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Article ; Online: How Should Health Professionalism Be Redefined to Address Health Equity?

Chen, Candice / Anderson, Andrea

AMA journal of ethics

2021 Volume 23, Issue 3, Page(s) E265–270

Abstract: Increasing focus on health equity is placing a spotlight on health professionals' roles. Recent public health crises-the opioid epidemic, maternal mortality, and the COVID-19 pandemic-have renewed focus on racial and ethnic inequity and underscored that ... ...

Abstract	Increasing focus on health equity is placing a spotlight on health professionals' roles. Recent public health crises-the opioid epidemic, maternal mortality, and the COVID-19 pandemic-have renewed focus on racial and ethnic inequity and underscored that trust is foundational to public health and health professionalism. Organizational, system, and policy reform demand that professionalism be redefined in terms of its capacity to motivate equity in health professions education and clinical practice.
MeSH term(s)	Health Equity ; Health Personnel/standards ; Humans ; Professionalism/ethics ; Public Health/ethics ; Role ; Social Responsibility
Language	English
Publishing date	2021-03-01
Publishing country	United States
Document type	Journal Article
ISSN	2376-6980
ISSN (online)	2376-6980
DOI	10.1001/amajethics.2021.265
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Contraception Usage and Workforce Trends Through 2022.

Strasser, Julia / Schenk, Ellen / Luo, Qian / Bodas, Mandar / Murray, Maria / Chen, Candice

JAMA network open

2024 Volume 7, Issue 4, Page(s) e246044

MeSH term(s)	Humans ; Contraception
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.6044
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Article ; Online: Global health workforce strategies to address the COVID-19 pandemic: Learning lessons for the future.

Williams, Gemma A / Ziemann, Margaret / Chen, Candice / Forman, Rebecca / Sagan, Anna / Pittman, Patricia

The International journal of health planning and management

2024 Volume 39, Issue 3, Page(s) 888–897

Abstract: COVID-19 put unprecedented strain on the health and care workforce (HCWF). Yet, it also brought the HCWF to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. In ... ...

Abstract	COVID-19 put unprecedented strain on the health and care workforce (HCWF). Yet, it also brought the HCWF to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. In this perspective, which draws on a Policy Brief prepared for the WHO Fifth Global Forum on Human Resources for Health, we present findings from a scoping review of global emergency workforce strategies implemented during the pandemic and consider what we can learn from them for the long-term sustainability of the HCWF. Our review shows that strategies to strengthen HCWF capacity during COVID-19 fell into three categories: (1) surging supply of health and care workers (HCWs); (2) optimizing the use of the workforce in terms of setting, skills and roles; and (3) providing HCWs with support and protection. While some initiatives were only short-term strategies, others have potential to be continued. COVID-19 demonstrated that changes to scope-of-practice and the introduction of team-based roles are possible and central to an effective, sustainable workforce. Additionally, the use of technology and digital tools increased rapidly during COVID-19 and can be built on to enhance access and efficiency. The pandemic also highlighted the importance of prioritizing the security, safety, and physical and mental health of workers, implementing measures that are gender and equity-focused, and ensuring the centrality of the worker perspective in efforts to improve HCWF retention. Flexibility of regulatory, financial, technical measures and quality assurance was critical in facilitating the implementation of HCWF strategies and needs to be continued. The lessons learned from COVID-19 can help countries strengthen the HCWF, health systems, and the health and well-being of all, now and in the future.
MeSH term(s)	COVID-19/epidemiology ; Humans ; Global Health ; Health Workforce/organization & administration ; Health Personnel/organization & administration ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2024-01-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632786-2
ISSN	1099-1751 ; 0749-6753
ISSN (online)	1099-1751
ISSN	0749-6753
DOI	10.1002/hpm.3762
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Article ; Online: Association of Primary Care Physicians' Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries.

Bodas, Mandar / Strasser, Julia / Luo, Qian / Schenk, Ellen / Chen, Candice

JAMA health forum

2023 Volume 4, Issue 3, Page(s) e230106

Abstract: Importance: Little is known about primary care physicians who provide contraceptive services to Medicaid beneficiaries. Evaluating this workforce may help explain barriers to accessing these services since contraceptive care access is critical for ... ...

