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Weissler EH, Ford CB, Narcisse DI, Lippmann SJ, Smerek MM, Greiner MA, Hardy NC, O'Brien B, Sullivan RC, Brock AJ, Long C, Curtis LH, Patel MR, Jones WS. Clinician Specialty, Access to Care, and Outcomes Among Patients with Peripheral Artery Disease. Am J Med 2022; 135:219-227. [PMID: 34627781 PMCID: PMC8840959 DOI: 10.1016/j.amjmed.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Understanding the relationship between patterns of peripheral artery disease and outcomes is an essential step toward improving care and outcomes. We hypothesized that clinician specialty would be associated with occurrence of major adverse vascular events (MAVE). METHODS Patients with at least 1 peripheral artery disease-related encounter in our health system and fee-for-service Medicare were divided into groups based on the specialty of the clinician (ie, cardiologist, surgeon, podiatrist, primary care, or other) providing a plurality of peripheral artery disease-coded care in the year prior to index encounter. The primary outcome was MAVE (a composite of all-cause mortality, myocardial infarction, stroke, lower extremity revascularization, and lower extremity amputation). RESULTS The cohort included 1768 patients, of whom 30.0% were Black, 23.9% were Medicaid dual-enrollment eligible, and 31.1% lived in rural areas. Patients receiving a plurality of their care from podiatrists had the highest 1-year rates of MAVE (34.4%, P <.001), hospitalization (65.9%, P <.001), and amputations (22.6%, P <.001). Clinician specialty was not associated with outcomes after adjustment. Patients who were Medicaid dual-eligible had higher adjusted risks of mortality (adjusted hazard ratio [HRadj] 1.54, 95% confidence interval [CI] 1.11-2.14) and all-cause hospitalization (HRadj 1.20, 95% CI 1.03-1.40) and patients who were Black had a higher adjusted risk of amputation (HRadj 1.49, 95% CI 1.03-2.15). CONCLUSIONS Clinician specialty was not associated with worse outcomes after adjustment, but certain socioeconomic factors were. The effects of clinician specialty and socioeconomic status were likely attenuated by the fact that all patients in this study had health insurance; these analyses require confirmation in a more representative cohort.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC.
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Dennis I Narcisse
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Steven J Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Michelle M Smerek
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - N Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Benjamin O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - R Casey Sullivan
- Division of Cardiology, Washington University School of Medicine, St. Louis, Mo
| | - Adam J Brock
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Chandler Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Lesley H Curtis
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Clinical Research Institute, Durham, NC
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Clinical Research Institute, Durham, NC
| | - W Schuyler Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC; Clinical Research Institute, Durham, NC
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Sammons MK, Gaskins M, Kutscha F, Nast A, Werner RN. HIV Pre-exposure Prophylaxis (PrEP): Knowledge, attitudes and counseling practices among physicians in Germany - A cross-sectional survey. PLoS One 2021; 16:e0250895. [PMID: 33914824 PMCID: PMC8084214 DOI: 10.1371/journal.pone.0250895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background German statutory health insurance began covering the costs associated with HIV PrEP in September 2019; however, to bill for PrEP services, physicians in Germany must either be certified as HIV-specialists according to a nationwide quality assurance agreement, or, if they are non-HIV-specialists, have completed substantial further training in HIV/PrEP care. Given the insufficient implementation of PrEP, the aim of our study was to explore the potential to increase the number of non-HIV-specialists providing PrEP-related services. Methods We conducted an anonymous survey among a random sample of internists, general practitioners, dermatologists and urologists throughout Germany using a self-developed questionnaire. We calculated a knowledge score and an attitudes score from individual items in these two domains. Both scores ranged from 0–20, with high values representing good knowledge or positive attitudes. We also asked participants about the proportion of PrEP advice they provided proactively to men who have sex with men (MSM) and trans-persons who met the criteria to be offered PrEP. Results 154 physicians completed the questionnaire. Self-assessed knowledge among HIV-specialists was greater than among non-HIV-specialists [Median knowledge score: 20.0 (IQR = 0.0) vs. 4.0 (IQR = 11.0), p<0.001]. Likewise, attitudes towards PrEP were more positive among HIV-specialists than non-HIV-specialists [Median attitudes score: 18.0 (IQR = 3.0) vs. 13.0 (IQR = 5.25), p<0.001]. The proportion of proactive advice on PrEP provided to at-risk MSM and trans-persons by HIV-specialists [Median: 30.0% (IQR = 63.5%)] was higher than that provided by non-HIV-specialists [Median: 0.0% (IQR = 11.3%), p<0.001]. However, the results of our multiple regression suggest the only independent predictor of proactive PrEP advice was the knowledge score, and not whether physicians were HIV-specialists or non-HIV-specialists. Conclusions These findings point to opportunities to improve PrEP implementation in individuals at risk of acquiring HIV. Targeted training, particularly for non-HIV-specialists, and the provision of patient-centered information material could help improve care, especially in rural areas.
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Affiliation(s)
- Mary Katherine Sammons
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthew Gaskins
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Kutscha
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Nast
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ricardo Niklas Werner
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- * E-mail:
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SUNG KC, CHUNG JY, FENG IJ, YANG SH, HSU CC, LIN HJ, WANG JJ, HUANG CC. Plantar fasciitis in physicians and nurses: a nationwide population-based study. Ind Health 2020; 58:153-160. [PMID: 31548445 PMCID: PMC7118066 DOI: 10.2486/indhealth.2019-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/13/2019] [Indexed: 06/10/2023]
Abstract
Physicians and nurses in Taiwan have heavy workload and long working hours, which may contribute to plantar fasciitis. However, this issue is unclear, and therefore, we conducted this study to delineate it. We conducted a nationwide population-based study by identifying 26,024 physicians and 127,455 nurses and an identical number of subjects for comparison (general population) via the National Health Insurance Research Database. The risk of plantar fasciitis between 2006 and 2012 was compared between physicians and general population, between nurses and general population, and between physicians and nurses. We also compared the risk of plantar fasciitis among physician subgroups. Physicians and nurses had a period prevalence of plantar fasciitis of 8.14% and 13.11% during the 7-yr period, respectively. The risk of plantar fasciitis was lower among physicians (odds ratio [OR]: 0.660; 95% confidence interval [CI]: 0.622-0.699) but higher among nurses (OR: 1.035; 95% CI: 1.011-1.059) compared with that in the general population. Nurses also had a higher risk than the physicians after adjusting for age and sex (adjusted odds ratio [AOR]: 1.541; 95% CI: 1.399-1.701). Physician subspecialties of orthopedics and physical medicine and rehabilitation showed a higher risk. Female physicians had a higher risk of plantar fasciitis than male physicians. This study showed that nurses, physician specialties of orthopedics and physical medicine and rehabilitation, and female physicians had a higher risk of plantar fasciitis. Improvement of the occupational environment and health promotion are suggested for these populations.
