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Nazir A, Zimmerman S, Meyer ML. No One Cares When Planes Don't Crash: The Message for Long-term Care. J Am Med Dir Assoc 2019; 20:583-585. [PMID: 31030742 DOI: 10.1016/j.jamda.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Michele L Meyer
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC
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2
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Abstract
Abstract
This paper explores how general practitioners (GPs) address potentially opposing motivations stemming from being altruistic and self-interested, and the implications for patients and GPs. The author finds that GPs address dual goals of patient care and profit generation. This can be challenging, while professional values (altruism) encourage a patient focus, business realities (self-interest) mandate other priorities. Viewing clinicians as altruistic in isolation of business needs is unrealistic, as is the notion that profit is the dominant motivation. A blending of interests occurs, pursuing reasonable self-interest, patients’ best interests are ultimately met. GPs need a profit focus to sustain/improve the practice, benefitting patients through continued availability and capacity for enhancement. Therefore, it is argued that GPs behave in a manner that is ‘part altruistic, part self-interested’ and mutually beneficial. These insights should be considered in designing incentive systems for GPs, raising compelling questions about contemporary understanding of the nature of professionals.
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Yoon JD, Daley BM, Curlin FA. The Association Between a Sense of Calling and Physician Well-Being: A National Study of Primary Care Physicians and Psychiatrists. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:167-173. [PMID: 26809782 DOI: 10.1007/s40596-016-0487-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/08/2016] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study assesses the association between calling and physician well-being, clinical commitment, and burnout. METHODS In 2009-2010, a survey was mailed to 1504 primary care physicians (PCPs) and 512 psychiatrists drawn from the American Medical Association Physician Masterfile. The primary independent variable was a single-item measure that assessed physicians' level of calling. Main outcomes were markers of physician well-being (career satisfaction and morale), clinical commitment (intentions to reduce time spent in direct patient care, leave practice in a few years), and experiences of burnout. RESULTS Adjusted response rates were 63 % (896/1427) for PCPs and 64 % (312/487) for psychiatrists. Forty-two percent of US PCPs and psychiatrists agree strongly that their practice of medicine is a calling. Physicians with a high sense of calling were less likely than those with low to report regret in choosing medicine as a career (18 vs. 38 %; odds ratio 0.3; 95 % confidence interval, 0.2-0.5), wanting to go into a different clinical specialty (28 vs. 49 %; OR 0.4; 95 % CI, 0.2-0.6), or wanting to leave the practice of medicine in the next few years (14 vs. 25 %, OR 0.4; 95 % CI 0.2-0.7). Physicians with a high sense of calling were less likely to report burnout (17 vs. 31 % low calling, OR 0.4; 95 % CI 0.3 to 0.7). CONCLUSIONS Physicians who reported that medicine was a calling may be experiencing higher levels of career satisfaction, more durable clinical commitments, and resilience from burnout. Though physicians may differ on their understanding of the concept of calling in medicine, this study highlights an important factor that should be investigated further when assessing long-term workforce retention in the fields of primary care and psychiatry.
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Jager AJ, Tutty MA, Kao AC. Association Between Physician Burnout and Identification With Medicine as a Calling. Mayo Clin Proc 2017; 92:415-422. [PMID: 28189341 DOI: 10.1016/j.mayocp.2016.11.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the association between degree of professional burnout and physicians' sense of calling. PARTICIPANTS AND METHODS US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one's life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions. RESULTS A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001). CONCLUSION Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care.
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Affiliation(s)
- Andrew J Jager
- Ethics Standards Group, American Medical Association, Chicago, IL
| | - Michael A Tutty
- Professional Satisfaction and Practice Sustainability Group, American Medical Association, Chicago, IL
| | - Audiey C Kao
- Ethics Standards Group, American Medical Association, Chicago, IL.
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Yoon JD, Hunt NB, Ravella KC, Jun CS, Curlin FA. Physician Burnout and the Calling to Care for the Dying: A National Survey. Am J Hosp Palliat Care 2016; 34:931-937. [PMID: 27465404 DOI: 10.1177/1049909116661817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout. METHODS In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue"). RESULTS Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious. CONCLUSION Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.
