当政策遇到现实:新的18小时随叫随到轮班政策和以色列麻醉劳动力危机。

IF 3.5 4区 医学 Q1 HEALTH POLICY & SERVICES
Ariel Wimpfheimer, Charles Weissman, Shai Fein, Yehuda Ginosar
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引用次数: 1

摘要

背景:以色列医生队伍面临多重挑战。其中包括计划中的政策,将医生随叫随到的时间从26小时减少到18小时,从2026年起,只允许卫生部批准的外国医学院的毕业生参加以色列执照考试,以及医生持续短缺(2019年:以色列有3.19名医生/1000人,而经合组织平均为3.49名医生/1000人)。本研究考察了这些计划政策对以色列麻醉学劳动力的潜在影响。方法:对以色列34家公立和私立医院麻醉科主任进行调查,收集其部门工作日随叫随到的麻醉师数量和当前麻醉师短缺的数据。随后的一项调查收集了劳动力中每个麻醉师的数据,包括他们学习医学的国家。结果:每个工作日晚上有114名值班麻醉医师;72名住院医生和42名主治医生。使用生产性工作系数,这意味着104名住院麻醉师和51名主治麻醉师。此外,21个科室存在麻醉人员短缺,共计110名麻醉医师。来自非经合组织国家的麻醉医师有873名,他们的医学院没有获得世界医学教育联合会的认可,其中332名是住院医师(占住院医师的61.9%)。只有20.1%的麻醉科住院医生是以色列医学院毕业生。结论:描述性调查数据评估了两项卫生部新政策对医疗保健系统和麻醉学工作人员的直接和长期影响。实施18小时政策将立即从日间工作队伍中撤出155名麻醉师,这些麻醉师将无法在工作人员选择的手术手术室工作。这将加剧目前全国110名麻醉师的短缺。目前尚不清楚如何弥补这一缺口,因为以色列没有多余的医生,而且很少有以色列毕业生选择麻醉学作为专业。2026年以后,某些外国医学院的毕业生将无法进入医疗队伍,这种情况将进一步恶化,从而进一步减少潜在的麻醉科住院医师人数。这两项政策都是在没有充分的业务和预算规划或财政或人力资源的情况下颁布的;18小时随叫随到政策的实施已经被推迟。因此,新的或更新的政策必须伴随着具体的业务计划、预算拨款和额外劳动力的资金。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

When policy meets reality: the new 18-hour on-call shift policy and the Israeli anesthesia workforce crisis.

When policy meets reality: the new 18-hour on-call shift policy and the Israeli anesthesia workforce crisis.

When policy meets reality: the new 18-hour on-call shift policy and the Israeli anesthesia workforce crisis.

When policy meets reality: the new 18-hour on-call shift policy and the Israeli anesthesia workforce crisis.

Background: The Israeli physician workforce faces multiple challenges. These include planned policies reducing physician on-call from 26 to 18 h and, from 2026, allowing only graduates of Ministry of Health approved foreign medical schools to take the Israeli licensing examination and an ongoing physician shortage (2019: Israel had 3.19 physicians/1000 persons vs. OECD average of 3.49 physicians/1000 persons). This study examines the potential impact of these planned policies on the Israeli anesthesiology workforce.

Methods: Surveys conducted among 34 public and private Israeli hospital anesthesiology department chairs collected data on their department's number of weekday on-call anesthesiologists and current shortage of anesthesiologists. A subsequent survey collected data on each anesthesiologist in the workforce, including the country where they studied medicine.

Results: Each weekday night there were 114 on-call anesthesiologists; 72 residents and 42 attendings. Using productive work coefficients, this translates to 104 resident and 51 attending anesthesiologists. Furthermore, 21 departments had existing anesthesia workforce shortages totaling 110 anesthesiologists. There were 873 anesthesiologists from non-OECD countries whose medical schools are not accredited by the World Federation for Medical Education, of whom 332 were residents (61.9% of residents). Only 20.1% of anesthesiology residents were Israeli medical school graduates.

Conclusions: Descriptive survey data assessed the immediate and long-term consequences for the healthcare system and anesthesiology workforce of two new Health Ministry policies. Implementing the 18-h policy will immediately remove from the daytime workforce 155 anesthesiologists and who will be unavailable to staff elective surgery operating rooms. This will compound the current national shortage of 110 anesthesiologists. It is unclear how to replace this shortfall since there are no surplus Israeli physicians and very few Israeli graduates choose anesthesiology as a specialty. This situation will be exacerbated after 2026 when graduates of certain foreign medical schools will be unable to enter the medical workforce, further reducing the pool of potential anesthesiology residents. Both policies were promulgated without adequate operational and budgetary planning or fiscal or workforce resources; implementation of the 18-h on-call policy has already been postponed. Therefore, new or updated policies must be accompanied by specific operational plans, budgetary allocations and funds for additional workforce.

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