Public health policy planning in the provision of the Finnish secondary care services has not ade... more Public health policy planning in the provision of the Finnish secondary care services has not adequately taken into account the substantial changes of the past decades in the demand for services and other factors influencing the healthcare structure. This research (TUOTA) was designed to generate a critical review of the development trends of the Finnish secondary care system, and the performance of the present service production structure, as well as possible alternative service production structures, based on population-based demand for services. The research included industrial management influenced calculations of the economies of scale in certain services of secondary care, and studied the production capacity in the Finnish public secondary care system. Also, other driving factors of health policy were considered, including the reachability and clinical quality of services, the available amount of workforce in the future and the population-based need for emergency medical services. The services that were studied included total hip or knee replacement, treatment of stroke, myocardial infarction, appendectomies and digestive system problems, uncomplicated births, psychiatric rehabilitation and treatment of schizophrenia in secondary care, cataract surgeries, partial mastectomies and secondary care level emergency medical services. In addition, the possibility of converting some of the free capacity in Finnish public secondary care services into health tourism related service models was considered. The results indicate that centralizing certain secondary health care services would yield substantial financial and quality related benefits. Stronger regional or country-level coordination in health policy, public services planning and resourcing in Finnish public secondary care system is suggested. Keywords: Health policy, economies of scale in healthcare, industrial management in healthcare, clinical quality of services, labour economics, emergency medical services, reachability of care, health tourism.
The objective was to investigate work satisfaction among recently graduated otorhinolaryngologist... more The objective was to investigate work satisfaction among recently graduated otorhinolaryngologist-head and neck surgeons-(ENT surgeons). An electronic questionnaire was sent to all ENT surgeons graduated in Finland during a ten-year period. Answers about work satisfaction were analyzed in detail with regards to age, gender, university of specialist training, experience, place of work and further education.Altogether 125/129 (96.9%) responded. The majority (87.8%) of the respondents enjoyed their current main occupation. The older age group (≥40 vs <40 years) was more satisfied (93.7% vs. 81.7%; p=0.042). Consultation opportunities and workplace atmosphere were reported as good by 85.6% and 90.4% of the respondents, respectively. Training opportunities were considered good by 82.4%, albeit by only 60% of the private physicians (p=0.047). Private sector practitioners were also less satisfied with the versatility of their work (p<0.001). Work at a university hospital was considered more strenuous (p<0.001). Over half (54.8%) felt insecure about continuation of their employment status. Most of the recently graduated Finnish ENT surgeons are satisfied with their current occupation, consultation opportunities and workplace atmosphere. However, work at university hospitals in particular was considered often strenuous and over half of the respondents felt insecure about the continuity of their employment.
The Physician 2018 study is part of a series of cross-sectional studies that began three decades ... more The Physician 2018 study is part of a series of cross-sectional studies that began three decades ago and that are conducted every five years. The population of the study consisted of physicians who had been licensed in 2007-2016 (N=6,472) of whom those born on an odd day were selected (n=3,148). The response rate was 39%. 85% of the respondents were fairly or very satisfied with their choice of profession. Physicians increasingly felt that they were members of a work group and almost one in three was interested in management. One quarter of the respondents had a doctoral degree or were in the process of preparing a doctoral thesis. Within basic medical education, physicians were more satisfied with teaching of hospital work than with teaching of health centre work. The respondents most satisfied with teaching of hospital work were graduates of the University of Eastern Finland and the University of Turku. Those most satisfied with teaching of health centre work had graduated from th...
