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Sample records for change physician performance

  1. PERFORMANCE MEASURES OF PHYSICIANS.

    ERIC Educational Resources Information Center

    PRICE, PHILIP B.; AND OTHERS

    CRITERION MEASURES DEVELOPED FOR ON-THE-JOB PERFORMANCE OF PHYSICIANS WILL BE USED IN A SUBSEQUENT STUDY TO DETERMINE HOW MUCH THE PERFORMANCE OF PHYSICIANS CAN BE PREDICTED BY THEIR INDIVIDUAL ACHIEVEMENTS IN MEDICAL AND PREMEDICAL SCHOOL. APPROXIMATELY 29 MEASURES OF THE UNIVERSITY OF UTAH COLLEGE OF MEDICINE AND OTHER PHYSICIANS IN THE UTAH…

  2. 360-degree physician performance assessment.

    PubMed

    Dubinsky, Isser; Jennings, Kelly; Greengarten, Moshe; Brans, Amy

    2010-01-01

    Few jurisdictions have a robust common approach to assessing the quantitative and qualitative dimensions of physician performance. In this article, we examine the need for 360-degree physician performance assessment and review the literature supporting comprehensive physician assessment. An evidence-based, "best practice" approach to the development of a 360-degree physician performance assessment framework is presented, including an overview of a tool kit to support implementation. The focus of the framework is to support physician career planning and to enhance the quality of patient care. Finally, the legal considerations related to implementing 360-degree physician performance assessment are explored. PMID:20357549

  3. Physician leadership in changing times.

    PubMed

    Cochran, Jack; Kaplan, Gary S; Nesse, Robert E

    2014-03-01

    Today, hospitals and physicians are reorganizing themselves in novel ways to take advantage of payment incentives that reward shared accountability for the total health care experience. These delivery system changes will take place with our without physician leadership. To optimize change on behalf of patients, physicians must play a conscious role in shaping future health care delivery organizations. As physician leaders of three of the nation׳s largest integrated health care delivery systems - Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System - we call on physicians to view leadership and the development of leaders as key aspects of their role as patient advocates. PMID:26250084

  4. Physicians' changing attitudes about striking.

    PubMed

    Wassertheil-Smoller, S; Croen, L; Siegel, B

    1979-01-01

    Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation. PMID:759745

  5. The New CME: Focus Shifts to Improving Physician Performance.

    PubMed

    Ortolon, Ken

    2010-10-01

    The traditional method of physicians earning continuing medical education credits by attending a lecture or case conference, watching a webinar, or reading a journal article is being replaceed with performance improvement CME. Requiring a much greater level of physician involvement, it involves chart audits to measure current physician performance, followed by an intervention to change physician behavior. Performance is then remeasured to gauge the level of improvement. PMID:20890801

  6. Relationships of physician characteristics to performance quality and improvement.

    PubMed Central

    Payne, B C; Lyons, T F; Neuhaus, E

    1984-01-01

    The quality of ambulatory medical care provided by 1,135 physicians in five separate practice settings in the Midwest was measured using predetermined process criteria. Specialists performed better in their own areas of specialized training than did family/general practitioners or specialists performing outside their specialty areas. Physicians with fewer years of practice performed somewhat better than physicians with more years since medical school graduation. Board certification was not consistently related to performance. Performances of the physicians improved following quality assurance interventions in these sites. Differences in the rates of change in performance quality were not consistently related to any of the physician characteristics studied. PMID:6746295

  7. Maximizing physician performance: a systems approach.

    PubMed

    Smith, R

    1997-12-01

    Managed care organizations are aware of the importance of managing the quality of care and controlling costs associated with the delivery of care. By utilizing physician-level performance reporting, an organization can help its physicians manage the organization's resources across the continuum of care. Physician participation can be obtained by developing a multicomponent program that includes opportunities for physician input regarding resource allocation and benefit packages; by articulating and documenting the organization's goals and priorities; by providing physicians with systemwide data related to indicators of their performance levels; and by offering financial incentives. PMID:10174784

  8. Physician Performance Assessment: Prevention of Cardiovascular Disease

    ERIC Educational Resources Information Center

    Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.

    2013-01-01

    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…

  9. Monitoring access following Medicare price changes: physician perspective.

    PubMed

    McCall, N T

    1993-01-01

    In this article, the author examines changes in Medicare beneficiaries' access to services following the Omnibus Budget Reconciliation Act of 1987 "overpriced" procedure price reductions from the physician perspective. Three measures of physician availability remained essentially constant: number of physicians treating beneficiaries or performing overpriced procedures; average Medicare caseload; and average share of a physician's Medicare practice comprised of those who are poor and not white. Physician practice characteristics were examined and provided evidence of continuing participation in Medicare: Average Medicare revenue increased 10 percent, and average volume of all services increased. However, physicians with the largest fee reductions or who were the most financially dependent on the procedures did not change overpriced procedure volume. PMID:10130586

  10. Measurement of Physicians' Performance Using Existing Techniques

    PubMed Central

    Sanazaro, Paul J.

    1980-01-01

    Existing techniques permit objective and valid measurement of limited elements of physicians' performance. These limited aspects, however, are of considerable importance to patients. The basic components of performance in medicine and surgery can be defined and used as the basis of organized programs for such evaluation. Interhospital comparisons can provide an effective impetus for assessing and improving performance of individual staff members when this is indicated. Professional auspices are needed for the development and application of methods that can provide continuing assurance that the clinical activity of physicians corresponds to contemporary standards. A system of incentives should be provided to physicians to promote their participation in voluntary programs of self-assessment. The incentives should be in the form of performance assessment credits, comparable in definition to continuing medical education credits, but granted for participation in an accredited program that objectively measures physicians' performance against national standards of the respective specialty. PMID:7222656

  11. Physician specialty societies and the development of physician performance measures.

    PubMed

    Ferris, Timothy G; Vogeli, Christine; Marder, Jessica; Sennett, Cary S; Campbell, Eric G

    2007-01-01

    Efforts to increase accountability in the delivery of care include attempts to measure performance of individual doctors. Although physician specialty societies may be best positioned to define best practices, they have not yet played a major role in the development of measures. We examined specialty society involvement in measure development through interviews and review of Web sites. We found that a minority (35 percent) of societies were engaged in developing performance measures. Key barriers included member reluctance, lack of resources for development, and problems with data collection; facilitators included strong leadership and the perception of increasing pressure for accountability. PMID:17978390

  12. The changing nature of physicians' office visits.

    PubMed Central

    Mitchell, J B; Schurman, R; Cromwell, J

    1988-01-01

    Although there is a general feeling that, into the early 1980s, overall improvement was occurring in the content and quality of physicians' services, no time-series documentation to date has appeared to support this assumption. This article provides empirical evidence that physicians' office visits were in fact changing over time, though not in ways that one might expect. Rather than involving more diagnostic services, such as laboratory tests and x-rays, the typical office visit had come to include more therapeutic services, especially counseling. This is consistent with the observed increase in time spent with patients: between 1974 and 1981, the average office visit increased in length by nearly one full minute. Multivariate analysis indicates that the typical office visit was changing largely because physicians themselves were changing. Not only were physicians becoming increasingly specialized, but they were also more likely to be female, in group practice, and board-certified. PMID:3182291

  13. Redesigning physician compensation and improving ED performance.

    PubMed

    Finkelstein, Jeff; Lifton, James; Capone, Claudio

    2011-06-01

    Redesigning a physician compensation system in the emergency department (ED) should include goals of improving quality, productivity, and patient satisfaction. Tips for hospital administrators: A contemporary ED information system is needed to ensure that the ED is essentially a paperless operation. Transparency, internally and externally, is essential. ED physicians should perform as individuals, yet as members of a team. Incentives, especially incentive compensation, should strike a balance between individual and team performance. PMID:21692383

  14. Developing physicians as catalysts for change.

    PubMed

    George, Aaron E; Frush, Karen; Michener, J Lloyd

    2013-11-01

    Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the "purely clinical" realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes. PMID:24072124

  15. Physician performance assessment: prevention of cardiovascular disease.

    PubMed

    Lipner, Rebecca S; Weng, Weifeng; Caverzagie, Kelly J; Hess, Brian J

    2013-12-01

    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight evidence-based clinical measures from 811 physicians that completed the American Board of Internal Medicine's Preventive Cardiology Practice Improvement Module(SM) to form an overall composite score for preventive cardiology care. An expert panel of nine internists/cardiologists skilled in preventive care for cardiovascular disease used an adaptation of the Angoff standard-setting method and the Dunn-Rankin method to create the composite and establish a standard. Physician characteristics were used to examine the validity of the inferences made from the composite scores. The mean composite score was 73.88 % (SD = 11.88 %). Reliability of the composite was high at 0.87. Specialized cardiologists had significantly lower composite scores (P = 0.04), while physicians who reported spending more time in primary, longitudinal, and preventive consultative care had significantly higher scores (P = 0.01), providing some evidence of score validity. The panel established a standard of 47.38 % on the composite measure with high classification accuracy (0.98). Only 2.7 % of the physicians performed below the standard for minimally acceptable preventive cardiovascular disease care. Of those, 64 % (N = 14) were not general cardiologists. Our study presents a psychometrically defensible methodology for assessing physician performance in preventive cardiology while also providing relative feedback with the hope of heightening physician awareness about deficits and improving patient care. PMID:23417594

  16. Improving performance in a contracted physician network.

    PubMed

    Smith, A L; Epstein, A L

    1999-01-01

    Health care organizations face significant performance challenges. Achieving desired results requires the highest level of partnership with independent physicians. Tufts Health Plan invited medical directors of its affiliated groups to participate in a leadership development process to improve clinical, service, and business performance. The design included performance review, gap analysis, priority setting, improvement work plans, and defining the optimum practice culture. Medical directors practiced core leadership capabilities, including building a shared context, getting physician buy-in, and managing outliers. The peer learning environment has been sustained in redesigned medical directors' meetings. There has been significant performance improvement in several practices and enhanced relations between the health plan and medical directors. PMID:10788102

  17. The physician's response to climate change.

    PubMed

    Sarfaty, Mona; Abouzaid, Safiya

    2009-05-01

    Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as medical professionals, health educators, and community leaders. Clinicians provide individual health services to patients, some of whom will be especially vulnerable to the emerging health consequences of global warming. Physicians also work in academic medical institutions and hospitals that educate and provide continuing medical education to students, residents, and practitioners. The institutions also produce a measurable carbon footprint. Societies of physicians at national, state, and local levels can choose to use their well-developed avenues of communication to raise awareness of the key issues that are raised by climate change as well as other environmental concerns that have profound implications for human health and well-being. PMID:19418286

  18. Evaluating policy change in physician manpower planning.

    PubMed

    Valentine, J A

    1992-06-01

    The decade of the 1980s witnessed a revitalization of free-market interest in the use of incentives and voluntary participation to promote activities in a wide range of fields. Because of its history of decentralized control over physician residency training, the state of New Jersey found such an approach appealing when it sought to restructure its graduate medical education system. Two statewide task forces spent a year developing policy changes designed to produce voluntary changes in such areas as the size and growth of the state system. However, a 2-year follow-up survey of the directors of state residency programs revealed little perceivable change. PMID:10119161

  19. Shedding light on physician performance transparency.

    PubMed

    Norris, David

    2016-02-01

    Healthcare providers can use performance data already being collected to: Manage risk more proactively by identifying high-risk, high-cost areas. Make call centers more effective and websites work better, thereby improving the patient experience. Embrace the trend toward consumerism by enabling patients with performance data. Modify behavior and make systemic improvements where weaknesses are identified. Improve the level of care by better matching patients and providers. Regain public trust and confidence by sharing real data as an alternative to subjective commentary on physician performance. PMID:26999978

  20. Physician response to fee changes with multiple payers.

    PubMed

    McGuire, T G; Pauly, M V

    1991-01-01

    This paper develops a general model of physician behavior with demand inducement encompassing the two benchmark cases of profit maximization and target-income behavior. It is shown that when income effects are absent, physicians maximize profits, and when income effects are very strong, physicians seek a target income. The model is used to derive own and cross-price expressions for the response of physicians to fee changes in the realistic context of more than one payer under the alternative behavior assumptions of profit maximization and target income behavior. The implications for public and private fee policy, and empirical research on physician response to fees, are discussed. PMID:10117011

  1. Can Visual Arts Training Improve Physician Performance?

    PubMed Central

    Katz, Joel T.; Khoshbin, Shahram

    2014-01-01

    Clinical educators use medical humanities as a means to improve patient care by training more self-aware, thoughtful, and collaborative physicians. We present three examples of integrating fine arts — a subset of medical humanities — into the preclinical and clinical training as models that can be adapted to other medical environments to address a wide variety of perceived deficiencies. This novel teaching method has promise to improve physician skills, but requires further validation. PMID:25125749

  2. Can visual arts training improve physician performance?

    PubMed

    Katz, Joel T; Khoshbin, Shahram

    2014-01-01

    Clinical educators use medical humanities as a means to improve patient care by training more self-aware, thoughtful, and collaborative physicians. We present three examples of integrating fine arts - a subset of medical humanities - into the preclinical and clinical training as models that can be adapted to other medical environments to address a wide variety of perceived deficiencies. This novel teaching method has promise to improve physician skills, but requires further validation. PMID:25125749

  3. Dynamics of change in local physician supply: an ecological perspective.

    PubMed

    Jiang, H Joanna; Begun, James W

    2002-05-01

    The purpose of this study is to employ an ecological framework to identify factors that have an impact on change in local physician supply within the USA. A particular specialty type of patient care physicians in a local market is defined as a physician population. Four physician populations are identified: generalists, medical specialists, surgical specialists, and hospital-based specialists. Based on population ecology theory, the proposed framework explains the growth of a particular physician population by four mechanisms: the intrinsic properties of this physician population; the local market's carrying capacity, which is determined by three environmental dimensions (munificence, concentration, diversity); competition within the same physician population; and interdependence between different physician populations. Data at the level of Metropolitan Statistical Areas (MSAs) were compiled from the US Area Resources File, the American Hospital Association Annual Surveys of Hospitals, the American Medical Association Census of Medical Groups, the InterStudy National HMO Census, and the US County Business Patterns. Changes in the number and percentage of physicians in a particular specialty population from 1985 to 1994 were regressed, respectively, on 1985-94 changes in the explanatory variables as well as their levels in 1985. The results indicate that the population ecology framework is useful in explaining dynamics of change in the local physician workforce. Variables measuring the three environmental dimensions were found to have significant, and in some cases, differential effects on change in the size of different specialty populations. For example, both hospital consolidation and managed care penetration showed significant positive eflects on growth of the generalist population but suppressing effects on growth of the specialist population. The percentage of physicians in a particular specialty population in 1985 was negatively related to change in the size

  4. The Changing Distribution of Physicians in Regionville.

    ERIC Educational Resources Information Center

    Sorensen, Andrew A.; Kunitz, Stephen J.

    1978-01-01

    The consequences of medical reform, the myth of the family doctor, the importance of foreign medical graduates in providing medical care, the importance of facilities and innovative practice settings for the attraction of physicians, and the significance of suburbanization in influencing the growth of the local service sector are addressed in this…

  5. Physician as Scientist: Preparation, Performance, and Prospects

    ERIC Educational Resources Information Center

    Castle, William B.

    1976-01-01

    Greatly modifying the present medical curriculum for the future physician-scientist is not recommended. The value of his having a PhD is questioned and the importance of his working in a hospital-based clinical department is stressed. The author contends that emphasizing the interrelationship between basic and applied research will increase public…

  6. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... physician or other supplier. The “office of the billing physician or other supplier” is any medical office... 42 Public Health 3 2013-10-01 2013-10-01 false Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing...

  7. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... physician or other supplier. The “office of the billing physician or other supplier” is any medical office... 42 Public Health 3 2012-10-01 2012-10-01 false Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing...

  8. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... physician or other supplier. The “office of the billing physician or other supplier” is any medical office... 42 Public Health 3 2014-10-01 2014-10-01 false Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing...

  9. How physicians can change the future of health care.

    PubMed

    Porter, Michael E; Teisberg, Elizabeth Olmsted

    2007-03-14

    Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition--competition to improve results--will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results--risk-adjusted outcomes and costs--must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system. PMID:17356031

  10. Physician practice management organizations: their prospects and performance.

    PubMed

    Conrad, D A; Koos, S; Harney, A; Haase, M

    1999-09-01

    As physician organizations adapt their incentives, processes, and structures to accommodate the demands of an increasingly competitive and performance-sensitive external environment, the development of more effective administrative and managerial mechanisms becomes critical to success. The emergence of physician practice management companies (PPMCs) represents a potentially positive step for physician practices seeking increased economies of scale through consolidation, as well as enhanced access to financial capital. However, economic and finance theory, coupled with some empirical "arithmetic" regarding the financial and operational performance of leading publicly traded PPMCs, suggest caution in one's forecasts of the future prospects for these evolving corporate forms. PMID:10510607

  11. Work Satisfaction and Performance of Physicians in Pediatric Outpatient Clinics

    PubMed Central

    Nathanson, Constance A.; Becker, Marshall H.

    1973-01-01

    The sources and consequences of variations in work satisfaction are investigated in a study of approximately 100 physicians in six pediatric outpatient clinics, half of them associated with teaching hospitals and half with community hospitals. Measures of work satisfaction, role conflict, and performance are related to physicians' perceived internal and external reward values, controlling for clinic attributes and physicians' background characteristics, and differences between the two clinic types are documented. Implications of the study results for potential conflict between outpatient care and academic aims in teaching hospitals are discussed and avenues of possible further research are suggested. PMID:4705214

  12. How Do Physicians Assess Their Family Physician Colleagues' Performance? Creating a Rubric to Inform Assessment and Feedback

    ERIC Educational Resources Information Center

    Sargeant, Joan; MacLeod, Tanya; Sinclair, Douglas; Power, Mary

    2011-01-01

    Introduction: The Colleges of Physicians and Surgeons of Alberta and Nova Scotia (CPSNS) use a standardized multisource feedback program, the Physician Achievement Review (PAR/NSPAR), to provide physicians with performance assessment data via questionnaires from medical colleagues, coworkers, and patients on 5 practice domains: consultation…

  13. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... “office of the billing physician or other supplier” is any medical office space, regardless of number of... 42 Public Health 3 2011-10-01 2011-10-01 false Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing...

  14. Measuring and Reporting Physician's Performance in a University Medical Center.

    ERIC Educational Resources Information Center

    Kazan-Fishman, Ana Lucia

    This paper describes a Patient Satisfaction survey and database used to measure and report on physician performance at the Ohio State University Health System (OSUHS). The OSUHS averages 6,000 inpatients in any given month, and more than 7,000 emergency patients and 70,000 outpatient encounters. Data from the Patient Satisfaction measures are…

  15. A Continuing Medical Education Lecture and Workshop, Physician Behavior, and Barriers To Change.

    ERIC Educational Resources Information Center

    Paprockas, Ken; Parochka, Jacqueline

    2001-01-01

    A 6-month follow-up study of 176 physicians who attended a breast cancer lecture/workshop found that 92 changed practice regarding tamoxifen; many now performed risk assessments on all patients. Barriers to change included lack of colleague consensus, lack of time for assessment and patient counseling, and lack of insurance reimbursement. (SK)

  16. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) or professional component (PC) of a diagnostic test that was ordered by the physician or other... behalf of the beneficiary) for the TC or PC of the diagnostic test may not exceed the lowest of the... who supervised the TC, and with respect to the PC, the performing supplier is the physician...

