Responding to the workforce crisis: consensus recommendations from the Second Workforce Summit of the American Society of Pediatric Nephrology.

IMPORTANCE: Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care. OBJECTIVE: To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce. EVIDENCE REVIEW: Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN's 2023 Strategic Plan survey, the ASPN's Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions. FINDINGS: A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member's time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology. CONCLUSIONS AND RELEVANCE: The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients.

Employment in the equine industry in 2022: Insights into career types, salaries, and benefits.

The equine industry contributes $74 billion and provides 1.3 million jobs annually to the United States economy. However, limited information is available on the current salaries and benefits of equine professionals. In 2022, an online survey was conducted to assess salaries, benefits, and education levels of equine professionals across several career types in the equine industry. The survey consisted of 38 questions with conditional branching and was distributed through social media and e-newsletters. Survey branching focused on grouping participants by career type into the following categories: farm management, government, industry, nonprofit, private practice, and university. The most prevalent career type represented was farm management (34%) followed by private practice (18%), academia (17%), industry (15%), nonprofit (12%), and government (4%). Associations between variables were examined with Chi-squared analysis. An association was observed between education level and salary (P = 0.001, X2 = 103.17) with salaries greater than $50,000 being more prevalent with advanced degrees. Similarly, job type and salary were associated (P = 0.001, X2 = 73.47), where salaries for academia and industry careers were often greater than $50,000 and nonprofit and farm management salaries were more often less or equal to $50,000. Compared to professionals in farm management or in private practice, those in academia and government received more benefits (P<0.05). Data collected from this survey creates a baseline for evaluating compensation across the equine industry and exposed opportunities for improvements in future surveys. Outside of industry salary comparisons, survey data can be used by educators to emphasize the benefit of further education to increase salary and benefits.

Commitment to inclusion: The importance of collaboration in gender equity work.

Despite decades of faculty professional development programs created to prepare women for leadership, gender inequities persist in salary, promotion, and leadership roles. Indeed, men still earn more than women, are more likely than women to hold the rank of professor, and hold the vast majority of positions of power in academic medicine. Institutions demonstrate commitment to their faculty's growth by investing resources, including creating faculty development programs. These programs are essential to help prepare women to lead and navigate the highly matrixed, complex systems of academic medicine. However, data still show that women persistently lag behind men in their career advancement and salary. Clearly, training women to adapt to existing structures and norms alone is not sufficient. To effectively generate organizational change, leaders with power and resources must commit to gender equity. This article describes several efforts by the Office of Faculty in the Johns Hopkins University School of Medicine to broaden inclusivity in collaborative work for gender equity. The authors are women and men leaders in the Office of Faculty, which is within the Johns Hopkins University School of Medicine dean's office and includes Women in Science and Medicine. Here, we discuss potential methods to advance gender equity using inclusivity based on our institutional experience and on the findings of other studies. Ongoing data collection to evaluate programmatic outcomes in the Johns Hopkins University School of Medicine will be reported in the future.

Trends in enrollment, retention, and graduation of United States veterinary technicians/nurses schools.

Objective: There is a significant shortage of veterinary technicians. To help address this issue, there has been a call to increase the capacity of United States VT/N educational programs. Yet, the current challenges within the field may be negatively impacting the number of people deciding to pursue VT/N certification. To assess this possibility, this study was designed to explore the enrollment, retention, and graduation trends within United States VT/N educational programs. Explore the trends between 2018 and 2022 in enrollment, retention, and graduation of veterinary technicians/nurses (VT/N) at educational programs located in the United States. Sample: Educators and administrators working in United States VT/N educational programs. Procedures: An electronic survey distributed via an anonymous link within emails sent from the Association of Veterinary Technician Educators. Results: A total of 82 responses from educators and administrators working in United States VT/N educational programs were received. Forty-three percent of participants indicated a decrease in student enrollment in the last 5 years. The factors seen to have the largest significant impact were "More potential students not convinced being credentialed will lead to a difference in job duties when compared to non-credentialed work," "More potential students who do not think being credentialed will lead to a substantial increase in pay when compared to non-credentialed work" and "More potential students not willing/able to invest the time needed to become credentialed." A total of 60% reported an increase in retention efforts within the last 5 years. The services most commonly reported as increasing included mental health support and academic mentoring. Conclusions and clinical relevance: This study suggests that an increased number of potential VT/N students are deciding that being credentialed is not worth the time or money. While additional resources directed toward recruitment and retention are needed within VT/N educational programs, without systematic changes within the field, it is likely that there will be a continued decline in the number of interested applicants.