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Affiliation(s)
- Kuo-Chang SUNG
- Department of Emergency Medicine, Chi-Mei Medical Center,
Taiwan
| | - Jui-Yuan CHUNG
- Department of Emergency Medicine, Cathay General Hospital,
Taiwan
| | - I-Jung FENG
- Department of Medical Research, Chi-Mei Medical Center,
Taiwan
| | - Shu-Han YANG
- Department of Physical Medicine and Rehabilitation, Chi-Mei
Medical Center, Taiwan
| | - Chien-Chin HSU
- Department of Emergency Medicine, Chi-Mei Medical Center,
Taiwan
- Department of Biotechnology, Southern Taiwan University of
Science and Technology, Taiwan
| | - Hung-Jung LIN
- Department of Emergency Medicine, Chi-Mei Medical Center,
Taiwan
- Department of Emergency Medicine, Taipei Medical University,
Taiwan
| | - Jhi-Joung WANG
- Department of Medical Research, Chi-Mei Medical Center,
Taiwan
- Allied AI Biomed Center, Southern Taiwan University of
Science and Technology, Taiwan
| | - Chien-Cheng HUANG
- Department of Emergency Medicine, Chi-Mei Medical Center,
Taiwan
- Department of Senior Services, Southern Taiwan University of
Science and Technology, Taiwan
- Department of Environmental and Occupational Health, College
of Medicine, National Cheng Kung University, Taiwan
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Abstract
OBJECTIVE To examine the distribution and patterns of opioid prescribing in the United States. DESIGN Retrospective, observational study. SETTING National private insurer covering all 50 US states and Washington DC. PARTICIPANTS An annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017. MAIN OUTCOME MEASURES Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions. RESULTS In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years. CONCLUSIONS Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.
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Affiliation(s)
- Mathew V Kiang
- Center for Population Health Sciences, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
- Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304, USA
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
- Research and Analytics, Collective Health, San Francisco, CA, USA
- School of Public Health, Imperial College, London, UK
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Price D, Campbell C, Van Hoof TJ, ElChamaa R, Jeong D, Chappell K, Moore D, Olson C, Danilovich N, Kitto S. Definitions of Physician Certification Used in the North American Literature: A Scoping Review. J Contin Educ Health Prof 2020; 40:147-157. [PMID: 32898116 DOI: 10.1097/ceh.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The authors sought to identify how physician specialty certification is defined in the North American literature. METHODS A rigorous, established six-stage scoping review framework was used to identify the North American certification literature published between January 2006 and May 2016 relating to physician specialty certification. Data were abstracted using a charting form developed by the study team. Quantitative summary data and qualitative thematic analysis of the purpose of certification were derived from the extracted data. RESULTS A two stage screening process identified 88 articles that met predefined criteria. Only 14 of the 88 articles (16%) contained a referenced purpose of certification. Eighteen definitions were identified from these articles. Definitional concepts included lifelong learning and continuous professional development, assessment of competence and performance, performance improvement, public accountability, and professional standing. DISCUSSION Most articles identified in this scoping review did not define certification or describe its purpose or intent. Future studies should provide a definition of certification to further scholarly examination of its intent and effects and inform its further evolution.
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Affiliation(s)
- David Price
- Dr. Price: The University of CO School of Medicine and Senior Advisor to the President, American Board of Family Medicine, Lexington, KY; Dr. Campbell: Associate Professor at the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Dr. Thomas Van Hoof: Associate Professor at the School of Nursing and School of Medicine, University of Connecticut, Mansfield, CT; Dr. Chappell: Senior Vice President of the Accreditation Program and Institute for Credentialing Research, American Nurses Credentialing Center, Silver Spring, MD; Dr. Moore: Director at the Division of Continuing Medical Education and Director of Evaluation and Education, Office of Graduate Medical Education, Vanderbilt University, Nashville, TN; and Professor of Medical Education and Administration, Vanderbilt University, Nashville, TN; Dr. Olson: Assistant Professor at the Geisel School of Medicine, Dartmouth College, Hanover, NH; Ms. ElChamaa: Research Associate at the Department of Innovation in Medical Education, and the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Ms. Jeong: Research Associate at the Department of Innovation in Medical Education, and the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Dr. Danilovich: Research Associate at the Department of Innovation in Medical Education, and the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada; and Dr. Kitto: Professor at the Department of Innovation in Medical Education and the Faculty of Education, and Director of Research at the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa; and Assistant Professor at the Department of Surgery, University of Toronto, Canada
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Hayes SN, Noseworthy JH, Farrugia G. A Structured Compensation Plan Results in Equitable Physician Compensation: A Single-Center Analysis. Mayo Clin Proc 2020; 95:35-43. [PMID: 31902427 DOI: 10.1016/j.mayocp.2019.09.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments. PARTICIPANTS AND METHODS All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary. RESULTS Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties. CONCLUSION A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.