  17. High-performance teams and the physician leader: an overview.

    PubMed

    Majmudar, Aalap; Jain, Anshu K; Chaudry, Joseph; Schwartz, Richard W

    2010-01-01

    The complexity of health care delivery within the United States continues to escalate in an exponential fashion driven by an explosion of medical technology, an ever-expanding research enterprise, and a growing emphasis on evidence-based practices. The delivery of care occurs on a continuum that spans across multiple disciplines, now requiring complex coordination of care through the use of novel clinical teams. The use of teams permeates the health care industry and has done so for many years, but confusion about the structure and role of teams in many organizations contributes to limited effectiveness and suboptimal outcomes. Teams are an essential component of graduate medical education training programs. The health care industry's relative lack of focus regarding the fundamentals of teamwork theory has contributed to ineffective team leadership at the physician level. As a follow-up to our earlier manuscripts on teamwork, this article clarifies a model of teamwork and discusses its application to high-performance teams in health care organizations. Emphasized in this discussion is the role played by the physician leader in ensuring team effectiveness. By educating health care professionals on the fundamentals of high-performance teamwork, we hope to stimulate the development of future physician leaders who use proven teamwork principles to achieve the goals of trainee education and excellent patient care. PMID:20816354

  18. Impacts of Changes in the Physician Manpower Sex Ratio

    ERIC Educational Resources Information Center

    Stern, Maxine Springer

    1976-01-01

    The findings of a study comparing the types of medical careers of female and male physicians in North Carolina in 1973 are reported. The main question addressed is whether female physicians have different medical careers, in terms of primary specialities and the settings of practice, from male physicians. (LBH)

  19. Physician-Patient Encounters: The Structure of Performance in Family and General Office Practice

    ERIC Educational Resources Information Center

    Wenghofer, Elizabeth F.; Williams, A. Paul; Klass, Daniel J.; Faulkner, Daniel

    2006-01-01

    Introduction: The College of Physicians and Surgeons of Ontario, the regulatory authority for physicians in Ontario, Canada, conducts peer assessments of physicians' practices as part of a broad quality assurance program. Outcomes are summarized as a single score and there is no differentiation between performance in various aspects of care. In…

  20. Are physicians performing neonatal circumcisions well-trained?

    PubMed Central

    DeMaria, Jorge; Abdulla, Alym; Pemberton, Julia; Raees, Ayman; Braga, Luis H.

    2013-01-01

    Introduction: Notwithstanding the recommendations from the Canadian Pediatric Association and the American Academy of Pediatrics on the indications for neonatal circumcision, this procedure is still common in North America and throughout the world. Our purpose is not to argue whether this procedure should be done, but rather to examine who is doing it, their training, how it is performed and how can we prevent unsatisfactory results and complications. The objective is to identify what fields of knowledge require improvement and then design a teaching module to improve the outcomes of neonatal circumcision. Methods: A 19-question cross-sectional survey, including a visual identification item, was submitted to 87 physicians who perform neonatal circumcisions in Southwestern Ontario, Canada. To improve our response rate, study subjects were contacted in a variety of ways, including mail and fax and telephone. Once the survey was completed, we produced a surgical technique training video on using the Gomco clamp and the Plastibell techiques. A knowledge dissemination workshop was held with survey participants to discuss contraindications and the use of anesthesia and management of complications of neonatal circumcision and to evaluate the surgical technique training video. A 6-month follow-up questionnaire was completed to determine the impact of the teaching course on participants’ daily practice. Results: In total, we received 54 responses (62% response rate). From these, 46 (85%) were family doctors and pediatricians, while the remaining 8 (15%) were pediatric general surgeons and urologists. The circumcisions were carried out with the Gomco clamp 35 (63%) and the Plastibell 21 (37%). No respondent admitted to learning the procedure through a structured training course. Of the non-surgeons, 19 (43%) learned to perform a circumcision from a non-surgeon colleague. A little over a third of the participants (17, 31%) were happy to perform a circumcision in a child

  1. Changes in learning-resource use across physicians' learning episodes*

    PubMed Central

    Slotnick, H.B.; Harris, T. Robert; Antonenko, David R.

    2001-01-01

    Introduction: This study explores the numbers of learning resources physicians use at each stage in self-directed learning episodes addressing general problems. Materials and Methods: A survey of a statewide random sample of doctors estimated the number of resources used at each stage in solving various general problems. Results: The 50% response rate for faculty allowed generalization of findings to the population of these physicians; the rate for nonfaculty physicians was too low to allow generalization. Faculty findings showed (1) broader resource use in learning about diseases than diagnosis or therapeutics, (2) comparable numbers of resources used in deciding whether to take on the learning problem and learning the required skills and knowledge, (3) greater numbers of resources selected to evaluate the problem and to learn the required skills and knowledge than to gain experience with the newly learned skills and knowledge, and (4) support for assertions that doctors value learning resources that are accessible, applicable, familiar, and time effective. Discussion: The findings were interpreted in light of theory describing physicians' self-directed learning episodes, and implications are presented for physicians-in-training, physicians, and medical librarians. PMID:11337951

  2. Physicians must cast off grief over change if they're to move forward, anthropologist advises

    PubMed Central

    Rafuse, Jill

    1996-01-01

    It's time for physicians to stop grieving over the massive changes occurring in health care and instead create a new vision that will lead them forward into the future, a cultural anthropologist told the CMA's 8th annual Leadership Conference in March. About 175 physicians attended the 2-day conference on regaining the perspective on values in times of change.

  3. Making it work: characteristics of high-performing hospital-physician networks.

    PubMed

    Bauman, Randy

    2011-01-01

    Physician practice is in the midst of another historic change--from solo and small groups to large, hospital-sponsored employed-physician networks. The question remains as to whether these large, hospital-centric physician organizations are sustainable. This article examines the stress points that physicians and practice managers face as they find themselves thrust into new but often ill-defined business models. It offers insights and pathways to help them navigate the changes that will be necessary for these business models to survive, evolve, and thrive. PMID:22111274

  4. Medicare program; physician performance standard rates of increase for federal fiscal year 1991--HCFA. Notice.

    PubMed

    1990-12-28

    This notice announces the Federal fiscal year (FY) 1991 physician performance standard rates of increase for expenditures and volume of physician services under the Medicare Supplementary Medical Insurance (part B) Program as required by section 1848(f)(2)(C) of the Social Security Act as added by section 4105(d) of the Omnibus Budget Reconciliation Act of 1990. The physician performance standard rates of increase for FY 1991 are the following: 7.3 percent for all physician services, 3.3 percent for surgical services, and 8.6 percent for nonsurgical services. PMID:10108587

  5. Value-based physician compensation: a link to performance improvement.

    PubMed

    Bunkers, Brian; Koch, Mark; Lubinsky, Jeanie; Weisz, Jeffrey A; Whited, Brian

    2016-03-01

    To prepare for the healthcare industry's transition to value-based care, Mayo Clinic Health System implemented a new, value-focused physician compensation plan as part of a larger initiative aimed at systemwide clinical integration. The plan uses three value-based metrics, focusing on outcomes, safety, and patient experience, that initially would determine 5 percent of a physician's compensation. Notable improvements achieved in the first year of the plan's implementation were strong indicators of the potential effectiveness of such a plan. PMID:27183759

  6. Poorly Performing Physicians: Does the Script Concordance Test Detect Bad Clinical Reasoning?

    ERIC Educational Resources Information Center

    Goulet, Francois; Jacques, Andre; Gagnon, Robert; Charlin, Bernard; Shabah, Abdo

    2010-01-01

    Introduction: Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The College des Medecins du Quebec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer…

  7. Engaging physician leaders in performance measurement and quality.

    PubMed

    Heenan, Michael; Higgins, David

    2009-01-01

    As part of its 2007 Innovation Series, the Institute for Healthcare Improvement released a white paper, Engaging Physicians in a Shared Quality Agenda, in which it described the importance of medical staff leadership and the participation of these leaders in achieving a patient safety and quality culture. Following the release of its strategic plan to 2012, in which it highlighted patient safety and quality as key directions, St. Joseph's Healthcare Hamilton recognized the importance of engaging its medical staff to achieve these goals. To facilitate engagement, a medical quality scorecard was developed in collaboration with medical leaders with a view to enabling physicians to easily identify their program goals, measure their progress and transfer knowledge across the organization. PMID:19369813

  8. Physician fee schedule update for calendar year 1992 and physician performance standard rates of increase for federal fiscal year 1992--HCFA. Notice.

    PubMed

    1991-11-25

    This notice announces the calendar year 1992 update to the Medicare physician fee schedule and the Federal fiscal year 1992 performance standard rates of increase for expenditures and volume of physician services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848 (d) and (f) respectively of the Social Security Act. The fee schedule update for calendar year 1992 is 1.9 percent. The physician performance standard rates of increase for Federal fiscal year 1992 are 10.0 percent for all physician services, 6.5 percent for surgical services, and 11.2 percent for nonsurgical services. PMID:10115702

  9. Do Physicians Change Prescription Practice in Response to Financial Incentives?

    PubMed

    Park, Sylvia; Han, Euna

    2016-07-01

    We assessed the impact on physician prescription behaviors of an outpatient prescription incentive program providing financial rewards to primary care physicians for saving prescription costs in South Korea. A 10% sample of clinics (N = 1,625) was randomly selected from all clinics in the National Health Insurance claims database for the years 2009-2012, and all claims with the primary diagnosis of peptic ulcer or gastro-esophageal reflux diseases were extracted from those clinics' data. A clinic-level random-effects model was used. After the program, clinics in general medicine showed a lower prescription rate (by 0.8 percentage points), lower number of medicines prescribed (by 0.02), lower prescription duration (by 0.15 days), and lower drug expenditure per claim (by 740 won). Small clinics on the <25th percentile of a regional sum of monthly drug expenditure had shorter prescription duration (by 0.76 days), while large clinics on the ≥75th percentile and clinics in group practice had a higher prescription rate (by 1.5 and 2.5 percentage points, respectively) and a higher number of medicines prescribed (by 0.03 for group practice only) after the program. The outpatient prescription incentive program worked as intended only in certain subgroup clinics for the target medicines. PMID:27193920

  10. Nurses versus physicians' knowledge, attitude, and performance on care for the family members of dying patients

    PubMed Central

    Abdollahimohammad, Abdolghani; Firouzkouhi, Mohammadreza; Amrollahimishvan, Fatemeh; Alimohammadi, Nasrollah

    2016-01-01

    Purpose: Nurses and physicians must be competent enough to provide care for the clients. As a lack of knowledge and a poor attitude result in a low performance of delivering care, this study aimed to explore the nurses versus physicians’ knowledge, attitude, and performance on care for the family members of dying patients (FMDPs). Methods: This descriptive study was conducted at the educational hospitals in Isfahan, Iran. The samples were 110 nurses and 110 physicians. The data were collected through a convenience sampling method and using a valid and reliable questionnaire. Results: The average knowledge, attitude, and performance on care for the FMDPs were not significantly different between nurses and physicians (p>0.05). The majority of nurses (55.4%) and physician (63.6%) were at a moderate and a fair level of knowledge of care for the FMDPs. Most of the nurses (81%) and physicians (87.3%) had a positive attitude towards caring the FMDPs. Most of the nurses (70%) and physicians (86.3%) had a moderate and fair performance. Conclusion: Having enough knowledge and skills, and a positive attitude are necessary for caring the FMDPs. Nurses’ and physicians' competencies must be improved through continuing educational programs and holding international and national conferences with a focus on the palliative care. PMID:26838571

  11. Challenges in making therapeutic lifestyle changes among hypercholesterolemic African-American patients and their physicians.

    PubMed Central

    Dailey, Rhonda; Schwartz, Kendra L.; Binienda, Juliann; Moorman, Jessica; Neale, Anne Victoria

    2006-01-01

    OBJECTIVE: We explored challenges faced by hypercholesterolemic African-American primary care patients and their physicians regarding therapeutic lifestyle changes (TLC) and provide patient-influenced recommendations to physicians. METHODS: In this qualitative study, 23 urban family medicine patients and their physicians (N=12) participated in separate focus groups, where they were asked semistructured, open-ended questions about knowledge and barriers to lifestyle treatment of high cholesterol. RESULTS: During the focus groups, barriers mentioned by physicians were: lack of time for TLC counseling, inadequate knowledge about counseling patients, and patient readiness and responsibility to change. Patient-revealed barriers included difficulty adhering to a diet/exercise regimen and a lack of knowledge about high cholesterol. Patients who were successful with adopting a healthy lifestyle identified personal experiences or those of family and friends as motivating. CONCLUSION: Physicians desire training and resources to better help patients adopt diet and exercise regimens specific to their general and health literacy and their access to healthy foods, along with their readiness to change. Patients desire that physicians tailor their TLC advice to be specific to their context and they want help from physicians in setting realistic goals. Such a patient-centered counseling approach may improve adherence to lifestyle guidelines and, thus, clinical outcomes. PMID:17225831

  12. Chemists, physicians, and changing perspectives on the scientific revolution.

    PubMed

    Debus, A G

    1998-03-01

    Positivism in the history of science and medicine was challenged by Walter Pagel more than fifty years ago. He sought to understand early modern figures such as Harvey, Paracelsus, and van Helmont by looking at all their work, including nonscientific material generally ignored by other scholars. Of special importance in the sixteenth and seventeenth centuries was the chemistry found in the writings of Paracelsus and his followers. These "chemical philosophers" offered a new philosophy based on chemistry and chemical analogies that was to replace the works of the ancients. As physicians, they debated first with Galenists and Aristotelians and later with mechanists. The essay argues that these debates were an essential chapter in the development of the Scientific Revolution and important for understanding the Chemical Revolution of the eighteenth century. PMID:9588105

  13. Climate Change and Health: A Position Paper of the American College of Physicians.

    PubMed

    Crowley, Ryan A

    2016-05-01

    Climate change could have a devastating effect on human and environmental health. Potential effects of climate change on human health include higher rates of respiratory and heat-related illness, increased prevalence of vector-borne and waterborne diseases, food and water insecurity, and malnutrition. Persons who are elderly, sick, or poor are especially vulnerable to these potential consequences. Addressing climate change could have substantial benefits to human health. In this position paper, the American College of Physicians (ACP) recommends that physicians and the broader health care community throughout the world engage in environmentally sustainable practices that reduce carbon emissions; support efforts to mitigate and adapt to the effects of climate change; and educate the public, their colleagues, their community, and lawmakers about the health risks posed by climate change. Tackling climate change is an opportunity to dramatically improve human health and avert dire environmental outcomes, and ACP believes that physicians can play a role in achieving this goal. PMID:27089232

  14. How far does family physician supply correlate with district health system performance?

    PubMed Central

    Mash, Robert; Naledi, Tracey

    2015-01-01

    Background Since 2011, a new cadre of family physicians, with 4 years of postgraduate training, was deployed in the district health services of the Western Cape, and tasked with a considerable range of duties aimed at a general improvement in care and health outcomes. There is a need to evaluate the contribution of these family physicians to the district health system. Aim To develop a methodology for describing the correlation between family physician supply and district health system performance, clinical processes and outcomes, and to measure this correlation at baseline. Method A cross-sectional study was undertaken that analysed data at an ecological level for the period of 01 April 2011 to 31 March 2012. This was a pilot project analysing data from the first year of a 4-year project. The correlations between family physician supply and 18 health system indicators were assessed within a logic model. The supplies of other categories of staff were also measured. Results Although most of the correlations with family physicians were positive, the study was unable to demonstrate any strong or statistically significant correlations at baseline. There were significant correlations with other categories of staff. Conclusions This study developed a methodology for monitoring the relationship between family physician supply using routinely collected indicators of health system performance, clinical processes and outcomes over time. Additional research will also be needed to investigate the impact of family physicians and triangulate findings as this methodology has many limitations and potential confounding factors. PMID:26245612

  15. Standing out and moving up: performance appraisal of cultural minority physicians.

    PubMed

    Leyerzapf, Hannah; Abma, Tineke A; Steenwijk, Reina R; Croiset, Gerda; Verdonk, Petra

    2015-10-01

    Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical practice is experienced and might affect the influx of cultural minority physicians into specialty training. A critical diversity study was completed in one academic hospital using interviews (N = 27) and focus groups (15 participants) with cultural minority physicians and residents, instructing specialists and executives of medical wards. Data were digitally recorded and transcribed verbatim. A thematic and integral content analysis was performed. In addition to explicit norms on high motivation and excellent performance, implicit norms on professionalism are considered crucial in qualifying for specialty training. Stereotyped imaging on the culture and identity of cultural minority physicians and categorical thinking on diversity seem to underlie daily processes of evaluation and performance appraisal. These are experienced as inhibiting the possibilities to successfully profile for selection into residency and specialist positions. Implicit criteria appear to affect selection processes on medical wards and possibly hinder the influx of cultural minority physicians into residency and making academic hospitals more diverse. Minority and majority physicians, together with the hospital management and medical education should target inclusive norms and practices within clinical practice. PMID:25549932

  16. Personality Traits Affect Teaching Performance of Attending Physicians: Results of a Multi-Center Observational Study

    PubMed Central

    Scheepers, Renée A.; Lombarts, Kiki M. J. M. H.; van Aken, Marcel A. G.; Heineman, Maas Jan; Arah, Onyebuchi A.

    2014-01-01

    Background Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties. Method We conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ). Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI), yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness. Results Overall, 622 (77%) attending physicians and 549 (68%) residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02). Openness was negatively associated with scores on feedback for surgical specialties only (B: −0.10, 95% CI: −0.15 to −0.05, P<0.001) and conscientiousness was positively related to evaluation of residents for non-surgical specialties only (B: 0.13, 95% CI: 0.03 to 0.22, p = 0.01). Conclusions Extraverted attending physicians were consistently evaluated as better supervisors. Surgical attending physicians who display high levels of

  17. The effects of hospital-physician integration strategies on hospital financial performance.

    PubMed Central

    Goes, J B; Zhan, C

    1995-01-01

    STUDY QUESTION. This study investigated the longitudinal relations between hospital financial performance outcomes and three hospital-physician integration strategies: physician involvement in hospital governance, hospital ownership by physicians, and the integration of hospital-physician financial relationships. DATA SOURCES AND STUDY SETTING. Using secondary data from the State of California, integration strategies in approximately 300 California short-term acute care hospitals were tracked over a ten-year period (1981-1990). STUDY DESIGN. The study used an archival design. Hospital performance was measured on three dimensions: operational profitability, occupancy, and costs. Thirteen control variables were used in the analyses: market competition, affluence, and rurality; hospital ownership; teaching costs and intensity; multihospital system membership; hospital size; outpatient service mix; patient volume case mix; Medicare and Medicaid intensity; and managed care intensity. DATA COLLECTION/EXTRACTION. Financial and utilization data were obtained from the State of California, which requires annual hospital reports. A series of longitudinal regressions tested the hypotheses. PRINCIPAL FINDINGS. Considerable variation was found in the popularity of the three strategies and their ability to predict hospital performance outcomes. Physician involvement in hospital governance increased modestly from 1981-1990, while ownership and financial integration declined significantly. Physician governance was associated with greater occupancy and higher operating margins, while financial integration was related to lower hospital operating costs. Direct physician ownership, particularly in small hospitals, was associated with lower operating margins and higher costs. Subsample analyses indicate that implementation of the Medicare prospective payment system in 1983 had a major impact on these relationships, especially on the benefits of financial integration. CONCLUSIONS. The

  18. The Performance of Direct Disk Diffusion for Community Acquired Bacteremia due to Gram-Negative Bacilli and Its Impact on Physician Treatment Decisions.

    PubMed

    Daley, Peter; Comerford, Adam; Umali, Jurgienne; Penney, Carla

    2016-01-01

    Background. Direct disk diffusion susceptibility testing provides faster results than standard microtitre susceptibility. The direct result may impact patient outcome in sepsis if it is accurate and if physicians use the information to promptly and appropriately change antibiotic treatment. Objective. To compare the performance of direct disk diffusion with standard susceptibility and to consider physician decisions in response to these early results, for community acquired bacteremia with Gram-negative Bacilli. Methods. Retrospective observational study of all positive blood cultures with Gram-negative Bacilli, collected over one year. Physician antibiotic treatment decisions were assessed by an infectious diseases physician based on information available to the physician at the time of the decision. Results. 89 bottles growing Gram-negative Bacilli were included in the analysis. Direct disk diffusion agreement with standard susceptibility varied widely. In 47 cases (52.8%), the physician should have changed to a narrower spectrum but did not, in 18 cases (20.2%), the physician correctly narrowed from appropriate broad coverage, and in 8 cases (9.0%), the empiric therapy was correct. Discussion. Because inoculum is not standardized, direct susceptibility results do not agree with standard susceptibility results for all drugs. Physicians do not act on direct susceptibility results. Conclusion. Direct susceptibility should be discontinued in clinical microbiology laboratories. PMID:27366172

  19. Chronological Changes in Japanese Physicians' Attitude and Behavior Concerning Relationships with Pharmaceutical Representatives: A Qualitative Study

    PubMed Central

    Saito, Sayaka; Mukohara, Kei; Miyata, Yasushi

    2014-01-01

    Background Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time. Methods and Findings A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position), role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms. Conclusions Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude. PMID:25238544

  20. Preparing the personal physician for practice: changing family medicine residency training to enable new model practice.