Uusinta tutkimustietoa lääkäreistä ja erikoislääkärikoulutuksesta Lähtökohdat Lääkäri 2018-tutkim... more Uusinta tutkimustietoa lääkäreistä ja erikoislääkärikoulutuksesta Lähtökohdat Lääkäri 2018-tutkimus kartoittaa suomalaisten lääkärien koulutusta, arvoja, ammatti-identiteettiä ja urasuunnitelmia. Tässä artikkelissa keskitymme erikoistumiskoulutuksen kysymyksiin ja kuvaamme tutkimusaineiston. MeneteLMät Perusjoukon muodostivat alle 70-vuotiaat Suomessa asuvat laillistetut lääkärit, jotka olivat antaneet luvan henkilötietojen luovuttamiselle (n = 23 131). Otokseen valittiin Suomen Lääkäriliiton rekisteristä parillisina päivinä syntyneet lääkärit (n = 11 336). Kyselytutkimuksen vastaukset kerättiin sähköisellä ja paperilomakkeella. Vastausosuus oli 46 %. tuLokset Tärkeimmät erikoisalan valintaan vaikuttaneet tekijät olivat omat taidot ja persoonallisuus sekä alan monipuolisuus. Mahdollisuudella tutkimustyöhön tai yksityissektorilla toimimiseen ei ollut merkittävää vaikutusta. Vastanneista 72 % oli melko tai erittäin tyytyväisiä erikoislääkärikoulutukseensa. PääteLMät Aineisto antaa kattavan kuvan lääkärien taustatiedoista, näkemyksistä ja lääkärikoulutuksen kehitystarpeista vuonna 2018. Erikoisalavalintoihin vaikuttavat tekijät ovat yksilöllisiä, ja lääkärit ovat yleisesti tyytyväisiä valintaansa. Pyry MattiLa LL, väitöskirjatutkija Itä-Suomen yliopisto Piitu ParManne VTM, tutkija Suomen Lääkäriliitto Johanna reLLMan LL, apulaisylilääkäri, koulutuskoordinaattori TAYS, yhtymähallinto Petri kuLMaLa LT, professori Oulun yliopisto, lääketieteellinen tiedekunta ja Medical Research Center Oulu OYS, lasten ja nuorten klinikka tePPo heikkiLä LT, va. hallintoylilääkäri Helsingin ja Uudenmaan sairaanhoitopiiri Markku suManen LT, professori Tampereen yliopisto, lääketieteen ja terveysteknologian tiedekunta outi kortekangas-savoLainen LT, dosentti Turun yliopisto Minna kaiLa LT, professori Helsingin yliopisto, Clinicum, lääketieteellinen tiedekunta saMi heistaro LT, terveydenhuollon erikoislääkäri, MBA, koulutuspäällikkö Suomen Lääkäriliitto hannu haLiLa LKT, erikoislääkäri, terveydenhuollon hallinnon dosentti, eMBA, varatoiminnanjohtaja Suomen Lääkäriliitto LIITEAInEISTO pdf-versiossa www.laakarilehti.fi Sisällysluettelot SLL9/2020
We determined the employment status of recently graduated otorhinolaryngologist-head and neck sur... more We determined the employment status of recently graduated otorhinolaryngologist-head and neck surgeons (ENT doctors) in Finland during the past 10 years. We also investigated the job vacancy rate of the Departments of Otorhinolaryngology-Head and Neck Surgery (Department of ORL-HNS). An electronic questionnaire was sent to all ENT doctors who had graduated during 2007-2017 and to chief physicians of all Departments of ORL-HNS. Chi-square and Fisher's test were used in the analyses. Altogether 129 ENT doctors had graduated and 125 (96.9%) responded. Thirty (24%) physicians had been employed in a position that did not correspond to their ENT doctor training. All 30 chief physicians responded and a total of 306 physicians were working at their departments (215 ENT doctors, 91 residents). However, there were only 241 available positions (197 for ENT doctors, 44 for residents). It was estimated that 65 ENT doctors would retire within 10 years. At the moment there does not seem to be a significant shortage of ENT doctors in Finland. The current national volume of resident intake in the ENT training programme is twofold in comparison with the estimated retirement rate in the public sector.
Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaite... more Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaiten saatavilla potilaille, jotka sairastavat tuki-ja liikuntaelinten tai verenkiertoelinten sairauksia, metabolista oireyhtymää tai diabetesta. Heikoimmin kuntoutusta on tarjolla oppimishäiriöihin.
Nuorten uratoiveet korva-, nenäja kurkkutautien erikoisalalla Lähtökohdat Erikoisalan ja sille ha... more Nuorten uratoiveet korva-, nenäja kurkkutautien erikoisalalla Lähtökohdat Erikoisalan ja sille hakeutuvien kannalta on hyödyllistä selvittää, mitkä tekijät ohjaavat lääkäreitä erikoisalan valinnassa ja uralla eteenpäin. MeneteLMät Haastattelimme 19 lääkäriä, jotka erikoistuivat tai olivat äskettäin erikoistuneet korva-, nenä-ja kurkkutauteihin. tuLokset Alan valintaan vaikutti sattuma. Sosiaaliset sekä käden taidot koettiin tärkeiksi, ja väitöskirjaa pidettiin oleellisena uralla etenemiselle. Johtotehtävissä toimivien epätasaisen sukupuolijakauman arvioitiin tasoittuvan, mutta yliopistoklinikoiden mukaan näin ei ole käynyt. PääteLMät Erikoisalan tulee profiloitua selvemmin. Erikoistumiskoulutuksessa tulee tukea sosiaalisia ja käden taitoja. Naisten urakehityksen esteiden tunnistaminen auttaa tasoittamaan sukupuolijakaumaa johtotehtävissä.