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Affiliation(s)
- Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Emeritus, Mayo Clinic, Rochester, MN; Mayo Foundation, Rochester, MN.
| | - John H Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Emeritus, Mayo Clinic, Rochester, MN; Mayo Foundation, Rochester, MN
| | - Gianrico Farrugia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Emeritus, Mayo Clinic, Rochester, MN; Mayo Foundation, Rochester, MN
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Quinn AE, Hemmelgarn BR, Tonelli M, McBrien KA, Edwards A, Senior P, Faris P, Au F, Ma Z, Weaver RG, Manns BJ. Association of Specialist Physician Payment Model With Visit Frequency, Quality, and Costs of Care for People With Chronic Disease. JAMA Netw Open 2019; 2:e1914861. [PMID: 31702800 PMCID: PMC6902778 DOI: 10.1001/jamanetworkopen.2019.14861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Specialist physicians are key members of chronic care management teams; to date, however, little is known about the association between specialist payment models and outcomes for patients with chronic diseases. OBJECTIVE To examine the association of payment model with visit frequency, quality of care, and costs for patients with chronic diseases seen by specialists. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using propensity-score matching in patients seen by a specialist physician was conducted between April 1, 2011, and September 31, 2014. The study was completed on March 31, 2015, and data analysis was conducted from June 2017 to February 2018 and finalized in August 2019. In a population-based design, 109 839 adults with diabetes or chronic kidney disease newly referred to specialists were included. Because patients seen by independent salary-based and fee-for-service (FFS) specialists were significantly different in observed baseline characteristics, patients were matched 1:1 on demographic, illness, and physician characteristics. EXPOSURES Specialist physician payment model (salary-based or FFS). MAIN OUTCOMES AND MEASURES Follow-up outpatient visits, guideline-recommended care delivery, adverse events, and costs. RESULTS A total of 90 605 patients received care from FFS physicians and 19 234 received care from salary-based physicians. Before matching, the patients seen by salary-based physicians had more advanced chronic kidney disease (2630 of 14 414 [18.2%] vs 6627 of 54 489 [12.2%]), and a higher proportion had 5 or more comorbidities (5989 of 19 234 [31.3%] vs 23 326 of 90 605 [25.7%]). Propensity-score matching resulted in a cohort of 31 898 patients (15 949 FFS, 15 949 salary-based) seeing 489 specialists. In the matched cohort, patients were similar (mean [SD] age, 61.3 [18.2] years; 17 632 women [55.3%]; 29 251 residing in urban settings [91.7%]). Patients seen by salary-based specialists had a higher follow-up visit rate compared with those seen by FFS specialists (1.74 visits; 95% CI, 1.58-1.92 visits vs 1.54 visits; 95% CI, 1.41-1.68 visits), but the difference was not significant (rate ratio, 1.13; 95% CI, 0.99-1.28; P = .06). There was no statistical difference in guideline-recommended care delivery, hospital or emergency department visits for ambulatory care-sensitive conditions, or costs between patients seeing FFS and salary-based specialists. The median association of physician clustering with health care use and quality outcomes was consistently greater than the association with the physician payment, suggesting variation between physicians (eg, median rate ratio for follow-up outpatient visit rate was 1.74, which is greater than the rate ratio of 1.13). CONCLUSIONS AND RELEVANCE Specialist physician payment does not appear to be associated with variation in visits, quality, and costs for outpatients with chronic diseases; however, there is variation in outcomes between physicians. This finding suggests the need to consider other strategies to reduce physician variation to improve the value of care and outcomes for people with chronic diseases.
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Affiliation(s)
- Amity E. Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerry A. McBrien
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alun Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter Senior
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Flora Au
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhihai Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert G. Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Ruzycki SM, Freeman G, Bharwani A, Brown A. Association of Physician Characteristics With Perceptions and Experiences of Gender Equity in an Academic Internal Medicine Department. JAMA Netw Open 2019; 2:e1915165. [PMID: 31722028 PMCID: PMC6902791 DOI: 10.1001/jamanetworkopen.2019.15165] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The persistence of inequities that disadvantage women physicians remains empirically underexplained. Understanding the cultural factors that are associated with disparities in harassment, discrimination, remuneration, and career trajectory are critical to addressing inequities. OBJECTIVES To explore how physicians perceive the climate for women physicians and compare perceptions and experiences of gender inequity among physicians based on characteristics including gender, faculty status, parental status, and years in practice. DESIGN, SETTING, AND PARTICIPANTS This sequential, explanatory, mixed-methods qualitative study used the Culture Conducive to Women's Academic Success (CCWAS; range 45-225, with higher scores indicating better perceived culture toward women), followed by individual semistructured interviews with physicians at the Department of Medicine of the University of Calgary. All 389 physician members of the Department of Medicine, including academic and clinical physicians and those of any gender, were invited to participate in the survey and interview phases. MAIN OUTCOMES AND MEASURES The culture within the department for women physicians was assessed using the CCWAS score. Scores were compared between respondents' gender and years in practice. Interviews with physicians were used to further explore findings from the CCWAS and to understand experiences and perceptions of gender disparities. RESULTS A total of 169 of 389 physicians completed the survey (response rate, 43.4%; 102 [59.9%] women; 65 [38.9%] men; and 2 [1.2%] who did not disclose gender); 28 participants (7.2%) elected to participate in an interview (22 [78.6%] women; 6 [21.4%] men). Women physicians perceived the culture of the department toward women as significantly worse than men physicians (median [interquartile range] CCWAS score, 137.0 [118.0-155.0] vs 164.5 [154.0-183.4]; P < .001). Physicians with more than 15 years in practice perceived the culture toward women as significantly more favorable than physicians with 15 years or less in practice (median [interquartile range] CCWAS score, 157.0 [138.8-181.3] vs 147.0 [127.5-164.3]; P = .02). Qualitative data demonstrated that experiences of junior women (ie, physicians who graduated medical school after 1996, when an equal number of men and women in medical school was achieved in Canada) and perceptions of senior men (ie, those who graduated before 1996) were most different; junior women reported high rates of discrimination and harassment, while senior men perceived that the Department of Medicine had achieved gender equity. CONCLUSIONS AND RELEVANCE In this study, senior men physicians' perceptions of gender equity were different from lived experiences of gender inequity reported by junior women physicians. This demographic mismatch between perceptions and experiences of gender equity in medicine may explain the lack of action by leaders and decision-makers in medicine to mitigate disparities.