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Affiliation(s)
- John D Yoon
- 1 Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.,2 The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Natalie B Hunt
- 3 The University of Chicago Divinity School, Chicago, IL, USA
| | | | - Christine S Jun
- 1 Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Farr A Curlin
- 5 Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, NC, USA
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Kao AC. Driven to Care: Aligning External Motivators with Intrinsic Motivation. Health Serv Res 2015; 50 Suppl 2:2216-22. [PMID: 26769060 PMCID: PMC5338198 DOI: 10.1111/1475-6773.12422] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pyramids and roundtables: a reflection on leadership. Am J Surg 2014; 208:873-80. [PMID: 25440475 DOI: 10.1016/j.amjsurg.2014.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/22/2022]
Abstract
By the nature of their career choice, surgeons are leaders at a variety of levels. The rise to leadership positions in surgery often requires scaling a steep pyramid. Many young surgeons are poorly prepared for what is frequently a competition with their peers. Some of the qualities young surgeons must possess to ascend the leadership pyramid are summarized by the "HOPES" of leadership: Honesty, recognition of Opportunity, having a Plan, knowing your Environment, and Self-assessment.
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Kontopantelis E, Springate D, Reeves D, Ashcroft DM, Valderas JM, Doran T. Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and Outcomes Framework. BMJ 2014; 348:g330. [PMID: 24468469 PMCID: PMC3903315 DOI: 10.1136/bmj.g330] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the effect of withdrawing incentives on recorded quality of care, in the context of the UK Quality and Outcomes Framework pay for performance scheme. DESIGN Retrospective longitudinal study. SETTING Data for 644 general practices, from 2004/05 to 2011/12, extracted from the Clinical Practice Research Datalink. PARTICIPANTS All patients registered with any of the practices over the study period-13,772,992 in total. INTERVENTION Removal of financial incentives for aspects of care for patients with asthma, coronary heart disease, diabetes, stroke, and psychosis. MAIN OUTCOME MEASURES Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium treatment monitoring (psychosis), removed in April 2006; blood pressure monitoring (coronary heart disease, diabetes, stroke), cholesterol concentration monitoring (coronary heart disease, diabetes), and blood glucose monitoring (diabetes), removed in April 2011. Multilevel mixed effects multiple linear regression models were used to quantify the effect of incentive withdrawal. RESULTS Mean levels of performance were generally stable after the removal of the incentives, in both the short and long term. For the two indicators removed in April 2006, levels in 2011/12 were very close to 2005/06 levels, although a small but statistically significant drop was estimated for influenza immunisation. For five of the six indicators withdrawn from April 2011, no significant effect on performance was seen following removal and differences between predicted and observed scores were small. Performance on related outcome indicators retained in the scheme (such as blood pressure control) was generally unaffected. CONCLUSIONS Following the removal of incentives, levels of performance across a range of clinical activities generally remained stable. This indicates that health benefits from incentive schemes can potentially be increased by periodically replacing existing indicators with new indicators relating to alternative aspects of care. However, all aspects of care investigated remained indirectly or partly incentivised in other indicators, and further work is needed to assess the generalisability of the findings when incentives are fully withdrawn.
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Affiliation(s)
- Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
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McDeavitt JT. The siren song of physician incentives: avoiding the rocks. PM R 2013; 5:970-3. [PMID: 24247016 DOI: 10.1016/j.pmrj.2013.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 09/26/2013] [Indexed: 11/17/2022]
Abstract
As the United States attempts to reform its health care system, various incentive programs are playing an increasingly important role. In this review, the primary dynamics that drive the rise of incentives in health care management are discussed. Increasingly well-designed studies on the impact of incentives on outcomes continue to yield variable and, at times, unexpected results. The incorporation of incentives into the overall process of organizational cultural change is an important tool but one with significant limitations.
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Affiliation(s)
- James T McDeavitt
- Division of Education and Research, Carolinas HealthCare System, PO Box 32861, Charlotte, NC 28232(∗).