Experiencing ethical problems requires both ethically problematic situations and ethical sensitiv... more Experiencing ethical problems requires both ethically problematic situations and ethical sensitivity. Ethically problematic treatment decisions are distressing and might reflect health care quality problems. Whether all physicians actually experience ethical problems, what these problems are and how they vary according to physician age, gender and work sector are largely unknown. A mail survey of all non-retired physicians licensed in Finland (n = 17,172, response rate 75.6%). The proportion of physicians reporting having made ethically problematic treatment decisions decreased in linear fashion from 60% at ages below 30 years to 21% at ages over 63 years. The only problem that did not decrease in frequency with age was having withdrawn necessary treatments. Women and primary care physicians reported problematic decisions most often, although gender differences were small. Primary care physicians most often reported having performed too many investigations or having pressured patients, whereas hospital physicians emphasized having withdrawn necessary treatments. Performing unnecessary treatments or investigations was explained by pressure from patients or relatives, and performing too few treatments or investigations was explained by inadequate resources. In general, young physicians felt pressured to do too much, whereas older physicians felt they could not do enough due to inadequate resources. Older physicians might be less exposed to ethically problematic situations, be more able to handle them or have lower ethical sensitivity. Young physicians could benefit from support in resisting pressure to perform unnecessary treatments, whereas older physicians might benefit from training in recognizing ethical issues.
Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaite... more Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaiten saatavilla potilaille, jotka sairastavat tuki-ja liikuntaelinten tai verenkiertoelinten sairauksia, metabolista oireyhtymää tai diabetesta. Heikoimmin kuntoutusta on tarjolla oppimishäiriöihin.
Public health policy planning in the provision of the Finnish secondary care services has not ade... more Public health policy planning in the provision of the Finnish secondary care services has not adequately taken into account the substantial changes of the past decades in the demand for services and other factors influencing the healthcare structure. This research (TUOTA) was designed to generate a critical review of the development trends of the Finnish secondary care system, and the performance of the present service production structure, as well as possible alternative service production structures, based on population-based demand for services. The research included industrial management influenced calculations of the economies of scale in certain services of secondary care, and studied the production capacity in the Finnish public secondary care system. Also, other driving factors of health policy were considered, including the reachability and clinical quality of services, the available amount of workforce in the future and the population-based need for emergency medical services. The services that were studied included total hip or knee replacement, treatment of stroke, myocardial infarction, appendectomies and digestive system problems, uncomplicated births, psychiatric rehabilitation and treatment of schizophrenia in secondary care, cataract surgeries, partial mastectomies and secondary care level emergency medical services. In addition, the possibility of converting some of the free capacity in Finnish public secondary care services into health tourism related service models was considered. The results indicate that centralizing certain secondary health care services would yield substantial financial and quality related benefits. Stronger regional or country-level coordination in health policy, public services planning and resourcing in Finnish public secondary care system is suggested. Keywords: Health policy, economies of scale in healthcare, industrial management in healthcare, clinical quality of services, labour economics, emergency medical services, reachability of care, health tourism.
The objective was to investigate work satisfaction among recently graduated otorhinolaryngologist... more The objective was to investigate work satisfaction among recently graduated otorhinolaryngologist-head and neck surgeons-(ENT surgeons). An electronic questionnaire was sent to all ENT surgeons graduated in Finland during a ten-year period. Answers about work satisfaction were analyzed in detail with regards to age, gender, university of specialist training, experience, place of work and further education.Altogether 125/129 (96.9%) responded. The majority (87.8%) of the respondents enjoyed their current main occupation. The older age group (≥40 vs <40 years) was more satisfied (93.7% vs. 81.7%; p=0.042). Consultation opportunities and workplace atmosphere were reported as good by 85.6% and 90.4% of the respondents, respectively. Training opportunities were considered good by 82.4%, albeit by only 60% of the private physicians (p=0.047). Private sector practitioners were also less satisfied with the versatility of their work (p<0.001). Work at a university hospital was considered more strenuous (p<0.001). Over half (54.8%) felt insecure about continuation of their employment status. Most of the recently graduated Finnish ENT surgeons are satisfied with their current occupation, consultation opportunities and workplace atmosphere. However, work at university hospitals in particular was considered often strenuous and over half of the respondents felt insecure about the continuity of their employment.
