Physician Workforce Disparities and Patient Care: A Narrative Review.

Autor:	Silver JK; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts., Bean AC; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York., Slocum C; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, and Massachusetts General Hospital, Boston, Massachusetts., Poorman JA; Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Network, Boston, Massachusetts., Tenforde A; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brigham and Women's Hospital, and Spaulding Rehabilitation Network, Boston, Massachusetts., Blauwet CA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brigham and Women's Hospital, and Spaulding Rehabilitation Network, Boston, Massachusetts., Kirch RA; National Patient Advocate Foundation, Washington, District of Columbia., Parekh R; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.; American Psychiatric Association, Washington, District of Columbia., Amonoo HL; Department of Psychiatry, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts., Zafonte R; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts., Osterbur D; Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Health equity [Health Equity] 2019 Jul 01; Vol. 3 (1), pp. 360-377. Date of Electronic Publication: 2019 Jul 01 (Print Publication: 2019).
DOI:	10.1089/heq.2019.0040
Abstrakt:	Background: Ensuring the strength of the physician workforce is essential to optimizing patient care. Challenges that undermine the profession include inequities in advancement, high levels of burnout, reduced career duration, and elevated risk for mental health problems, including suicide. This narrative review explores whether physicians within four subpopulations represented in the workforce at levels lower than predicted from their numbers in the general population-women, racial and ethnic minorities in medicine, sexual and gender minorities, and people with disabilities-are at elevated risk for these problems, and if present, how these problems might be addressed to support patient care. In essence, the underlying question this narrative review explores is as follows: Do physician workforce disparities affect patient care? While numerous articles and high-profile reports have examined the relationship between workforce diversity and patient care, to our knowledge, this is the first review to examine the important relationship between diversity-related workforce disparities and patient care. Methods: Five databases (PubMed, the Cochrane Library of Systematic Reviews, EMBASE, Web of Knowledge, and EBSCO Discovery Service) were searched by a librarian. Additional resources were included by authors, as deemed relevant to the investigation. Results: The initial database searches identified 440 potentially relevant articles. Articles were categorized according to subtopics, including (1) underrepresented physicians and support for vulnerable patient populations; (2) factors that could exacerbate the projected physician deficit; (3) methods of addressing disparities among underrepresented physicians to support patient care; or (4) excluded ( n =155). The authors identified another 220 potentially relevant articles. Of 505 potentially relevant articles, 199 (39.4%) were included in this review. Conclusions: This report demonstrates an important gap in the literature regarding the impact of physician workforce disparities and their effect on patient care. This is a critical public health issue and should be urgently addressed in future research and considered in clinical practice and policy decision-making. Competing Interests: J.K.S. discloses that she received a grant from the Arnold P. Gold Foundation to support this work. As an academic physician, she has published books and receives royalties from book publishers, gives professional talks such as Grand Rounds and medical conference plenary lectures, and receives honoraria from conference organizers. She has grant funding from the Binational Scientific Foundation (culinary telemedicine research). She has personally funded the Be Ethical Campaign and proceeds from the campaign support disparities research. C.S. has Grant funding from National Institutes of Health, Wings for Life, Craig H. Neilsen Foundation. A.T. receives financial support for research on health outcomes from American Style Football, from a grant from the Football Players Health Study at Harvard University, which is funded by the NFL Players Association (NFLPA). He also has received funding from the American Medical Society for Sports Medicine. C.A.B. has grant funding from the International Olympic Committee (characterization of shoulder injuries in Para athletes) and is partially supported by the Spaulding New England Regional Spinal Cord Injury Center (Agency for Community Living/NIDLRR). R.Z. evaluates patients in the MGH Brain and Body-TRUST Program, which is funded by the NFL Players Association. He was partially supported by NIDILRR: 90DP0039-03-00, 90SI5007-02-04, and 90 D P0060; USAMRC-W81XWH-112-0210; and NIH: 4U01NS086090-04, 5R24HD082302-02, and 5U01NS091951-03, and by a grant from the Football Players Health Study at Harvard University, which is funded by the NFL Players Association (NFLPA). He also evaluates patients for the MGH brain and Body TRUST center sponsored, in part, by the NFLPA and serves on the Mackey White health committee. This project was made possible with a Mapping the Landscape, Journeying Together grant from the Arnold P. Gold Foundation Research Institute. C.S. received financial consulting fees from Acumen, LLC, for work related to health care payment policy and honoraria from Becker's Health care and Oakstone Publishing. C.A.B. discloses that as an academic physician, she gives professional talks such as Grand Rounds and medical conference plenary lectures, and receives honoraria from conference organizers. R.A.K. is employed by National Patient Advocate Foundation and as a consulting faculty advisor to the Center to Advance Palliative Care. R.Z. receives royalties from (1) Oakstone for an educational CD-Physical Medicine and Rehabilitation a Comprehensive Review and (2) Demos publishing for serving as co-editor of the text Brain Injury Medicine. R.Z. serves on the Scientific Advisory Board of Oxeia Biopharma, Biodirection, ElMINDA, and Myomo. H.L.A. reports time for development and completion of this work was funded by the Harvard Medical School Dupont-Warren Research Fellowship Award and the Harvard Medical School Livingston Research Award. No competing financial interests exist for the other authors.
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