    PubMed

    Green, Larry A; Jones, Samuel M; Fetter, Gerald; Pugno, Perry A

    2007-12-01

    After two years of intensive study, in 2004 the Future of Family Medicine report concluded that the current U.S. health care system is inadequate and unsustainable, and called for changes within the specialty of family medicine to ensure the future health of the American public. With guidance and encouragement from many disciplines and health experts, a set of 10 recommendations was established to accomplish a transformative change in how family physicians serve their patients and how the essential function of primary care is achieved. From these recommendations came a period of innovation and experimentation in the training of family physicians, entitled Preparing the Personal Physician for Practice (P4). The P4 project is a carefully designed and evaluated initiative led by the American Board of Family Medicine and the Association of Family Medicine Residency Directors and administered by TransforMED, a practice redesign initiative of the American Academy of Family Physicians. Fourteen family medicine programs were chosen to participate and will put their innovations into practice from 2007 to 2012, during which time regular evaluation will be conducted. The purpose of P4 is to learn how to improve the graduate medical education of family physicians such that they are prepared to be outstanding personal physicians and to work in the new models of practice now emerging. The innovations tested by P4 residencies are expected to inspire substantial changes in the content, structure, and locations of training of family physicians and to guide future revisions in accreditation and certification requirements. PMID:18046133

  1. Factors Affecting Physician Satisfaction and Wisconsin Medical Society Strategies to Drive Change.

    PubMed

    Coleman, Michele; Dexter, Donn; Nankivil, Nancy

    2015-08-01

    Physicians' dissatisfaction in their work is increasing, which is affecting the stability of health care in America. The Wisconsin Medical Society (Society) surveyed 1016 Wisconsin physicians to determine the source of their dissatisfaction. The survey results indicate Wisconsin physicians are satisfied when it comes to practice environment, work-life balance, and income. In addition, they are extremely satisfied when it comes to rating their ability to provide high quality care, and they have identified some benefits related to the adoption of electronic health records. However, they are feeling burned out, very unsatisfied with the amount of time spent in direct patient care compared to indirect patient care, and that they are spending too much time on administrative and data entry tasks. In terms of future workforce, many physicians are either unsure or would not recommend the profession to a prospective medical student. Electronic health records serve as both a satisfier and dissatisfier and as a potential driver for future physician satisfaction interventions. Changes at the institutional, organizational, and individual levels potentially could address the identified dissatisfiers and build upon the satisfiers. The Society identifies 12 strategies to improve upon the physician experience. PMID:26436181

  2. Changes in physicians' sources of pharmaceutical information: a review and analysis.

    PubMed

    Williams, J R; Hensel, P J

    1991-09-01

    Since 1952, 20 datasets have been generated through 17 studies in an attempt to describe the sources and importance and/or use of information about pharmaceuticals by physicians. The authors review the findings of the studies and subject them to three sequentially relevant, but different, meta-analytic procedures. The results of these analyses indicate significant changes in the sources and importance of various commercial/noncommercial and personal/nonpersonal information as they relate to physicians' prescribing behavior. Those changes over time have specific implications for marketers of pharmaceuticals. PMID:10120930

  3. Physician performance standard rates of increase for federal fiscal year 1993 and physician fee schedule update for calendar year 1993--HCFA. Final notice with comment period.

    PubMed

    1992-11-25

    This notice announces the calendar year (CY) 1993 updates to the Medicare physician fee schedule and the Federal fiscal year (FY) 1993 performance standard rates of increase for expenditures and volume of physician services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848(d) and (f), respectively, of the Social Security Act. It also sets forth an "initial" procedure-specific list of surgical and nonsurgical services to be used in applying the CY 1993 updates. These surgical and nonsurgical designations are subject to public comment. The physician performance standard rates of increase for Federal FY 1993 are 10.0 percent for all physician services, 8.4 percent for surgical services, and 10.8 percent for nonsurgical services. The fee schedule update for CY 1993 is 3.1 percent for surgical services and 0.8 percent for nonsurgical services. PMID:10171308

  4. 20 CFR 702.406 - Change of physicians; non-emergencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.406 Change of physicians; non-emergencies. (a) Whenever the employee has... necessary for, and appropriate to, the proper care and treatment of the compensable injury or disease....

  5. Evaluation of physicians' professional performance: An iterative development and validation study of multisource feedback instruments

    PubMed Central

    2012-01-01

    Background There is a global need to assess physicians' professional performance in actual clinical practice. Valid and reliable instruments are necessary to support these efforts. This study focuses on the reliability and validity, the influences of some sociodemographic biasing factors, associations between self and other evaluations, and the number of evaluations needed for reliable assessment of a physician based on the three instruments used for the multisource assessment of physicians' professional performance in the Netherlands. Methods This observational validation study of three instruments underlying multisource feedback (MSF) was set in 26 non-academic hospitals in the Netherlands. In total, 146 hospital-based physicians took part in the study. Each physician's professional performance was assessed by peers (physician colleagues), co-workers (including nurses, secretary assistants and other healthcare professionals) and patients. Physicians also completed a self-evaluation. Ratings of 864 peers, 894 co-workers and 1960 patients on MSF were available. We used principal components analysis and methods of classical test theory to evaluate the factor structure, reliability and validity of instruments. We used Pearson's correlation coefficient and linear mixed models to address other objectives. Results The peer, co-worker and patient instruments respectively had six factors, three factors and one factor with high internal consistencies (Cronbach's alpha 0.95 - 0.96). It appeared that only 2 percent of variance in the mean ratings could be attributed to biasing factors. Self-ratings were not correlated with peer, co-worker or patient ratings. However, ratings of peers, co-workers and patients were correlated. Five peer evaluations, five co-worker evaluations and 11 patient evaluations are required to achieve reliable results (reliability coefficient ≥ 0.70). Conclusions The study demonstrated that the three MSF instruments produced reliable and valid data

  6. Assessment and Remediation for Physicians with Suspected Performance Problems: An International Survey

    ERIC Educational Resources Information Center

    Humphrey, Charlotte

    2010-01-01

    Introduction: Little is known about the overall appropriateness and value of the various programs available internationally for assessment and remediation for individual physicians whose performance in their clinical practice has been identified as giving cause for concern. Method: A questionnaire was e-mailed to members of the International…

  7. Standing Out and Moving Up: Performance Appraisal of Cultural Minority Physicians

    ERIC Educational Resources Information Center

    Leyerzapf, Hannah; Abma, Tineke A.; Steenwijk, Reina R.; Croiset, Gerda; Verdonk, Petra

    2015-01-01

    Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical…

  8. Physician response to pay-for-performance: evidence from a natural experiment.

    PubMed

    Li, Jinhu; Hurley, Jeremiah; DeCicca, Philip; Buckley, Gioia

    2014-08-01

    This study exploits a natural experiment in the province of Ontario, Canada, to identify the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services and whether physicians' responses differ by age, size of patient population, and baseline compliance level. We use administrative data that cover the full population of Ontario and nearly all the services provided by primary care physicians. We employ a difference-in-differences approach that controls for selection on observables and selection on unobservables that may cause estimation bias. We implement a set of robustness checks to control for confounding from other contemporaneous interventions of the primary care reform in Ontario. The results indicate that responses were modest and that physicians responded to the financial incentives for some services but not others. The results provide a cautionary message regarding the effectiveness of employing P4P to increase the quality of health care. PMID:23861240

  9. [The influence of changes in the human subjectivity concept of formation of physician-patient relations].

    PubMed

    Płonka-Syroka, Boźena

    2003-01-01

    Changes in the human subjectivity concept, expressing influences of cultural and outlook elements on formation of object of the European medicine, have so much affected evolution of the discipline, that it is currently directed to bring an image of a human body to anatomy, to treat a course of a disease in medical aspect and to give to diagnostic processes and therapy a character of means which can be verified in an empirical way. The changes are also reflected in a patient - physician relation, which develops in that time. A direct nature of contacts between the treated and the treating persons was taken as grounds of the relation. But reasons of the privileged position of therapists in comparison to patients have changed. The paper aims to show main trends in development of the patient -physician relationship and to represent the changing reasons for superiority of the treating persons who are in a therapeutic relation with a patient. PMID:14524371

  10. Changing Physician Behavior With Implementation Intentions: Closing the Gap Between Intentions and Actions.

    PubMed

    Saddawi-Konefka, Daniel; Schumacher, Daniel J; Baker, Keith H; Charnin, Jonathan E; Gollwitzer, Peter M

    2016-09-01

    In medical education, even well-intentioned learners struggle to change their practice. This intention-action gap is a well-described phenomenon. Strong commitment to changing behaviors is important, but by itself it is only a modest predictor of goal attainment.Implementation intentions are an extensively studied strategy from cognitive psychology that have been shown to close the intention-action gap and increase goal attainment across myriad domains. Implementation intentions are "if-then" plans that specify an anticipated future situation and a planned response-"If I encounter situation X, then I will respond with action Y." They differ from simple goals, which specify only a desired behavior or outcome-"I intend to perform action Z." Despite this subtle difference, they have shown substantial effectiveness over goals alone in increasing goal attainment.In this article, the authors first describe implementation intentions, review the substantial body of evidence demonstrating their effectiveness, and explain the underlying psychological mechanisms. They then illustrate the connections between implementation intentions and established learning theory. The final section focuses on forming effective implementation intentions in medical education. The authors provide concrete examples across the continuum of learners (from medical students to attending physicians) and competencies, and make recommendations for when and how to employ implementation intentions. PMID:27008360

  11. Physician strikes.

    PubMed

    Thompson, Stephen L; Salmon, J Warren

    2014-11-01

    Throughout medical history, physicians have rarely formed unions and/or carried out strikes. In a profession faced with the turmoil of health reform and increasing pressure to change their practices and lifestyles, will physicians resort to unionization for collective bargaining, and will a strike weapon be used to fight back against the array of corporate and government powers involved in the transformation of the American health-care system? This article examines the question of whether there could be such a thing as an ethical physician strike. Although physicians have not historically used collective bargaining or the strike weapon, the rapidly changing practice environment in the United States might push physicians and other health-care professionals toward unionization. This article considers the ethical questions that would arise if physicians started taking advantage of labor laws, and it lays out criteria for an ethical strike. PMID:25367473

  12. The use of information technology in improving medical performance. Part II. Physician-support tools.

    PubMed

    Gawande, A A; Bates, D W

    2000-02-14

    Increasing data from a few sites demonstrate that information technologies can improve physician decision making and clinical effectiveness. For example, computer-based physician order entry systems, automated laboratory alert systems, and artificial neural networks have demonstrated significant reductions in medical errors. In addition, Internet services to disseminate new knowledge and safety alerts to physicians more rationally and effectively are rapidly developing, and telemedicine to improve rural access to specialty services is undergoing substantial growth. However, even technologies demonstrated to yield beneficial effects have not yet achieved widespread adoption, though the pace of change appears to be increasing as the Internet takes hold. Scientific evaluation of many technologies is also lacking, and the dangers of some of these technologies may be underappreciated. Research on the effects of specific technologies should be a priority. Policies should be developed to press information technology companies, such as pharmaceutical and medical device manufacturers, to recognize the importance of clinical evaluation. Research could also analyze the characteristics of effective technologies and of physicians and organizations who implement these technologies effectively. PMID:11104459

  13. A survey of African American physicians on the health effects of climate change.

    PubMed

    Sarfaty, Mona; Mitchell, Mark; Bloodhart, Brittany; Maibach, Edward W

    2014-12-01

    The U.S. National Climate Assessment concluded that climate change is harming the health of many Americans and identified people in some communities of color as particularly vulnerable to these effects. In Spring 2014, we surveyed members of the National Medical Association, a society of African American physicians who care for a disproportionate number of African American patients, to determine whether they were seeing the health effects of climate change in their practices; the response rate was 30% (n = 284). Over 86% of respondents indicated that climate change was relevant to direct patient care, and 61% that their own patients were already being harmed by climate change moderately or a great deal. The most commonly reported health effects were injuries from severe storms, floods, and wildfires (88%), increases in severity of chronic disease due to air pollution (88%), and allergic symptoms from prolonged exposure to plants or mold (80%). The majority of survey respondents support medical training, patient and public education regarding the impact of climate change on health, and advocacy by their professional society; nearly all respondents indicated that the US should invest in significant efforts to protect people from the health effects of climate change (88%), and to reduce the potential impacts of climate change (93%). These findings suggest that African American physicians are currently seeing the health impacts of climate change among their patients, and that they support a range of responses by the medical profession, and public policy makers, to prevent further harm. PMID:25464138

  14. A Survey of African American Physicians on the Health Effects of Climate Change

    PubMed Central

    Sarfaty, Mona; Mitchell, Mark; Bloodhart, Brittany; Maibach, Edward W

    2014-01-01

    The U.S. National Climate Assessment concluded that climate change is harming the health of many Americans and identified people in some communities of color as particularly vulnerable to these effects. In Spring 2014, we surveyed members of the National Medical Association, a society of African American physicians who care for a disproportionate number of African American patients, to determine whether they were seeing the health effects of climate change in their practices; the response rate was 30% (n = 284). Over 86% of respondents indicated that climate change was relevant to direct patient care, and 61% that their own patients were already being harmed by climate change moderately or a great deal. The most commonly reported health effects were injuries from severe storms, floods, and wildfires (88%), increases in severity of chronic disease due to air pollution (88%), and allergic symptoms from prolonged exposure to plants or mold (80%). The majority of survey respondents support medical training, patient and public education regarding the impact of climate change on health, and advocacy by their professional society; nearly all respondents indicated that the US should invest in significant efforts to protect people from the health effects of climate change (88%), and to reduce the potential impacts of climate change (93%). These findings suggest that African American physicians are currently seeing the health impacts of climate change among their patients, and that they support a range of responses by the medical profession, and public policy makers, to prevent further harm. PMID:25464138

  15. Financial performance of primary care physician practices prior to electronic health record implementation

    PubMed Central

    Becker, Edmund R.; Culler, Steven; Cheng, Dunlei; McCorkle, Russell; Ballard, David J.

    2009-01-01

    While electronic health records (EHRs) are being widely implemented across the nation, few empirical data are currently available regarding their potential impact on financial performance and resource use. HealthTexas Provider Network is implementing a networkwide EHR, providing a unique opportunity to describe and evaluate fiscal effects. We conducted a retrospective, longitudinal observational study of financial performance related to inputs and income- and productivity-related outputs for the 33 primary care practices (July 2002–April 2006). Models for each outcome were constructed to test for a linear trend over time, adjusted for practice characteristics. F tests based on these models were used to determine the effect of each adjustor and to determine existence of a trend in each outcome. The observed staff per physician full-time equivalent (FTE) (3.6) was similar to staffing ratios reported for other primary care–only practices, while observation of 4692 work relative value units per physician FTE annually was higher than reported nationally. Significant monthly trends were identified for three of the outcome measures. During the pre-EHR baseline period, staffing ratios were equivalent to and physician productivity greater than reports available for these measures nationally or in other settings. Identification of time trends in three measures will allow these to be accounted for in the model used to evaluate the financial performance impact of EHR implementation. PMID:19381309

  16. CME, Physicians, and Pavlov: Can We Change What Happens When Industry Rings the Bell?

    PubMed Central

    Lichter, Paul R.

    2008-01-01

    Purpose To show how physicians’ conditioned response to “keeping up” has helped industry’s opportunistic funding of continuing medical education (CME) and to propose ways to counter the conditioned response to the benefit of patients and the public. Methods Review of the literature and commentary on it. Results The pharmaceutical and device industries (hereafter referred to as industry) have a long history of bribing physicians to prescribe and use their products. Increasing pressure from Congress and the public has been brought to bear on industry gifting. This pressure, coinciding with increasing financial problems for the providers of CME, provided industry with reason and opportunity to expand its role in the financing of CME. Industry’s incentive to make its CME funding appear to be an arm’s-length transaction has spawned medical education service supplier (MESS) companies. Industry makes “unrestricted grants” to the MESS, and the MESS puts on the CME program. Helped by these CME programs, industry is able to subtly “buy” physicians one at a time, so that under the cover of “education” they and their academic institutions and medical organizations lose sight of being CME pawns in industry’s sole objective: profit. Conclusions Despite a vast literature showing how physician integrity is easy prey to industry, the medical profession continues to allow industry to have a detrimental influence on the practice of medicine and on physician respectability. It will take resolute action to change the medical profession’s conditioned response to industry’s CME bell and its negative effect on patients and the public. PMID:19277219

  17. Do Primary Care Physician Perform Clinical Breast Exams Prior to Ordering a Mammogram?

    PubMed

    Larson, Kelsey E; Cowher, Michael S; O'Rourke, Colin; Patel, Mita; Pratt, Debra

    2016-03-01

    Both the American Cancer Society and National Comprehensive Cancer Network recommend annual clinical breast examination (CBE) along with screening mammogram (SM) for patients starting at 40 years of age. However, patients with a palpable breast mass should have a diagnostic mammogram (DM) during workup. Review at our institution demonstrated that 11% of patients with newly diagnosed breast cancer and self-identified breast mass had SM instead of DM. This led us to question whether primary care physicians (PCP) perform CBE prior to ordering mammography. As part of the routine preimaging screening, patients were asked if they had undergone breast examination by a medical provider prior to mammogram order. Data on mammogram type, ordering physician specialty, and presence of symptoms on day of mammogram were recorded. Of 6,109 mammograms, 4,823 were ordered by PCPs. CBE was performed prior to 67.2% SM and 64.8% DM (p = 0.12). OB/GYN performed statistically significantly higher CBE (81.6%) compared to internal (45.4%) and family (50.5%) medicine physicians (p < 0.001). Of patients with self-reported breast symptoms, 8.7% had SM ordered rather than DM. Despite recommendations, approximately 1/3 of women report not having CBE prior to mammogram. The chances of having a CBE varied significantly by PCP specialty. Lack of CBE can lead to incorrect type of mammogram, with possibly increased cost and delay in diagnosis. Further evaluation is needed to understand why CBE was not performed in some patients. PMID:26687763

  18. High-performance teams for current and future physician leaders: an introduction.

    PubMed

    Jain, Anshu K; Thompson, Jon M; Chaudry, Joseph; McKenzie, Shaun; Schwartz, Richard W

    2008-01-01

    The scope of patient management increasingly crosses the defined lines of multiple medical specialties and services to meet patient needs. Concurrently, many hospitals and health-care systems have adapted new multidisciplinary team structures that provide patient-centric care as opposed to the more traditional discipline-centered delivery of care. As health care continues to evolve, the use of teams becomes even more critical in allowing interdependence between multiple disciplines to provide excellent care delivery and ongoing patient management. The use of teams permeates the health-care industry (and has done so for many years), but confusion about the structure, role, and use of teams contributes to limited effectiveness. The health-care industry's underuse of the fundamentals of corporate teamwork has, in part, created ineffective team leadership at the physician level. As the first in a series of documents on teamwork, this article is intended to introduce the reader to the rudiments of team theory and to present an introduction to a model of teamwork. The role of current and future physician leaders in ensuring team effectiveness is emphasized in this discussion. By educating health-care professionals on the foundations of high-performance teamwork, we hope to accomplish two main goals. The first goal is to help create a common and systematic taxonomy that physician leaders and institutional management can agree on and refer to concerning the development of high-performance health-care teams. The second goal is to stimulate the development of future physician leaders who use proven teamwork principles as a powerful modality to achieve efficient and optimal patient care. Most importantly, we wish to emphasize that health care, both philosophically and practically, is delivered best through high-performance teams. For such teams to perform properly, the organizational environment must support the team concept tangibly. In concert, we believe the best manner in

  19. Zika virus: A call to action for physicians in the era of climate change.

    PubMed

    Yang, Y Tony; Sarfaty, Mona

    2016-12-01

    In February 2016, the World Health Organization declared the mosquito-borne Zika virus to be a "public health emergency of international concern" as the disease linked to thousands of birth defects in Brazil spreads rapidly. The distribution of the Aedes mosquitos has drastically increased over the past few decades, which have been the hottest decades on Earth in more than 1000 years based on climate proxy measures. Although a combination of factors explains the current Zika virus outbreak, it's highly likely that the changes in the climate contribute to the spread of Aedes vector carrying the Zika virus, the pathogen causing serious birth defects. Physicians, both individually and collectively, as trusted and educated members of society have critical roles to play. In addition to clinical management and prevention of Zika, physicians should communicate about the health benefits of addressing climate change in straightforward evidence-based language to their local communities and policymakers, and make clear their support for policies mitigating climate change. PMID:27617189

  20. Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series

    PubMed Central

    Bramante, Robert; Radomski, Marek; Nelson, Mathew; Raio, Christopher

    2013-01-01

    Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP). Point-of-care ultrasound (US) allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and adnexal tenderness where transvaginal ultrasonography revealed acute appendicitis. The discussion focuses on the use of EP- performed transvaginal US in gynecologic and intra-abdominal pathology and discusses the use of a staged approach to evaluation using US and computed tomography, as indicated. PMID:24106529

  1. Deterioration of Neurobehavioral Performance in Resident Physicians During Repeated Exposure to Extended Duration Work Shifts

    PubMed Central

    Anderson, Clare; Sullivan, Jason P.; Flynn-Evans, Erin E.; Cade, Brian E.; Czeisler, Charles A.; Lockley, Steven W.

