United States anesthesiologists over 50: retirement decision making and workforce implications.

BACKGROUND: Anesthesiology is among the medical specialties expected to have physician shortage. With little known about older anesthesiologists' work effort and retirement decision making, the American Society of Anesthesiologists participated in a 2006 national survey of physicians aged 50-79 yr. METHODS: Samples of anesthesiologists and other specialists completed a survey of work activities, professional satisfaction, self-defined health and financial status, retirement plans and perspectives, and demographics. A complex survey design enabled adjustments for sampling and response-rate biases so that respondents' characteristics resembled those in the American Medical Association Physician Masterfile. Retirement decision making was modeled with multivariable ordinal logistic regression. Life-table analysis provided a forecast of likely clinical workforce trends over an ensuing 30 yr. RESULTS: Anesthesiologists (N = 3,222; response rate = 37%) reported a mean work week of 49.4 h and a mean retirement age of 62.7 yr, both values similar to those of other older physicians. Work week decreased with age, and part-time work increased. Women worked a shorter work week (mean, 47.9 vs. 49.7 h, P = 0.024), partly due to greater part-time work (20.2 vs. 13.1%, P value less than 0.001). Relative importance of factors reported among those leaving patient care differed by age cohort, subspecialty, and work status. Poor health was cited by 64% of anesthesiologists retiring in their 50s as compared with 43% of those retiring later (P = 0.039). CONCLUSIONS: This survey lends support for greater attention to potentially modifiable factors, such as workplace wellness and professional satisfaction, to prevent premature retirement. The growing trend in part-time work deserves further study.

Cultural similarity, cultural competence, and nurse workforce diversity.

Proponents of health workforce diversity argue that increasing the number of minority health care providers will enhance cultural similarity between patients and providers as well as the health system's capacity to provide culturally competent care. Measuring cultural similarity has been difficult, however, given that current benchmarks of workforce diversity categorize health workers by major racial/ethnic classifications rather than by cultural measures. This study examined the use of national racial/ethnic categories in both patient and registered nurse (RN) populations and found them to be a poor indicator of cultural similarity. Rather, we found that cultural similarity between RN and patient populations needs to be established at the level of local labor markets and broadened to include other cultural parameters such as country of origin, primary language, and self-identified ancestry. Only then can the relationship between cultural similarity and cultural competence be accurately determined and its outcomes measured.

Toward a new method for identifying facilities and communities with critical shortages of nurses.

This article summarizes the key findings of a study designed to evaluate the effectiveness of different methods for assessing the severity of nursing shortages in four types of health care facilities in the United States (hospitals, long-term care facilities, home health agencies, and public health agencies). The study involves testing several statistical models using currently available data to assess their accuracy and ease of use as possible bases for estimating and predicting the severity of nursing shortages in individual health care facilities. The assessments are based on criteria developed with the advice of panels of experts knowledgeable about each of the four types of facilities. The results of a "preferred method" for rating the severity of nursing shortages in counties in the United States are presented, along with key findings based on a variety of other models and analyses. Although it requires some refinement and a systematic validation, this method holds promise as a possible basis for targeting federal resources to alleviate the most critical nursing shortages across the country.

An analysis of racial/ethnic pay disparities among hospital nurses in New York City.

Despite growing concern over cultural competence and diversity in the registered nursing (RN) workforce, minority RNs working in hospitals in New York City who were surveyed in 2007 earned less on average than their non-Hispanic White counterparts. Regression decomposition was applied to these data to investigate how much of the differential could be attributed to different characteristics of different racial/ethnic groups and how much could be attributed to differential valuation of characteristics between racial/ethnic groups. The earnings differential between Black/African American and non-Hispanic White RNs was about equally due to different characteristics and differential valuation of characteristics, but the earnings differentials between Hispanic/Latino RNs and non-Hispanic White RNs and between Asian/Pacific Islander RNs and non-Hispanic White RNs were about two-thirds due to different characteristics and one-third due to differential valuation of their characteristics. In particular, years of nursing experience did not translate into the same earnings advantages for minority RNs.

The emerging role of faith community nurses in prevention and management of chronic disease.

Faith community nursing, formerly known as parish nursing, is one model of care that relies heavily on older registered nurses (RNs) to provide population-based and other nonclinical services in community settings. Faith community nursing provides services not commonly available in the traditional health care system (e.g., community case management, community advocacy, community health education). With appropriate support, this model of nursing could be expanded into other settings within the community and has the potential to draw on the skills of experienced RNs to provide communities with services that address unmet health care needs.