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Affiliation(s)
- Shannon M. Ruzycki
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Georgina Freeman
- W21C Research and Innovation Centre, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Aleem Bharwani
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Allison Brown
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Rello J, Kalwaje Eshwara V, Conway-Morris A, Lagunes L, Alves J, Alp E, Zhang Z, Mer M. Perceived differences between intensivists and infectious diseases consultants facing antimicrobial resistance: a global cross-sectional survey. Eur J Clin Microbiol Infect Dis 2019; 38:1235-1240. [PMID: 30900056 DOI: 10.1007/s10096-019-03530-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023]
Abstract
To identify differences in perception on multi-drug-resistant (MDR) organisms and their management at intensive care units (ICU). A cross-sectional survey was conducted. A proposal addressing a pathogen priority list (PPL) for ICU, arising from the TOTEM study, was compared with a sample of global experts in infections in critically ill patients. The survey was responded by 129 experts. Globally, ESBL Enterobacteriaceae, followed by carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae, were the main concerns. Some differences in opinion were identified between 63 (49%) ICU physicians (ICU/anesthesiology) and 43 (33%) infectious disease consultants (ID physicians/microbiologists). The pathogens most concerning in the ICU for intensivists were ESBL Enterobacteriaceae (38%) versus carbapenem-resistant A. baumannii (48.3%) for ID consultants, (p < 0.05). Increasing number of ID consultants over intensivists (26% vs 14%) reported difficulty in choosing initial therapy for carbapenem-resistant A. baumannii. For intensivists, the urgent measures to limit development of antibiotic resistance were headed by cohort measures (26.3%) versus increasing nurse/patient ratio (32.5%) for ID consultants, (p < 0.05). Regarding effectiveness to prevent MDR development and spread, education programs (42.4%) were the priority for intensivists versus external consultation (35.7%) for ID consultants. Finally, both groups agreed that carbapenem resistance was the most pressing concern (> 70%) regarding emerging resistance. Differences in priorities regarding organisms, infection control practices, and educational priorities were visualized between ID/clinical microbiologists and ICU/anesthesiologists. Multi-disciplinary collaboration is required to achieve best care for ICU patients with severe infections.
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Affiliation(s)
- Jordi Rello
- CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, Spain.
- Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.
| | - Vandana Kalwaje Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Andrew Conway-Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Joana Alves
- Infectious Diseases, Braga Hospital Center, Braga, Portugal
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mervyn Mer
- Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Heath Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Affiliation(s)
- Tara Lagu
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA
| | | | | | | | - Aruna Priya
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA
| | - Sarah L. Goff
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA
| | - Peter K. Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, MA
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Raffoul MC, Petterson SM, Rayburn WF, Wingrove P, Bazemore AW. Office Visits for Women Aged 45-64 Years According to Physician Specialties. J Womens Health (Larchmt) 2016; 25:1231-1236. [PMID: 27585369 DOI: 10.1089/jwh.2015.5599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The increase in access to healthcare through the Affordable Care Act highlights the need to track where women seek their office-based care. The objectives of this study were to examine the types of physicians sought by women beyond their customary reproductive years and before being elderly. METHODS This retrospective cohort study involved an analysis of national data from the Medical Expenditure Panel Survey (MEPS) between 2002 and 2012. Women between 45 and 64 years old (n = 44,830) were interviewed, and reviews of corresponding office visits (n = 330,114) were undertaken. RESULTS In 2002, women aged 45-64 years (62%) went to a family or internal medicine physician only and this reached 72% in 2012. The percentage of women who went to an obstetrician-gynecologist (ob-gyn) only decreased from 20% in 2002 to 12% in 2012. Most went to a family physician or general internist for a general checkup or for diagnosis or treatment. By contrast, visits to ob-gyn physicians were predominantly for general checkups. Those who went to an ob-gyn office were more likely to have a higher family income, live in the Northeast, and describe their overall health as being excellent. CONCLUSIONS Women aged 45-64 years were substantially more likely to obtain care exclusively at offices of family physicians or general internists than of ob-gyn physicians. Overlap in care provided at more than one physician's office requires continued surveillance in minimizing redundant cost and optimizing resource utilization.
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Affiliation(s)
- Melanie C Raffoul
- 1 Robert Graham Center, Center for Policy Studies , American Academy of Family Physicians, Washington, District of Columbia
| | - Stephen M Petterson
- 1 Robert Graham Center, Center for Policy Studies , American Academy of Family Physicians, Washington, District of Columbia
| | - William F Rayburn
- 1 Robert Graham Center, Center for Policy Studies , American Academy of Family Physicians, Washington, District of Columbia
- 2 Department of Obstetrics and Gynecology, University of New Mexico School of Medicine , Albuquerque, New Mexico
| | - Peter Wingrove
- 1 Robert Graham Center, Center for Policy Studies , American Academy of Family Physicians, Washington, District of Columbia
| | - Andrew W Bazemore
- 1 Robert Graham Center, Center for Policy Studies , American Academy of Family Physicians, Washington, District of Columbia
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Relić D. Development of a Model for Planning Specialist Education of Medical Doctors in Croatia. Stud Health Technol Inform 2016; 228:798-800. [PMID: 27577497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Development of a model for simulation of the needed number of specialists of different specialties in the Republic of Croatia by the year 2035 based on the expected changes in size and age structure of population and experts' estimates of the needs. The model will be implemented in the form of a computer program based on the estimated most potent predictors. The developed model will be used as a tool for the simulation of different scenarios for specialist education combined with other factors like migration flows, changes in retirement age and skill mixing in order to compare different possibilities and options for the renewal of the Croatian healthcare personnel. Results will enable the development of recommendations for decision making and the adoption of a rational plan of referral to specialist training. Indirectly, developed model will be useful for needs assessment and simulation and planning of workforce renewal of other health professionals and for other countries.
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Affiliation(s)
- Danko Relić
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb
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Emmert M, Epping B. [Not Available]. Z Orthop Unfall 2015; 153:363-365. [PMID: 26313763 DOI: 10.1055/s-0035-1563631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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15
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Epping B. [Not Available]. Z Orthop Unfall 2015; 153:359-362. [PMID: 26313762 DOI: 10.1055/s-0035-1563628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Humphries N, McAleese S, Tyrrell E, Thomas S, Normand C, Brugha R. Applying a typology of health worker migration to non-EU migrant doctors in Ireland. Hum Resour Health 2015; 13:52. [PMID: 26111814 PMCID: PMC4488134 DOI: 10.1186/s12960-015-0042-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 06/02/2015] [Indexed: 05/28/2023]
Abstract
BACKGROUND Research on health worker migration in the Irish context has categorized migrant health workers by country or region of training (for example, non-EU nurses or doctors) or recruitment mechanism (for example, actively recruited nurses). This paper applies a new typology of health worker migrants - livelihood, career-oriented, backpacker, commuter, undocumented and returner migrants (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014) - to the experiences of non-EU migrant doctors in Ireland and tests its utility for understanding health worker migration internationally. METHODS The paper draws on quantitative survey (N = 366) and qualitative interview (N = 37) data collected from non-EU migrant doctors in Ireland between 2011 and 2013. RESULTS Categorizing non-EU migrant doctors in Ireland according to the typology (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014) offers insight into their differing motivations, particularly on arrival. Findings suggest that the career-oriented migrant is the most common type of doctor among non-EU migrant doctor respondents, accounting for 60 % (N = 220) of quantitative and 54 % (N = 20) of qualitative respondents. The authors propose a modification to the typology via the addition of two additional categories - the family migrant and the safety and security migrant. CONCLUSIONS Employing a typology of health worker migration can facilitate a more comprehensive understanding of the migrant medical workforce, a necessary prerequisite for the development of useful policy tools (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014). The findings indicate that there is some fluidity between categories, as health worker motivations change over time. This indicates the potential for policy levers to influence migrant health worker decision-making, if they are sufficiently "tuned in" to migrant health worker motivation.
