The report also pinpoints reasons why newly certified specialists are having trouble finding work: older doctors are delaying retirement; established surgeons are protecting their precious (often only one day a week) operating room time so young doctors arenat getting the hospital/surgical positions they covet; and a lack of cohesion in medical resource planning and coordination between medical schools, governments and hospital or health care authorities. As well, there are relatively new categories of health professionals encroaching on doctorsa territory, such as advanced practice nurses, nurse practitioners and physician assistants. Respondents to the survey were graduates of Canadaas 17 medical schools and/or Canadian residency training programs in fields such as cardiac surgery, neurosurgery, nuclear medicine, ophthalmology, radiation oncology, urology, critical care, gastroenterology, general surgery, hematology and medical microbiology. The report does not include data on family doctors. While about one in five specialists or subspecialists said they are having challenges finding jobs, another 22 per cent of newly certified specialists said they are taking locum positions or other various part-time positions. Locums assume another doctoras duties during holidays or extended absences. In the survey, 40 per cent said they werenat happy they had to do that. The report draws attention to the fact that more than half of the respondents said they hadnat received any career counselling about the most promising job prospects while doing their training. They also complained that there are inadequate avenues for finding out where the jobs might be. Cunningham said since taxpayers are largely sponsoring medical education, there should be a fix to the problem through better planning of medical human resource needs. aWe need a more robust national/provincial system and thereas a really great need for more career counselling,a he said. Dr. Dave Snadden, associate dean of education at UBC medical school, said since the report is based on a survey with a response rate of about one-third (43 per cent in B.C.) of 4,233 doctors polled, it has to be seen as less than perfect from a research methodology perspective. He defended UBCas approach to matching residency training positions with community needs and noted that is one reason why UBC has been pushing for more and more family medicine residencies.
Non-specialist psychosocial interventions for children with autism spectrum disorders
If non-specialists were able to deliver such care, more children may be able to receive treatment. In this week’s PLOS Medicine, Brian Reichow (Yale Child Study Center, University of Connecticut Health Center, US) and colleagues from the World Health Organization conducted a systematic review of studies of non-specialist psychosocial interventions for children and adolescents with intellectual disability or lower functioning autism spectrum disorders. In a search of several international databases for studies published through June 2013, the authors found 34 articles describing 29 studies (including 15 randomized controlled trials) involving 1,305 participants that met their inclusion criteria. The studies evaluated behavior analytic techniques, cognitive rehabilitation, training, and support, and parent training interventions. The authors found that for behavior analytic interventions, the best outcomes were shown for developmental and daily skills; cognitive rehabilitation , training, and support were found to be most effective for improving developmental outcomes; and parent training interventions to be most effective for improving developmental, behavioral, and family outcomes. The study limitations included that in research of this type it is difficult to mask individuals to the intervention, and therefore the studies are susceptible to performance bias, and the fact that few studies were conducted in low and middle income countries . The authors state, “Overall, the outcomes of the studies included in this review show that non-specialist providers can deliver effective treatments to children with intellectual disabilities or lower-functioning autism spectrum disorders Our findings that psychosocial interventions can be effective when delivered by nonspecialist providers has much relevance for improving access to care for children and adolescents with intellectual disabilities or lower-functioning autism spectrum disorders who live in both [high income countries] and [low and middle income countries], but it is useful especially in low-resource settings.” In an accompanying Perspective, Mashudat Bello-Mojeed and Muideen Bakare (Federal Neuro-Psychiatric Hospital, Lagos, Nigeria) (uninvolved in the study) discuss the implications of the study for care of children with intellectual disability or lower functioning autism spectrum disorders in low income countries . They state, “With under-five child mortality declining in resource-poor countries, an increasing number of children will live on to experience an increasing burden of neurodevelopmental disorders while the family shares a huge burden of caregiving Interventions provided by non-specialist care providers could help alleviate the scarcity of specialist care by task shifting and potentially also help reduce the risk of burn-out among existing specialists.” They conclude, “Ultimately, non-specialist psychosocial interventions for [neurodevelopmental disorders] will require advocacy and government support in [low and middle income countries], where mortality is given priority over morbidity and disability.” More information: Reichow B, Servili C, Yasamy MT, Barbui C, Saxena S (2013) Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Review. PLoS Med 10(12): e1001572. DOI: 10.1371/journal.pmed.1001572 Provided by Public Library of Science