A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

Adde, H A; Duinen, Alex J. van; Sherman, Lawrence Mark; Andrews, B C; Salvesen, Øyvind; Dunbar, Nelson; Bleah, A J; Weiser, Thomas; Bolkan, Håkon A.

doi:10.1007/s00268-021-06379-8

Cited by 8 publications

(11 citation statements)

References 38 publications

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“…Consequently, female physicians worked significantly fewer hours than male physicians in Austria but not Sweden [ 42 ]. In a recent study from Liberia, surgical practitioners averaged even fewer operative workdays per week than typical for the United States [ 10 , 20 - 25 , 43 ]. Consequently, differences between genders may be smaller.…”

Section: Discussionmentioning

confidence: 99%

Benchmarking Surgeons’ Gender and Year of Medical School Graduation Associated With Monthly Operative Workdays for Multispecialty Groups

Dexter¹,

Epstein²,

Ledolter³

et al. 2022

Cureus

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Background Female surgeons reportedly receive less surgical block time and fewer procedural referrals than male surgeons. In this study, we compared operative days between female and male surgeons throughout Florida. Our objective was to facilitate benchmarking by multispecialty groups, both the endpoint to use for statistically reliable results and expected differences. Methodology The historical cohort study included all 4,060,070 ambulatory procedural encounters and inpatient elective surgical states performed between January 2017 and December 2019 by 8,472 surgeons at 609 facilities. Surgeons’ gender, year of medical school graduation, and surgical specialty were obtained from their National Provider Identifiers. Results Female surgeons operated an average of 1.0 fewer days per month than matched male surgeons (99% confidence interval 0.8 to 1.2 fewer days, P < 0.0001). The mean differences were 0.8 to 1.4 fewer days per month among each of the five quintiles of years of graduation from medical school (all P ≤ 0.0050). Results were comparable when repeated using the number of monthly cases the surgeons performed. Conclusions An average difference of ≤1.4 days per month is a conservative estimate for the current status quo of the workload difference in Florida. Suppose that a group’s female surgeons average more than two fewer operative days per month than the group’s male surgeons of the same specialty. Such a large average difference would call for investigation of what might reflect systematic bias. While such a difference may reflect good flexibility of the organization, it may show a lack of responsiveness (e.g., fewer referrals of procedural patients to female surgeons or bias when apportioning allocated operating room time).

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Section: Discussionmentioning

confidence: 99%

Benchmarking Surgeons’ Gender and Year of Medical School Graduation Associated With Monthly Operative Workdays for Multispecialty Groups

Dexter¹,

Epstein²,

Ledolter³

et al. 2022

Cureus

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“…The low volumes of caesarean sections among adequately prepared facilities are another area of concern. There is a critical shortage of skilled surgical providers and that individual providers have low productivity, carrying out a median of just one surgery a week [ 46 ]. Given that population coverage of caesarean section is dangerously low, more investigation must be done to understand why these facilities- which can nominally provide caesarean sections- carry out so few, and if there are cost barriers or deficiencies in needed equipment, commodities or skills (e.g.…”

Section: Discussionmentioning

confidence: 99%

Readiness of health facilities to provide safe childbirth in Liberia: a cross-sectional analysis of population surveys, facility censuses and facility birth records