Veterinary students are willing to accept job flexibility by trading off some salary.

OBJECTIVE: To determine the value veterinary students place on nonpecuniary job benefits related to working arrangements. SAMPLE: 381 companion animal-focused veterinary students at 14 US veterinary colleges. METHODS: We employed a survey with a choice-based conjoint experiment. The experimental data were analyzed with a random parameter logit model, from which willingness to accept was calculated. RESULTS: The results indicated that students would prefer working 4 days a week and closer to 40 hours per week, with 13 days of paid time off. Flexible working arrangements were valued from approximately $1,500 to $3,400, depending on the attribute being analyzed. Paid time off was most highly valued. CLINICAL RELEVANCE: These results will help employers better identify the current preferences of soon-to-be associate veterinarians and can match job offer/working arrangements to enhance recruitment and retention within veterinary practices.

US neonatal intensive care unit registered dietitian nutritionists salary description and correlates: results of a survey.

BACKGROUND: This survey described the compensation of neonatal intensive care unit (NICU) registered dietitian nutritionists (RDNs) in the United States and examined correlates of higher salaries within this group. METHODS: A cross-sectional online survey was completed in 2021 by 143 NICU RDNs from 127 US hospitals who reported hourly wage in US dollars (USD). We used initial bivariate analyses to assess the relationship of selected institution-level and individual-level variables to hourly wage; the rank-sum test for binary variables; bivariate regression and Pearson correlation coefficients for continuous variables; the Kruskal-Wallis test for categorical variables. Variables with a compelling relationship to the hourly wage outcome were considered in model creation. Final model selection was based on comparisons of model fit. RESULTS: Median hourly compensation was USD 33.24 (interquartile range [IQR] 29.81, 38.49). Seven variables had a compelling bivariate relationship with hourly wage: cost of living, employer facility with a paediatric residency, employer facility with a neonatal fellowship, NICU bed: full-time equivalents (FTE) RDN ratio, years in neonatal nutrition, having a certification and order writing privileges. In the final adjusted model (R2 = 0.42), three variables remained associated with increased hourly wage: higher cost of living, longer length of career in neonatal nutrition and fewer NICU beds per NICU RDN FTE. CONCLUSIONS: US NICU RDNs earn similar or slightly higher wages than other US paediatric RDNs; they earn substantially less than other NICU healthcare team members. Employers need to improve compensation for NICU RDNs to incentivise their retention and recognise their additional non-clinical responsibilities.

Unlocking the potential of LSTM for accurate salary prediction with MLE, Jeffreys prior, and advanced risk functions.

This article aims to address the challenge of predicting the salaries of college graduates, a subject of significant practical value in the fields of human resources and career planning. Traditional prediction models often overlook diverse influencing factors and complex data distributions, limiting the accuracy and reliability of their predictions. Against this backdrop, we propose a novel prediction model that integrates maximum likelihood estimation (MLE), Jeffreys priors, Kullback-Leibler risk function, and Gaussian mixture models to optimize LSTM models in deep learning. Compared to existing research, our approach has multiple innovations: First, we successfully improve the model's predictive accuracy through the use of MLE. Second, we reduce the model's complexity and enhance its interpretability by applying Jeffreys priors. Lastly, we employ the Kullback-Leibler risk function for model selection and optimization, while the Gaussian mixture models further refine the capture of complex characteristics of salary distribution. To validate the effectiveness and robustness of our model, we conducted experiments on two different datasets. The results show significant improvements in prediction accuracy, model complexity, and risk performance. This study not only provides an efficient and reliable tool for predicting the salaries of college graduates but also offers robust theoretical and empirical foundations for future research in this field.