Abstract	Importance: Little is known about primary care physicians who provide contraceptive services to Medicaid beneficiaries. Evaluating this workforce may help explain barriers to accessing these services since contraceptive care access is critical for Medicaid beneficiaries' health. Objective: To describe the primary care physician workforce that provides contraceptive services to Medicaid beneficiaries and explore the factors associated with their Medicaid contraceptive service provision. Design, setting, and participants: This cross-sectional study, conducted from August 1 to October 10, 2022, used data from the Transformed Medicaid Statistical Information System from 2016 for primary care physicians from 4 specialties (family medicine, internal medicine, obstetrics and gynecology [OBGYN], and pediatrics). Main outcomes and measures: The main outcomes were providing intrauterine devices (IUDs) or contraceptive implants to at least 1 Medicaid beneficiary, prescribing hormonal birth control methods (including a pill, patch, or ring) to at least 1 Medicaid beneficiary, the total number of Medicaid beneficiaries provided IUDs or implants, and the total number Medicaid beneficiaries prescribed hormonal birth control methods in 2016. Physician- and community-level factors associated with contraceptive care provision were assessed using multivariate regression methods. Results: In the sample of 251 017 physicians (54% male; mean [SD] age, 49.17 [12.58] years), 28% were international medical graduates (IMGs) and 70% practiced in a state that had expanded Medicaid in 2016. Of the total physicians, 48% prescribed hormonal birth control methods while 10% provided IUDs or implants. For OBGYN physicians, compared with physicians younger than 35 years, being aged 35 to 44 years (odds ratio [OR], 3.51; 95% CI, 2.93-4.21), 45 to 54 years (OR, 3.01; 95% CI, 2.43-3.72), or 55 to 64 years (OR, 2.27; 95% CI, 1.82-2.83) was associated with higher odds of providing IUDs and implants. However, among family medicine physicians, age groups associated with lower odds of providing IUDs or implants were 45 to 54 years (OR, 0.66; 95% CI, 0.55-0.80), 55 to 64 years (OR, 0.51; 95% CI, 0.39-0.65), and 65 years or older (OR, 0.29; 95% CI, 0.19-0.44). Except for those specializing in OBGYN, being an IMG was associated with lower odds of providing hormonal contraceptive service (family medicine IMGs: OR, 0.80 [95% CI, 0.73-0.88]; internal medicine IMGs: OR, 0.85 [95% CI, 0.77-0.93]; and pediatric IMGs: OR, 0.85 [95% CI, 0.78-0.93]). Practicing in a state that expanded Medicaid by 2016 was associated with higher odds of prescribing hormonal contraception for family medicine (OR 1.50; 95% CI, 1.06-2.12) and internal medicine (OR, 1.71; 95% CI, 1.18-2.48) physicians but not for physicians from other specialties. Conclusions and relevance: In this cross-sectional study of primary care physicians, physician- and community-level factors, such as specialty, age, and the Medicaid expansion status of their state, were significantly associated with how they provided contraceptive services to Medicaid beneficiaries. However, the existence of associations varied across clinical specialties. Ensuring access to contraception among Medicaid beneficiaries may therefore require policy and program approaches tailored for different physician types.
MeSH term(s)	Female ; Pregnancy ; United States ; Humans ; Male ; Child ; Middle Aged ; Physicians, Primary Care ; Contraceptive Agents ; Medicaid ; Cross-Sectional Studies ; Gynecology
Chemical Substances	Contraceptive Agents
Language	English
Publishing date	2023-03-03
Publishing country	United States
Document type	Journal Article
ISSN	2689-0186
ISSN (online)	2689-0186
DOI	10.1001/jamahealthforum.2023.0106
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Article ; Online: Changes in the Clinical Workforce Providing Contraception and Abortion Care in the US, 2019-2021.

Strasser, Julia / Schenk, Ellen / Dewhurst, Emma / Chen, Candice

JAMA network open

2022 Volume 5, Issue 11, Page(s) e2239657

MeSH term(s)	Pregnancy ; Female ; Humans ; Contraception ; Family Planning Services ; Workforce
Language	English
Publishing date	2022-11-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.39657
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Article: Use of Temporary Primary Care Providers in Federally Qualified Health Centers

Han, Xinxin / Chen, Candice / Pittman, Patricia

Journal of rural health. 2021 Jan., v. 37, no. 1

2021

Abstract: OBJECTIVE: This study examines the use of temporary providers in federally qualified health centers (FQHCs) in recent years and identifies associated factors. METHODS: Using 2013‐2017 federal administrative data of 1,028 FQHCs, we describe trends in the ... ...

