Public health physicians and dentists in Poland: results from public health workforce pilot study

• Autorzy: Cianciara D. , Lewtak K. , Piotrowicz M. , Gajewska M. , Urban E. , Brukalo K.
• Języki publikacji: EN

Abstrakty

EN

Background. Monitoring public health workforce is one of the essential functions of the public health system. Objective. The aim of the study was to identify the specialities for physicians and dentists related to public health in the years 1951-2013, and analyse of available data on physicians and dentists certified as public health specialists (PHS) in 2003-2015. Material and Methods. The historical analysis covers a relevant regulations of a minister in charge of health. The data on PHS were obtained from the Centre of Medical Exams and included: the number of specialists and their demographic characteristics, professional background, spatial distribution. Density was also calculated. Results. The public health specialty was introduced in 1999. Before there were specialties in disciplines related to public health. In the years of 2003-2015, 360 physicians and dentists were certified as PHS. The majority of them had former background in another discipline, mostly related to clinical medicine. The average age of specialists was 47.2. Currently, the average age of specialists is ca. 57.6 years, with a prevalence of people aged 61-70 years (36.9%). PHS tend to be older than specialists in other disciplines. Over three fourths of PHS were certified in 2004. With the exception of that year, the public health specialist title was annually obtained by an average of 9 persons. The density of PHS in Poland was 0.94 per 100 thousand inhabitants, ranging between 0.16 and 3.12 in a given voivodeship. Conclusions. The analysis has revealed numerous obstacles in estimation of the number of PHS and indicated a lack of relevant mechanisms aimed at workforce development. A relevant policy for developing public health workforce is urgently needed.

PL

Wprowadzenie. Monitorowanie zasobów kadrowych zdrowia publicznego (ZP) stanowi jedną z podstawowych funkcji systemu ZP. Cel. Analiza specjalizacji przeznaczonych dla lekarzy i lekarzy dentystów w dziedzinach związanych ze zdrowiem publicznym w latach 1951-2013 oraz danych dotyczących lekarzy i lekarzy dentystów specjalistów ZP w latach 2003-2015. Materiał i metody. Historyczna analiza rozwoju objęła przegląd rozporządzeń ministra właściwego ds. zdrowia, które regulowały tę kwestię. Aktualne dane dotyczące lekarzy uzyskano z Centrum Egzaminów Medycznych (CEM). Uwzględniono: liczbę lekarzy i lekarzy dentystów specjalistów ZP oraz ich demograficzną charakterystykę, doświadczenie zawodowe, dystrybucję przestrzenną oraz liczbę specjalistów na 100 tys. mieszkańców. Wyniki. Szkolenie specjalizacyjne w zakresie ZP dla lekarzy dostępne jest od 1999 r. W latach wcześniejszych lekarze mogli uzyskiwać specjalizacje w dziedzinach pokrewnych. W okresie 2003-2015 tytuł specjalisty ZP uzyskało 360 lekarzy i lekarzy dentystów. Większość lekarzy i lekarzy dentystów specjalistów ZP posiadała wcześniejsze doświadczenie zawodowe i inne specjalizacje, głównie kliniczne. Średni wiek, w którym lekarze uzyskali tytuł specjalisty w tej dziedzinie wyniósł 47,2 lat. Obecnie średni wiek lekarza specjalisty ZP wynosi 57,6 lat, dominują osoby w grupie wieku 61-70 lat (36,9%). Lekarze specjaliści ZP są starsi niż specjaliści w innych dziedzinach medycyny. Ponad trzy czwarte specjalistów zdało egzamin specjalizacyjny w 2004 r. Wyłączając ten rok, tytuł specjalisty ZP uzyskuje każdego roku przeciętnie 9 lekarzy. W przeliczeniu na 100 tys. mieszkańców liczba lekarzy specjalistów ZP wyniosła 0,94 i wahała się w granicach 0,16-3,12 w poszczególnych województwach. Wnioski. Uzyskane wyniki dowodzą licznych trudności w oszacowaniu liczby lekarzy zajmujących się szeroko rozumianym zdrowiem publicznym i wskazują na brak mechanizmów rozwoju kadry. Niezbędne jest pilne opracowanie polityki rozwoju zasobów kadrowych ZP.

Słowa kluczowe

EN

public health; physician; dentist; Poland; workforce; manpower

• Wydawca: -
• Czasopismo: Roczniki Państwowego Zakładu Higieny
• Rocznik: 2016
• Tom: 67
• Numer: 4
• Opis fizyczny: p.435-444,fig.,ref.

