More survey results...oh, and Happy Friday!

A couple of weeks ago I posted results from the Health Sector Council’s grade 12 exit strategy survey showing that parents are the strongest influence on students’ education and career plans. I’d like to point out a few other results from the survey in this post.

One of the things we found was that many students were interested in the health sector as a career option (33% of students indicated interest). When asked about specific occupational groups within the health sector that they were interested in pursuing, the majority indicated nurse (22.3%), doctor (18.2%) and pharmacist (9.5%). Either students are not interested in other health careers, or (more likely) are not aware of the variety of health careers available.

Later in the survey students were provided a list of 62 health occupations that are practiced on PEI – jobs like medical lab technologist, addictions counsellor, emergency medical technician, resident care worker, nuclear medicine technologist, and so on – and were asked to indicate which careers looked interesting. Each entry included a small amount of information on the occupation, including salary range and education requirements, so that students could make an informed decision. Not surprisingly, many students were interested in other health careers, in addition to nurse, physician and pharmacist. Interest was strong in higher salaried positions like medical physicist, dentist, family doctor, specialist physician and psychiatrist, but was also strong in occupations with much lower remuneration – jobs like addictions counsellor and child development worker – suggesting salary wasn’t the sole factor influencing students’ expression of interest. In fact, the most popular jobs were those that included a high degree of social interaction and whose practitioners might be viewed as helping clients ‘better’ themselves (addictions counsellor, child development worker, psychiatrist, psychologist, social worker, dietitian and physiotherapist, for example).

Overall interest in health careers increased dramatically (from 33% to 53.6%) after the students reviewed the 62 occupations, suggesting that the more health career information students have at their disposal, the more likely they are to find a job that matches their interest. Not rocket science, obviously, but the simple fact is that many students don’t have access to this information. As I mentioned in an earlier post, we have a directory of PEI health careers available for download. Let me know if you want a hard copy.

Cheers,
Mark

A Family Health Team model

The article below describes a community’s response to pressures affecting its health human resources and its ability to deliver effective, quality health care. Many of the issues raised in the article are ones that we share in PEI – physician recruitment challenges, shifting demographics among the medical profession whereby more medical school graduates are choosing to specialize rather than enter family medicine, physician retirement, and so on.... Granted, there have been some good news stories, including some recent success recruiting physicians, but the times are changing and recruitment is just one piece of the puzzle.

The article outlines the development of an interprofessional, team-based health delivery system for the Peterborough region of Ontario, adhering to the ideals of collaborative, patient-centred care outlined in one of my previous blog posts. The Peterborough region currently has five interprofessional family health teams (two in the city of Peterborough), consisting of family doctors, nurse practitioners, receptionists (yes...they are an integral part of the health team concept), registered nurses, dietitians, social workers and so on. In 2008 the Peterborough Regional Health Centre was opened with the intention of expanding the interprofessional care concept to include outpatient services and bring specialist physicians into the mix.

It’s an interesting concept and one that appears to be working. Fourteen thousand people have been taken off the waiting list for a family doctor in the Peterborough region in the last two years and wait times have decreased. We have family health teams on PEI and I’m not sure how they compare to those in Peterborough, but the two jurisdictions are strikingly similar. Peterborough and Prince Edward Island are almost exactly equivalent in population (139,818 in PEI as of 2008 vs. 133,080 in Peterborough as of 2006). Both jurisdictions are also largely rural and comparable in overall area and population density (23.9 people per square kilometre in PEI vs. 35 per square kilometre in Peterborough).

I think it’s something that bears watching. If successful, some of the concepts that drive the Peterborough model might be worth adopting on PEI. For one thing, I’m curious to know how many people the Peterborough health teams count as patients compared to PEI teams. I’ll keep you posted if I find out. What are your thoughts?

The Perfect Storm

How a community calmed the rough waters of health care
By Gordon Gibb

You’ll have to forgive Dr. Don Harterre for choosing a winged warthog as his office mascot. The diminutive porker suspended above his desk serves as a delicious metaphor in view of recent success implementing family health teams in Peterborough, Ont., — something one local physician predicted would only happen "when pigs fly."

In Peterborough, an idyllic city of 75,000 located 90 minutes northeast of Toronto, health care is something people love to talk about these days.

Little wonder. The sprawling, state-of-the-art Peterborough Regional Health Centre (PRHC) is slated to open in June, consolidating two outdated hospitals into one meticulously planned facility. The Peterborough Clinic has just moved into a new building adjacent to the PRHC, with its orphaned facility downtown tagged to house expanded vascular health services. Five family health teams are flourishing. And upwards of 14,000 people have come off the waiting list for a family doctor in the past two years.

read the rest of the article here...

Happy humpday!

Some comic relief is in order after the last number of serious and reflective posts. Here's a bit of satire to lighten the mood.

A debate from the Canadian Medical Association Journal

The following two articles: Physicians, it‘s in your court now, by Stephen Lewis, and Doctors put patients first in health care debate, by Albert Schumacher, present two sides of a heated debate on the responsibilities that governments and physicians have played in the health care crises facing Canada, and the roles that each should assume in solving them. The articles were originally published in the Canadian Medical Association Journal and I’m linking to them here to spark some debate; they do not necessarily represent my views or the opinion of the Health Sector Council.