    2012-01-01

    Study Objectives: Although acute sleep loss during 24- to 30-h extended duration work shifts (EDWS) has been shown to impair the performance of resident physicians, little is known about the effects of cumulative sleep deficiency on performance during residency training. Chronic sleep restriction induces a gradual degradation of neurobehavioral performance and exacerbates the effects of acute sleep loss in the laboratory, yet the extent to which this occurs under real-world conditions is unknown. In this study, the authors quantify the time course of neurobehavioral deterioration due to repeated exposure to EDWS during a 3-week residency rotation. Design: A prospective, repeated-measures, within-subject design. Setting: Medical and cardiac intensive care units, Brigham and Women's Hospital, Boston, MA. Participants: Thirty-four postgraduate year one resident physicians (23 males; age 28.0 ± 1.83 (standard deviation) years) Measurements and Results: Residents working a 3-week Q3 schedule (24- to 30-h work shift starts every 3rd day), consisting of alternating 24- to 30-h (EDWS) and approximately 8-h shifts, underwent psychomotor vigilance testing before, during, and after each work shift. Mean response time, number of lapses, and slowest 10% of responses were calculated for each test. Residents also maintained daily sleep/wake/work logs. EDWS resulted in cumulative sleep deficiency over the 21-day rotation (6.3 h sleep obtained per day; average 2.3 h sleep obtained per extended shift). Response times deteriorated over a single 24- to 30-h shift (P < 0.0005), and also cumulatively with each successive EDWS: Performance on the fifth and sixth shift was significantly worse than on the first shift (P < 0.01). Controlling for time of day, there was a significant acute (time on shift) and chronic (successive EDWS) interaction on psychomotor vigilance testing response times (P < 0.05). Conclusions: Chronic sleep deficiency caused progressive degradation in residents

  2. The education of physicians and other health care professionals about climate change

    SciTech Connect

    Hayes, R.L.; Hussain, S.T.

    1996-12-31

    The impact of rapidly changing local and regional environments upon the health of human populations must be appreciated by physicians as well as other public health officials. Any system of health care delivery depends upon an understanding of scientific principles. Current issues of importance include the greenhouse effect, the ozone hole, global warming, sea level rise, emerging and resurgent microbial diseases, air and water pollution, biodiversity losses, UVB-induced immunosuppression, and antibiotic resistance. These concerns must be firmly within the grasp of the health care practitioner for the 21st century. To assure transfer of information, these topics should be integrated into existing course content or should provide the basis for new course offerings during the training of the professional. Focus should be given to scientific principles as the foundation for understanding climate change.

  3. Physician perspectives on colorectal cancer surveillance care in a changing environment.

    PubMed

    Zapka, Jane; Sterba, Katherine R; LaPelle, Nancy; Armeson, Kent; Burshell, Dana R; Ford, Marvella E

    2015-06-01

    The purpose of this formative qualitatively driven mixed-methods study was to refine a measurement tool for use in interventions to improve colorectal cancer (CRC) surveillance care. We employed key informant interviews to explore the attitudes, practices, and preferences of four physician specialties. A national survey, literature review, and expert consultation also informed survey development. Cognitive pretesting obtained participant feedback to improve the survey's face and content validity and reliability. Results showed that additional domains were needed to reflect contemporary interdisciplinary trends in survivorship care, evolving practice changes and current health policy. Observed dissonance in specialists' perspectives poses challenges for the development of interventions and psychometrically sound measurement. Implications for future research include need for a flexible care model with enhanced communication and role definitions among clinical specialists, improvements in surveillance at multilevels (patients, providers, and systems), and measurement tools that focus on multispecialty involvement and the changing practice and policy environment. PMID:25878188

  4. Engaging Physicians in Change: Results of a Safety Net Quality Improvement Program to Reduce Overuse

    PubMed Central

    Cammisa, Chris; Partridge, Gregory; Ardans, Cynthia; Buehrer, Katrina; Chapman, Ben; Beckman, Howard

    2013-01-01

    Identifying, understanding, and addressing clinical variation is a useful tool to promote appropriate care while helping control health care costs. Although accurate, relevant, and useful data are important in the process, successfully engaging physicians to change behavior is often the most significant challenge. Using a commercially available variation analysis process, a California Medicaid managed care plan identified significant network practice pattern variation. A team of panel practitioners then developed a strategy to reduce overuse of 5 identified behaviors. The intervention was evaluated using a pre–post comparison of the panel’s use of the 5 behaviors. During the preintervention period, narcotics, muscle relaxants, magnetic resonance imaging (MRI), and spinal injections increased between 8% and 18% per month. Postintervention, the trends reversed. The differences were statistically significant (P < .0001) for muscle relaxant use, narcotic use, overall MRI use, and spinal injections. Peer comparison data and respectful feedback was associated with significant change in patterns of overuse. PMID:20876341

  5. The Changing Dynamics of Health Care: Physician Perceptions of Technology in Medical Practices

    ERIC Educational Resources Information Center

    Hatton, Jerald D.

    2012-01-01

    Political, economic, and safety concerns have militated for the adoption of electronic health records (EHR) by physicians in the United States, but current rates of adoption have failed to achieve the expected levels. This qualitative phenomenological study of practicing physicians reveals obstacles to adoption. Maintaining the physicians'…

  6. Aging and Cognitive Performance: Challenges and Implications for Physicians Practicing in the 21st Century

    ERIC Educational Resources Information Center

    Durning, Steven J.; Artino, Anthony R.; Holmboe, Eric; Beckman, Thomas J.; van der Vleuten, Cees; Schuwirth, Lambert

    2010-01-01

    The demands of physician practice are growing. Some specialties face critical shortages and a significant percentage of physicians are aging. To improve health care it is paramount to understand and address challenges, including cognitive issues, facing aging physicians. In this article, we outline several issues related to cognitive performance…

  7. Can Outcome-Based Continuing Medical Education Improve Performance of Immigrant Physicians?

    ERIC Educational Resources Information Center

    Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

    2011-01-01

    Introduction: Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians…

  8. Managing Technological Change by Changing Performance Appraisal to Performance Evaluation.

    ERIC Educational Resources Information Center

    Marquardt, Steve

    1996-01-01

    Academic libraries can improve their management of change by reshaping performance appraisal into performance planning. This article notes problems with traditional employee evaluation as well as benefits of alternatives that focus on the future, on users, on planning and learning, and on skills needed to address problems and enhance individual…

  9. Moving from Clinical Practice to Academe: An Analysis of Career Change for Physician Assistants

    ERIC Educational Resources Information Center

    Marciano, Gerard Jude

    2013-01-01

    Recruitment of qualified and motivated faculty for physician assistant education programs is difficult. While the causes of the difficulty may be many, the primary one is the physician assistants (PAs) must choose between clinical and academic practice in order to pursue a career in academe. Little if any research has been conducted in this area.…

  10. Link between pay for performance incentives and physician payment mechanisms: evidence from the diabetes management incentive in Ontario.

    PubMed

    Kantarevic, Jasmin; Kralj, Boris

    2013-12-01

    Pay for performance (P4P) incentives for physicians are generally designed as additional payments that can be paired with any existing payment mechanism such as a salary, fee-for-services and capitation. However, the link between the physician response to performance incentives and the existing payment mechanisms is still not well understood. In this article, we study this link using the recent primary care physician payment reform in Ontario as a natural experiment and the Diabetes Management Incentive as a case study. Using a comprehensive administrative data strategy and a difference-in-differences matching strategy, we find that physicians in a blended capitation model are more responsive to the Diabetes Management Incentive than physicians in an enhanced fee-for-service model. We show that this result implies that the optimal size of P4P incentives vary negatively with the degree of supply-side cost-sharing. These results have important implications for the design of P4P programs and the cost of their implementation. PMID:23203722

  11. Developing physician leaders in academic medical centers. Part 1: Their changing role.

    PubMed

    Bachrach, D J

    1996-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal. PMID:10162876

  12. Changing Teacher Performance with Protocols.

    ERIC Educational Resources Information Center

    Galluzzo, Gary R.

    This study examined whether selected protocol materials in classroom management, used in inservice courses, would bring about long-term significant changes in teachers' classroom performance. Fifteen teachers participated in the study by taking an inservice course on classroom management and discipline. Two modules of classroom management…

  13. What makes a top research medical school? A call for a new model to evaluate academic physicians and medical school performance.

    PubMed

    Goldstein, Matthew J; Lunn, Mitchell R; Peng, Lily

    2015-05-01

    Since the publication of the Flexner Report in 1910, the medical education enterprise has undergone many changes to ensure that medical schools meet a minimum standard for the curricula and clinical training they offer students. Although the efforts of the licensing and accrediting bodies have raised the quality of medical education, the educational processes that produce the physicians who provide the best patient care and conduct the best biomedical research have not been identified. Comparative analyses are powerful tools to understand the differences between institutions, but they are challenging to carry out. As a result, the analysis performed by U.S. News & World Report (USN&WR) has become the default tool to compare U.S. medical schools. Medical educators must explore more rigorous and equitable approaches to analyze and understand the performance of medical schools. In particular, a better understanding and more thorough evaluation of the most successful institutions in producing academic physicians with biomedical research careers are needed. In this Perspective, the authors present a new model to evaluate medical schools' production of academic physicians who advance medicine through basic, clinical, translational, and implementation science research. This model is based on relevant and accessible objective criteria that should replace the subjective criteria used in the current USN&WR rankings system. By fostering a national discussion about the most meaningful criteria that should be measured and reported, the authors hope to increase transparency of assessment standards and ultimately improve educational quality. PMID:25607941

  14. Pharmacotherapy for Obesity and Changes in Eating Behavior: a Patient and Physician's Perspective.

    PubMed

    Miguelgorry, Piper L; Hendricks, Ed J

    2016-07-01

    This article, co-authored by a patient with obesity, diabetes, and hypertension, and an obesity medicine specialist, discusses the patient's experience with the onset of diabetes complicating obesity and with her frustration living with these diagnoses until finding an obesity medicine specialist physician who helped her lose weight and reverse her diabetes. The patient continues to maintain a significant weight loss and is diabetes free for 5.5 years after treatment initiation. The physician discusses the application of combination treatment that can be effective in diabetes reversal in such cases. He also discusses salient clinical lessons exemplified by this case. PMID:27246171

  15. 360-degree Evaluations on Physician Performance as an Effective Tool for Interprofessional Teams: A critical analysis of physician self-assessment as compared to nursing staff and patient evaluations of providers.

    PubMed

    Kamangar, Faranak; Davari, Parastoo; Parsi, Kory K; Li, Chin-Shang; Wang, Qinlu; Mathis, Stephen; Fazel, Nasim

    2016-01-01

    ImportanceThe dynamics of the medical care team, including interactions between physicians and nursing staff, has a large role to play in patient care, patient satisfaction, and future possible reimbursement determination. In order to implement changes to improve this dynamic within the medical team, it is imperative that appropriate assessments are completed to determine baseline satisfaction of our patients and nursing staff in addition to provider self-assessment.ObjectiveWe aimed to investigate patient and nursing staff satisfaction with regards to provider quality of care in an outpatient academic dermatology clinic setting. We also sought out to determine provider insight in regards to satisfaction of patient and nursing staff.MethodsOur nursing staff, patients, and providers completed a questionnaire. We then compared nursing satisfaction data and patient satisfaction data with provider self-assessment to determine provider self-awareness.ResultsA total of 23 provider and nurse surveys and 562 patient satisfaction surveys were completed. Paired comparison and descriptive statistics were utilized to compare patient satisfaction, nursing satisfaction, and provider self-assessments.ConclusionsOverall, the results of the surveys demonstrated that the nursing staff and patients had high satisfaction in their interactions with the dermatology physicians. The physicians had appropriate insight into how they were perceived by the nursing staff and patients. Attending physicians as compared to resident physicians and male physicians as compared to female physicians tended to underrate themselves. PMID:27617720

  16. Strategies to Enhance Physician Engagement.

    PubMed

    Rosenstein, Alan H

    2015-01-01

    Healthcare reform and other externally driven healthcare initiatives have introduced a number of new healthcare requirements that are restructuring the way we provide healthcare services. With a growing focus on health plan efficiency and accountability for value-based performance metrics extending across the full spectrum of care, healthcare organizations are looking to develop new models of care to meet the needs of today's healthcare environment. Physician alignment and engagement are keys to success. But many physicians feel threatened, overwhelmed, and frustrated with the changes, and it's beginning to take its toll on physician attitudes and perspectives about care. Enhancing physician engagement requires a multistep process that includes making an effort to better understand their world; encouraging opportunities for input and participation in care redesign; providing education, training, guidance, and support; and making the effort to recognize and thank them for what they do. PMID:26665482

  17. Topic Transitions in Physician-Patient Interviews: Power; Gender, and Discourse Change.

    ERIC Educational Resources Information Center

    Ainsworth-Vaughn, Nancy

    1992-01-01

    The explicit theoretical frame in which topic transitions have been described and the types of transitions are discussed, based on a study of 12 physician-patient encounters. Reciprocal and unilateral activities are identified that relate to allocation of power. (34 references) (Author/LB)

  18. Family physician practice visits arising from the Alberta Physician Achievement Review

    PubMed Central

    2013-01-01

    Background Licensed physicians in Alberta are required to participate in the Physician Achievement Review (PAR) program every 5 years, comprising multi-source feedback questionnaires with confidential feedback, and practice visits for a minority of physicians. We wished to identify and classify issues requiring change or improvement from the family practice visits, and the responses to advice. Methods Retrospective analysis of narrative practice visit reports data using a mixed methods design to study records of visits to 51 family physicians and general practitioners who participated in PAR during the period 2010 to 2011, and whose ratings in one or more major assessment domains were significantly lower than their peer group. Results Reports from visits to the practices of family physicians and general practitioners confirmed opportunities for change and improvement, with two main groupings – practice environment and physician performance. For 40/51 physicians (78%) suggested actions were discussed with physicians and changes were confirmed. Areas of particular concern included problems arising from practice isolation and diagnostic conclusions being reached with incomplete clinical evidence. Conclusion This study provides additional evidence for the construct validity of a regulatory authority educational program in which multi-source performance feedback identifies areas for practice quality improvement, and change is encouraged by supplementary contact for selected physicians. PMID:24010980

  19. Training Primary Care Physicians in Flexible Sigmoidoscopy—Performance Evaluation of 17, 167 Procedures

    PubMed Central

    Groveman, Howard D.; Sanowski, Robert A.; Klauber, Melville R.

    1988-01-01

    The flexible fiber-optic sigmoidoscope is rapidly replacing the rigid sigmoidoscope in routine screening for colorectal cancer. This study was undertaken to evaluate the safety, usage pattern, and efficacy of fiber-optic sigmoidoscopy by evaluating the outcome of training and the results of procedures carried out by a group of primary care physicians. Of 1,153 participants in one-day flexible sigmoidoscopy workshops, 764 (66%) returned questionnaires evaluating their experiences following this training. Of these, 438 physicians had obtained a flexible sigmoidoscope, used it frequently, and had done a total of 17,167 examinations. The average time of scope usage was nine months. Although additional supervised training was suggested at the time of the workshop, 68% of physicians began doing flexible sigmoidoscopy without it. A total of 465 polyps and 153 cancers were detected by the study group for an overall detection rate of 2.7% for polyps and 0.9% for cancers. Four complications were reported. This study indicates that the technique of flexible sigmoidoscopy is readily learned, is diagnostically productive, and is reasonably safe in the hands of primary care physicians. PMID:3348037

  20. Strategic alliance between the infectious diseases specialist and intensive care unit physician for change in antibiotic use.

    PubMed

    Curcio, D; Belloni, R

    2005-02-01

    There is a general consensus that antimicrobial use in intensive care units (ICU) is greater than that in general wards. By implementing a strategy of systematic infectious disease consultations in agreement with the ICU chief, we have modified the antibiotic prescription habits of the ICU physician. A reduction was observed in the use of selected antibiotics (third-generation cephalosporins, vancomycin, carbapenems and piperacillin-tazobactam), with a significant reduction in the length of hospital stay for ICU patients and lower antibiotic costs without negative impact on patient mortality. Leadership by the infectious diseases consultant in combination with commitment by ICU physicians is a simple and effective method to change antibiotic prescription habits in the ICU. PMID:15828447

  1. Secure e-mailing between physicians and patients: transformational change in ambulatory care.

    PubMed

    Garrido, Terhilda; Meng, Di; Wang, Jian J; Palen, Ted E; Kanter, Michael H

    2014-01-01

    Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization. PMID:24887522

  2. Effect of an EBM course in combination with case method learning sessions: an RCT on professional performance, job satisfaction, and self-efficacy of occupational physicians

    PubMed Central

    Schaafsma, Frederieke G.; Nieuwenhuijsen, Karen; van Dijk, Frank J. H.

    2008-01-01

    Objective An intervention existing of an evidence-based medicine (EBM) course in combination with case method learning sessions (CMLSs) was designed to enhance the professional performance, self-efficacy and job satisfaction of occupational physicians. Methods A cluster randomized controlled trial was set up and data were collected through questionnaires at baseline (T0), directly after the intervention (T1) and 7 months after baseline (T2). The data of the intervention group [T0 (n = 49), T1 (n = 31), T2 (n = 29)] and control group [T0 (n = 49), T1 (n = 28), T2 (n = 28)] were analysed in mixed model analyses. Mean scores of the perceived value of the CMLS were calculated in the intervention group. Results The overall effect of the intervention over time comparing the intervention with the control group was statistically significant for professional performance (p < 0.001). Job satisfaction and self-efficacy changes were small and not statistically significant between the groups. The perceived value of the CMLS to gain new insights and to improve the quality of their performance increased with the number of sessions followed. Conclusion An EBM course in combination with case method learning sessions is perceived as valuable and offers evidence to enhance the professional performance of occupational physicians. However, it does not seem to influence their self-efficacy and job satisfaction. PMID:18386046

  3. [Exploring the changes of inheritance model of medical knowledge as viewed from the description of physicians in the Song Dynasty].