Abstract	OBJECTIVE: This study examines the use of temporary providers in federally qualified health centers (FQHCs) in recent years and identifies associated factors. METHODS: Using 2013‐2017 federal administrative data of 1,028 FQHCs, we describe trends in the number and percentage of FQHCs that used temporary primary care physicians and advanced practice providers (nurse practitioners, physician assistants, and certified nurse midwives). We employed descriptive statistics to compare facility and patient characteristics between FQHCs that used and did not use temporary providers and constructed multivariate linear probability models to identify factors associated with their use. FINDINGS: Slightly over one‐third of FQHCs used temporary primary care providers during 2013‐2017. During this period, fewer FQHCs used temporary family physicians, while more FQHCs used nurse practitioners and physician assistants. Centers that used temporary providers were larger and less rural. Multivariate regression analysis showed that neither Health Professional Shortage Area facility scores (a measure of provider shortage), nor the county primary care provider‐to‐population ratio, was a predictor of temporary provider usage in FQHCs. Instead, facility regular primary care staff‐to‐patient ratio was positively associated with use of temporary providers. CONCLUSION: Temporary providers tend to be used in FQHCs where measure of underservice appears to be less severe. Future research should use qualitative interviews or other data sources to explore further the underlying reasons for using temporary providers in FQHCs.
Keywords	area ; descriptive statistics ; interviews ; midwives ; models ; nurses ; patients ; physicians ; probability ; regression analysis ; research ; rural health
Language	English
Dates of publication	2021-01
Size	p. 61-68.
Publishing place	John Wiley & Sons, Ltd
Document type	Article
Note	NAL-light ; JOURNAL ARTICLE
ZDB-ID	639160-6
ISSN	0890-765X
ISSN	0890-765X
DOI	10.1111/jrh.12424
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: How Can Health Care Organizations Address Burnout? A Description of the Dr. Lorna Breen Act Grantees.

Chen, Candice / Strasser, Julia / Dent, Randl / Blanchard, Janice / Portela-Martinez, Maria / Muñoz, Lauren / DeSmidt, Becka / Perlo, Jessica

American journal of public health

2024 Volume 114, Issue S2, Page(s) 148–151

MeSH term(s)	Humans ; Burnout, Professional/prevention & control ; Burnout, Psychological ; Delivery of Health Care
Language	English
Publishing date	2024-02-14
Publishing country	United States
Document type	Editorial
ZDB-ID	121100-6
ISSN	1541-0048 ; 0090-0036 ; 0002-9572
ISSN (online)	1541-0048
ISSN	0090-0036 ; 0002-9572
DOI	10.2105/AJPH.2023.307459
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Article ; Online: Community Health Center Residency Training: Improving Staffing, Service, and Quality.

Chen, Candice / Chong, Nicholas / Luo, Qian / Park, Jeongyoung

Family medicine

2021 Volume 53, Issue 8, Page(s) 689–696

Abstract: Background and objectives: Community-based residency programs are an important strategy to address rural and underserved primary care shortages, however, health centers report both benefits and challenges to training. This study aims to understand the ... ...

Abstract	Background and objectives: Community-based residency programs are an important strategy to address rural and underserved primary care shortages, however, health centers report both benefits and challenges to training. This study aims to understand the impact of new Teaching Health Center (THC) residency programs on health center staffing, patient service, quality of care, and provider productivity. Methods: Using the Uniform Data System, we used inverse propensity score weighting to create a balanced sample of new THC and non-THC health centers in 2010. Using 2018 data, we applied propensity score weighted regressions to examine changes in staffing, service, quality of care, and productivity in THC versus non-THC health centers. Results: In 2018, health centers with new THC programs were associated with increased physician (16.40, P<.01) staffing, yet decreased physician visits per full-time equivalent (-425.3, P<.01) relative to non-THC centers. New THC centers had increased delivery visits (231.0, P<.05), and had a greater rate of early entry into prenatal care (4.90%, P<.01). Conclusions: New residency programs are associated with increased provider recruitment, expanded patient service, and some improved health outcomes, but also with potential decreased provider productivity in health centers.
MeSH term(s)	Community Health Centers ; Humans ; Internship and Residency ; Physicians ; Primary Health Care ; Workforce
Language	English
Publishing date	2021-09-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	639374-3
ISSN	1938-3800 ; 0742-3225
ISSN (online)	1938-3800
ISSN	0742-3225
DOI	10.22454/FamMed.2021.843335
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Article ; Online: What Does It Mean for Medical School Admissions to Be Socially Accountable?