The two articles present very polarized points of view and both authors are painting with broad strokes. Have a read and let us know what you think. And don’t forget to check out the e-letter responses at the bottom of each article; there are some great responses to Lewis and Schumacher from other physicians and medical students (see this one in particular).

All of this being said, it would seem to me that moving away from polarized points of view and finding the “best” and “doable” solutions to all of our healthcare problems would be more appropriate than trying to figure out who is to blame. But that is just me….what do you think?

Cheers,
Mark

This just in - students actually listen to their parents (sometimes)!

The PEIHSC released a report on grade 12 students’ education and career plans in January. The report was based on a survey we conducted with grade 12 students during the 2007/2008 school year, and we were really impressed with the number of students (almost half of the grade 12 population) who took the time to fill out the survey. I thought this would be a good venue to point out some of the findings of the survey, especially for members of the public who might not be aware of it.

For this post I’d like to focus on the part of the survey where we asked students about what influences their education and career plans. We found that parents have the most influence on high school students’ plans (does this surprise you?). We asked students the degree to which their career plans were influenced by three different factors – parents/guardians, friends and career promotions campaigns. 36.6% were influenced “some” or “a lot” by career promotions campaigns, 39.6% were influenced “some” or “a lot” by friends, and 66.8% were influence “some” or “a lot” by parents. That’s a significant percentage of high school students who rely on parents for information and insight on future education and careers, and I think it drives home the fact that parents need to have access to the right information.

In an effort to get information out there about opportunities in the health sector and the variety of occupations available, we published Health Careers on PEI, a directory of 62 health occupations practiced on the Island. Most of us are aware of the staffing issues with physicians, nurses and pharmacists and that demand for those careers are high, but there are other health careers that are also in high demand. Additionally, many health careers are accessible to people who may not be interested in pursuing the education required for a career as a family doctor or specialist surgeon. Occupations like medical laboratory technologists, licensed practical nurses, dental hygienists, resident care workers and emergency medical technicians require between 6 months and 2 years of college education.

If you would like a hardcopy of the Grade 12 Exit Strategy report or the health careers directory drop me a line or give me a call and I’ll see what I can do for you. My contact info can be found on my profile or the Health Sector Council website.

Cheers,
Mark

HR strategies to address shift work

My phone rang at 5:30 this morning, waking me from a deep sleep and giving me an instant feeling of dread. My heart pounding, I thought: “this can’t be good.” Luckily it was the wrong number; the call was for someone else, letting them know there was a day-shift available (at the hospital, possibly?) if they were interested. I fell back asleep and then had trouble getting up at my usual time of 7:00 (or so), which I would like to blame on the 5:30 call but is more likely due to my habit of staying up too late.

Health workers must be pretty used to those kinds of disturbances, considering the prevalence of shift-work and casual employment in the health sector. So after getting to work I did a little searching and came across a fact sheet on the health effects of shift-work and some of the things that can be done (by employees and employers) to address them. Most of these suggestions are quite simple, but even simple strategies can be difficult to follow.

For those of you who work shifts, do you enjoy it? How do you adjust to irregular shifts or those early morning calls? For the health sector employers reading this, do you have strategies in place to address the human resource issues that arise due to shift-work?

What are the health effects of shiftwork?
from the Workers Health Centre website

Partial sleep deprivation is the main problem that affects the health of shift workers.

Night work disturbs the circadian rhythm in the human body. This is an internal body clock that is synchronised to a 24 hour period. It regulates a number of physiological functions such as body temperature, hormone secretion, heart rate, blood pressure, respiration, digestion and mental alertness. It lets us know, among other things, when to sleep and when to eat. Shiftworkers can have health problems because this internal clock is disturbed.

Shift workers and extended hour workers suffer from sleep disturbances and the physiological consequences that result from it. The social effects extend to their family and friends.

Researchers have found several negative health effects in shiftworkers and workers on extended hours. Some of these are:

• increased heart disease
• gastric ulcers and gastro intestinal problems
• social problems and minor psychiatric disorders
• sleep disorders and increased fatigue
• increased error rates and accident rates.

Some personal factors can make workers more susceptible to problems when doing shiftwork or extended hours. These include:

• a heavy domestic work load
• psychiatric illness
• a history of alcohol or drug abuse
• epilepsy
• diabetes
• heart disease

How can employers address shiftwork problems?

There are a number of steps that employers can take to address the problems faced by shift workers. Some of the solutions suggested for employers are:

• Improve workplace lighting and canteen and recreation facilities.
• Ensure workers undertake no more than two consecutive night shifts.
• Ensure workers undertake no more than two or three consecutive 12 hour shifts.
• Ensure an even distribution of days off with shift blocks.
• Avoid compacting shifts to produce longer breaks.
• Allow workers time for breaks, time to move around and time to interact with other workers.
• Ensure job rotation by moving employees to different tasks or responsibilities.
• Educate workers on lifestyle advice such as eating and sleeping patterns.