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Affiliation(s)
- Niamh Humphries
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Sara McAleese
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Ella Tyrrell
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
| | - Ruairí Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
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Kmietowicz Z. Patients and nurses are confused by doctors' titles, survey finds. BMJ 2014; 348:g1950. [PMID: 24603123 DOI: 10.1136/bmj.g1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ellimoottil C, Kadlec AO, Farooq A, Quek ML. Choosing a physician in the Yelp era. Bull Am Coll Surg 2013; 98:20-21. [PMID: 24313135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
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Roberts DL, Cannon KJ, Wellik KE, Wu Q, Budavari AI. Burnout in inpatient-based versus outpatient-based physicians: a systematic review and meta-analysis. J Hosp Med 2013; 8:653-64. [PMID: 24167011 DOI: 10.1002/jhm.2093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 09/05/2013] [Accepted: 09/13/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Burnout is a syndrome affecting the entirety of work life and characterized by cynicism, detachment, and inefficacy. Despite longstanding concerns about burnout in hospital medicine, few data about burnout in hospitalists have been published. PURPOSE A systematic review of the literature on burnout in inpatient-based and outpatient-based physicians worldwide was undertaken to determine whether inpatient physicians experience more burnout than outpatient physicians. DATA SOURCES Five medical databases were searched for relevant terms with no language restrictions. Authors were contacted for unpublished data and clarification of the practice location of study subjects. STUDY SELECTION Two investigators independently reviewed each article. Included studies provided a measure of burnout in inpatient and/or outpatient nontrainee physicians. DATA EXTRACTION Fifty-four studies met inclusion criteria, 15 of which provided direct comparisons of inpatient and outpatient physicians. Twenty-eight studies used the same burnout measure and therefore were amenable to statistical analysis. DATA SYNTHESIS Outpatient physicians reported more emotional exhaustion than inpatient physicians. No statistically significant differences in depersonalization or personal accomplishment were found. Further comparisons were limited by the heterogeneity of instruments used to measure burnout and the lack of available information about practice location in many studies. CONCLUSIONS The existing literature does not support the widely held belief that burnout is more frequent in hospitalists than outpatient physicians. Better comparative studies of hospitalist burnout are needed.
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Affiliation(s)
- Daniel L Roberts
- Division of Hospital Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona
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Robeznieks A. Still a work in progress: providers skeptical of accuracy of CMS' physician compare website. Mod Healthc 2013; 43:10. [PMID: 23878900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Maddocks I, Luxford Y. Palliative care is everyone's business - is it yours, doctor? Med J Aust 2013; 198:481-2. [PMID: 23682888 DOI: 10.5694/mja13.10471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
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Shannon D. Publicly reported physician ratings: here to stay but not yet ready for prime time. Physician Exec 2013; 39:14-26. [PMID: 23437752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Johnson C. Survey finds physicians very wary of doctor ratings. Physician Exec 2013; 39:6-12. [PMID: 23437751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Fernández González F, Detrés J, Torrellas P, Balleste CR. Comparison of the appropriate use of antibiotics based on clinical guidelines between physicians in-training versus practicing physicians. Bol Asoc Med P R 2013; 105:21-24. [PMID: 24282916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The inappropriate antibiotic can lead to serious negative effects on health. This has been the cause of emergence of multidrug resistant bacteria and the need of surveillance of antibiotics in the inpatient setting. An adequate knowledge on which and when prescribing antibiotics is essential to avoid these issues. Because of this problems, guidelines have been developed to educate and control the misuse and abuse of antibiotics and improve clinical outcomes. We evaluated the medical knowledge, medical trends, and the effectiveness of professional interventions among Puerto Rico physicians in promoting prudent antibiotic prescribing. A comparative study was performed using a questionnaire about prudent antibiotic use in common infections seen in Puerto Rico. It was distributed among the major three internal medicine training programs at San Juan, internal medicine physicians and general physicians. General physicians failed to treat adequately asymptomatic bacteriuria, and overall failed in treating other common conditions when compared with residents and internal medicine physicians. One of our questions was related to the treatment of Extended Spectrum Beta Lactamase (ESBL) positive Escherichia coli (E. coli) and more than 50% of the surveyed failed to answer the question correctly. Conditions as viral respiratory tract infections and community acquired pneumonia had the higher correctly answered questions among the groups. Our questionnaire demonstrates that guidelines have to reach the education among the general physician population to decrease the overuse of inadequate antibiotics, and education should be strengthen on those internal medicine physicians that have already completed formal training.
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Mazurenko O, Menachemi N. Environmental market factors associated with physician career satisfaction. J Healthc Manag 2012; 57:307-324. [PMID: 23087994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Previous research has found that physician career satisfaction is declining, but no study has examined the relationship between market factors and physician career satisfaction. Using a theoretical framework, we examined how various aspects of the market environment (e.g., munificence, dynamism, complexity) are related to overall career satisfaction. Nationally representative data from the 2008 Health Tracking Physician Survey were combined with environmental market variables from the 2008 Area Resource File. After controlling for physician and practice characteristics, at least one variable each representing munificence, dynamism, and complexity was associated with satisfaction. An increase in the market number of primary care physicians per capita was positively associated with physician career satisfaction (OR = 2.11, 95% CI: 1.13 to 3.9) whereas an increase in the number of specialists per capita was negatively associated with physician satisfaction (OR = 0.68, 95% CI: 0.48 to 0.97). Moreover, an increase in poverty rates was negatively associated with physician career satisfaction (OR = 0.95, 95% CI: 0.91 to 1.01). Lastly, physicians practicing in states with a malpractice crisis (OR = 0.81, 95% CI: 0.68 to 0.96) and/or those who perceived high competition in their markets (OR = 0.76, 95% CI: 0.61 to 0.95) had lower odds of being satisfied. A better understanding of an organization's environment could assist healthcare managers in shaping their policies and strategies to increase physician satisfaction.
