[Do the emergency medical services need more paramedics? An examination of supply and demand].

BACKGROUND: Paramedics are a critical national resource. The paramedic workforce is dynamic and has never been studied, thereby limiting the possibility of appropriate planning. OBJECTIVES: To examine the present and projected supply and demand for paramedics, the balance between supply and demand, and how this affects the planning of the paramedic workforce. METHODS: Supply was assessed by the annual number of graduates of paramedic training programs, the duration of stay in the profession and the likelihood of staying in the profession, using data obtained by structured telephone interviews with a sample of graduates of paramedic courses. Demand was assessed by interviewing key figures in the emergency medical services (EMS). RESULTS: There are about 1000 certified paramedics in Israel. Of them, 64% are active in the civilian labor market. If the demand does not change beyond the natural annual increase of two advanced life support (ALS) ambulances (which are staffed by paramedics), there may be a surplus of 180 paramedics by 2010. Increased demand outside the EMS may temporarily absorb this surplus, but it will reappear by 2015 or 2020. Conversely, upgrading all ambulances to ALS vehicles will result in a shortage of 400-900 paramedics by 2010 (depending on the number of paramedics per vehicle) if the number of paramedics trained annually is not increased. CONCLUSIONS: These findings may provide a better basis for long-term planning for training, recruitment, and employment of paramedics and may serve as an example for workforce planning for other health professions.

Stress, work overload, burnout, and satisfaction among paramedics in Israel.

INTRODUCTION: The number of paramedics in Israel is increasing. Despite this growth and important role, the emergency medical organizations lack information about the characteristics of their work. OBJECTIVE: The objective of this study was to examine the characteristics of the paramedics' work, the quality of their working lives, the factors that keep them in the profession, or conversely, draw them away from it. METHODS: Cross-sectional study conducted through telephone interviews of a random sample of 50% of the graduates of paramedic courses in Israel (excluding conscripted soldiers). RESULTS: The factors that attract paramedics to the profession have much to do with the essence of the job-rescuing and saving-and a love of what it involves, as well as interest and variety. Pressures at work result from having to cope with a lack of administrative support, paperwork, long hours, imbalance between work and family life, and salary. They do not come from having to cope with responsibility, the pressure of working under uncertain conditions, and the sudden transition from calm situations to emergencies. Dissatisfaction at work is caused by burnout, work overload, and poor health. Physical and mental health that impedes their ability to work is related to a sense of burnout and the intention to change professions. CONCLUSIONS: The findings about the relationships between health, job satisfaction, and burnout, coupled with the fact that within a decade, half of the currently employed paramedics will reach an age at which it is hard for them to perform their job, lead to the conclusion that there is a need to reconsider the optimum length of service in the profession. There also is a need to form organizational arrangements to change the work procedures of aging paramedics.

Health care systems in transition: Israel

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).

Predictors of patient dissatisfaction with emergency care.

BACKGROUND: Patient feedback is increasingly being used to assess the quality of healthcare. OBJECTIVE: To identify modifiable independent determinants of patients dissatisfaction with hospital emergency care. METHODS: The study group comprised a random sample of 3,152 of the 65,966 adult Israeli citizens discharged during November 1999 from emergency departments in 17 of the 32 acute care hospitals in Israel. A total of 2,543 (81%) responded to a telephone survey that used a structured questionnaire. The dependent variables included: hospital characteristics, patient demographic variables, patient perception of care, self-rated health status, problem severity, and outcome of care. The dependent variable was dissatisfaction with overall ED experience on a 1-5 Likert-type scale dichotomized into not satisfied (4 and 5) and satisfied (1, 2 and 3). RESULTS: Eleven percent of the population reported being dissatisfied with their emergency room visit. Univariate analyses revealed that dissatisfaction was significantly related to ethnic group, patient education, hospital identity and geographic location, perceived comfort of ED facilities, registration expediency, waiting times, perceived competence and attitudes of caregivers, explanations provided, self-rated health status, and resolution of the problem that led to referral to the ED. Multivariate analyses using logistic regressions indicated that the four most powerful predictors of dissatisfaction were patient perception of doctor competence and attitudes, outcomes of care, ethnicity, and self-rated health status. CONCLUSIONS: Attempts to reduce dissatisfaction with emergency care should focus on caregiver conduct and attitudes. It may also be useful to improve caregiver communication skills, specifically with ethnic minorities and with patients who rate their health status as poor.