    PubMed

    Zhang, Haipeng

    2014-11-01

    From the Southern and Northern Dynasties to the beginning of the Northern Song Dynasty, the models of "master and apprentice" and "physician of long family tradition for generations" were the main ways for teaching medical knowledge. With the rapid amassment of medical books in the Song Dynasty, "reading text" became increasingly important and prominent in the inheritance of medical knowledge, which could be seen clearly from the descriptions on physicians in the Song Dynasty. For instance, Hao Yun's medical knowledge was recorded as a model of "master and apprentice" in Hao Yun's Epitaph written by Zhang Xun. However, in Ye Mengde's description, this model was played down, while at the same time, "reading text" was emphasized. Pang Anshi, though coming from a physician family for generations, got rid of some medical knowledge from his own family and turned to the medical knowledge by "reading text". According to Pang Anshi's Epitaph written by Zhang Lei and Fang ji Zhuan (Biography of Technicians) in Song shi (The Song History), Pang Anshi was a typical model of becoming a famous physician by "reading text". In the Epitaph, Pang Anshi's brilliance was stressed, and in the latter, "reading text" was more important and the family tradition was denied. In the description of the Song Dynasty, Chen Zhaoyu's wonderful medical skills was coming from the "practice", and "reading text" was denied right away. What is more, "reading text" was introspected and criticized through Chen Zhaoyu's lip. The different descriptions of the Song Dynasty reflected the change of inheritance model of medical knowledge. PMID:25620356

  4. Restructuring the primary health care services and changing profile of family physicians in Turkey.

    PubMed

    Ersoy, F; Sarp, N

    1998-12-01

    A new health-reform process has been initiated by Ministry of Health in Turkey. The aim of that reform is to improve the health status of the Turkish population and to provide health care to all citizens in an efficient and equitable manner. The restructuring of the current health system will allow more funds to be allocated to primary and preventive care and will create a managed market for secondary and tertiary care. In this article, we review the current and proposed primary care services models and the role of family physicians therein. PMID:10078801

  5. Katrina Kinetics: The Physician Supply.

    PubMed

    Heckle, Mark R; Askari, Raza; Morsy, Mohamed; Ibebuogu, Uzoma N

    2016-01-01

    In the aftermath of Hurricane Katrina 10 years ago, acute changes were recognized and reported; acute kinetic destruction and desperation. Physicians performed heroically, but after the flood and the closing of hospitals, most left at least briefly. The chronic recovery began with spirit, but was uncharted and unplanned with the recognition that individual decisions were a necessity. The documentation of physician numbers of practicing doctors, residents and fellows, from the AMA as related to geography, population, and other circumstances tells an additional story of renewal, more objectively without the hype. The fall and rise of the physician population occurred, and was and is remarkable in its consistency, smaller than expected variations. Its effect generated promise for continuous chronic conditions of recovery and positive change. PMID:27598896

  6. Managing Performance to Change Behavior

    ERIC Educational Resources Information Center

    Denisi, Angelo S.

    2011-01-01

    Performance appraisal systems are often considered primarily in their role as criterion measures for validation studies. Even when they are considered in other organizational roles, there has traditionally been a strong focus on improving the accuracy of the appraisals. The present article argues that the proper focus of performance appraisal is…

  7. Changes in physicians' computer anxiety and attitudes related to clinical information system use.

    PubMed Central

    Brown, S H; Coney, R D

    1994-01-01

    STUDY OVERVIEW: Interns' anxiety about computer use ("computer anxiety") and their attitudes toward medical computer applications were determined by a standardized questionnaire. Participants were surveyed before and after three months of differential exposure to three clinical information systems (CISs), including one with provider-entered encounters. POPULATION: Fifty-one interns completed both surveys. Their average age was 27 years. Thirty-three percent were female, 7% were African American, and 8% were foreign graduates. RESULTS: The most common previous exposures to computers were for literature searching and retrieval of patient information (both 92%). Factors that commonly emerged as predictive of anxiety about computer use included self-rated skills, typing ability, and computer attitudes. Factors predictive of attitudes toward computers included self-rated skills, typing ability, maximal frequency of prior computer use, computer ownership, and computer anxiety. Factors that were not predictive of computer anxiety or attitudes toward computers included age, gender, and physician input of data. CONCLUSION: Identification of markers for negative psychological reactions to computer use may allow development of interventions to improve acceptance of computer base patient records (CBPRs). PMID:7850562

  8. The effects of noise on the cognitive performance of physicians in a hospital emergency department

    NASA Astrophysics Data System (ADS)

    Dodds, Peter

    In this research, the acoustic environment of a contemporary urban hospital emergency department has been characterized. Perceptive and cognitive tests relating to the acoustic environment were conducted on both medical professionals and lay people and a methodology for developing augmentable acoustic simulations from field recordings was developed. While research of healthcare environments remains a popular area of investigation for the acoustics community, a lack of communication between medical and acoustics researchers as well as a lack of sophistication in the methods implemented to evaluate hospital environments and their occupants has led to stagnation. This research attempted to replicate traditional methods for the evaluation of hospital acoustic environments including impulse response based room acoustics measurements as well as psychoacoustic evaluations. This thesis also demonstrates some of the issues associated with conducting such research and provides an outline and implementation for alternative advanced methods of re- search. Advancements include the use of the n-Back test to evaluate the effects of the acoustic environment on cognitive function as well as the outline of a new methodology for implementing realistic immersive simulations for cognitive and perceptual testing using field recordings and signal processing techniques. Additionally, this research utilizes feedback from working emergency medicine physicians to determine the subjective degree of distraction subjects felt in response to a simulated acoustic environment. Results of the room acoustics measurements and all experiments will be presented and analyzed and possible directions for future research will be presented.

  9. [Medical claims and women's experience. Physician-performed abortions in the Weimar Republic].

    PubMed

    Usborne, C

    2000-01-01

    The campaign for abortion reform in the Weimar Republic occasioned passionate disputes between factions supporting and opposing liberalization of abortion laws. Nevertheless, both camps agreed on one issue: that doctors, and only doctors, should be authorized to terminate a pregnancy. The implication was that an operation induced by a registered medical practitioner was safe, while so-called back-street operations were always dangerous. By and large, this view has also been accepted by historians, often uncritically. This article shows that evidence of the very real risks of terminating a pregnancy was open to cultural and political manipulation. The claims of academic physicians were often contradictory: on the one hand, they dismissed the risks of medical procedures as a way of fighting lay abortions; on the other hand, they exaggerated these risks as a way of explaining unsuccessful surgeries. Using a case study from Bavaria at the beginning of the Republic, this article shows the ambiguous role doctors played and the biased view of the courts. It also sheds light on the experience of abortion-seeking women, whose interests were largely ignored by the law enforcement agencies. PMID:14674407

  10. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review.

    PubMed

    Gasperino, James

    2011-10-01

    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States. PMID:21439669

  11. Physicians' Perceptions of Clinical Teaching: A Qualitative Analysis in the Context of Change

    ERIC Educational Resources Information Center

    Knight, Lynn V.; Bligh, John

    2006-01-01

    Background: Change is ubiquitous. Current trends in both educational and clinical settings bring new challenges to clinicians and have the potential to threaten the quality of clinical teaching. Objective: To investigate hospital specialists' perceptions of clinical teaching in the context of change. Design: Qualitative study using in-depth…

  12. Physician Information Seeking Behaviors: Are Physicians Successful Searchers?

    ERIC Educational Resources Information Center

    Swiatek-Kelley, Janice

    2010-01-01

    In the recent past, physicians found answers to questions by consulting colleagues, textbooks, and professional journals. Now, the availability of medical information through electronic resources has changed physician information-seeking behaviors. Evidence-based medicine is now the accepted decision-making paradigm, and a physician's ability to…

  13. Physician treatment decisions in a multiple treatment model. The effect of physician supply.

    PubMed

    McCombs, J S

    1984-08-01

    This paper develops a neoclassical utility maximization model of physician behavior in which the physician determines the price of physician office and hospital visits, the utilization rates for physician office and hospital visits and hospital days, and the resources and physician time inputs in the production of visits. The model assumes that the physician acts as a perfect agent for the patient. The analysis traces substitutions between physician office visits, physician hospital visits, and hospital days in response to changes in physician supply. The analysis also traces physician supply induced changes in the input mix used to produce visits. The substitution effects of physician supply are then used to reinterpret previous statistical estimates of the physician supply elasticities of per capita utilization of physician office visits and hospital days, length of visit, waiting time, and physician workloads. PMID:10268370

  14. Prevalence and impact of body physical changes in HIV patients treated with highly active antiretroviral therapy: results from a study on patient and physician perceptions.

    PubMed

    Cabrero, Esther; Griffa, Laura; Burgos, Angel

    2010-01-01

    Patients infected with HIV treated with highly active antiretroviral therapy (HAART) frequently develop body physical changes (BPC) that have an important psychosocial burden. The purpose of this study was to determine the prevalence of BPC observed by HIV-infected patients and their attending physicians and to assess the impact BPC had on daily life. In this epidemiologic multicenter study, patients with HIV infection and their treating physicians filled out parallel questionnaires about their perceptions of specific BPC and their impact on daily activities. A total of 965 patient-physician questionnaires were collected across 98 health centers. Patient's mean age was 43.7 +/- 8.5 years and 72.6% were men. Adjusted prevalence of perceived BPC by patients and physicians was 55.1% (95% confidence interval [CI]: 52.0-58.1) and 55.2% (95% CI: 52.1-58.2), respectively (p = 1.000). Overall patient-physician agreement concerning perception of BPC was 83% (p < 0.0005). The most common BPC was lipoatrophy, described by 46.8% (95% CI: 43.7-49.8) of patients and 49.4% (95% CI: 46.3-52.5) of physicians (p = 0.033) followed by lipohypertrophy. No gender differences were observed in the global prevalence of BPC (p = 0.649). However, significantly more women reported lipoatrophy of the lower limbs (p = 0.009) and buttocks (p = 0.007), as well as lipohypertrophy (p = 0.007), than men; 58.2% (95% CI: 54.0-62.4) patients noted that BPC negatively affected their daily activities. This study reflects the high prevalence of patient and physician-perceived BPC in the HIV population, and the adverse impact on daily life. Physicians should be aware of the psychosocial consequences of BPC in HIV patients in order to improve patient well-being. PMID:20095903

  15. Factors Associated with Behavior Change in Family Physicians After CME Presentation.

    ERIC Educational Resources Information Center

    Ferguson, Kristi J.; And Others

    1984-01-01

    Registrants of a four-day family practice refresher course responded to a survey assessing their reaction to a brief presentation recommending the use of penile anesthesia in newborn circumcision. The results suggest that evaluation of behavior change should consider attitudinal variables. (Author/MLW)

  16. Psychosocial challenges facing physicians of today.

    PubMed

    Arnetz, B B

    2001-01-01

    leadership and the physician team impact on the overall work atmosphere. Physicians unaware of the goals of the department as well as the hospital, that do not receive management performance feedback, and who do not get annual performance appraisals and career guidance, rate their psychosocial environment as more adverse than their colleagues. There is also a great need to offer personally targeted competence development plans. Heads of department and senior physicians rate their work environment as of higher quality than more junior and mid-career physicians. More specifically, less senior physicians perceive similar work demands as their senior colleagues but rate influence over work, skills utilization, and intellectual stimulation at work as significantly worse. In order to combat negative stressors in the physicians' work environment, enhancement initiatives should be considered both at the individual, group, and structural level. Successful resources used by physicians to manage the stress of everyday medicine should be identified. Physicians are a key group to ensure a well-functioning health care system. In order to be able to change and adapt to the ongoing evolution of the Western health care system, more focus needs to be put on the psychosocial aspects of physicians' work. PMID:11144776

  17. [Changing role of the family physician in British National Health Service].

    PubMed

    Goodwin, N

    2000-01-01

    Over the last ten years the traditional role of primary care in Great Britain has been undergoing major changes with the major impact being the introduction of what is termed "GP fundholding", a process by which GPs hold budgets to purchase care from hospitals on behalf of their patients. This paper addresses how the system of fundholding operates in practice and points out the difference between the new and the previous system in which the health authority would plan care for the whole of a district and costs by hospitals would be covered by an all-inclusive system. The paper studies the rationale of the introduction of the fundholding and examines the evidence on how successful the approach has been. With reference to a systematic literature review of the evidence on fundholding's outcomes undertaken by the author, the paper examines the evidence for and against fundholding under the following headings: efficiency, equity, quality, choice and responsiveness. The paper then addresses more recent changes to the British health care system and shows how these have changed the role of the family doctor irrevocablly. PMID:10748549

  18. Psychometric Equivalence of Ratings for Repeat Examinees on a Performance Assessment for Physician Licensure

    ERIC Educational Resources Information Center

    Raymond, Mark R.; Swygert, Kimberly A.; Kahraman, Nilufer

    2012-01-01

    Although a few studies report sizable score gains for examinees who repeat performance-based assessments, research has not yet addressed the reliability and validity of inferences based on ratings of repeat examinees on such tests. This study analyzed scores for 8,457 single-take examinees and 4,030 repeat examinees who completed a 6-hour clinical…

  19. Task shifting in Mozambique: cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care

    PubMed Central

    2010-01-01

    Background Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (técnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART). Methods Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course. Results In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6%, and correctly managed co-trimoxazole prophylaxis in 71.6% and ART in 75.5% (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6% of encounters. The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated. Conclusions In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments. PMID:20939909

  20. Multiple goals and time constraints: perceived impact on physicians' performance of evidence-based behaviours

    PubMed Central

    2009-01-01

    Background Behavioural approaches to knowledge translation inform interventions to improve healthcare. However, such approaches often focus on a single behaviour without considering that health professionals perform multiple behaviours in pursuit of multiple goals in a given clinical context. In resource-limited consultations, performing these other goal-directed behaviours may influence optimal performance of a particular evidence-based behaviour. This study aimed to investigate whether a multiple goal-directed behaviour perspective might inform implementation research beyond single-behaviour approaches. Methods We conducted theory-based semi-structured interviews with 12 general medical practitioners (GPs) in Scotland on their views regarding two focal clinical behaviours--providing physical activity (PA) advice and prescribing to reduce blood pressure (BP) to <140/80 mmHg--in consultations with patients with diabetes and persistent hypertension. Theory-based constructs investigated were: intention and control beliefs from the theory of planned behaviour, and perceived interfering and facilitating influence of other goal-directed behaviours performed in a diabetes consultation. We coded interview content into pre-specified theory-based constructs and organised codes into themes within each construct using thematic analysis. Results Most GPs reported strong intention to prescribe to reduce BP but expressed reasons why they would not. Intention to provide PA advice was variable. Most GPs reported that time constraints and patient preference detrimentally affected their control over providing PA advice and prescribing to reduce BP, respectively. Most GPs perceived many of their other goal-directed behaviours as interfering with providing PA advice, while fewer GPs reported goal-directed behaviours that interfere with prescribing to reduce BP. Providing PA advice and prescribing to reduce BP were perceived to be facilitated by similar diabetes-related behaviours (e

  1. Finding the Why, Changing the How: Improving the Mental Health of Medical Students, Residents, and Physicians.

    PubMed

    Slavin, Stuart J; Chibnall, John T

    2016-09-01

    The poor mental health of residents, characterized by high rates of burnout, depression, and suicidal ideation, is a growing concern in graduate medical education. Research is needed to gain a deeper understanding of the sources of distress as well as the sources of sustenance in residency training. The study by Mata and colleagues contributes significantly to this understanding. In addition to this line of research, however, studies are needed that assess the impact of interventions to help residents deal more effectively with the stress of training and find meaning in their work. Given the stresses of residency training, this approach may not make a dramatic difference in mental health outcomes. Efforts directed at changing the educational and clinical environments are also needed to reduce unnecessary stressors and create more positive settings for learning and clinical care. Since 2011, Saint Louis University School of Medicine has been pursuing a multipronged strategy to address these issues in the preclinical years. These efforts have led to dramatic decreases in depression and anxiety symptoms in students. An essential component of these interventions is the ongoing measurement of mental health outcomes across all four years of the curriculum. Leaders of residency programs, medical schools, and hospitals need to have the courage to measure these kinds of outcomes to spur change and track the efficacy of programs. PMID:27166866

  2. Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

    PubMed Central

    2011-01-01

    Background Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. Methods A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. Results We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. Conclusions Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings. PMID:22166064

  3. The physician quality reporting initiative--a gateway to pay for performance: what every health care professional should know.

    PubMed

    Stulberg, Jonah

    2008-01-01

    The Physician Quality Reporting Initiative (PQRI) is a pay-for-reporting (P4R) program sponsored by the Centers for Medicare & Medicaid Services open to all health care providers that treat Medicare patients. This P4R initiative provides financial incentives for participation and unlike most pay-for-performance (P4P) programs, there are no penalties for poor performance. PQRI therefore offers Medicare providers nationwide a low-risk opportunity to gain experience with reporting procedures likely to be incorporated into P4P reimbursement schemes. The 74 measures used during the first reporting period are applicable to both generalist and specialist providers and open participation in PQRI to a much broader audience compared with previous federal initiatives. Also in contrast to programs that measure hospital or group quality and reimburse for services at the health system level, measurement and reimbursement in PQRI directly affects individual Medicare providers. The combination of provider-level measurement and reimbursement and efforts to assess care delivered by both generalist and specialist Medicare providers highlights how this P4R initiative is truly a gateway to a P4P reimbursement system. Participation in the PQRI program provides useful experience to Medicare providers and their staff in preparing for future initiatives that try to tie quality to reimbursement. PMID:18204372

  4. Massachusetts General Physicians Organization's quality incentive program produces encouraging results.

    PubMed

    Torchiana, David F; Colton, Deborah G; Rao, Sandhya K; Lenz, Sarah K; Meyer, Gregg S; Ferris, Timothy G

    2013-10-01

    Physicians are increasingly becoming salaried employees of hospitals or large physician groups. Yet few published reports have evaluated provider-driven quality incentive programs for salaried physicians. In 2006 the Massachusetts General Physicians Organization began a quality incentive program for its salaried physicians. Eligible physicians were given performance targets for three quality measures every six months. The incentive payments could be as much as 2 percent of a physician's annual income. Over thirteen six-month terms, the program used 130 different quality measures. Although quality-of-care improvements and cost reductions were difficult to calculate, anecdotal evidence points to multiple successes. For example, the program helped physicians meet many federal health information technology meaningful-use criteria and produced $15.5 million in incentive payments. The program also facilitated the adoption of an electronic health record, improved hand hygiene compliance, increased efficiency in radiology and the cancer center, and decreased emergency department use. The program demonstrated that even small incentives tied to carefully structured metrics, priority setting, and clear communication can help change salaried physicians' behavior in ways that improve the quality and safety of health care and ease the physicians' sense of administrative burden. PMID:24101064

  5. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales

    PubMed Central

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-01-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue. PMID:16762127

  6. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales.

    PubMed

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-06-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue. PMID:16762127

  7. [The role of the team of family physician in prevention of changing risk factors important in development of arterial hypertension].