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Abstract
CONTEXT Physicians are embedded in informal networks that result from their sharing of patients, information, and behaviors. OBJECTIVES To identify professional networks among physicians, examine how such networks vary across geographic regions, and determine factors associated with physician connections. DESIGN, SETTING, AND PARTICIPANTS Using methods adopted from social network analysis, Medicare administrative data from 2006 were used to study 4,586,044 Medicare beneficiaries seen by 68,288 physicians practicing in 51 hospital referral regions (HRRs). Distinct networks depicting connections between physicians (defined based on shared patients) were constructed for each of the 51 HRRs. MAIN OUTCOMES MEASURES Variation in network characteristics across HRRs and factors associated with physicians being connected. RESULTS The number of physicians per HRR ranged from 135 in Minot, North Dakota, to 8197 in Boston, Massachusetts. There was substantial variation in network characteristics across HRRs. For example, the mean (SD) adjusted degree (number of other physicians each physician was connected to per 100 Medicare beneficiaries) across all HRRs was 27.3 (range, 11.7-54.4); also, primary care physician relative centrality (how central primary care physicians were in the network relative to other physicians) ranged from 0.19 to 1.06, suggesting that primary care physicians were more than 5 times more central in some markets than in others. Physicians with ties to each other were far more likely to be based at the same hospital (69.2% of unconnected physician pairs vs 96.0% of connected physician pairs; adjusted rate ratio, 0.12 [95% CI, 0.12-0.12]; P < .001), and were in closer geographic proximity (mean office distance of 21.1 km for those with connections vs 38.7 km for those without connections, P < .001). Connected physicians also had more similar patient panels in terms of the race or illness burden than unconnected physicians. For instance, connected physician pairs had an average difference of 8.8 points in the percentage of black patients in their 2 patient panels compared with a difference of 14.0 percentage points for unconnected physician pairs (P < .001). CONCLUSIONS Network characteristics vary across geographic areas. Physicians tend to share patients with other physicians with similar physician-level and patient-panel characteristics.
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Affiliation(s)
- Bruce E Landon
- Department of Health Care Policy, School of Medicine, Harvard University, Cambridge, Massachusetts, USA.
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Morrissey J. Documentation. Hosp Health Netw 2012; 86:24-1. [PMID: 22838146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
For hospitals to get properly reimbursed under the new coding system, they must make sure physicians document medical activities better. Engaging them can be tricky.
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González López-Valcárcel B, Barber Pérez P. [Health workforce planning and training, with emphasis on primary care. SESPAS Report 2012]. Gac Sanit 2012; 26 Suppl 1:46-51. [PMID: 22305292 DOI: 10.1016/j.gaceta.2011.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/25/2011] [Accepted: 07/21/2011] [Indexed: 11/19/2022]
Abstract
The present article provides an overview of workforce planning for health professionals in Spain, with emphasis on physicians and primary care. We analyze trends, describe threats and make some suggestions. In Spain some structural imbalances remain endemic, such as the low number of nurses with respect to physicians, which may become a barrier to needed reforms. The new medical degree, with the rank of master, will not involve major changes to training. Nursing, which will require a university degree, leaves a gap that will be filled by nursing assistants.This domino effect ends in family medicine, which has no upgrading potential. Hence reasonable objectives for the system are to prioritize the post-specialization training of family physicians, enhance their research capacity and define a career that does not equate productivity with seniority. What is undergoing a crisis of identity and prestige is family medicine, not primary care. There is a risk that the specialty of family medicine will lose rank after the specialty of emergency medicine is approved. Today, about 40% of emergency physicians in the public network are specialists, most of them in family medicine. In 2010 a new fact emerged: an elite of foreign doctors obtained positions as resident medical interns in highly sought-after specialties through the national competitive examination. This phenomenon should be closely monitored and requires Spain to define the pattern of internationalization of health professionals in a clear and precise model.
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Payers: expect to feel a double-team pinch. Manag Care 2011; 20:13. [PMID: 21667621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Kronberger MP, Bakken LL. Identifying the educationally influential physician: a systematic review of approaches. J Contin Educ Health Prof 2011; 31:247-257. [PMID: 22189988 DOI: 10.1002/chp.20137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Previous studies have indicated that educationally influential physicians' (EIPs) interactions with peers can lead to practice changes and improved patient outcomes. However, multiple approaches have been used to identify and investigate EIPs' informal or formal influence on practice, which creates study outcomes that are difficult to compare. The purposes of this systematic literature review were to (1) compare approaches used to identify EIPs and (2) identify and compare shared characteristics of EIPs as defined by the included studies. METHODS Articles in English were obtained from PubMed, CINAHL Plus, ERIC, PsycINFO, Web of Science, Google Scholar databases, and reference lists of identified articles. Studies were compared and contrasted based on terminology, identification approach, selection criteria, and EIP characteristics according to Cresswell's 5 steps in conducting a literature review. RESULTS Thirty-one studies met the inclusion criteria. Sociometric questionnaires and peer informants were used most frequently to identify EIPs. Multiple and varied criteria, including physician ranking, nomination by peers, percentage of nominations received, and number of votes were used by researchers to select physicians who were classified as EIPs. The identified characteristics of EIPs varied by study, with some researchers adhering to characteristics previously described by Hiss, and others adding to or deviating from those characteristics, at times based on physician specialty. CONCLUSION Selection of an EIP identification approach requires agreement on EIPs' characteristics, consistent approaches and identification criteria, and common terms and definitions. Additional research is needed to compare characteristics of EIPs and study outcomes based on the identification method employed.
