatisfaction were remuneration for LTC work, on-call coverage, and excessive paperwork. Directors suggested increases to fee schedules as the main recruitment and retention strategy, and many believed that increasing exposure to LTC during residency would increase recruitment. Development of larger on-call groups for coverage and alternative methods of remuneration were not cited as important factors. Most did not believe that working in a teaching nursing home would increase their satisfaction. Directors did not think the use of nurse practitioners would alleviate concerns about shortages of physicians. CONCLUSION: Medical directors of LTC facilities are aging, and many are considering leaving their work in LTC. Without an increase in the number of physicians willing to work in LTC institutions, the current shortage of LTC physicians could increase in the near future. Medical directors' responses to questions could help guide strategies to recruit and retain physicians. Future areas of research should include the perspectives of physicians who are not medical directors and of family medicine residents.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».