    PubMed

    Beganlić, Azijada; Batić-Mujanović, Olivera; Tulumović, Ajsa; Zilzić, Muharem

    2005-01-01

    Arterial hypertension (AH) is one of the commonest noninfective chronic disease according to its important and the role in the morbidity and mortality, which is the reason for patients coming to the family phisician. Detection and treatment of high blood pressure are the major responsibility of physician in the primary care. If the family physician team (physician and nurse) make a good assessment of the risk factors which is important in development of arterial hypertension, the appearance of disease and its complications can be prevented or delayed. The most important for prevention of arterial hypertension is adoption a healthy lifestyle and it is nonseparate part of arterial hypertension treatment. PMID:16268072

  8. Managing margins through physician engagement.

    PubMed

    Sears, Nicholas J

    2012-07-01

    Hospitals should take the following steps as they seek to engage physicians in an enterprisewide effort to effectively manage margins: Consider physicians' daily professional practice requirements and demands for time in balancing patient care and administrative duties. Share detailed transactional supply data with physicians to give them a behind-the-scenes look at the cost of products used for procedures. Institute physician-led management and monitoring of protocol compliance and shifts in utilization to promote clinical support for change. Select a physician champion to provide the framework for managing initiatives with targeted, efficient communication. PMID:22788036

  9. Physician collective bargaining.

    PubMed

    Schiff, Anthony Hunter

    2009-11-01

    Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices. Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive

  10. Leadership Attributes of Physician Assistant Program Directors

    ERIC Educational Resources Information Center

    Eifel, Raymond Leo

    2014-01-01

    Physician assistant (PA) program directors perform an essential role in the initiation, continuation, and development of PA education programs in the rapidly changing environments of both health care and higher education. However, only limited research exists on this academic leader. This study examined the leadership roles of PA program directors…

  11. Napping on the Night Shift: A Study of Sleep, Performance, and Learning in Physicians-in-Training

    PubMed Central

    McDonald, Jennifer; Potyk, Darryl; Fischer, David; Parmenter, Brett; Lillis, Teresa; Tompkins, Lindsey; Bowen, Angela; Grant, Devon; Lamp, Amanda; Belenky, Gregory

    2013-01-01

    Background Physicians in training experience fatigue from sleep loss, high workload, and working at an adverse phase of the circadian rhythm, which collectively degrades task performance and the ability to learn and remember. To minimize fatigue and sustain performance, learning, and memory, humans generally need 7 to 8 hours of sleep in every 24-hour period. Methods In a naturalistic, within-subjects design, we studied 17 first- and second-year internal medicine residents working in a tertiary care medical center, rotating between day shift and night float every 4 weeks. We studied each resident for 2 weeks while he/she worked the day shift and for 2 weeks while he/she worked the night float, objectively measuring sleep by wrist actigraphy, vigilance by the Psychomotor Vigilance Task test, and visual-spatial and verbal learning and memory by the Brief Visuospatial Memory Test-Revised and the Rey Auditory-Verbal Learning Test. Results Residents, whether working day shift or night float, slept approximately 7 hours in every 24-hour period. Residents, when working day shift, consolidated their sleep into 1 main sleep period at night. Residents working night float split their sleep, supplementing their truncated daytime sleep with nighttime on-duty naps. There was no difference in vigilance or learning and memory, whether residents worked day shift or night float. Conclusions Off-duty sleep supplemented with naps while on duty appears to be an effective strategy for sustaining vigilance, learning, and memory when working night float. PMID:24455014

  12. Profit-Seeking, Corporate Control, and the Trustworthiness of Health Care Organizations: Assessments of Health Plan Performance by Their Affiliated Physicians

    PubMed Central

    Schlesinger, Mark; Quon, Nicole; Wynia, Matthew; Cummins, Deborah; Gray, Bradford

    2005-01-01

    Objective To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. Data Source A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. Study Design Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. Data Collection The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. Principal Findings Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for

  13. The Challenges for Physicians of Demonstrating Continuing Competence in the Changing World of Medical Regulation: Osteopathic Pediatrician Case Report

    ERIC Educational Resources Information Center

    Langenau, Erik E.; Gimpel, John R.

    2012-01-01

    The current system of continuing medical education, maintenance of certification, and renewal of medical licenses can be quite burdensome and inefficient for all practicing physicians: medical doctors (M.D.s) and doctors of osteopathic medicine (D.O.s). D.O.s have opportunities for residency training and specialty certification which are not…

  14. Comparing the Performance of Allopathically and Osteopathically Trained Physicians on the American Board of Family Medicine's Certification Examination

    ERIC Educational Resources Information Center

    O'Neill, Thomas R.; Royal, Kenneth D.; Schulte, Bradley M.; Leigh, Terrence

    2009-01-01

    Background: Two medical specialty boards offer certification in family medicine: the American Board of Family Medicine (ABFM) and the American Osteopathic Board of Family Physicians (AOBFP). The AOBFP certification is offered only to graduates of osteopathic colleges; however, graduates of both osteopathic and allopathic medical schools who have…

  15. Physicians as Patient Teachers

    PubMed Central

    Brunton, Stephen A.

    1984-01-01

    Physicians have a central role in educating patients and the public in the elements of personal health maintenance. To be an effective teacher, one must recognize the learning needs of each patient and use methods of information transfer that will result in comprehension and compliance. To bring about a change in life-style, one must also have an understanding of a patient's health beliefs and the determinants of human behavior. Using this information together with behavior modification strategies, physicians can forge an effective partnership with patients working toward the goal of optimum health. PMID:6395500

  16. Measuring input prices for physicians: The revised Medicare Economic Index

    PubMed Central

    Freeland, Mark S.; Chulis, George S.; Arnett, Ross H.; Brown, Aaron P.

    1991-01-01

    Medicare payments for physician services under Part B were historically restrained by capping prevailing charges using the Medicare Economic Index (MEI). The MEI, an input price index for physician services that incorporates an adjustment for economywide labor productivity, has not undergone a major revision since 1975. The MEI is an important determinant of the annual volume performance standard that will be used to set aggregate increases in the revised system for paying physicians under Medicare beginning in 1992. The MEI will also be used in establishing the annual changes to the payment conversion factors under the new payment system. PMID:10170807

  17. Physician Challenges in 2015.

    PubMed

    Cascardo, Debra

    2015-01-01

    While the influx of new patients resulting from the ACA will increase the number of people receiving healthcare, the regulations associated with it will add to physicians' administrative duties, as will government regulations associated with HIPAA and Meaningful Use. Further stress will come from the demands of both payers and patients, requiring doctors to walk a fine line to protect themselves from litigation. Technology also will play an increasing role. The continuing move toward EHRs and the new ICD-10 coding standard will require investments in software, testing, and training staff, and may also require an investment in new computer hardware. Physicians and staff will have to teach patients how to use EHR portals and how to follow the record-keeping requirements of their insurance providers. The regulatory changes and increased costs of time and money associated with them may drive many physicians out of private practice and into hospital system-based team practices, which will face a greater challenge in recruiting and retaining top talent. Other physicians, in contrast, may continue to seek the independence of private practice; some of them may decide to stop accepting insurance because of their need for autonomy in their practices. Regardless of what decisions doctors choose to make within the changing nature of healthcare, it is important to keep abreast of the changes and develop a plan for dealing with them, in 2015 and beyond. PMID:26182706

  18. Consideration of environmental change in performance assessments.

    PubMed

    Pinedo, P; Thorne, M; Egan, M; Calvez, M; Kautsky, U

    2005-01-01

    Depending on the particular circumstances in which a post-closure performance assessment of a radioactive waste repository is made, it may be appropriate to follow simple or more complex approaches in characterising the biosphere. Several different Example Reference Biospheres were explored in BIOMASS Theme 1 to address a range of issues that arise. Here, consideration is given to Example Reference Biospheres relevant to representing the implications of changes that may occur within the biosphere system during the period over which releases of radionuclides from a disposal facility might take place. Mechanisms of change considered include those extrinsic and intrinsic to the system of interest. An overall methodology for incorporating environmental change into assessments is proposed. This includes screening of primary mechanisms of change; identification of possible time sequences of change; development of a coherent description of the regional landscape response for each time sequence; integration of source term and geosphere-biosphere interface information; identification and description of one or more time series of assessment biospheres; and evaluation of the advantages and disadvantages of simulating the effects of sequences of biosphere systems and the transitions between them, or of defining a set of biosphere systems to be represented individually in a non-sequential analysis. The usefulness of the methodology is explored in two site-specific examples and one generic example. PMID:16198459

  19. Physician ownership of medical equipment.

    PubMed

    Reschovsky, James; Cassil, Alwyn; Pham, Hoangmai H

    2010-12-01

    This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally rep­resentative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 phy­sicians, and the response rate was 62 percent. Since this Data Bulletin examines the extent of physician practice ownership or leasing of medical equipment, the sample was limited to 2,750 physicians practic­ing in community-based, physician-owned practices, who represent 58 percent of all physicians surveyed. Physicians employed by hospitals, who practiced in hospital-based settings or who worked in hospital-owned practices were excluded. PMID:21192487

  20. Burnout among physicians.

    PubMed

    Romani, Maya; Ashkar, Khalil

    2014-01-01

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians' quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as the

  1. How French physicians manage with a future change in the primary vaccination of infants against diphtheria, tetanus, pertussis and poliomyelitis? A qualitative study with focus groups

    PubMed Central

    2013-01-01

    Background As in other European countries, the French vaccination schedule changes according to epidemiological and socio-economic situations. Further changes are planned for 2013, including the withdrawal of one dose for primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. A partnership between the French Technical Vaccination Committee and the French Institute for Health and Medical Research designed a study to assess primary care physicians’ agreement about this modification. Methods Qualitative study with focus groups and semi-structured interviews in France. Four focus groups were conducted with physicians, supplemented by four individual interviews. Results The physicians of the survey had accepted the suggested vaccination schedule well. A few concerns had been underlined: fear of less follow-up care for infants resulting from the removal of one visit driven by the primary vaccination; fear of loss of vaccine efficacy; suspicion of the existence of financial arguments at the origin of this change; and adjustment to current vaccination schedule. Several suggestions were made: providing strong support from health authorities; developing stable and simple recommendations; providing effective tools for monitoring patient’s vaccination status. Conclusions Physicians’ opinions suggested a good acceptance of a possible change about primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. Physicians’ suggestions resulted from this qualitative study on a new vaccination schedule. It showed how that their involvement was feasible for preparing the implementation of a new vaccination schedule. PMID:23782853

  2. Ethical principles for physician rating sites.

    PubMed

    Strech, Daniel

    2011-01-01

    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites' effects on physicians' performance, patient outcomes, or the public's trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians' performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician-patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for

  3. Rewarding imperfect motor performance reduces adaptive changes.

    PubMed

    van der Kooij, K; Overvliet, K E

    2016-06-01

    Could a pat on the back affect motor adaptation? Recent studies indeed suggest that rewards can boost motor adaptation. However, the rewards used were typically reward gradients that carried quite detailed information about performance. We investigated whether simple binary rewards affected how participants learned to correct for a visual rotation of performance feedback in a 3D pointing task. To do so, we asked participants to align their unseen hand with virtual target cubes in alternating blocks with and without spatial performance feedback. Forty participants were assigned to one of two groups: a 'spatial only' group, in which the feedback consisted of showing the (perturbed) endpoint of the hand, or to a 'spatial & reward' group, in which a reward could be received in addition to the spatial feedback. In addition, six participants were tested in a 'reward only' group. Binary reward was given when the participants' hand landed in a virtual 'hit area' that was adapted to individual performance to reward about half the trials. The results show a typical pattern of adaptation in both the 'spatial only' and the 'spatial & reward' groups, whereas the 'reward only' group was unable to adapt. The rewards did not affect the overall pattern of adaptation in the 'spatial & reward' group. However, on a trial-by-trial basis, the rewards reduced adaptive changes to spatial errors. PMID:26758721

  4. Understanding the business of employed physician practices.

    PubMed

    Sanford, Kathleen D

    2013-09-01

    Health system leaders should understand issues related to finance, compliance, human resources, quality, and safety in their employed physician practices to better support the success of these practices. New business and payment models are driving operational changes in physician offices. Catholic Health Initiatives (CHI) has added new system roles and responsibilities to oversee physician practices. PMID:24050054

  5. The chaotic physician work world.

    PubMed

    Paterick, Timothy E

    2014-01-01

    Physicians are immersed in a work environment where daily challenges seem to represent a condition or place of increasing disorder and confusion. The degree of "entropy" in the physician workplace is increasing exponentially. Healthcare systems are in a state of chaos and are dynamic--meaning the behavior at one time influences its behavior in the future. The initial changes have future exponential fluctuations that have created a state of healthcare crisis. These systems are nonlinear; the metaphor to describe the unruly nature of the physician work world is that in which the flap of a butterfly wing in Brazil can set off a tornado in Texas. The tornado affecting physician work life must be understood to be rectified. Physicians must slow down and pay attention. PMID:25807614

  6. Physicians and airline medical emergencies.

    PubMed

    Hays, M B

    1977-05-01

    Physician passengers on airlines are frequently called to assist the flight crew if an emergency medical situation arises. There have been numerous studies and reports pertaining to medical emergencies inflight, the various aspects of crew responsibility and reaction, and the types of emergency medical supplies available. This paper is to present the comments and opinions of physicians who have been called upon to assist the flight crew during inflight emergency medical situations. The background information is presented followed by statistics as to types of conditions encountered; physicians' responses; physicians' comments as to airline emergency medical supplies; flight crew, airline, and airport responses to medical emergencies and suggestions from physicians as to what significant changes may be indicated. PMID:880187

  7. Burnout among physicians

    PubMed Central

    Romani, Maya; Ashkar, Khalil

    2014-01-01

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians’ quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as

  8. Ethical Principles for Physician Rating Sites

    PubMed Central

    2011-01-01

    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites’ effects on physicians’ performance, patient outcomes, or the public’s trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians’ performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician–patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial

  9. Medical Students' Images of 'Most Physicians' and 'Effective Physicians' over Time.

    ERIC Educational Resources Information Center

    Grant, Linda; And Others

    Students' perceptions of actual and idealized qualities of practicing physicians were studied longitudinally at three points in students' medical education. Questionnaire data were collected to assess stability and change in students' images of qualities of "most" physicians and of "effective" physicians. Male and female students' images of…

  10. Exploring family physician stress

    PubMed Central

    Lee, F. Joseph; Brown, Judith Belle; Stewart, Moira

    2009-01-01

    ABSTRACT OBJECTIVE To explore the nature of professional stress and the strategies used by family physicians to deal with this stress. DESIGN Qualitative study. SETTING Kitchener-Waterloo, Ont. PARTICIPANTS Ten key-informant family physicians. METHODS In-depth interviews were conducted with key informants. A total of 40 key informants were identified, based on selected criteria; 24 provided consent. The potential participants were rank-ordered for interviews to provide maximum variation in age, sex, and years in practice. Interviews were conducted, audiotaped, transcribed verbatim, and analyzed until thematic saturation was reached, as determined through an iterative process. This occurred after 10 in-depth interviews. Immersion and crystallization techniques were used. MAIN FINDINGS The participants described professional stresses and strategies at the personal, occupational, and health care system levels. Personal stressors included personality traits and the need to balance family and career, which were countered by biological, psychological, social, and spiritual strategies. Occupational stressors included challenging patients, high workload, time limitations, competency issues, challenges of documentation and practice management, and changing roles within the workplace. Occupational stressors were countered by strategies such as setting limits, participating in continuing medical education, soliciting support from colleagues and staff, making use of teams, improving patient-physician relationships, exploring new forms of remuneration, and scheduling appropriately. Stressors affecting the wider health care system included limited resources, imposed rules and regulations, lack of support from specialists, feeling undervalued, and financial concerns. CONCLUSION Family physicians face a multitude of challenges at personal, occupational, and health care system levels. A systems approach provides a new framework in which proactive strategies can augment more than

  11. Hospital demand for physicians.

    PubMed

    Morrisey, M A; Jensen, G A

    1990-01-01

    This article develops a derived demand for physicians that is general enough to encompass physician control, simple profit maximization and hospital utility maximization models of the hospital. The analysis focuses on three special aspects of physician affiliations: the price of adding a physician to the staff is unobserved; the physician holds appointments at multiple hospitals, and physicians are not homogeneous. Using 1983 American Hospital Association data, a system of specialty-specific demand equations is estimated. The results are consistent with the model and suggest that physicians should be concerned about reduced access to hospitals, particularly as the stock of hospitals declines. PMID:10104050

  12. Linking Competence Change and Organization Performance

    ERIC Educational Resources Information Center

    Boulay, David

    2007-01-01

    The notion of long term sustainable competitive advantage assumes that environment changes are engrained into organizations. Yet, the principles of continuous improvement suggest a shorter and shorter lifecycle of skills and knowledge that provides the sustainable advantage. Continuous change resulting from new ideas, practices, and technologies…

  13. [Dangerous liaisons--physicians and pharmaceutical sales representatives].

    PubMed

    Granja, Mónica

    2005-01-01

    Interactions between physicians and detailers (even when legitimate ones) raise scientific and ethical questions. In Portugal little thinking and discussion has been done on the subject and the blames for bribery have monopolized the media. This work intended to review what has been said in medical literature about these interactions. How do physicians see themselves when interacting with pharmaceutical companies and their representatives? Do these companies in fact change their prescriptive behaviour, and, if so, how do they change it? How can physicians interact with detailers and still keep their best practice? A Medline research, from 1966 till 2002, was performed using the key-words as follows. A database similar to Medline but concerning medical journals published in Portugal, Index das Revistas Médicas Portuguesas, was also researched from 1992 to 2002. Pharmaceutical companies are profit bound and they allot promoting activities, and detailing in particular, huge amounts of money. Most physicians hold firmly to the belief that they are able to resist and not be influenced by drug companies promotion activities. Nevertheless, all previous works on literature tell us the opposite. Market research also indicates that detailers effectively promote drug sales. Various works also suggest that the information detailers provide to physicians may be largely incorrect, even comparing it to the written information provided by the pharmaceutical companies they work for. The frequency at which portuguese physicians (especially family physicians) contact with pharmaceutical sales representatives is higher than the frequency reported in countries where the available studies come from (namely, Canada and the United States of America). This may put portuguese physicians at a higher risk, making it imperative that work and wide debate are initiated among the class. PMID:16202335

  14. Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients

    PubMed Central

    Ghane, Mohammad Reza; Gharib, Mohammadhadi; Ebrahimi, Ali; Saeedi, Morteza; Akbari-Kamrani, Marjan; Rezaee, Maryam; Rasouli, Hamidreza

    2015-01-01

    Background: Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients. Materials and Methods: Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. We enrolled 52 patients with shock state in the emergency department from April 2013 to October 2013. We performed early bed-side sonographic examination for participants based on RUSH protocol. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final diagnosis. Agreement (Kappa index) of initial impression provided by RUSH with final diagnosis, and also sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RUSH for diagnosis of each shock type were calculated. Results: Fifty-two patients were enrolled in our study. Kappa index was 0.7 (P value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic and obstructive shocks, the protocol had sensitivity of 100% but had lower PPV. For shocks with distributive or mixed etiology, RUSH showed PPV of 100% but had low sensitivity. For cardiogenic shocks, all reliability indices were above 90%. Conclusion: We highlight the role of RUSH examination in the hands of an emergency physician in making a rapid diagnosis of shock etiology, especially in ruling out obstructive, cardiogenic, and hypovolemic types. PMID:25709245

  15. How physicians choose drugs.

    PubMed

    Denig, P; Haaijer-Ruskamp, F M; Zijsling, D H

    1988-01-01

    A drug choice model which includes the physician's attitudes, norms and personal experiences with drugs, was tested. One hundred and sixty-nine physicians were asked to estimate the model's components for the treatment of irritable bowel syndrome (IBS) and of renal colic. Given three drugs for both indications, the physicians gave their expectancies about the treatment outcomes, professional acceptability, patient demand and their personal experiences with the drugs. They also stated the value they assign to each of these components when choosing a drug for IBS and for renal colic. The influence of patient demand on the choice of a specific drug appeared to be negligible. The combined effect of the other three elements of the model predicted the stated drug of first choice correctly in 74% (for IBS) and 78% (for renal colic) of the cases, but further analysis showed that only the drug choices for renal colic were as reasoned as the model assumed. Expectancies and values about treatment outcomes determined the drug choice only in part. For choosing a drug for renal colic, the professional environment was more important. Moreover it was found that drug preferences were more related to expectancies about efficacy than to expectancies about side effects for both disorders. The findings can be useful when trying to change prescribing behaviour. Only a limited effect can be expected from the provision of technical drug information. Especially information about costs is unlikely to change prescribing easily, unless values and norms are changed as well. The importance of the professional environment implies that educational programmes in groups might be more effective than individual approaches. PMID:3238456

  16. Siren song: physicians, congress, and medicare fees.

    PubMed

    Laugesen, Miriam J

    2009-04-01

    Physicians' fees under Medicare are updated by regulation annually based on a formula called the Sustainable Growth Rate (SGR). Since 2003 Congress has reversed impending cuts to fees in response to physician calls for reform of the SGR, yet physician groups supported the SGR when fee increases outstripped medical inflation. Physician groups are partly culpable for the failure of cost containment because physician groups have resisted efforts to regulate their practice or link effectiveness research to coverage and reimbursement decisions. In the story of Ulysses and the Sirens, Ulysses has himself bound to the mast so that he cannot be seduced by the calls of the Sirens. Physician groups are like sirens because legislators cannot resist their songs. Future policy changes should consider physician needs alongside broader cost-containment goals, including linking reimbursement to comparative effectiveness research. PMID:19276315

  17. Darpana for development: performance and change. The Darpana outreach programme: performance, education and change.

    PubMed

    Yarrow, R

    1997-03-01

    This paper reports on the advancement and assessment results of three project strategies--Awakening Awareness, Jagruti, and Parivartan--based on project documentations, interviews and direct observation conducted among 6th grade school children in Ahmedabad, Gujarat. Awakening Awareness aimed to motivate children in facing problems through story telling. Results of this pilot project indicate a significant impact on the children. Jagruti discusses the environmental and health issues through performing arts. Results reveal that the communication approach is an effective method in providing knowledge-awareness-skill among students. Parivartan, which included music and dance performance in initiating social, cultural, gender and health change revealed significant shifts in their behavior. These three projects exhibit success in the promotion of knowledge and awareness, instigation of attitude change, and stimulation of subsequent responsible action through performative and interactive methods. Furthermore, these initiatives provided more significance in the local and national contexts, which provides not only a way to develop responsibility, but also a practical, testable and direct addition to the aesthetic and educational repertoire. PMID:12295807

  18. Primary care physician supply, physician compensation, and Medicare fees: what is the connection?

    PubMed

    Dummit, Laura A

    2008-11-01

    Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a primary care physician crisis? Why does compensation across physician specialties vary so widely? Can Medicare physician fee changes affect access to primary care? These questions defy simple answers. This issue brief lays out the latest information on physician workforce, compensation differences across physician specialties, and Medicare's physician fee-setting process. PMID:19048687

  19. The Association between Medical Education Accreditation and Examination Performance of Internationally Educated Physicians Seeking Certification in the United States

    ERIC Educational Resources Information Center

    van Zanten, Marta; Boulet, John R.