Clinical duties and compensation for U.S. emergency medicine fellows at academic centers: A descriptive, cross-sectional survey.

Objective: Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little is known about the clinical hours worked and financial compensation received by fellows during training. We sought to describe the clinical duties and financial compensation of EM fellows at U.S. academic centers. Methods: This cross-sectional study surveyed U.S. academic EM department administrators who were members of the Society for Academic Emergency Medicine's Academy of Administrators in Academic Emergency Medicine (AAAEM) regarding their fellowship programs and fellows. We electronically distributed the validated survey instrument to 73 member sites between October 2022 and January 2023. Survey domains included fellow and fellowship demographics, base and total annual clinical hours, and base and total annual compensation. We calculated descriptive statistics and compared fellows by accreditation (Accreditation Council for Graduate Medical Education [ACGME] or non-ACGME) using chi-square and Wilcoxon rank-sum testing. We conducted a secondary analysis of base and total salary by gender and accreditation using Wilcoxon rank-sum testing. Results: We received 38 institutional responses (response rate 52%), which represented 217 individual fellows. Nearly three-fourths (n = 158, 72.8%) of fellows enrolled in non-ACGME fellowships, worked 33% more base hours annually than ACGME fellows (median 571 h vs. 768 h, p < 0.001), and received base compensation 20% higher than ACGME fellows ($88,540 vs. $70,777, p < 0.001). Accounting for additional compensation, the median total annual compensation for non-ACGME fellows remained 11% higher than ACGME fellows ($105,000 vs. $93,853, p = 0.004). We observed no significant differences salary when stratified by gender. Conclusions: Most EM fellows at U.S. academic institutions enrolled in non-ACGME fellowships with significantly higher base hours and financial compensation than ACGME fellowships. These results represent the first description of the clinical hours and financial compensation of academic EM fellows and should be considered in ongoing benchmarking efforts by AAAEM.

Factors Associated with Israeli Social Workers' Intention to Stay in the Profession.

The phenomenon of social workers leaving the profession occurs frequently, underscoring the importance of understanding factors contributing to the intention to stay (ITS) in the profession. Based on the job demands-resources theory (JD-R), this study examined selected social worker workplace "demands" (i.e., their organizational sector of employment and level of work-family conflict) and "resources" (i.e., levels of meaning, locus of control, and salary satisfaction at work). Online survey data were obtained from 407 Israeli social workers. The findings showed that higher levels of meaning and salary satisfaction at work, greater professional seniority, and lower levels of work-family conflict were associated with greater ITS in the profession. Data were gathered during the COVID-19 pandemic, enabling examination of variables contributing to the ITS during times of crisis. These findings confirm that meaning at work is the main factor that motivates social worker ITS in the profession. Salary satisfaction was also found to be an essential factor, highlighting the recent escalation in social worker demands for fair compensation in Israel. Greater work-family balance also contributed to ITS. These findings should be considered by governmental decision makers and welfare service providers wishing to preserve this essential workforce, not just in Israel but also in other countries.

Examining Full-Time Academic General Pediatric Faculty Compensation by Gender, Race, and Ethnicity: 2020-2021.