Twórcy

autor

Cianciara D.

• Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland

autor

Lewtak K.

• Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland

autor

Piotrowicz M.

• Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland

autor

Gajewska M.

• Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland

autor

Urban E.

• Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland

autor

Brukalo K.

• Department of Health Policy, Medical University of Silesia, Department of Public Health in Bytom, Bytom, Poland

Bibliografia

• 1. Album D.: The prestige of diseases and medical specialties. Tidsskr Nor Lægeforen 1991;106:232–236.
• 2. Album D., Steinar W.: Do diseases have a prestige hierarchy? A survey among physicians and medical students. Social Science and Medicine 2008;66:182-188.
• 3. Ashton J.: The history of public health in Liverpool: upwards and onwards, pendulum or helix? Available http://www.evolve360.co.uk/Data/10/Docs/workhouse/Poor_Ashton.pdf. (Accessed 22.04.2016)
• 4. Beck A.J., Boulton M.L., Coronado F.: Enumeration of the Governmental Public Health Workforce, 2014. American Journal of Preventive Medicine 2016;50(5): 53-676.
• 5. British Medical Association. Social Determinants of Health – What Doctors Can Do. October 2011.
• 6. Cole K., Sim F., Hogan H.: The evolution of public health education and training in the United Kingdom. Public Health Rev. 2011;33(1);87-104.
• 7. Creed P.A., Searle J., Rogers M.E.: Medical specialty prestige and lifestyle preferences for medical students. Social Science and Medicine 2010;71:1084-1088.
• 8. Faerstein E., Winkelstein W.: William Gorgas: Yellow fever meets its nemesis. Epidemiology 2011;22(6):872.
• 9. Fineberg H.V.: Public Health and Medicine: where the twain shall meet. Am J Prev Med 2011;41(4S3):S149-S151.
• 10. Frenk J., Chen L., Bhutta Z.A., Cohen J., Crisp N., Evans T., Fineberg H., Garcia P., Ke Y., Kelley P., Meleis A., Naylor D., Reddy S., Scrimshaw S., Sepulveda J., Serwadda D., Zurayk H.: Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010;376(9756):1923-1958.
• 11. Gillam S., Maudsley G.: Public health education for medical students: rising to the professional challenge. J Public Health 2010;32(1):125-131.
• 12. Hempel S.: John Snow. Lancet 2013;381(9874):1269. doi:10.1016/S0140-6736(13)60830-2.
• 13. Hinze S.W.: Gender and the body of medicine or at least some body parts: (Re)constructing the prestige hierarchy of medical specialties. Sociological Quarterly 1999;40(2):217–239.
• 14. Koike S., Kodama T., Matsumoto S., Ide H., Yasunaga H., Imamura T.: Retention rate of physicians in public health administration agencies and their career paths in Japan. BMC Health Services Research 2010;10:101 doi: 10.1186/1472-6963-10-101.
• 15. Koo K., Lapp I.: Educating the next generation of physicians in public health: the MPH for medical students. Public Health Reports 2014;129(5):460-464.
• 16. Krousel-Wood M., He J., Booth M., Chen C-S., Rice J., Kahn M.J., Maeshiro R., Whelton P.K.: Formal Public Health Education and Career Outcomes of Medical School Graduates. PLoS ONE 7(6): e39020. doi: 10.1371/journal.pone.0039020
• 17. Lawrence C.L., Bart J.H.: A look to the past as we look ahead: the specialty of public health medicine in Canada. Can J Public Health 2013;104(2):e108-e110.
• 18. Medical labour force 2007. Australian Institute of Health and Welfare. Canberra. October 2009. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458402 (Accessed 21.04.2016)
• 19. Naczelna Izba Lekarska. Demografia lekarze specjaliści 2015 [Supreme Medical Chamber. Demography of physicians (specialists) 2015]. Available at: http://nil.org.pl/dzialalnosc/osrodki-naczelnej-izby-lekarskiej/orodek-studiow,-analiz-i-informacji/demografialekarze-specjalisci-2015 (Accessed 21.04.2016) (in Polish).
• 20. Naczelna Izba Lekarska. Lekarze specjaliści i lekarze dentyści specjaliści 2015 [Supreme Medical Chamber. Physicians and dentists (specialists) 2015]. Available at: http://www.nil.org.pl/__data/assets/pdf_file/0005/99743/Demografia-lekarze-specjalisci-2015-v-0423.pdf (Accessed 13.04.2016) (in Polish).