    2013-01-01

    The purposes of this research were to examine medical education accreditation practices around the world, with special focus on the Caribbean, and to explore the association between medical school accreditation and graduates' examination performance. In addition to other requirements, graduates of international medical schools seeking to…

  20. The Association between Medical Education Accreditation and the Examination Performance of Internationally Educated Physicians Seeking Certification in the United States

    ERIC Educational Resources Information Center

    van Zanten, Marta

    2012-01-01

    Background: The purpose of the first phase of the present research was to examine medical education accreditation practices around the world, with special focus on the Caribbean region, to determine the association of accreditation of medical schools with student/graduate performance on examinations. The aim of the second phase of this research…

  1. Physicians in transition: practice due diligence.

    PubMed

    Paterick, Timothy E

    2013-01-01

    The landscape of healthcare is changing rapidly. That landscape is now a business model of medicine. That rapid change resulting in a business model is affecting physicians professionally and personally. The new business model of medicine has led to large healthcare organizations hiring physicians as employees. The role of a physician as an employee has many limitations in terms of practice and personal autonomy. Employed physicians sign legally binding employment agreements that are written by the legal team working for the healthcare organization. Thus physicians should practice due diligence before signing the employment agreement. "Due diligence" refers to the care a reasonable person should take before entering into an agreement with another party. That reasonable person should seek expertise to represent his or her interests when searching a balanced agreement between the physician and organization. PMID:23866658

  2. Physician leadership.

    PubMed

    Woo, K T

    2007-12-01

    Doctors, because of the nature of their training and their profession, have to be leaders. Subsequently, when they specialise, leadership qualities are even more important if they are to be effective in leading the specialty team. It is common knowledge that doctors have become leaders in various sectors of society. One of the fundamental advantages a doctor has over others in leadership positions is his basic training in studying and understanding human nature. With years of practice and experience, the doctor, a student of human nature, has a good grasp of human behaviour which enables him to become a better leader. The six universal and timeless characteristics of great leaders are: ability to share a vision, surrounding oneself with great people, ability to coach other team members, ability to focus on perfection, developing emotional intelligence and ability to train effective leaders. I would like to see three essential qualities in a strong leader: ability to secure an "envisioned future", ability to sacrifice in order to cultivate loyalty, and courage to do the right thing and protect his people. An effective leader positions himself in a situation to ensure survival. Having secured the leadership position, one must take certain steps to strengthen one's leadership so that it will survive. Six strategies from the Art of War by Sun Tzu which are of great practical value are: walk the ground, have trusted lieutenants, information gathering, confuse the enemy, win most while doing nothing, and that which is too good will not last forever. Sometimes we have to change in order to survive. We need to get rid of outmoded practices and shed old burdens to take advantage of the present. The task of exiting from leadership is facilitated if one has groomed a successor. The longer one is in a leadership position, the more difficult it is for one to step down. Some organisations retain old leaders as advisors or mentors. They should be just seen and not heard and go

  3. Changes in Memory Prediction Accuracy: Age and Performance Effects

    ERIC Educational Resources Information Center

    Pearman, Ann; Trujillo, Amanda

    2013-01-01

    Memory performance predictions are subjective estimates of possible memory task performance. The purpose of this study was to examine possible factors related to changes in word list performance predictions made by younger and older adults. Factors included memory self-efficacy, actual performance, and perceptions of performance. The current study…

  4. The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - ‘a remote virtual mentor’

    PubMed Central

    2013-01-01

    Background Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic ‘off-the-shelf’ technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal. Methods The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted. Results Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination. Conclusions Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings. PMID:23805869

  5. Physician buy-in for EMRs.

    PubMed

    Yackanicz, Lori; Kerr, Richard; Levick, Donald

    2010-01-01

    Implementing an EMR in an ambulatory practice requires intense workflow analysis, introduction of new technologies and significant cultural change for the physicians and physician champion. This paper will relate the experience at Lehigh Valley Health Network in the implementation of an ambulatory EMR and with the physician champions that were selected to assist the effort. The choice of a physician champion involves political considerations, variation in leadership and communication styles, and a cornucopia of personalities. Physician leadership has been shown to be a critical success factor for any successful technology implementation. An effective physician champion can help develop and promote a clear vision of an improved future, enlist the support of the physicians and staff, drive the process changes needs and manage the cultural change required. The experience with various types of physician champions will be discussed, including, the "reluctant leader", the "techie leader", the "whiny leader", and the "mature leader". Experiences with each type have resulted in a valuable, "lessons learned" summary. LVHN is a tertiary academic community medical center consisting of 950 beds and over 450 employed physicians. LVHN has been named to the Health and Hospital Network's 100 Top Wired and 25 Most Wireless Hospitals. PMID:20397333

  6. Making pharmacogenomic-based prescribing alerts more effective: A scenario-based pilot study with physicians.

    PubMed

    Overby, Casey Lynnette; Devine, Emily Beth; Abernethy, Neil; McCune, Jeannine S; Tarczy-Hornoch, Peter

    2015-06-01

    To facilitate personalized drug dosing (PDD), this pilot study explored the communication effectiveness and clinical impact of using a prototype clinical decision support (CDS) system embedded in an electronic health record (EHR) to deliver pharmacogenomic (PGx) information to physicians. We employed a conceptual framework and measurement model to access the impact of physician characteristics (previous experience, awareness, relative advantage, perceived usefulness), technology characteristics (methods of implementation-semi-active/active, actionability-low/high) and a task characteristic (drug prescribed) on communication effectiveness (usefulness, confidence in prescribing decision), and clinical impact (uptake, prescribing intent, change in drug dosing). Physicians performed prescribing tasks using five simulated clinical case scenarios, presented in random order within the prototype PGx-CDS system. Twenty-two physicians completed the study. The proportion of physicians that saw a relative advantage to using PGx-CDS was 83% at the start and 94% at the conclusion of our study. Physicians used semi-active alerts 74-88% of the time. There was no association between previous experience with, awareness of, and belief in a relative advantage of using PGx-CDS and improved uptake. The proportion of physicians reporting confidence in their prescribing decisions decreased significantly after using the prototype PGx-CDS system (p=0.02). Despite decreases in confidence, physicians perceived a relative advantage to using PGx-CDS, viewed semi-active alerts on most occasions, and more frequently changed doses toward doses supported by published evidence. Specifically, sixty-five percent of physicians reduced their dosing, significantly for capecitabine (p=0.002) and mercaptopurine/thioguanine (p=0.03). These findings suggest a need to improve our prototype such that PGx CDS content is more useful and delivered in a way that improves physician's confidence in their prescribing

  7. Effects of Gain Changes on RPM Performance

    SciTech Connect

    Lousteau, Angela L; York, Robbie Lynn; Livesay, Jake

    2012-03-01

    gains are less than 5% (Fig. 6). ORNL does not consider this slight increase in sensitivity to be a worthwhile pursuit. Second, increasing the ULD will increase sensitivity a few percent (Fig. 7); however, it is not clear that the slight increase in sensitivity is worth the effort required to make the change (e.g., reliability, cost, etc.). Additionally, while the monitor would be more sensitive to HEU, it would also be more sensitive to NORM. Third, the sensitivity of the system remains approximately the same whether it is calibrated to a small source on contact or a large source far away (Fig. 6). This affirms that no changes to the existing calibration procedure are necessary.

  8. Knowledge Crystallization and Clinical Priorities: Evaluating How Physicians Collect and Synthesize Patient-Related Data

    PubMed Central

    Pollack, Ari H; Tweedy, Carolyn G.; Blondon, Katherine; Pratt, Wanda

    2014-01-01

    Information seeking and synthesis are time consuming processes for physicians. Although systems have the potential to simplify these tasks, future improvements must be based on an understanding of how physicians perform these tasks during clinical prioritization. We enrolled 23 physicians in semi-structured focus groups discussing simulated inpatient populations. Participants documented and discussed their data gathering and prioritization processes. Transcripts were coded to identify themes and generalized process flows. Results indicate that data are collected to categorize and prioritize patients according to expected clinical course. When data do not support these expectations, or when categorization indicates potential for morbidity, physicians increase efforts to act or recategorize patients. Unexpected clinical changes have a significant impact on the decision-making and prioritization by clinicians. A modified version of the Knowledge Crystallization Framework helps to frame this work laying a foundation to advance information displays and facilitate information processing by physicians in clinical care environments. PMID:25954460

  9. Physician professionalism for a new century.

    PubMed

    Holsinger, James W; Beaton, Benjamin

    2006-07-01

    During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society. PMID:16506233

  10. Physicians: Requirements for Becoming a Physician

    MedlinePlus

    ... Us Contact Us A | A Text size Email Requirements for Becoming a Physician Note: We are not ... the doctor's knowledge and skills remain current. CME requirements vary by state, by professional organizations, and by ...

  11. Urban-Rural Flows of Physicians

    ERIC Educational Resources Information Center

    Ricketts, Thomas C.; Randolph, Randy

    2007-01-01

    Context: Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies. Purpose: To determine whether there was a significant flow of…

  12. Are physicians obligated to provide preventive services?

    PubMed

    Belcher, D W

    1990-01-01

    Preventive care is considered a benefit to the patient. Physicians express a positive attitude towards prevention, but their performance of recommended activities is low, as shown in a five-year trial at the Seattle VA Medical Center. The release of the U.S. Preventive Services Task Force's guide to clinical preventive services has provided physicians with authoritative prevention recommendations. While most physicians are specialists with little interest or skill in preventive care, primary care providers do accept an obligation to provide comprehensive care, including prevention. This paper examines the ethical basis for the idea of obligation. External pressures, legal, economic, and organizational, are affecting the physician-patient relationship in ways that encourage a contract mode of medical practice and limit physicians' ability to provide preventive care. As a profession, medicine needs to speak for the health needs of the public. As practitioners, physicians need to seek the welfare of their patients. PMID:2231049

  13. Editorial Changes and Item Performance: Implications for Calibration and Pretesting

    ERIC Educational Resources Information Center

    Stoffel, Heather; Raymond, Mark R.; Bucak, S. Deniz; Haist, Steven A.

    2014-01-01

    Previous research on the impact of text and formatting changes on test-item performance has produced mixed results. This matter is important because it is generally acknowledged that "any" change to an item requires that it be recalibrated. The present study investigated the effects of seven classes of stylistic changes on item…

  14. An obligation to provide abortion services: what happens when physicians refuse?

    PubMed Central

    Meyers, C; Woods, R D

    1996-01-01

    Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer and fewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden of justification lies upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to their fundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection. PMID:8731539

  15. Construction of a Physician Skills Inventory

    ERIC Educational Resources Information Center

    Richard, George V.; Zarconi, Joseph; Savickas, Mark L.

    2012-01-01

    The current study applied Holland's RIASEC typology to develop a "Physician Skills Inventory". We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced…

  16. 20 CFR 725.703 - Physician defined.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Physician defined. 725.703 Section 725.703... AND HEALTH ACT, AS AMENDED Medical Benefits and Vocational Rehabilitation § 725.703 Physician defined... scope of their practices as defined by State law. No treatment or medical services performed by...

  17. Computerized Physician Order Entry

    PubMed Central

    Khanna, Raman; Yen, Tony

    2014-01-01

    Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks. PMID:24381708

  18. Difficulties facing physician mothers in Japan.

    PubMed

    Yamazaki, Yuka; Kozono, Yuki; Mori, Ryo; Marui, Eiji

    2011-01-01

    Despite recent increases in the number of female physicians graduating in Japan, their premature resignations after childbirth are contributing to the acute shortage of physicians. Previous Japanese studies have explored supportive measures in the workplace, but have rarely focused on the specific problems or concerns of physician-mothers. Therefore, this study explored the challenges facing Japanese physician-mothers in efforts to identify solutions for their retention. Open-ended questionnaires were mailed to 646 alumnae of Juntendo University School of Medicine. We asked subjects to describe their opinions about 'The challenges related to female physicians' resignations'. Comments gathered from alumnae who graduated between 6 and 30 years ago and have children were analyzed qualitatively. Overall, 249 physicians returned the questionnaire (response rate 38.5%), and 73 alumnae with children who graduated in the stated time period provided comments. The challenges facing physician-mothers mainly consisted of factors associated with Japanese society, family responsibilities, and work environment. Japanese society epitomized by traditional gender roles heightened stress related to family responsibilities and promoted gender discrimination at work environment. Additionally, changing Japanese society positively influenced working atmosphere and husband's support. Moreover, the introduction of educational curriculums that alleviated traditional gender role was proposed for pre- and post- medical students. Traditional gender roles encourage discrimination by male physicians or work-family conflicts. The problems facing female physicians involve more than just family responsibilities: diminishing the notion of gender role is key to helping retain them in the workforce. PMID:22027270

  19. The Impact of Tiered Physician Networks on Patient Choices

    PubMed Central

    Sinaiko, Anna D; Rosenthal, Meredith B

    2014-01-01

    Objective To assess whether patient choice of physician or health plan was affected by physician tier-rankings. Data Sources Administrative claims and enrollment data on 171,581 nonelderly beneficiaries enrolled in Massachusetts Group Insurance Commission health plans that include a tiered physician network and who had an office visit with a tiered physician. Study Design We estimate the impact of tier-rankings on physician market share within a plan of new patients and on the percent of a physician's patients who switch to other physicians with fixed effects regression models. The effect of tiering on consumer plan choice is estimated using logistic regression and a pre–post study design. Principal Findings Physicians in the bottom (least-preferred) tier, particularly certain specialist physicians, had lower market share of new patient visits than physicians with higher tier-rankings. Patients whose physician was in the bottom tier were more likely to switch health plans. There was no effect of tier-ranking on patients switching away from physicians whom they have seen previously. Conclusions The effect of tiering appears to be among patients who choose new physicians and at the lower end of the distribution of tiered physicians, rather than moving patients to the “best” performers. These findings suggest strong loyalty of patients to physicians more likely to be considered their personal doctor. PMID:24611599

  20. A snapshot of U.S. physicians: key findings from the 2008 Health Tracking Physician Survey.

    PubMed

    Boukus, Ellyn; Cassil, Alwyn; O'Malley, Ann S

    2009-09-01

    This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally representative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 physicians, and the response rate was 62 percent. Estimates from this survey should not be compared to estimates from HSC's previous Community Tracking Study (CTS) Physician Surveys because of changes in the survey administration mode from telephone to mail, question wording, skip patterns, sample structure and population represented. More detailed information on survey content and methodology can be found at www.hschange.org. PMID:19768851

  1. Physician Tiering by Health Plans in Massachusetts

    PubMed Central

    Wadgaonkar, Ajay D.; Schneider, Eric C.; Bhattacharyya, Timothy

    2010-01-01

    Background: Physician tiering is an emerging health-care strategy that purports to grade physicians on the basis of cost-efficiency and quality-performance measures. We investigated the consistency of tiering of orthopaedic surgeons by examining tier agreement between health plans and physician factors associated with top-tier ranking. Methods: Health plan tier, demographic, and training data were collected on 615 licensed orthopaedic surgeons who accepted one or more of three health plans and practiced in Massachusetts. We then computed the concordance of physician tier rankings between the health plans. We further examined the factors associated with top-tier ranking, such as malpractice claims and socioeconomic conditions of the practice area. Results: The concordance of physician tiering between health plans was poor to fair (range, 8% to 28%, κ = 0.06 to 0.25). The percentage of physicians ranked as top-tier varied widely among the health plans, from 21% to 62%. Thirty-eight percent of physicians were not rated top-tier by any of the health plans, whereas only 5.2% of physicians were rated top-tier by all three health plans. Multivariate analysis showed that board certification, accepting Medicaid, and practicing in a suburban location were the independent factors associated with being ranked in the top tier. More years in practice or fewer malpractice claims were not related to tier. Conclusions: Current methods of physician tiering have low consistency and manifest evidence of geographic and demographic biases. PMID:20844163

  2. How does burnout affect physician productivity? A systematic literature review

    PubMed Central

    2014-01-01

    Background Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, “How does burnout affect physician productivity?” Methods A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used. Results The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between

  3. Unemployment and health: physicians' role.

    PubMed

    Guirguis, S S

    1999-01-01

    Unemployment has been documented to have detrimental impacts on a person's mental, physical and social well being. When unemployment or being out of work is due to injury or sickness, the effects are compounded by mental and social factors. In an effort to prevent prolonged unemployment due to injury or sickness, changes were made to existing disability income supplement plans to redirect their focus from basic income support to active employment measures. This is intended to reduce individual's dependency on financial assistance and encourage individuals to take personal responsibility for getting back to work. The various disability insurance plans require primary care physicians to provide opinion and participate in the recovery and safety return to work of injured or sick persons. The physician approach to medical care of the injured/sick person with employment problems should focus on return to work as a goal of treatment. The patient should be seen as part of a social or environmental system and not as an isolated individual. The physician has a significant role to play in the diagnosis, determining functional abilities and participation in the return to work plan. The physician positive participation, not only provides an intrinsic cost saving value in insurance costs, but more important, helps patients maintain gainful employment. Work often helps in regaining health. Many factors are involved in a return to work outcome and physicians need to know how to identify and track the factors that facilitate or impede return to work. The challenge for the physician is to utilize the available resources to facilitate the recovery and communicate with other parties involved in the return to work process. This paper discusses the disability insurance plans in Canada and the community expectations from physicians dealing with patients who are out of work because of injury or sickness. It is acknowledged that primary care physicians' skills are not adequate in this

  4. Prerequisite Change and Its Effect on Intermediate Accounting Performance

    ERIC Educational Resources Information Center

    Huang, Jiunn; O'Shaughnessy, John; Wagner, Robin

    2005-01-01

    As of Fall 1996, San Francisco State University changed its introductory financial accounting course to focus on a "user's" perspective, de-emphasizing the accounting cycle. Anticipating that these changes could impair subsequent performance, the Department of Accounting instituted a new prerequisite for intermediate accounting: Students would…

  5. First and foremost, physicians: the clinical versus leadership identities of physician leaders.

    PubMed

    Quinn, Joann Farrell; Perelli, Sheri

    2016-06-20

    Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer

  6. The Effect of Stylistic Changes on Item Performance.

    ERIC Educational Resources Information Center

    O'Neill, Kathleen A.