OBJECTIVE: In medicine, women have lower lifetime earnings than men. To our knowledge, an in-depth examination of academic general pediatric faculty compensation by gender, race, and ethnicity has not been conducted. We aimed to 1) explore full-time academic general pediatric faculty salary differences by race and ethnicity; 2) explore these differences among all full-time pediatric faculty. METHODS: We performed a cross-sectional study using data on median full-time academic general pediatric faculty compensation for the academic year of 2020-2021 from the Association of American Medical Colleges Medical School Faculty Salary Survey report. Pearson's chi-square tests were used to evaluate the association of faculty rank with gender, race, ethnicity, and degree. We used hierarchical generalize linear models with a log link and a gamma distribution to model to assess the association of median salary with faculty race and ethnicity, adjusting for degree, rank, and gender. RESULTS: Men academic general pediatric faculty consistently had higher median salaries than women faculty even after adjusting for degree, rank, race, and ethnicity. Underrepresented in medicine academic general pediatric faculty had a lower median salary when compared to White faculty, and this was similar when adjusted for degree, rank, race, and ethnicity. CONCLUSIONS: Our results demonstrated broad disparities in general academic pediatric compensation by both gender and race and ethnicity. Academic medical centers must identify, acknowledge, and address inequities in compensation models.

O trabalho feminino assalariado: a dialética na produção e reprodução / Salaried female work: the dialectic in production and reproduction

Resumo: Neste texto, estamos trazendo alguns apontamentos baseados nas obras de Marx sobre trabalho produtivo e improdutivo. Refletimos também sobre aquele trabalho não remunerado realizado pela mulher no espaço doméstico. Com este pano de fundo, estamos dialogando criticamente com o texto "Salários contra o trabalho doméstico" ("Wages against housework"), presente no livro O ponto zero da revolução: trabalho doméstico, reprodução e luta feminista, de Silvia Federici.

Abstract: In this text we are bringing some notes based on Marx, about productive and unproductive work. We also reflect on the unpaid work performed by women in the domestic space. And against this backdrop, we are critically dialoguing with the text "Wages against housework", present in the book Revolution at point zero: housework, reproduction and feminist struggle by Silvia Federici.

Physician Variation and the Impact of Payment Model in Cardiac Imaging.

BACKGROUND: The influence of fee-for-service reimbursement on cardiac imaging has not been compared with other payment models. Furthermore, variation in ordering practices is not well understood. METHODS AND RESULTS: This retrospective, population-based cohort study using linked administrative data from Alberta, Canada included adults with chronic heart disease (atrial fibrillation, coronary artery disease, and heart failure) seen by cardiac specialists for a new outpatient consultation April 2012 to December 2018. Generalized linear mixed-effects models estimated the association of payment model (including the ability to bill to interpret imaging tests) and the use of cardiac imaging and quantified variation in cardiac imaging. Among 31 685 adults seen by 308 physicians at 136 sites, patients received an observed mean of 0.67 (95% CI, 0.67-0.68) imaging tests per consultation. After adjustment, patients seeing fee-for-service physicians had 2.07 (95% CI, 1.68-2.54) and fee-for-service physicians with ability to interpret had 2.87 (95% CI, 2.16-3.81) times the rate of receiving a test than those seeing salaried physicians. Measured patient, physician, and site effects accounted for 31% of imaging variation and, following adjustment, reduced unexplained site-level variation 40% and physician-level variation 29%. CONCLUSIONS: We identified substantial variation in the use of outpatient cardiac imaging related to physician and site factors. Physician payment models have a significant association with imaging use. Our results raise concern that payment models may influence cardiac imaging practice. Similar methods could be applied to identify the source and magnitude of variation in other health care processes and outcomes.

Athletic Trainers' Perceptions of Salary Negotiation Decision-Making During the Hiring Process.