The Physician 2018 study is part of a series of cross-sectional studies that began three decades ... more The Physician 2018 study is part of a series of cross-sectional studies that began three decades ago and that are conducted every five years. The population of the study consisted of physicians who had been licensed in 2007-2016 (N=6,472) of whom those born on an odd day were selected (n=3,148). The response rate was 39%. 85% of the respondents were fairly or very satisfied with their choice of profession. Physicians increasingly felt that they were members of a work group and almost one in three was interested in management. One quarter of the respondents had a doctoral degree or were in the process of preparing a doctoral thesis. Within basic medical education, physicians were more satisfied with teaching of hospital work than with teaching of health centre work. The respondents most satisfied with teaching of hospital work were graduates of the University of Eastern Finland and the University of Turku. Those most satisfied with teaching of health centre work had graduated from th...
Uusinta tutkimustietoa lääkäreistä ja erikoislääkärikoulutuksesta Lähtökohdat Lääkäri 2018-tutkim... more Uusinta tutkimustietoa lääkäreistä ja erikoislääkärikoulutuksesta Lähtökohdat Lääkäri 2018-tutkimus kartoittaa suomalaisten lääkärien koulutusta, arvoja, ammatti-identiteettiä ja urasuunnitelmia. Tässä artikkelissa keskitymme erikoistumiskoulutuksen kysymyksiin ja kuvaamme tutkimusaineiston. MeneteLMät Perusjoukon muodostivat alle 70-vuotiaat Suomessa asuvat laillistetut lääkärit, jotka olivat antaneet luvan henkilötietojen luovuttamiselle (n = 23 131). Otokseen valittiin Suomen Lääkäriliiton rekisteristä parillisina päivinä syntyneet lääkärit (n = 11 336). Kyselytutkimuksen vastaukset kerättiin sähköisellä ja paperilomakkeella. Vastausosuus oli 46 %. tuLokset Tärkeimmät erikoisalan valintaan vaikuttaneet tekijät olivat omat taidot ja persoonallisuus sekä alan monipuolisuus. Mahdollisuudella tutkimustyöhön tai yksityissektorilla toimimiseen ei ollut merkittävää vaikutusta. Vastanneista 72 % oli melko tai erittäin tyytyväisiä erikoislääkärikoulutukseensa. PääteLMät Aineisto antaa kattavan kuvan lääkärien taustatiedoista, näkemyksistä ja lääkärikoulutuksen kehitystarpeista vuonna 2018. Erikoisalavalintoihin vaikuttavat tekijät ovat yksilöllisiä, ja lääkärit ovat yleisesti tyytyväisiä valintaansa. Pyry MattiLa LL, väitöskirjatutkija Itä-Suomen yliopisto Piitu ParManne VTM, tutkija Suomen Lääkäriliitto Johanna reLLMan LL, apulaisylilääkäri, koulutuskoordinaattori TAYS, yhtymähallinto Petri kuLMaLa LT, professori Oulun yliopisto, lääketieteellinen tiedekunta ja Medical Research Center Oulu OYS, lasten ja nuorten klinikka tePPo heikkiLä LT, va. hallintoylilääkäri Helsingin ja Uudenmaan sairaanhoitopiiri Markku suManen LT, professori Tampereen yliopisto, lääketieteen ja terveysteknologian tiedekunta outi kortekangas-savoLainen LT, dosentti Turun yliopisto Minna kaiLa LT, professori Helsingin yliopisto, Clinicum, lääketieteellinen tiedekunta saMi heistaro LT, terveydenhuollon erikoislääkäri, MBA, koulutuspäällikkö Suomen Lääkäriliitto hannu haLiLa LKT, erikoislääkäri, terveydenhuollon hallinnon dosentti, eMBA, varatoiminnanjohtaja Suomen Lääkäriliitto LIITEAInEISTO pdf-versiossa www.laakarilehti.fi Sisällysluettelot SLL9/2020
We determined the employment status of recently graduated otorhinolaryngologist-head and neck sur... more We determined the employment status of recently graduated otorhinolaryngologist-head and neck surgeons (ENT doctors) in Finland during the past 10 years. We also investigated the job vacancy rate of the Departments of Otorhinolaryngology-Head and Neck Surgery (Department of ORL-HNS). An electronic questionnaire was sent to all ENT doctors who had graduated during 2007-2017 and to chief physicians of all Departments of ORL-HNS. Chi-square and Fisher's test were used in the analyses. Altogether 129 ENT doctors had graduated and 125 (96.9%) responded. Thirty (24%) physicians had been employed in a position that did not correspond to their ENT doctor training. All 30 chief physicians responded and a total of 306 physicians were working at their departments (215 ENT doctors, 91 residents). However, there were only 241 available positions (197 for ENT doctors, 44 for residents). It was estimated that 65 ENT doctors would retire within 10 years. At the moment there does not seem to be a significant shortage of ENT doctors in Finland. The current national volume of resident intake in the ENT training programme is twofold in comparison with the estimated retirement rate in the public sector.
Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaite... more Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaiten saatavilla potilaille, jotka sairastavat tuki-ja liikuntaelinten tai verenkiertoelinten sairauksia, metabolista oireyhtymää tai diabetesta. Heikoimmin kuntoutusta on tarjolla oppimishäiriöihin.
Nuorten uratoiveet korva-, nenäja kurkkutautien erikoisalalla Lähtökohdat Erikoisalan ja sille ha... more Nuorten uratoiveet korva-, nenäja kurkkutautien erikoisalalla Lähtökohdat Erikoisalan ja sille hakeutuvien kannalta on hyödyllistä selvittää, mitkä tekijät ohjaavat lääkäreitä erikoisalan valinnassa ja uralla eteenpäin. MeneteLMät Haastattelimme 19 lääkäriä, jotka erikoistuivat tai olivat äskettäin erikoistuneet korva-, nenä-ja kurkkutauteihin. tuLokset Alan valintaan vaikutti sattuma. Sosiaaliset sekä käden taidot koettiin tärkeiksi, ja väitöskirjaa pidettiin oleellisena uralla etenemiselle. Johtotehtävissä toimivien epätasaisen sukupuolijakauman arvioitiin tasoittuvan, mutta yliopistoklinikoiden mukaan näin ei ole käynyt. PääteLMät Erikoisalan tulee profiloitua selvemmin. Erikoistumiskoulutuksessa tulee tukea sosiaalisia ja käden taitoja. Naisten urakehityksen esteiden tunnistaminen auttaa tasoittamaan sukupuolijakaumaa johtotehtävissä.
Experiencing ethical problems requires both ethically problematic situations and ethical sensitiv... more Experiencing ethical problems requires both ethically problematic situations and ethical sensitivity. Ethically problematic treatment decisions are distressing and might reflect health care quality problems. Whether all physicians actually experience ethical problems, what these problems are and how they vary according to physician age, gender and work sector are largely unknown. A mail survey of all non-retired physicians licensed in Finland (n = 17,172, response rate 75.6%). The proportion of physicians reporting having made ethically problematic treatment decisions decreased in linear fashion from 60% at ages below 30 years to 21% at ages over 63 years. The only problem that did not decrease in frequency with age was having withdrawn necessary treatments. Women and primary care physicians reported problematic decisions most often, although gender differences were small. Primary care physicians most often reported having performed too many investigations or having pressured patients, whereas hospital physicians emphasized having withdrawn necessary treatments. Performing unnecessary treatments or investigations was explained by pressure from patients or relatives, and performing too few treatments or investigations was explained by inadequate resources. In general, young physicians felt pressured to do too much, whereas older physicians felt they could not do enough due to inadequate resources. Older physicians might be less exposed to ethically problematic situations, be more able to handle them or have lower ethical sensitivity. Young physicians could benefit from support in resisting pressure to perform unnecessary treatments, whereas older physicians might benefit from training in recognizing ethical issues.
Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaite... more Lääkäri löytää kuntoutusta helpoimmin tules-potilaille Lääkärien mielestä kuntoutusta on parhaiten saatavilla potilaille, jotka sairastavat tuki-ja liikuntaelinten tai verenkiertoelinten sairauksia, metabolista oireyhtymää tai diabetesta. Heikoimmin kuntoutusta on tarjolla oppimishäiriöihin.
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