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Affiliation(s)
- Matthew P Kronberger
- Department of Educational Leadership & Policy Analysis, School of Medicine and Public Health, Office of Continuing Professional Development, University of Wisconsin, Madison, WI 53706, USA
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Friedman SH, Cerny CA, Soliman S, West SG. Reel forensic experts: Forensic psychiatrists as portrayed on screen. J Am Acad Psychiatry Law 2011; 39:412-417. [PMID: 21908760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The lay public is much more likely to have encountered a forensic psychiatrist on television or in the movies than to have encountered a real one. Thus, by way of popular culture, the jury's perceptions and expectations of forensic expert witnesses may have been formed long before they take the stand. We describe a typology of five categories of forensic experts portrayed in fiction: Dr. Evil, The Professor, The Hired Gun, The Activist, and the Jack of All Trades. As art imitates life, these categories (aside from Dr. Evil) mirror real-life criticisms that have been made about forensic experts.
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Affiliation(s)
- Susan Hatters Friedman
- Northcoast Behavioral Healthcare, McKee 2, 1756 Sagamore Road, Northfield, OH 44067, USA.
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Medica to rate individual physicians. Minn Med 2011; 94:21. [PMID: 21366101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Reimann S, Strech D. The representation of patient experience and satisfaction in physician rating sites. A criteria-based analysis of English- and German-language sites. BMC Health Serv Res 2010; 10:332. [PMID: 21138579 PMCID: PMC3017530 DOI: 10.1186/1472-6963-10-332] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 12/07/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information on patient experience and satisfaction with individual physicians could play an important role for performance measures, improved health care and health literacy. Physician rating sites (PRSs) bear the potential to be a widely available source for this kind of information. However, patient experience and satisfaction are complex constructs operationalized by multiple dimensions. The way in which PRSs allow users to express and rate patient experience and satisfaction could likely influence the image of doctors in society and the self-understanding of both doctors and patients. This study examines the extent to which PRSs currently represent the constructs of patient experience and satisfaction. METHODS First, a systematic review of research instruments for measuring patient experience and satisfaction was conducted. The content of these instruments was analyzed qualitatively to create a comprehensive set of dimensions for patient experience and patient satisfaction. Second, PRSs were searched for systematically in English-language and German-language search engines of Google and Yahoo. Finally, we classified every structured question asked by the different PRS using the set of dimensions of patient experience and satisfaction. RESULTS The qualitative content analysis of the measurement instruments produced 13 dimensions of patient experience and satisfaction. We identified a total of 21 PRSs. No PRSs represented all 13 dimensions of patient satisfaction and experience with its structured questions. The 3 most trafficked English-language PRS represent between 5 and 6 dimensions and the 3 most trafficked German language PRSs between 8 and 11 dimensions The dimensions for patient experience and satisfaction most frequently represented in PRSs included diversely operationalized ones such as professional competence and doctor-patient relationship/support. However, other less complex but nevertheless important dimensions such as communication skills and information/advice were rarely represented, especially in English-language PRSs. CONCLUSIONS Concerning the potential impact of PRSs on health systems, further research is needed to show which of the current operationalizations of patient experience and satisfaction presented in our study are establishing themselves in PRSs. Independently of this factual development, the question also arises whether and to what extent health policy can and should influence the operationalization of patient experience and satisfaction in PRSs. Here, the challenge would be to produce a set of dimensions capable of consensus from among the wide range of operationalizations found by this study.
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Affiliation(s)
- Swantje Reimann
- Hannover Medical School, CELLS - Centre for Ethics and Law in the Life Sciences, Institute for History, Ethics and Philosophy of Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Daniel Strech
- Hannover Medical School, CELLS - Centre for Ethics and Law in the Life Sciences, Institute for History, Ethics and Philosophy of Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Hong CS, Atlas SJ, Chang Y, Subramanian SV, Ashburner JM, Barry MJ, Grant RW. Relationship between patient panel characteristics and primary care physician clinical performance rankings. JAMA 2010; 304:1107-13. [PMID: 20823437 DOI: 10.1001/jama.2010.1287] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Physicians have increasingly become the focus of clinical performance measurement. OBJECTIVE To investigate the relationship between patient panel characteristics and relative physician clinical performance rankings within a large academic primary care network. DESIGN, SETTING, AND PARTICIPANTS Cohort study using data from 125,303 adult patients who had visited any of the 9 hospital-affiliated practices or 4 community health centers between January 1, 2003, and December 31, 2005, (162 primary care physicians in 1 physician organization linked by a common electronic medical record system in Eastern Massachusetts) to determine changes in physician quality ranking based on an aggregate of Health Plan Employer and Data Information Set (HEDIS) measures after adjusting for practice site, visit frequency, and patient panel characteristics. MAIN OUTCOME MEASURES Composite physician clinical performance score based on 9 HEDIS quality measures (reported by percentile, with lower scores indicating higher quality). RESULTS Patients of primary care physicians in the top quality performance tertile compared with patients of primary care physicians in the bottom quality tertile were older (51.1 years [95% confidence interval {CI}, 49.6-52.6 years] vs 46.6 years [95% CI, 43.8-49.5 years], respectively; P < .001), had a higher number of comorbidities (0.91 [95% CI, 0.83-0.98] vs 0.80 [95% CI, 0.66-0.95]; P = .008), and made more frequent primary care practice visits (71.0% [95% CI, 68.5%-73.5%] vs 61.8% [95% CI, 57.3%-66.3%] with >3 visits/year; P = .003). Top tertile primary care physicians compared with the bottom tertile physicians had fewer minority patients (13.7% [95% CI, 10.6%-16.7%] vs 25.6% [95% CI, 20.2%-31.1%], respectively; P < .001), non-English-speaking patients (3.2% [95% CI, 0.7%-5.6%] vs 10.2% [95% CI, 5.5%-14.9%]; P <.001), and patients with Medicaid coverage or without insurance (9.6% [95% CI, 7.5%-11.7%] vs 17.2% [95% CI, 13.5%-21.0%]; P <.001). After accounting for practice site and visit frequency differences, adjusting for patient panel factors resulted in a relative mean change in physician rankings of 7.6 percentiles (95% CI, 6.6-8.7 percentiles) per primary care physician, with more than one-third (36%) of primary care physicians (59/162) reclassified into different quality tertiles. CONCLUSION Among primary care physicians practicing within the same large academic primary care system, patient panels with greater proportions of underinsured, minority, and non-English-speaking patients were associated with lower quality rankings for primary care physicians.
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Affiliation(s)
- Clemens S Hong
- School of Medicine, Harvard University, and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts 02115, USA.
