Hiring intentions and remuneration of veterinary practitioners in western Canada.

All private veterinary practices in western Canada (N = 1333) were surveyed during the SARS-CoV-2 pandemic (January to November 2020) to generate data on the demographics of the profession, and to quantify past and present hiring intentions (demand) as well as remuneration for veterinary associates. The response rate was 39.5% (526/1333), 186 of which had hired at least one full- (FT) or part-time (PT) associate within the 12-month period preceding the completion of the survey. When extrapolated to the practices that did not respond (nonresponders), as many as 471 practices may have hired an associate within the previous 12 mo. The median (mean) annual remuneration paid to FT associates was $90 000 ($91 730). The median number of months it took to hire an associate did not vary by province (P = 0.52); however, it did vary by practice type (P <0.0001): companion animal practice, 3.0 mo; food animal practice, 8.0 mo; and mixed animal practice, 12.0 mo. At the time of the survey, 232 of the 526 (44.1%) responding practices were currently seeking to fill 281 vacancies, representing 274 full-time equivalents (FTE). If extrapolated to the nonresponders, the total number of vacant FTE positions could have been as high as 694. The median (mean) annual wage offered for a FT associate was $87 500 ($88 940), which did not differ by province (P = 0.14) or practice type (P = 0.22). The results of this study support anecdotal reports of a shortage of private veterinary practitioners in western Canada.

Intentions d'embauche et rémunération des vétérinaires praticiens dans l'Ouest canadien. Tous les cabinets vétérinaires privés de l'Ouest canadien (N = 1333) ont été interrogés pendant la pandémie de SARS-CoV-2 (janvier à novembre 2020) afin de générer des données sur la démographie de la profession et de quantifier les intentions d'embauche passées et présentes (demande) ainsi que rémunération des associés vétérinaires. Le taux de réponse était de 39,5 % (526/1333), dont 186 avaient embauché au moins un associé à temps plein (FT) ou à temps partiel (PT) au cours de la période de 12 mois précédant la fin de l'enquête. Lorsqu'ils sont extrapolés aux pratiques qui n'ont pas répondu (non-répondants), jusqu'à 471 pratiques peuvent avoir embauché un associé au cours des 12 derniers mois. La rémunération annuelle médiane (moyenne) versée aux associés de FT était de 90 000 $ (91 730 $). Le nombre de mois qu'il a fallu pour embaucher un associé ne variait pas selon la province (P = 0,52); cependant, elle variait selon le type de pratique (P <0,0001) : pratique des animaux de compagnie, 3,0 mois; pratique des animaux destinés à l'alimentation, 8,0 mois; et pratique animale mixte, 12,0 mois. Au moment de l'enquête, 232 des 526 cabinets répondants (44,1 %) cherchaient actuellement à pourvoir 281 postes vacants, représentant 274 équivalents temps plein (ETP). Si extrapolé aux non-répondants, le nombre total de postes vacants en ETP aurait pu atteindre 694. Le salaire annuel médian (moyen) offert pour un associé à temps plein était de 87 500 $ (88 940 $), ce qui ne différait pas selon la province (P = 0,14) ou type de pratique (P = 0,22). Les résultats de cette étude appuient les rapports anecdotiques d'une pénurie de vétérinaires praticiens privés dans l'Ouest canadien.(Traduit par Dr Serge Messier).

Fighting for America's Paradise: The Struggle against Structural Racism.

Structural racism is a fundamental cause of racial inequities in health in the United States. Structural racism is manifested in inequality in the criminal justice system; de facto segregation in education, health care, and housing; and ineffective and disproportionately violent policing and economic disenfranchisement in communities of color. The inequality that Black people and communities of color face is the direct result of centuries of public policy that made Black and Brown skin a liability. The United States is now in an unprecedented moment in its history with a new administration that explicitly states, "The moment has come for our nation to deal with systemic racism . . . and to deal with the denial of the promise of this nation-to so many." The opportunities for creating innovative and bold policy must reflect the urgency of the moment and seek to dismantle the systems of oppression that have for far too long left the American promise unfulfilled. The policy suggestions made by the authors of this article speak to the structural targets needed for dismantling some of the many manifestations of structural racism so as to achieve health equity.

Stopping exploitation: Properly remunerating healthcare workers for risk in the COVID-19 pandemic.

We argue that we should provide extra payment not only for extra time worked but also for the extra risks healthcare workers (and those working in healthcare settings) incur while caring for COVID-19 patients-and more generally when caring for patients poses them at significantly higher risks than normal. We argue that the extra payment is warranted regardless of whether healthcare workers have a professional obligation to provide such risky healthcare. Payment for risk would meet four essential ethical requirements. First, assuming healthcare workers do not have a professional obligation to take on themselves the risks, payments in the form of incentives would preserve autonomy in deciding what risks to take on oneself. Second, even assuming that healthcare workers do have a professional obligation to take on themselves the risks, payments for risk would create fair working conditions by avoiding exploitation. Third, payments for risk would make it more likely that public healthcare systems can discharge their institutional responsibility to provide healthcare in circumstances where healthcare workers may otherwise (perhaps legitimately) opt out. Fourth, payments for risk would guarantee an efficient healthcare system in pandemic situations. Finally, we address two likely objections that some might raise against our proposal, particularly with regard to incentives, namely that such payments or incentives can themselves be coercive and that they represent a form of undue inducement.

Assessment of blood supply and usage pre- and during COVID-19 pandemic: A lesson from non-voluntary donation.

BACKGROUND: Ensuring steady stream of safe blood is the ultimate goal of blood transfusion practice. The current COVID-19 pandemic has affected almost every part of life and economy. Consequently, this study sets off to assess the effect of the pandemic on blood supply and blood transfusion in the University of Calabar Teaching Hospital. METHODS: Data from the Donor Clinic and Blood Group Serology Unit of the University of Calabar Teaching Hospital were retrospectively extracted to evaluate supply and use of blood before and during COVID-19 pandemic. RESULT: A total of 1638 donors were recorded within the study period. Age range 15-29 and 30-44 years constituted majority of the subjects (58.9% and 33.4%, respectively). The donor pool were male-dominated. Commercial donors (61.7%) and family replacement donors (30.6%) constituted majority of the donor pool. Most of the donor pool were students (37.1%), public servants (22.8%) and artisans (18.6%). A concomitant decrease of 26.1% and 18.9% were recorded in blood donation and request during the COVID-19 pandemic. CONCLUSION: Blood supply was not significantly affected in our study center as both requests and donations decreased. Consideration for improving family replacement donation was advised.

Payment in challenge studies: ethics, attitudes and a new payment for risk model.

Controlled Human Infection Model (CHIM) research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: reimbursement, wage payment and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways (value of statistical life or consistency with risk in other employment) by which payment for risk could be calculated.

Economics of Coding, Coverage, and Reimbursement for Molecular Diagnostics.

This editorial highlights the article from the Association for Molecular Pathology's Economic Affairs Committee that appears in this issue.