In addition, shift workers should have the same access as day workers to services such as counselling and the same opportunities for participation in training and meetings. Workplace safety committee meetings should also be scheduled for those on evening and night shifts.

Solutions for workers

The shift worker can also take a number of steps to make living with shift work more bearable.

Setting up the conditions for sleep is very important

Family, neighbours and friends need to know and understand the shift schedule.

Let relatives and neighbours know about the work schedule. The bedroom must be dark and cool. Noise levels can be reduced by heavy curtains and sound insulation on the doors and windows. An air conditioner can mask minor noises from outside. An answering machine for the phone and lowering the ring tone may also be helpful.

There should be a routine for waking up as well, just as there is for the average day-worker.

Night-shift workers should exercise

Exercising is not an easy task because shift workers usually start the day exhausted and pressed for time. However, exercise can simply mean being active in general; for example, a walk around the neighbourhood for half an hour or a game of backyard soccer with the children. Exercise should be a part of every day, but vigorous exercise should be avoided within the last two hours before bed time.

Shift workers’ diet is very important

Shift workers should have three meals a day, at roughly the same time every day. The timing of meals can keep energy levels up, improve sleep and help the body adjust to the shiftwork schedule.

Restrict the intake of caffeine, not only in coffee and tea, but in soft drinks too.

Healthy snacks like fruit and fruit juice, raw vegetables and cheese are very good at home or at work.

Family understanding and co-operation is crucial

Stress seems a common problem in shiftworkers’ lifestyle and a good home environment can help reduce stress.

Useful hints to apply during shiftwork

• When the work is sedentary, contact others on the same shift regularly; it may help to keep alert.
• Stand up and walk occasionally.
• Go to the toilet and wash your hands and wet your face.
• Be aware of fatigue after the shift is over, especially while driving home.
• Keep your mind active by listening to the radio.
• Avoid overall heating - in winter, it is better to direct warmth to the feet and open the window a little to let the fresh air in on your face.
  

The Expanding Health Team - Nurse Practitioners

The health sector is changing, not only in PEI and Canada but worldwide, and with good reason. Why?

There is no other option.

One of the most startling statistics I read in the Corpus Sanchez report was the rate at which the cost of the health system is growing relative to the provincial treasury. Based on that report, by 2013 our health system will consume all new incremental revenue, meaning the spending of every other department will have to be frozen in order to pay for increases in the health budget. By 2014, only five years from now, other departments will have to reduce spending to pay for health care cost increases. It’s a sobering statistic....

As we move toward a primary care model – community-based, preventive, continuous and integrated care with a focus on interprofessional collaboration – we have to find new, more efficient ways of accessing the health system to avoid the grim situation described above. One way of doing that is to make better use of the health team.

Nurse practitioners are a central part of the health team. According to a recent CBC report, nurse practitioners can see from 60 to 70 percent of patients that would normally see a family doctor. That is a significant burden removed from the family doctor and also a much more cost-effective way of accessing the health system. After all, a nurse practitioner exerts a much lighter burden on the province’s pocketbook than a doctor.

The article at this link is from a Newfoundland perspective, but is also relevant to PEI and presents a good example of how nurse practitioners can help ease demands and pressures on the health system.

Mark

Recruiting men to nursing

I was checking out a few university websites yesterday looking for information on programs in dentistry, wondering what kind of entry requirements there were and whether my BA would give me the necessary background to get into one of them. Simply out of curiosity, of course; I’m not thinking of leaving the Health Sector Council.

Not surprisingly, the courses I took on Maritime Archaic Prehistory, Old English and Medieval Art and Architecture may not have prepared me for a doctorate in dental surgery. Apparently dentists need some sort of science background...go figure. So I was chatting to James about this (again, this is all hypothetical) and he said, “What about becoming a dental hygienist?”

I hadn’t considered a dental hygienist program, and that made me wonder why? Did it have something to do with dental hygienist being a primarily female profession? Was I conditioned to omit dental hygiene as a consideration for this reason? Dental hygienists are in-demand after all, work regular hours as far as I know, and get paid well. It sounds like a great profession with great opportunity.

James sent me a CBC article on the challenges of recruiting men into nursing professions, another field represented primarily by women. Here is a link to that article. The article points out that although men make up about 10-13% of students in nursing programs, only 5% of practicing nurses are men. Additionally, male students are more likely to drop out of nursing programs than female students. Why is that?

The article also points out that there is no shortage of people applying to nursing programs. In that light, should we be concerned with recruiting men into nursing programs (or other traditionally female occupations)? While I’m not sure that recruiting men into occupations traditionally practiced by women is important just for the sake of creating gender balance, I do think it is important to encourage people to pursue the career path of their choice.

It’s a tricky subject, and one that is difficult to discuss wearing my PEIHSC cap and trying to stay on the path of political correctness. So, as usual, I will turn the question back on you and get your take. Why aren’t more men becoming dental hygienists, RNs, LPNs, etc.? Is it important to recruit more men into traditionally female occupations? Click on the comments link below this entry to let us know.

Cheers,
Mark