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Vesely R. Docs hail cost-rating critique. 22% of physicians misclassified, RAND study says. Mod Healthc 2010; 40:14. [PMID: 20380061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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37
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Joint Commission anticipates more discussion on physician. Jt Comm Perspect 2010; 30:1, 3. [PMID: 20698091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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38
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Affiliation(s)
- Shaili Jain
- Aurora Behavioral Health Services, Milwaukee, USA
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Ortolon K. Rating the rater: new law makes Blue Cross rankings more transparent. Tex Med 2009; 105:41-44. [PMID: 19885755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Carlson B. Are you on Angie's List--yet? Physician Exec 2009; 35:6-10. [PMID: 19780381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Joint Commission. Revision: Definition of physician for ambulatory care. Jt Comm Perspect 2009; 29:6-7. [PMID: 19658281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Glenn B. The rating game. Patients & insurers are rating the quality of your care. Do you know what they're saying? Med Econ 2008; 85:18-22. [PMID: 19209532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Aungst H. Patients say the darnedest things. You can't stop online ratings, but you can stop fretting about them. Med Econ 2008; 85:27-29. [PMID: 19209533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Scholle SH, Roski J, Adams JL, Dunn DL, Kerr EA, Dugan DP, Jensen RE. Benchmarking physician performance: reliability of individual and composite measures. Am J Manag Care 2008; 14:833-838. [PMID: 19067500 PMCID: PMC2667340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine the reliability of quality measures to assess physician performance, which are increasingly used as the basis for quality improvement efforts, contracting decisions, and financial incentives, despite concerns about the methodological challenges. STUDY DESIGN Evaluation of health plan administrative claims and enrollment data. METHODS The study used administrative data from 9 health plans representing more than 11 million patients. The number of quality events (patients eligible for a quality measure), mean performance, and reliability estimates were calculated for 27 quality measures. Composite scores for preventive, chronic, acute, and overall care were calculated as the weighted mean of the standardized scores. Reliability was estimated by calculating the physician-to-physician variance divided by the sum of the physician-to-physician variance plus the measurement variance, and 0.70 was considered adequate. RESULTS Ten quality measures had reliability estimates above 0.70 at a minimum of 50 quality events. For other quality measures, reliability was low even when physicians had 50 quality events. The largest proportion of physicians who could be reliably evaluated on a single quality measure was 8% for colorectal cancer screening and 2% for nephropathy screening among patients with diabetes mellitus. More physicians could be reliably evaluated using composite scores (<17% for preventive care, >7% for chronic care, and 15%-20% for an overall composite). CONCLUSIONS In typical health plan administrative data, most physicians do not have adequate numbers of quality events to support reliable quality measurement. The reliability of quality measures should be taken into account when quality information is used for public reporting and accountability. Efforts to improve data available for physician profiling are also needed.
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Voltmer E, Kieschke U, Schwappach DLB, Wirsching M, Spahn C. Psychosocial health risk factors and resources of medical students and physicians: a cross-sectional study. BMC Med Educ 2008; 8:46. [PMID: 18831732 PMCID: PMC2567308 DOI: 10.1186/1472-6920-8-46] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 10/02/2008] [Indexed: 05/15/2023]
Abstract
BACKGROUND Epidemiological data indicate elevated psychosocial health risks for physicians, e. g., burnout, depression, marital disturbances, alcohol and substance abuse, and suicide. The purpose of this study was to identify psychosocial health resources and risk factors in profession-related behaviour and experience patterns of medical students and physicians that may serve as a basis for appropriate health promoting interventions. METHODS The questionnaire -Related Behaviour and Experience "Work administered in cross-sectional surveys to students in the first (n = 475) and in the fifth year of studies (n = 355) in required courses at three German universities and to physicians in early professional life in the vicinity of these universities (n = 381). RESULTS Scores reflecting a healthy behaviour pattern were less likely in physicians (16.7%) compared to 5th year (26.0%) and 1st year students (35.1%) while scores representing unambitious and resigned patterns were more common among physicians (43.4% vs. 24.4% vs. 41.0% and 27.3% vs. 17.2% vs. 23.3 respectively). Female and male responders differed in the domains professional commitment, resistance to stress and emotional well-being. Female physicians on average scored higher in the dimensions resignation tendencies, satisfaction with life and experience of social support, and lower in career ambition. CONCLUSION The results show distinct psychosocial stress patterns among medical students and physicians. Health promotion and prevention of psychosocial symptoms and impairments should be integrated as a required part of the medical curriculum and be considered an important issue during the further training of physicians.
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MESH Headings
- Adult
- Behavioral Research
- Burnout, Professional/epidemiology
- Burnout, Professional/psychology
- Cross-Sectional Studies
- Depression/epidemiology
- Education, Medical, Undergraduate
- Female
- Germany/epidemiology
- Humans
- Male
- Physician Impairment/psychology
- Physician Impairment/statistics & numerical data
- Physicians/classification
- Physicians/psychology
- Physicians/statistics & numerical data
- Risk Assessment
- Risk Factors
- Schools, Medical
- Sex Factors
- Stress, Psychological/complications
- Stress, Psychological/epidemiology
- Students, Medical/classification
- Students, Medical/psychology
- Students, Medical/statistics & numerical data
- Substance-Related Disorders/epidemiology
- Substance-Related Disorders/psychology
- Suicide/psychology
- Surveys and Questionnaires
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Affiliation(s)
- Edgar Voltmer
- Department of Health and Behavioural Sciences, Friedensau Adventist University, An der Ihle 19, 39291 Friedensau, Germany
| | - Ulf Kieschke
- Institute of Psychology, Psychological Diagnostics, Campus Golm, University of Potsdam, Karl-Liebknecht Str. 24-25, Potsdam, Germany
| | | | - Michael Wirsching
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Hauptstr. 8, Freiburg, Germany
| | - Claudia Spahn
- Institute for Musicians' Medicine, Medical School of the University of Freiburg, Breisacher Str. 60, Freiburg, Germany
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Schulte DJ. Physician tiering programs. Mich Med 2008; 107:6-7. [PMID: 18839547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Williams B. Insurance rating & tiering: the TMA fights for a fair system for physicians. Tenn Med 2008; 101:21-27. [PMID: 18807693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Williams B. Drastic measures in Massachusetts. Tenn Med 2008; 101:28-29. [PMID: 18807694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Connolly J. Castle Connolly "top doctors" ratings. Medscape J Med 2008; 10:72. [PMID: 18449371 PMCID: PMC2329775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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