King

Tarway‐Twalla

Dennis³

et al. 2022

BMC Pregnancy Childbirth

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Background The provision of quality obstetric care in health facilities is central to reducing maternal mortality, but simply increasing childbirth in facilities not enough, with evidence that many facilities in sub-Saharan Africa do not fulfil even basic requirements for safe childbirth care. There is ongoing debate on whether to recommend a policy of birth in hospitals, where staffing and capacity may be better, over lower level facilities, which are closer to women’s homes and more accessible. Little is known about the quality of childbirth care in Liberia, where facility births have increased in recent decades, but maternal mortality remains among the highest in the world. We will analyse quality in terms of readiness for emergency care and referral, staffing, and volume of births. Methods We assessed the readiness of the Liberian health system to provide safe care during childbirth use using three data sources: Demographic and Health Surveys (DHS), Service Availability and Readiness Assessments (SARA), and the Health Management Information System (HMIS). We estimated trends in the percentage of births by location and population caesarean-section coverage from 3 DHS surveys (2007, 2013 and 2019–20). We examined readiness for safe childbirth care among all Liberian health facilities by analysing reported emergency obstetric and neonatal care signal functions (EmONC) and staffing from SARA 2018, and linking with volume of births reported in HMIS 2019. Results The percentage of births in facilities increased from 37 to 80% between 2004 and 2017, while the caesarean section rate increased from 3.3 to 5.0%. 18% of facilities could carry out basic EmONC signal functions, and 8% could provide blood transfusion and caesarean section. Overall, 63% of facility births were in places without full basic emergency readiness. 60% of facilities could not make emergency referrals, and 54% had fewer than one birth every two days. Conclusions The increase in proportions of facility births over time occurred because women gave birth in lower-level facilities. However, most facilities are very low volume, and cannot provide safe EmONC, even at the basic level. This presents the health system with a serious challenge for assuring safe, good-quality childbirth services.

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“…A surgical provider was defined as any provider listed as the main operator in the 4-month logbook sample. A full-time equivalent (FTE) position was quantified for each surgical provider to reflect the length and size of their working position over the study period; a half-time position over 1 year and a full-time position over half a year both equalled 0.5 FTE 18…”

Section: Methodsmentioning

confidence: 99%

“…In the health sector, the financial constraints are demonstrated by the fact that 41% of the governmental health workers were not on the payroll in 2015 13. The surgical system is undersized with a density of 1.6 specialist surgical providers per 100 000 population18 and a surgical volume of 462 surgical procedures per 100 000 population,19 resulting in a high unmet need for surgery. Long travel times delay surgical treatment, and many patients lack coverage of essential surgical care 20.…”

Section: Introductionmentioning

confidence: 99%

The economic burden associated with unmet surgical needs in Liberia: a retrospective macroeconomic analysis based on a nationwide enumeration of surgical procedures

Adde,

Oghogho,

van Duinen

et al. 2024

BMJ Open

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ObjectivesThe economic consequences of untreated surgical disease are potentially large. The aim of this study was to estimate the economic burden associated with unmet surgical needs in Liberia.DesignA nationwide enumeration of surgical procedures and providers was conducted in Liberia in 2018. We estimated the number of disability-adjusted life years (DALYs) saved by operative activities and converted these into economic losses averted using gross national income per capita and value of a statistical life (VSL) approaches. The total, the met and the unmet needs for surgery were determined, and economic losses caused by unmet surgical needs were estimated. Finally, we valued the economic losses avoided by various surgical provider groups.ResultsA total of 55 890 DALYs were averted by surgical activities in 2018; these activities prevented an economic loss of between US$35 and US$141 million. About half of these values were generated by the non-specialist physician workforce. Furthermore, a non-specialist physician working a full-time position for 1 year prevented an economic loss of US$717 069 using the VSL approach, while a specialist resident and a certified specialist saved US$726 606 and US$698 877, respectively. The burden of unmet surgical need was associated with productivity losses of between US$388 million and US$1.6 billion; these losses equate to 11% and 46% of the annual gross domestic product for Liberia.ConclusionThe economic burden of untreated surgical disease is large in Liberia. There is a need to strengthen the surgical system to reduce ongoing economic losses; a framework where specialist and non-specialist physicians collaborate may result in better economic return than a narrower focus on training specialists alone.

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A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

Cited by 8 publications

References 38 publications

Benchmarking Surgeons’ Gender and Year of Medical School Graduation Associated With Monthly Operative Workdays for Multispecialty Groups

Benchmarking Surgeons’ Gender and Year of Medical School Graduation Associated With Monthly Operative Workdays for Multispecialty Groups

Readiness of health facilities to provide safe childbirth in Liberia: a cross-sectional analysis of population surveys, facility censuses and facility birth records

The economic burden associated with unmet surgical needs in Liberia: a retrospective macroeconomic analysis based on a nationwide enumeration of surgical procedures

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