Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US.

Importance: Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however. Objective: To describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US. Design, Setting, and Participants: This national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020. Main Outcomes and Measures: The Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates. Results: A total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P = .006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population. Conclusions and Relevance: This study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing emergency care.

Salud

Población por tipo de cobertura médica; gráfico de hospitales con internación por tipo y especialidad, y de centros de salud; y promedio diario de niños y adolescentes beneficiados por distintas dependencias de la Dirección General de Niños/as y Adolescentes.

Salud

Cobertura de atención de salud de la población; gráfico de hospitales con internación por tipo y especialidad, y de centros de salud y acción comunitaria; y datos de atención social a niños, niñas y adolescentes

Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran.

BACKGROUND: This study aims to assess geographical distribution of hospitals and extent of inequalities in hospital beds against socioeconomic status (SES) of residents of five metropolitan cities in Iran. METHODS: A cross-sectional analysis was conducted to measure geographical inequality in hospital and hospital bed distributions of 68 districts in five metropolitan cities during 2016 using geographic information system (GIS), and Gini and Concentration indices. Correlation analysis was performed to show the relationship between the SES and inequality in hospital beds densities. RESULTS: The study uncovered marked inequalities in hospitals and hospital beds distributions. The Gini indices for hospital beds were greater than 0.55. The aggregated concentration indices for public and private hospital beds were 0.33 and 0.49, respectively. The GIS revealed that 216 (70.6%) hospitals were located in two highest socioeconomic status classes in the cities. Only 29 (9.5%) hospitals were located in the lowest class. The public, private, and the cumulative hospitals beds distributions in Tehran and Esfahan showed significant (p < 0.05) positive correlation with SES of the residents. CONCLUSIONS: The high inequalities in hospital and hospital beds distributions in our study imply an overlooked but growing concern for geographical access to healthcare in rapidly urbanizing metropolitan cities in Iran. Thus, regardless of ownership, decision-makers should emphasize the disadvantaged areas in metropolitan cities when need arises for the establishment of new healthcare facilities in order to ensure fairness in healthcare. The metropolitan cities and rapid urbanization settings in other countries could learn lessons to reduce or prevent similar issues which might have hampered access to healthcare.

Salud

Tipo de cobertura de la atención medica de la población de la Ciudad de Buenos Aires, gráfico de la distribución de hospitales con internación y centros de salud comunitarios, y datos de la atención social a niños, niñas, y adolescentes.

Salud

Población por tipo de cobertura médica; distribución de hospitales con internación por tipo y especialidad, y de Centros de Salud y Acción Comunitaria, año 2017; atención social a niños, niñas y adolescentes; y Actividades deportivas en polideportivos del GCBA, de niños y adolescentes.

Salud

Población con cobertura médica, en el año 2015; distribución de hospitales con internación por tipo y especialidad; y actividades deportivas en polideportivos del GCBA de niños y adolescentes.

Urban hospitals, an endangered species, still fill a unique role in their communities.

As the CEO of a hospital named after Albert Einstein, I'm otten asked which of his quotes is my favorite. My answer is always the same: "Life is like riding a bicycle. To keep your balance, you must keep moving."

Urban hospital 'clusters' do shift high-risk procedures to key facilities, but more could be done.

Since the 1990s, rapid consolidation in the hospital sector has resulted in the vast majority of hospitals joining systems that already had a considerable presence within their markets. We refer to these important local and regional systems as "clusters." To determine whether hospital clusters have taken measurable steps aimed at improving the quality of care-specifically, by concentrating low-volume, high-complexity services within selected "lead" facilities-this study examined within-cluster concentrations of high-risk cases for seven surgical procedures. We found that lead hospitals on average performed fairly high percentages of the procedures per cluster, ranging from 59 percent for esophagectomy to 87 percent for aortic valve replacement. The numbers indicate that hospitals might need to work with rival facilities outside their cluster to concentrate cases for the lowest-volume procedures, such as esophagectomies, whereas coordination among cluster members might be sufficient for higher-volume procedures. The results imply that policy makers should focus on clusters' potential for restructuring care and further coordinating services across hospitals in local areas.

Need of improvement in emergency medical service in urban cities.

INTRODUCTION: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. METHODS: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis. RESULTS: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. CONCLUSIONS: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.

The changing landscape of hospital capacity in large cities and suburbs: implications for the safety net in metropolitan America.

An analysis of trends in hospital use and capacity by ownership status and community poverty levels for large urban and suburban areas was undertaken to examine changes that may have important implications for the future of the hospital safety net in large metropolitan areas. Using data on general acute care hospitals located in the 100 largest cities and their suburbs for the years 1996, 1999, and 2002, we examined a number of measures of use and capacity, including staffed beds, admissions, outpatient and emergency department visits, trauma centers, and positron emission tomography scanners. Over the 6-year period, the number of for-profit, nonprofit, and public hospitals declined in both cities and suburbs, with public hospitals showing the largest percentage of decreases. By 2002, for-profit hospitals were responsible for more Medicaid admissions than public hospitals for the 100 largest cities combined. Public hospitals, however, maintained the longest Medicaid average length of stay. The proportion of urban hospital resources located in high poverty cities was slightly higher than the proportion of urban population living in high poverty cities. However, the results demonstrate for the first time, a highly disproportionate share of hospital resources and use among suburbs with a low poverty rate compared to suburbs with a high poverty rate. High poverty communities represented the greatest proportion of suburban population in 2000 but had the smallest proportion of hospital use and specialty care capacity, whereas the opposite was true of low poverty suburbs. The results raise questions about the effects of the expanding role of private hospitals as safety net providers, and have implications for poor residents in high poverty suburban areas, and for urban safety net hospitals that care for poor suburban residents in surrounding communities.

[Current issues in municipal health services]. / Aktual'nye voprosy razvitiia munitsipal'nogo zdravookhraneniia.

A study, held in the Krasnodar Territory in 1994-2002, showed an increasing morbidity in residents of all age-categories. Essential differences in the prevalence of registered pathologies and in the nature of their dynamics were registered in some districts. An optimized structure of hospital beds resulted, in the above Territory, in a reduced quantity of beds, primarily in rural areas, and in their more effective utilization. More rural citizens applied for medical care to urban and territorial patient-care facilities, by 1.5 and 1.4 times respectively. Such reduction of hospital beds is possible only after advancing appropriately the regular medical check-ups and clinical care and after diminishing the need in the treatment of patients at hospitals. The data of sociological questioning of residents and of doctors held in three municipal entities by using the method of monitoring are presented. It was demonstrated that promotion of inter-district diagnostic centers, priority development of regular medical check-ups and purpose-oriented measures of reprofiling the specialized bed funds are topical issues in promoting the municipal medical care.

The effect of urban hospital closure on markets.

We measure the effect of urban hospital closure on the operating efficiency of the remaining hospitals in the local market. Closure of a hospital other than the least efficient can be detrimental to social welfare because treatment costs will be higher at surviving hospitals. The results show that hospital closure has led to an evolutionary increase in efficiency in urban markets. The hospitals that closed were less efficient at baseline, and after closure their competitors realized lower costs per adjusted admission through an increase in inpatient admissions and emergency room visits. Overall, we estimate that costs per adjusted admission declined by 2-4% for all patients and about 6-8% for patients who would have been treated at the closed hospital.