• 21. Program specjalizacji w dziedzinie zdrowia publicznego dla lekarzy nieposiadających odpowiedniej specjalizacji I lub II stopnia, lub tytułu specjalisty w odpowiedniej dziedzinie medycyny, lub zrealizowanego i zaliczonego odpowiedniego modułu podstawowego [Public health specialty programme for physicians].Warszawa 2014. Available at: http://www.cmkp.edu.pl/wp-content/uploads/akredytacja2014/0730-program-1.pdf (Accessed 21.04.2016) (in Polish).
• 22. Public health and preventive medicine profile. Available at: https://www.cma.ca/Assets/assets-library/document/en/advocacy/Public-Health-e.pdf (Accessed 21.04.2016)
• 23. Rosenberg S.N., Schorow M., Haynes M.L.: Bridging the gap between clinical medicine and public health: an experimental course for medical students. Public Health Rep. 1978;93(6):673–677.
• 24. Rosoff S.M., Leone M.C.: The public prestige of medical specialties: overviews and undercurrents. Social Science & Medicine 1999:32(3):321–326.
• 25. Royal College of Physicians. How doctors can close the gap. Tackling the social determinants of health through culture change, advocacy and education. London 2010.
• 26. Regulation of the Polish Minister of Health dated 8 January 2013 on the specialisations of physicians and dentists. Journal of Laws from 2013, item 26 (in Polish).
• 27. Regulation of the Polish Minister of Health dated 12 December 2013 on the list of fields for nursing and fields related to health care, in which specialisation and qualification courses can be conducted. Journal of Laws from 2013, item 1562 (in Polish).
• 28. Regulation of the Polish Minister of Health dated 30 September 2002 on the obtaining the title of specialist in the fields related to health care. Journal of Laws from 2002, No. 173, item 1419, with subsequent amendments (in Polish).
• 29. Regulation of the Polish Minister of Health dated 18 December 2001 amending the regulation on the specialisations of physicians and dentists. Journal of Laws from 2001, No. 148, item 1661 (in Polish).
• 30. Regulation of the Polish Minister of Health and Social Care dated 25 March 1999 on the specialisations of physicians and dentists. Journal of Laws from 1999, No. 31, item 302 (in Polish).
• 31. Ruis A.R.: The Schism between Medical and Public Health Education: A Historical Perspective. Available from: http://www.academia.edu/6294811/The_Schism_between_Medical_and_Public_Health_Education_A_Historical_Perspective (Accessed 21.04.2016)
• 32. Sava S., Karen A., Kaufman A.: It’s time to integrate public health into medical education and clinical care. Journal of Public Health Management & Practice 2013;19(3):197–198.
• 33. Shortell S.M.: Occupational prestige differences within the medical and allied health professions. Social Science & Medicine 1974; 8(1):1–9. Available
• 34. The creation of the faculty of public health: a personal reflection by Walter Holland. http://www.fph.org.uk/uploads/THE%20CREATION%20%20of%20the%20FACULTY%20of%20PUBLIC%20HEALTH%20-%20Walter%20Holland.pdf (Accessed 21.04.2016)
• 35. The harmonization of the medical speciality in public health in the EU countries – a challenge for the profession. Eur J Public Health 2009;19(3):230-235.
• 36. The Norwegian Medical Association. Available http://legeforeningen.no/Emner/Andre-emner/Legestatistikk/ (Accessed 5.05.2016)
• 37. The unique contribution of public health physicians to the public health workforce. Final Report. 2010. Human Capital Allinance, Australia. Available http://www.racp.edu.au/docs/default-source/default-document-library/afphm-rep-unique-contribution-of-public-healthworkforce-report.pdf?sfvrsn=2 (Accessed 21.04.2016)
• 38. To M.J., Sharma M.: Training tomorrow’s physicianadvocates. Med Education 2015;49(8):752-754.
• 39. WHO Regional Office for South-East Asia. Teaching of public health in medical schools. Report of the Regional Meeting. Bangkok, Thailand, 8-10 December 2009. WHO, New Delhi 2010.
• 40. WHO. The 10 Essential Public Health Operations. Available http://www.euro.who.int/en/health-topics/Health-systems/public-health-services/policy/the-10-essential-public-health-operations (Accessed 22.04.2016)