CONTEXT: Appropriate salaries for athletic trainers (ATs) have been a contentious topic for decades. While professional advocacy efforts to increase ATs' salaries have gained traction, little is known about ATs' experiences with negotiation during the hiring process. OBJECTIVE: To explore the reasons, influences, and factors influencing ATs' negotiation decisions. DESIGN: Qualitative study. SETTING: Individual video interviews. PATIENTS OR OTHER PARTICIPANTS: 28 ATs who participated in a previous study and indicated a willingness to participate in the qualitative follow-up were interviewed (17 women, 10 men, 1 non-binary individual; age = 37.8±8.9 years; athletic training experience = 15.1±8.3 years). Of the 28 participants, 18 did negotiate, while 10 did not. DATA COLLECTION AND ANALYSIS: An individual videoconference interview was conducted with each participant. After transcription, data were analyzed into themes and categories following the consensual qualitative research tradition. To ensure trustworthiness of the findings, we confirmed accuracy through member checks, triangulated the data using multi-analyst research teams, and confirmed representativeness by including an external auditor. RESULTS: Four parallel themes emerged during data analysis; factors for determining salary negotiation, reasons for negotiating/not negotiating, negotiation influencers/deterrents, and experiences with negotiation/impact of not negotiating. CONCLUSIONS: Negotiators used a variety of data sources to support their requests, and their decisions were motivated by their known value, the area's cost of living, and their current financial or employment situations. Negotiators relied on previous experiences to guide negotiations and provided successes and regrets from their negotiation experience. Nonnegotiators also used a variety of data types but were deterred by fear: of not knowing how to negotiate, losing the offer, or off 26 ending those involved. Non-negotiators highlighted lack of confidence they had in their ability to negotiate and provided the financial consequences and personal regrets from not negotiating. More training, education, and publicly available data are needed to assist ATs in future negotiation attempts.

The effect of internal salary incentives based on insurance payment on physicians' behavior: experimental evidence.

BACKGROUND: Understanding how physicians respond to payment methods is crucial for designing effective incentives and enhancing the insurance system. Previous theoretical research has explored the effects of payment methods on physician behavior based on a two-level incentive path; however, empirical evidence to validate these theoretical frameworks is lacking. To address this research gap, we conducted a laboratory experiment to investigate physicians' behavioral responses to three types of internal salary incentives based on diagnosis-related-group (DRG) and fee-for-service (FFS). METHODS: A total of 150 medical students from Capital Medical University were recruited as participants. These subjects played the role of physicians in choosing the quantity of medical services for nine types of patients under three types of salary incentives-fixed wage, constant fixed wage with variable performance wage, and variable fixed wage with variable performance wage, of which performance wage referred to the payment method balance under FFS or DRG. We collected data on the quantities of medical services provided by the participants and analyzed the results using the Friedman test and the fixed effects model. RESULTS: The results showed that a fixed wage level did not have a significant impact on physicians' behavior. However, the patients benefited more under the fixed wage compared to other salary incentives. In the case of a floating wage system, which consisted of a constant fixed wage and a variable performance wage from the payment method balance, an increase in performance wage led to a decrease in physicians' service provision under DRG but an increase under FFS. Consequently, this resulted in a decrease in patient benefit. When the salary level remained constant, but the composition of the salary varied, physicians' behavior changed slightly under FFS but not significantly under DRG. Additionally, patient benefits decreased as the ratio of performance wages increased under FFS. CONCLUSIONS: While using payment method balance as physicians' salary may be effective in transferring incentives of payment methods to physicians through internal compensation frameworks, it should be used with caution, particularly when the measurement standard of care is imperfect.

Total rewards preferences: A cross-sectional study among two generations of nurses in rural and remote Thailand.

BACKGROUND: Nursing and health policy focus on retaining nurses in practice, especially because the world lacks more than 6 million nurses. Rewards are believed to be an effective strategy to attract, retain, and improve the performance of nurses in rural and remote areas where nursing shortages are more severe. However, Generations X and Y have been found to have different preferences for rewards in various settings, so a one-size-fits-all approach may not work for rewarding work. OBJECTIVE: To examine the perceptions of satisfaction and the importance of rewards among two generations of Thai registered nurses. METHODS: Using the Total Reward Scale, a descriptive comparative study design was employed and the data was collected from 354 nurses in rural and remote Thai community hospitals. This study is reported using the STROBE checklist. Descriptive statistics and the Mann-Whitney U test were used to analyze data. RESULTS: Generations X (born in 1965-1980) and Y (born in 1981-2000) were most satisfied with and rated base salary as the most important reward. However, these generations significantly differed in their perspective about importance of healthcare, leadership, long-term incentives, time-off leave, and variable pay. CONCLUSION: Different types of rewards were satisfying and essential for Thai nurses in Generations X and Y. IMPLICATIONS FOR NURSING AND HEALTH POLICY: National reward policies and management should be designed on priorities regarding reasonable base salary, and retirement benefits to address nursing shortages in rural and remote areas. Policymakers in health and nursing must invest in developing funded policies that consider the needs of different generations of nurses if they want success in retaining them on the job.