Henderson, Mark C / Green, Charlene / Chen, Candice

AMA journal of ethics

2021 Volume 23, Issue 12, Page(s) E965–974

Abstract: Health care workforce diversity is a critical determinant of health equity and the social mission of medical education. Medical schools have a social contract with the public, which provides significant financial support to academic medical centers. ... ...

Abstract	Health care workforce diversity is a critical determinant of health equity and the social mission of medical education. Medical schools have a social contract with the public, which provides significant financial support to academic medical centers. Although a focus on diversity is critical in the admissions process for health professions schools, most US medical schools have failed to achieve racial-ethnic or economic diversity representative of the general US population. This article discusses limitations of holistic admissions, structural challenges for diverse learners in medical education, and how to implement socially accountable admissions.
MeSH term(s)	Education, Medical ; Ethnicity ; Humans ; Racial Groups ; Schools, Medical ; Social Responsibility
Language	English
Publishing date	2021-12-01
Publishing country	United States
Document type	Journal Article
ISSN	2376-6980
ISSN (online)	2376-6980
DOI	10.1001/amajethics.2021.965
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Article ; Online: Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians.

Strasser, Julia / Schenk, Ellen / Luo, Qian / Bodas, Mandar / Anderson, Olivia / Chen, Candice

JAMA network open

2023 Volume 6, Issue 8, Page(s) e2330489

Abstract: Importance: Contraception and abortion services are essential health care, and family medicine (FM) physicians are an important part of the workforce providing this care. Residency could inform the reproductive health services FM physicians provide.: ... ...

Abstract	Importance: Contraception and abortion services are essential health care, and family medicine (FM) physicians are an important part of the workforce providing this care. Residency could inform the reproductive health services FM physicians provide. Objective: To determine which residency training factors are associated with FM physicians' provision of reproductive health services to Medicaid beneficiaries. Design, setting, and participants: This cross-sectional, population-based observational study of inpatient and outpatient FM physicians who completed residency between 2008 and 2018 and treated at least 1 Medicaid beneficiary in 2019 was conducted from November 2022 to March 2023. The study used 2019 American Medical Association Masterfile and Historical Residency file, as well as the 2019 Transformed Medicaid Statistical Information System claims. Exposures: Residency training in community-based or reproductive health-focused programs. Main outcomes and measures: The outcomes were providing the following to at least 1 Medicaid beneficiary in 2019: prescription contraception (pill, patch, and/or ring), intrauterine device (IUD) and/or contraceptive implant, and dilation and curettage (D&C). Odds of providing each outcome were measured using correlated random-effects regression models adjusted for physician, residency program, and county characteristics. Results: In the sample of 21 904 FM physician graduates from 410 FM residency programs, 12 307 were female (56.3%). More than half prescribed contraception to Medicaid beneficiaries (13 373 physicians [61.1%]), with lower proportions providing IUD or implant (4059 physicians [18.5%]) and D&C (152 physicians [.7%]). FM physicians who graduated from a Reproductive Health Education in Family Medicine program, which fully integrates family planning into residency training, had significantly greater odds of providing prescription contraception (odds ratio [OR], 1.23; 95% CI, 1.07-1.42), IUD or implant (OR, 1.79; 95% CI, 1.28-2.48), and D&C (OR, 3.61; 95% CI, 2.02-6.44). Physicians who completed residency at a Teaching Health Center, which emphasizes community-based care, had higher odds of providing an IUD or implant (OR, 1.51; 95% CI, 1.19-1.91). Conclusions and relevance: In this cross-sectional study of FM physicians providing Medicaid service, characteristics of residency training including community-based care and integration of family planning training are associated with greater odds of providing reproductive health services. With growing reproductive health policy restrictions, providing adequate training in reproductive health is critical to maintaining access to care, especially for underserved populations.
MeSH term(s)	Pregnancy ; Female ; Humans ; Male ; Cross-Sectional Studies ; Family Practice ; Internship and Residency ; Reproductive Health Services ; Physicians
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Observational Study ; Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.30489
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