Characterizing the direct care health workforce in the United States, 2010-2019.

BACKGROUND: To describe the growth and characteristics of the direct care health workforce, encompassing home health aides, personal care aides, nursing assistants, and orderlies and psychiatric aides from 2010 to 2019 in the United States. METHODS: Using nationally representative data from the 2010 to 2019 American Community Survey, we described the growth in the direct care health workforce overall and by type of direct care health worker. In addition, we examined the distribution of direct care workers by geographic region of the country, age categories, citizenship, world area of birth, income, health insurance status, and other characteristics. RESULTS: From 2010 to 2019, the number of direct care health workers in the United States per 10,000 individuals decreased slightly from 135.81 in 2010 to 133.78 in 2019. Personal care aides made up 42.1% of the direct care health workforce in 2019, followed by nursing assistants (39.5%) and home health aides (16.3%). In 2019, the number of direct care health workers who were not U.S. citizens accounted for roughly 10% of all workers in each year. The relative percentage of direct care health workers that were not a citizen of the United States was highest among home health aides (16.3%). Among workers born outside of the United States, the majority were from Latin America, followed by Asia. CONCLUSION: From 2010 to 2019, there was little growth in the direct care health workforce despite growing demand for direct care health workers. In the midst of the current and projected shortage of direct care health workers-particularly during the COVID-19 pandemic, longer-term solutions to improve retention of direct care health workers and increase the supply of direct care health workers may be needed.

Preparedness and guidelines for neurosurgery in the COVID-19 era: Indian perspective from a tertiary care referral hospital.

The COVID-19 pandemic has severely impacted healthcare systems globally. The need of the hour is the development of effective strategies for protecting the lives of healthcare providers (HCPs) and judicious triage for optimal utilization of human and hospital resources. During this pandemic, neurosurgery, like other specialties, must transform, innovate, and adopt new guidelines and safety protocols for reducing the risk of cross-infection of HCPs without compromising patient care. In this article, the authors discuss the current neurosurgical practice guidelines at a high-volume tertiary care referral hospital in India and compare them with international guidelines and global consensus for neurosurgery practice in the COVID-19 era. Additionally, the authors highlight some of the modifications incorporated into their clinical practice, including those for stratification of neurosurgical cases, patient triaging based on COVID-19 testing, optimal manpower management, infrastructure reorganization, evolving modules for resident training, and innovations in operating guidelines. The authors recommend the use of their blueprint for stratification of neurosurgical cases, including their protocol for algorithmic patient triage and management and their template for manpower allocation to COVID-19 duty, as a replicable model for efficient healthcare delivery.

COVID-19 and the Health Workforce.

The health workforce has been greatly affected by COVID-19. In this commentary, we describe the articles included in this health workforce research supplement and how the issues raised by the authors relate to the COVID-19 pandemic and rapidly changing health care environment.

Surgery for non-Covid-19 patients during the pandemic.

BACKGROUND: In the early phase of the Covid-19 pandemic, mainly data related to the burden of care required by infected patients were reported. The aim of this study was to illustrate the timeline of actions taken and to measure and analyze their impact on surgical patients. METHOD: This is a retrospective review of actions to limit Covid-19 spread and their impact on surgical activity in a Swiss tertiary referral center. Data on patient care, human resources and hospital logistics were collected. Impact on surgical activity was measured by comparing 6-week periods before and after the first measures were taken. RESULTS: After the first Swiss Covid-19 case appeared on February 25, progressively restrictive measures were taken over a period of 23 days. Covid-19 positive inpatients increased from 5 to 131, and ICU patients from 2 to 31, between days 10 and 30, respectively, without ever overloading resources. A 43% decrease of elective visceral surgical procedures was observed after Covid-19 (295 vs 165, p<0.01), while the urgent operations (all specialties) decreased by 39% (1476 vs 897, p<0.01). Fifty-two and 38 major oncological surgeries were performed, respectively, representing a 27% decrease (p = 0.316). Outpatient consultations dropped by 59%, from 728 to 296 (p<0.01). CONCLUSION: While allowing for maximal care of Covid-19 patients during the pandemic, the shift of resources limited the access to elective surgical care, with less impact on cancer care.

Emerging From the COVID-19 Crisis With a Stronger Health Care Workforce.

The COVID-19 pandemic has highlighted the limitations of the current health care workforce. As health care workers across the globe have been overwhelmed by the crisis, oversight entities and training programs have sought to loosen regulations to support ongoing care. Notably, however, workforce challenges preceded the current crisis. Now may be the time to address these underlying workforce challenges and emerge from the COVID-19 pandemic with a stronger health care workforce.Building upon historical exemplars in the context of the current crisis, the authors of this Perspective provide a roadmap to rapidly and safely increase the workforce for COVID-19 and beyond. The authors recommend the following: (1) a comprehensive approach to guide health care workforce development, (2) streamlining transitions to the next level of practice, (3) reciprocity among state licensing boards or national licensure, (4) payment reform to support a strengthened health care workforce, and (5) efforts by employers to ensure the ongoing safety and competence of the bolstered workforce. These steps require urgent collaboration among stakeholders commensurate with the acuity of the pandemic. Implemented together, these actions could address not only the novel challenges presented by COVID-19 but also the underlying inadequacies of the health care workforce that must be remedied to create a healthier society.

COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper.

BACKGROUND: The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. AIMS: To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. METHODS & PROCEDURES: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. MAIN CONTRIBUTION: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. CONCLUSIONS & IMPLICATIONS: The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper adds What is already known on the subject ENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high-risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID-19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research. What this paper adds to existing knowledge This study provides a discussion of the threats and opportunities from the COVID-19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership. What are the potential or actual clinical implications of this work? The COVID-19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post-COVID era.

Will Losing Black Physicians Be a Consequence of the COVID-19 Pandemic?

A compelling case exists that increasing the number of Black physicians trained and practicing in the United States is one effective intervention to promote health equity and reduce the persistent health disparities that have become glaringly evident during the COVID-19 pandemic. However, the U.S. physician workforce has relatively few Black physicians. Blacks comprise approximately 13% of the U.S. population but only 5% of practicing physicians. In this Invited Commentary, the authors caution that the COVID-19 pandemic may erode the meager progress that has been made in increasing the number of Black physicians. This loss of Black physicians may happen because Black patients are overrepresented among cases of COVID-19, Black physicians care for relatively more Black patients often in settings with less access to SARS-CoV-2 testing and personal protective equipment, and Black physicians have more comorbid chronic conditions that increase their own susceptibility to mortality from COVID-19. All organizations in which physicians train and practice must redouble their efforts to recruit, train, and retain Black physicians. If nothing else, the COVID-19 pandemic must make academic health centers and health care systems recognize Black physicians as the precious resource they are and protect and reward them accordingly.