[The characteristics and problems of professional activity of medical workers in conditions of COVID-19 pandemic].

The article is based on the results of sociological survey of medical workers of the Republic of Bashkortostan in 2021. The approaches to issues of their professional activities are analyzed. It is argued that the COVID-19 pandemic has aggravated a number of systemic problems accumulated in health care system in last years. The main difficulties are associated with shortage of medical personnel, increased workload, low remuneration of labor of medical workers, unpractical work organization decreasing quality of medical care, etc. The majority of respondents (68.4%) are not satisfied with their salaries. The highest percentage of negative assessments is fixed among physicians and paramedical personnel. The amount of average monthly salary of junior medical personnel is so low that it does not correlate with the minimum wage accepted in the Republic. The study discovered sufficiently high occupational risk, determined by biological production factor related to possibility COVID-19 contamination. The assessment of occupational morbidity demonstrated that at present the most widely-spread occupational pathologies in medical workers are infection with COVID-19 (70.2%) and emotional burnout syndrome (67.2%). Such measures as annual dispensarization, provision of medical workers with sanatorium-and-spa vouchers are obviously insufficient. Only 14.1% of respondents could underwent annual medical examination. Only 13.8% of respondents had opportunity to take advantage of sanatorium-and-spa vouchers. The study revealed deficiency of personnel in medical organizations among paramedical and junior medical personnel and physicians as well.

Healthcare educational debt in the united states: unequal economic impact within interprofessional team members.

BACKGROUND: Advancing healthcare access and quality for underserved populations requires a diverse, culturally competent interprofessional workforce. However, high educational debt may influence career choice of healthcare professionals. In the United States, health professions lack insight into the maximum educational debt that can be supported by current entry-level salaries. The purpose of this interprofessional economic analysis was to examine whether average educational debt for US healthcare graduates is supportable by entry-level salaries. Additionally, the study explored whether trainees from minoritized backgrounds graduate with more educational debt than their peers in physical therapy. METHODS: The study modeled maximum educational debt service ratios for 12 healthcare professions and 6 physician specialties, incorporating profession-specific estimates of entry-level salary, salary growth, national average debt, and 4 loan repayment scenarios offered by the US Department of Education Office of Student Financial Aid. Net present value (NPV) provided an estimate for lifetime "economic power" for the modeled careers. The study used a unique data source available from a single profession (physical therapy, N = 4,954) to examine whether educational debt thresholds based on the repayment model varied between minoritized groups and non-minoritized peers. RESULTS: High salary physician specialties (e.g. obstetrics/gynecology, surgery) and professions without graduate debt (e.g. registered nurse) met debt ratio targets under any repayment plan. Professions with strong salary growth and moderate debt (e.g. physician assistant) required extended repayment plans but had high career NPV. Careers with low salary growth and high debt relative to salary (e.g. physical therapy) had career NPV at the lowest range of modeled professions. 29% of physical therapy students graduated with more debt than could be supported by entry-level salaries. Physical therapy students from minoritized groups graduated with 10-30% more debt than their non-minoritized peers. CONCLUSIONS: Graduates from most healthcare professions required extended repayment plans (higher interest) to meet debt ratio benchmarks. For several healthcare professions, low debt relative to salary protected career NPV. Students from minoritized groups incurred higher debt than their peers in physical therapy.