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Herzer KR, Pronovost PJ. Motivating physicians to improve quality: light the intrinsic fire. Am J Med Qual 2013; 29:451-3. [PMID: 24249836 DOI: 10.1177/1062860613510201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Czeisler CA, Pellegrini CA, Sade RM. Should sleep-deprived surgeons be prohibited from operating without patients' consent? Ann Thorac Surg 2013; 95:757-66. [PMID: 23336899 PMCID: PMC4497533 DOI: 10.1016/j.athoracsur.2012.11.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 11/26/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Charles A. Czeisler
- Baldino Professor of Sleep Medicine, Harvard Medical School; Chief of the Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital; and Director of the Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Carlos A. Pellegrini
- Henry N. Harkins Professor and Chair, Department of Surgery, University of Washington, Seattle, WA
| | - Robert M. Sade
- Professor of Surgery, Division of Cardiothoracic Surgery; Director of the Institute of Human Values in Health Care; and Director of the Clinical Research Ethics Core of the South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC
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Sasson C, Wiler JL, Haukoos JS, Sklar D, Kellermann AL, Beck D, Urbina C, Heilpern K, Magid DJ. The Changing Landscape of America’s Health Care System and the Value of Emergency Medicine. Acad Emerg Med 2012; 19:1204-11. [DOI: 10.1111/j.1553-2712.2012.1446.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Efforts to address the current fragmented US health care structure, including controversial federal reform, cannot succeed without a reinvigoration of community-centered health systems. A blueprint for systematic implementation of community services exists in the 1967 Folsom Report--calling for "communities of solution." We propose an updated vision of the Folsom Report for integrated and effective services, incorporating the principles of community-oriented primary care. The 21st century primary care physician must be a true public health professional, forming partnerships and assisting data sharing with community organizations to facilitate healthy changes. Current policy reform efforts should build upon Folsom Report's goal of transforming personal and population health.
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Affiliation(s)
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- American Board of Family Medicine Young Leaders Advisory Group
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Abstract
Conflicts of interest (COIs) exist when someone who has a fiduciary responsibility for another's welfare acts, or has the potential to act, in a manner inconsistent with their charge's best interests. COIs exist in all professions as well as in public service; however, in medicine, COIs pose a unique problem, given the responsibilities and special status that society grants to physicians. In this commentary, I explore conflicts of interest in various contexts: medical practice, continuing medical education, practice guidelines, medical journals, academic institutions and researchers, and medical professional societies and associations. I define the term "conflicts of interest" and review its ethical basis, offer common examples of COIs, discuss the importance of disclosure, and suggest ways beyond disclosure to minimize or limit COIs in the various settings in which physicians work. Ideally, physicians should try to avoid COIs, but when situations arise where physicians have COIs, how they manage them will depend on a combination of physicians' personal conscience and professional ethics, professional society ethics codes, and governmental regulation.
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Allen JI. Gastroenterologists and the triple aim: how to become accountable. Gastrointest Endosc Clin N Am 2012; 22:85-96. [PMID: 22099715 DOI: 10.1016/j.giec.2011.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
US medicine is fragmented and economically unsustainable and has vast opportunities for quality improvement. A current solution is to create large accountable care organizations. Fragmentation should be reduced and clinical coordination be improved, which means that gastroenterologists and other specialists will be challenged to change practices from traditional reactive and consultative care to a principal care model in which they manage appropriate clinical service lines. The pay-off in improved patient care and financial stability can be substantial. This article discusses a proposed evolution toward clinical service line management that might be achieved by an independent single specialty practice.
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Affiliation(s)
- John I Allen
- Minnesota Gastroenterology PA, Bloomington, MN 55437, USA.
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Comstock CH. Coping with changes in health care. Am J Obstet Gynecol 2011; 204:256-8. [PMID: 21376164 DOI: 10.1016/j.ajog.2011.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/18/2011] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Christine H Comstock
- Department of Obstetrics and Gynecology, Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Abstract
Yes, but we do not know why
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Brindis RG. President's Page: Cardiovascular Professionals: Are We Knights in Shining Armor or Just Knaves and Pawns? J Am Coll Cardiol 2010; 56:1606-8. [DOI: 10.1016/j.jacc.2010.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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