[Current problems of the public health X-ray service of the Russian Federation and ways of their solution (according to the analysis materials of their activities of the service in 2001 and its tasks in 2002].
BACKGROUND: Postgraduate medical training in Denmark consists of basic training, offered to all medical doctors, followed by specialist training. The National Board of Health is responsible for the overall frame of medical training in Denmark and determines the number of trainee positions for each of the 42 specialities available. The total number of positions and their distribution between specialities are based on demand, supply and demographic considerations. Approximately 85% of medical doctors finalise specialist training. METHODS: Denmark is divided into three educational regions: North, South and East. Each region consists of counties, with their own administration. The National Board of Health approves each position for postgraduate training. All new positions and changes of existing positions are evaluated before approval by The National Board of Health. An updated version of the list of educational positions is available on the internet. CONCLUSION: The Danish governmental authorities have an efficient tool to control the dimensioning of the postgraduate medical education and thereby the production of specialists. Medical doctors can easily get information about where to obtain trainee positions. The majority of hospital departments improve their recruitment potential by participating in medical training. A number of structural changes, for instance establishing of medical centres and corporations within larger entities across an extended geographic area, specialisation between hospitals and reduced number of hospitals, calls for decentralisation of the administration in order to improve flexibility in the organisation of postgraduate medical training. However, the National Board of Health will still co-ordinate at the national level.
This paper outlines the evolution of the training of Canadian physicians and other professionals in the mental health care needs of older adults over the past 2 decades, which has culminated in long-awaited subspecialty recognition by the Royal College of Physicians and Surgeons of Canada (RCPSC). Despite the fact that Canada has more than 4000 psychiatrists officially recognized by RCPSC, and a national body of more than 200 members who practice primarily in geriatric psychiatry, the status of geriatric psychiatry as a subspecialty of psychiatry in Canada remained "unofficial" until 2009.
Early along the pathway toward subspecialization, Canadian educational efforts focused on enhancing the capacity of primary care physicians and other mental health professionals to meet the mental health needs of older adults. Over the past decade, and with the encouragement of RCPSC, Canadian psychiatric educators have carefully and collaboratively defined the competencies necessary for general psychiatrists to practice across the life span, thereby influencing the psychiatry training programs to include dedicated time in geriatric psychiatry, and a more consistently defined training experience.
With these two important building blocks in place, Canadian psychiatry was truly ready to move ahead with subspecialization. Three new psychiatric subspecialties - geriatric, child and adolescent, and forensic - were approved at the RCPSC in September 2009.
The developments of the past 20 years have paved the way for a subspecialty geriatric psychiatry curriculum that will be well-aligned with a new general psychiatry curriculum, and ready to complement the existing mental health work force with subspecialized skills aimed at caring for the most complex elderly patients.
Division of General Surgery, Department of Surgery, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada. Electronic address: janetpatriciaedwards@gmail.com.
To develop a microsimulation model of thoracic surgery workforce supply and demand to forecast future labor requirements.
The Canadian Community Health Survey and Canadian Census data were used to develop a microsimulation model. The demand component simulated the incidence of lung cancer; the supply component simulated the number of practicing thoracic surgeons. The full model predicted the rate of operable lung cancers per surgeon according to varying numbers of graduates per year.
From 2011 to 2030, the Canadian national population will increase by 10 million. The lung cancer incidence rates will increase until 2030, then plateau and decline. The rate will vary by region (12.5% in Western Canada, 37.2% in Eastern Canada) and will be less pronounced in major cities (10.3%). Minor fluctuations in the yearly thoracic surgery graduation rates (range, 4-8) will dramatically affect the future number of practicing surgeons (range, 116-215). The rate of operable lung cancer varies from 35.0 to 64.9 cases per surgeon annually. Training 8 surgeons annually would maintain the current rate of operable lung cancer cases per surgeon per year (range, 32-36). However, this increased rate of training will outpace the lung cancer incidence after 2030.
At the current rate of training, the incidence of operable lung cancer will increase until 2030 and then plateau and decline. The increase will outstrip the supply of thoracic surgeons, but the decline after 2030 will translate into an excess future supply. Minor increases in the rate of training in response to short-term needs could be problematic in the longer term. Unregulated workforce changes should, therefore, be approached with care.