    When test questions are not intended to measure language skills, it is important to know if language is an extraneous characteristic that affects item performance. This study investigates whether certain stylistic changes in the way items are presented affect item performance on examinations for a health profession. The subjects were medical…

  7. Physician burnout: A neurologic crisis.

    PubMed

    Sigsbee, Bruce; Bernat, James L

    2014-12-01

    The prevalence of burnout is higher in physicians than in other professions and is especially high in neurologists. Physician burnout encompasses 3 domains: (1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalization: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value. Burnout results in reduced work hours, relocation, depression, and suicide. Burned-out physicians harm patients because they lack empathy and make errors. Studies of motivational factors in the workplace suggest several preventive interventions: (1) Provide counseling for physicians either individually or in groups with a goal of improving adaptive skills to the stress and rapid changes in the health care environment. (2) Identify and eliminate meaningless required hassle factors such as electronic health record "clicks" or insurance mandates. (3) Redesign practice to remove pressure to see patients in limited time slots and shift to team-based care. (4) Create a culture that promotes career advancement, mentoring, and recognition of accomplishments. PMID:25378679

  8. Physician-Assisted Suicide

    Cancer.gov

    Module fourteen of the EPEC-O Self-Study Original Version focuses on the skills that the physician can use to respond both compassionately and confidently to a request, not on the merits of arguments for or against legalizing physician-assisted suicide (PAS) or euthanasia.

  9. Negotiation for physicians.

    PubMed

    Hill, Micah J; DeCherney, Alan H

    2013-05-01

    Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools. PMID:23609153

  10. Physician drug dispensing.

    PubMed

    Lober, C W; Behlmer, S D; Penneys, N S; Shupack, J L; Thiers, B H

    1988-11-01

    We have reviewed the issue of physician drug dispensing by focusing upon quality of care, economic considerations, drug availability, patient compliance, safety, and increased governmental regulation. From a quality of care perspective, the increased use of pharmacist assistants, the tendency toward generic and therapeutic drug substitution, and the less specialized clinical education of pharmacists all pose hazards rather than safety checks upon physician prescribing. There is no evidence that pharmacists charge less than physicians. If they did, there would be no need to protect their incomes legislatively by restricting physician dispensing. Economic motivation per se is less important to a physician than providing a true convenience for his patients and thus encouraging a closer doctor-patient relationship. Physician dispensing adds to the availability of medication and may minimize the number of patients shuttling between pharmacies to obtain complex multi-ingredient preparations. Compliance is enhanced as availability increases. Prepackaged pharmaceuticals prepared under the auspices of pharmacists and dispensed by physicians are at least as safe as those prepared by the ungloved hands of a pharmacist hidden behind store counters. Thus, restricting the physician's right to dispense can negatively affect the quality of medical care, the cost of medications, safety, the availability of pharmaceuticals, and patient compliance. Such limitation is certainly not in the best interest of our patients. PMID:3056999

  11. Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study☆

    PubMed Central

    van Ryn, Michelle; Hardeman, Rachel R.; Phelan, Sean M.; Burke, Sara E.; Przedworski, Julia; Allen, Michele L.; Burgess, Diana J.; Ridgeway, Jennifer; White, Richard O.; Dovidio, John F.

    2014-01-01

    Objective Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students’ attitudes toward the value of physician empathy in clinical encounters. Methods First year students (n = 4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being. Results Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students’ attitudes toward the benefit of physician empathy in clinical encounters. Conclusion Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care. Practice implications Curricula in medical school promoting empathic care may be more universally effective if students’ preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students. PMID:25065328

  12. Hospitals focus on physician relations.

    PubMed

    Rubright, R

    1987-09-01

    Many hospital administrators are shifting their marketing focus from consumers and referral agents to the hospital's attending physicians. These new comprehensive physician relations or retention programs are much broader than those implemented in the past and are used to build mutual exchanges between hospitals and physicians, sharpen the physicians' awareness of the hospital's most appealing attributes, compete with nearby hospitals that develop their own aggressive physician relations programs, and ensure a more promising financial picture for both parties. "Cutting-edge" physician relations plans in Catholic hospitals include the following: Marketing plans for the medical staff alone or with key medical staff sections; A strong physician data base; A physician referral system; A director of medical affairs; Practice enhancement and business assistance services; A young physicians section; Continuing marketing auditing and research into physicians' opinions, attitudes, and behavior patterns; Physician inclusion in all major programs, services, policies, and events; Programs for physician office staff; Marketing committees consisting of physicians. PMID:10283486

  13. Providing capital for physician group practices: new opportunities for hospitals.

    PubMed

    Coddington, D C; Moore, K D; Clarke, R L

    1999-12-01

    As physician group practices grow and consolidate, they have an increasing interest in developing close capital partnerships to ensure access to capital. Yet as many healthcare organizations have sought to divest poorly performing acquired physician practices, physicians have seen their pool of potential capital partners shrink. Under these conditions, hospitals have a new opportunity to present themselves to physician group practices as attractive capital partners. To understand the nature of this opportunity, one needs to know why group practices seek capital, how groups approach their investment strategies, and what criteria they use to compare prospective capital partners. To build stronger relationships with physicians, hospitals should focus on turning around their poorly performing acquired physician practices and pursue strategies such as collaborating with physician practice management companies and developing new models for partnering with physicians (e.g., special purchase agreements and more advanced management services organizations). PMID:11066695

  14. Performing Environmental Change: MED Theatre and the Changing Face of Community-Based Performance Research

    ERIC Educational Resources Information Center

    Schaefer, Kerrie

    2012-01-01

    This article examines a programme of work produced by community-based theatre company, Manaton and East Dartmoor (MED) Theatre, addressing issues of climate change as they impact on life in rural Devon, UK. After some discussion of MED Theatre's constitution as a community-based company and the group's long-term engagement with the place, history,…

  15. Factors affecting the valuation of physician practices.

    PubMed

    Cleverley, W O

    1997-12-01

    Valuation of physician practices provides physicians with a benchmark of their business success and helps purchasers negotiate a purchase price. The Center for Healthcare Industry Performance Studies (CHIPS) recently conducted a survey of physician practice acquisitions. The survey collected data on salaries and benefits paid to physicians after practice acquisition, historical profitability of the acquired practice, and specific values assigned to both tangible and intangible assets in the practice. Some of the survey's critical conclusions include: hospitals tend to acquire unprofitable practices, value is based on historical revenues rather than historical profits, the importance of valuation methodology and payer mix is underestimated, tangible assets represent a large part of the purchase price, and hospitals tend to pay higher physician compensation than do other purchasers. PMID:10174788

  16. 42 CFR 412.46 - Medical review requirements: Physician acknowledgement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Medical review requirements: Physician... Capital-Related Costs § 412.46 Medical review requirements: Physician acknowledgement. (a) Basis. Because... diagnoses and major procedures performed, as evidenced by the physician's entries in the patient's...

  17. Ethics in the locker room: the challenges for team physicians.

    PubMed

    Salomon, Bonnie

    2002-01-01

    Team physicians act as occupational physicians in many traditional ways. However, they face unique ethical challenges when caring for athletes. Sports physicians must be cognizant of special aspects of the doctor-patient relationship, as well as issues related to informed consent, autonomy, and confidentiality. Conflicts of interest with players themselves, as well as with team management, are common. Team physicians must act professionally and maintain ethical principles, even in the high-pressure, high-performance world of athletics. PMID:12225938

  18. Performance enhancement of hermetic compressor using phase change materials

    NASA Astrophysics Data System (ADS)

    Mahmoud, I. M.; Rady, M. A.; Huzayyin, A. S.

    2015-08-01

    The present study is motivated by the need for the research of simple measures for increasing energy efficiency of hermetic compressor. The measure is the application of phase change materials for performance enhancement. The first experimental study should be guide for choice of PCM. It has been performed to investigate the effects of thermostat setting temperature on the performance of hermetic compressor. The effects of thermostat setting temperature with and without load on power consumption have been analyzed. Performance enhancement using phase change materials (PCMs) has been studied by employing a phase change material Rubitherm-42 (RT-42) on the top surface of compressor. Choice of PCM material is based on basic compressor performance measured in the first part of the present study. Experiments have been carried out for different load values and different quantities of PCM. The quantity and phase change characteristic of PCM are essential parameters that determine the percentage of performance enhancement in term of energy consumption. Reduction of energy consumption of about 10% has been achieved in the present study by using PCM. The present study shows that how to reduce the electrical power consumption to enhance compressor heat dissipation method to improve efficiency.

  19. Physician profiling: 12 critical points.

    PubMed

    Bell, K M

    1996-01-01

    Physician profilers encompass an array of technological products that purport to evaluate individual clinician performance on utilization and other measures. Prior to installation, an organization should be familiar with a number of major concepts that encompass understanding of clinical practice processes, claims data limitations and idiosyncrasies, ethical issues, and mathematical principles. Twelve specific elements are described to assure that these concepts are addressed. PMID:10154371

  20. Remembering More Jewish Physicians.

    PubMed

    Weisz, George M; Grzybowski, Andrzej

    2016-01-01

    The history of medicine has been an intriguing topic for both authors. The modern relevance of past discoveries led both authors to take a closer look at the lives and contributions of persecuted physicians. The Jewish physicians who died in the Holocaust stand out as a stark example of those who merit being remembered. Many made important contributions to medicine which remain relevant to this day. Hence, this paper reviews the lives and important contributions of two persecuted Jewish physicians: Arthur Kessler (1903-2000) and Bronislawa Fejgin (1883-1943). PMID:27487308

  1. [Which place for physicians in blood supply?].

    PubMed

    Danic, B; Pelletier, B

    2013-05-01

    Historically, blood transfusion has been divised, enhanced and organized by physicians. The special status of blood led to ensure that collection of blood and its components were placed under the supervision of a physician. Throughout its history, blood transfusion organization in France has established an exclusive exercise of the collection of blood and its components entrusted to doctors, thus creating the concept of "medicine of donation". This view is changing, and programmed exercise of this activity by nurses led to question about this profession perimeter, its necessary evolution, and finally about the place of physicians in blood supply. PMID:23537956

  2. Facilitating Physician Access to Medical Reference Information

    PubMed Central

    Bellman, Philip; Havens, Carol; Bertolucci, Ysabel; Streeter, Beth

    2005-01-01

    Context: Computer-based medical reference information is augmenting—and in some cases, replacing—many traditional sources. For Kaiser Permanente (KP) physicians, this change presents both advantages and obstacles to finding medical reference information. Objective: To improve understanding of physician information-seeking behavior and the barriers that limit use of both print-based and computer-based medical reference resources. Design: During 2002 and 2003, two quality-improvement surveys were distributed to full-time KP physicians. Survey instruments sent by conventional mail and by e-mail were based on results of telephone interviews and focus groups, and were designed to be concise and easy to use. Participant response rates exceeded 83%. Outcomes Measures: The surveys examined physician use of online medical reference information, medical libraries and services, self-directed learning resources, and continuing medical education (CME). Results: Of the physicians who responded to the survey, 89% used online resources frequently to enhance care, to inform clinical decisions, to update knowledge, to educate patients, or for a combination of these purposes. Compared with responses from older physicians, responses from younger physicians showed a greater proclivity for using nearly all types of online information. Most physicians obtained CME credits primarily through in-person education programs; few physicians used self-directed electronic learning tools. Obstacles to effective access to information included lack of time, overly complex access methods, and lack of awareness about available resources. Conclusions: A considerable gap exists between physicians' need for information and the resources currently available for delivering this information. Although we observed a clear shift from using printed medical references to using computer-based resources, many barriers prevent their effective use. Clinicians need easy-to-use, seamless systems of medical

  3. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

    PubMed

    Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

    2016-01-19

    Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care. PMID:26595370

  4. The Phoenix Physician: defining a pathway toward leadership in patient-centered care.

    PubMed

    Good, Robert G; Bulger, John B; Hasty, Robert T; Hubbard, Kevin P; Schwartz, Elliott R; Sutton, John R; Troutman, Monte E; Nelinson, Donald S

    2012-08-01

    Health care delivery has evolved in reaction to scientific and technological discoveries, emergent patient needs, and market forces. A current focus on patient-centered care has pointed to the need for the reallocation of resources to improve access to and delivery of efficient, cost-effective, quality care. In response to this need, primary care physicians will find themselves in a new role as team leader. The American College of Osteopathic Internists has developed the Phoenix Physician, a training program that will prepare primary care residents and practicing physicians for the changes in health care delivery and provide them with skills such as understanding the contributions of all team members (including an empowered and educated patient), evaluating and treating patients, and applying performance metrics and information technology to measure and improve patient care and satisfaction. Through the program, physicians will also develop personal leadership and communication skills. PMID:22904250

  5. Measuring Physician Quality and Efficiency in an Era of Practice Transformation: PCMH as a Case Study

    PubMed Central

    Sandy, Lewis G.; Haltson, Heidi; Metfessel, Brent A.; Reese, Conway

    2015-01-01

    Practicing physicians face myriad challenges as health care undergoes considerable transformation, including advancing efforts to measure and report on physician quality and efficiency, as well as the growth of new care models such as Accountable Care Organizations and patient-centered medical homes (PCMHs). How do these transformational forces relate to one another? How should practicing physicians focus and prioritize their improvement efforts? This Special Report examines how physicians’ performance on quality and efficiency measures may interact with delivery reforms, focusing on the PCMH. We note that although the PCMH is a promising model, published evidence is mixed. Using data and experience from a large commercial insurer’s performance transparency and PCMH programs, we further report that longitudinal analysis of UnitedHealthcare’s PCMH program experience has shown favorable changes; however, cross-sectional analysis indicates that National Committee for Quality Assurance’s PCMH designation is positively associated with achieving program Quality benchmarks, but negatively associated with program Efficiency benchmarks. This example illustrates some key issues for physicians in the current environment, and we provide suggestions for physicians and other stakeholders on understanding and acting on information from physician performance measurement programs. PMID:25964406

  6. Movement amplitude and tempo change in piano performance

    NASA Astrophysics Data System (ADS)

    Palmer, Caroline

    2001-05-01

    Music performance places stringent temporal and cognitive demands on individuals that should yield large speed/accuracy tradeoffs. Skilled piano performance, however, shows consistently high accuracy across a wide variety of rates. Movement amplitude may affect the speed/accuracy tradeoff, so that high accuracy can be obtained even at very fast tempi. The contribution of movement amplitude changes in rate (tempo) is investigated with motion capture. Cameras recorded pianists with passive markers on hands and fingers, who performed on an electronic (MIDI) keyboard. Pianists performed short melodies at faster and faster tempi until they made errors (altering the speed/accuracy function). Variability of finger movements in the three motion planes indicated most change in the plane perpendicular to the keyboard across tempi. Surprisingly, peak amplitudes of motion before striking the keys increased as tempo increased. Increased movement amplitudes at faster rates may reduce or compensate for speed/accuracy tradeoffs. [Work supported by Canada Research Chairs program, HIMH R01 45764.

  7. Ensuring Competent Care by Senior Physicians.

    PubMed

    Hawkins, Richard E; Welcher, Catherine M; Stagg Elliott, Victoria; Pieters, Richard S; Puscas, Liana; Wick, Paul H

    2016-01-01

    The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have initiated age-based screening, but there is no agreed upon assessment process. Licensing and certifying organizations generally do not require that senior physicians pass additional assessments of health, competency, or quality performance. Studies suggest that physician performance, on average, declines with increasing years in medical practice, but the effect of age on an individual physician's competence is highly variable. Many senior physicians practice effectively and should be allowed to remain in practice as long as quality and safety are not endangered. Stakeholders in the medical profession should consider the need to develop guidelines and methods for monitoring and/or screening to ensure that senior physicians provide safe and effective care for patients. Any screening process needs to achieve a balance between protecting patients from harm due to substandard practice, while at the same time ensuring fairness to physicians and avoiding unnecessary reductions in workforce. PMID:27584000

  8. Physician Assistant profession (PA)

    MedlinePlus

    ... provide health care services under the direction and supervision of a doctor of medicine (MD) or a ... location as the PA. Most states allow physician supervision by telephone communication with periodic site visits. Supervising ...

  9. Find an ACFAS Physician

    MedlinePlus

    ... Search Text Size Print Bookmark Find an ACFAS Physician Acceptance Policy By clicking on the "I Accept" ... Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Dem People's Rep Korea, Rebublic Of Kuwait Kyrgyzstan ...

  10. American College of Physicians

    MedlinePlus

    ... Health Policy Advocacy in Action Current Public Policy Papers ACP Policies & Recommendations Store Membership Benefits for Physicians ... Health Policy Advocacy in Action Current Public Policy Papers ACP Policies & Recommendations Store Search Google Appliance Enter ...

  11. Education and the physician's office laboratory.

    PubMed

    Fischer, P M; Addison, L A; Koneman, E W; Crowley, J

    1986-03-21

    The field of physicians' office laboratory testing has witnessed an increase in test volume and advances in technology, but little attention to educational issues. If this field is to continue to grow and to perform high-quality testing, primary care physicians will need to be trained in the role of laboratory director. Office staff will require "in the office" continuing education. Formal technician and technologist training will need to focus some attention on office test procedures. The development of these new educational programs will require the cooperative efforts of primary care physician educators, pathologists, allied health faculty, and the diagnostic equipment industry. PMID:3951080

  12. Alzheimer's disease. Physician-patient communication.

    PubMed Central

    Orange, J. B.; Molloy, D. W.; Lever, J. A.; Darzins, P.; Ganesan, C. R.

    1994-01-01

    The number of cognitively impaired elderly in Canada has increased greatly during the past two decades; nearly all have Alzheimer's disease (AD). The memory problems and changes in language and communication of these patients place tremendous strain on physicians who are searching for a differential diagnosis and are trying to communicate with them. Reviewing the salient language and communication features of AD patients leads to strategies for improving effective physician-patient communication. PMID:8019193

  13. Physiological Factors Contributing to Postflight Changes in Functional Performance

    NASA Technical Reports Server (NTRS)

    Bloomberg, J. J.; Feedback, D. L.; Feiverson, A. H.; Lee, S. M. C.; Mulavara, A. P.; Peters, B. T.; Platts, S. H.; Reschke, M. F.; Ryder, J.; Spiering, B. A.; Stenger, M. B.; Wood, S.; Lawrence, E.; Arzeno, N.

    2009-01-01

    Astronauts experience alterations in multiple physiological systems due to exposure to the microgravity conditions of space flight. These physiological changes include sensorimotor disturbances, cardiovascular deconditioning and loss of muscle mass and strength. These changes might affect the ability of crewmembers to perform critical mission tasks immediately after landing on lunar and Martian surfaces. To date, changes in functional performance have not been systematically studied or correlated with physiological changes. To understand how changes in physiological function impact functional performance an interdisciplinary pre/postflight testing regimen (Functional Task Test, FTT) has been developed that systematically evaluates both astronaut postflight functional performance and related physiological changes. The overall objectives of the FTT are to: Develop a set of functional tasks that represent critical mission tasks for Constellation. Determine the ability to perform these tasks after flight. Identify the key physiological factors that contribute to functional decrements. Use this information to develop targeted countermeasures. The functional test battery was designed to address high priority tasks identified by the Constellation program as critical for mission success. The set of functional tests making up the FTT include the: 1) Seat Egress and Walk Test, 2) Ladder Climb Test, 3) Recovery from Fall/Stand Test, 4) Rock Translation Test, 5) Jump Down Test, 6) Torque Generation Test, and 7) Construction Activity Board Test. Corresponding physiological measures include assessments of postural and gait control, dynamic visual acuity, fine motor control, plasma volume, orthostatic intolerance, upper and lower body muscle strength, power, fatigue, control and neuromuscular drive. Crewmembers will perform both functional and physiological tests before and after short (Shuttle) and long-duration (ISS) space flight. Data will be collected on R+0 (Shuttle only), R

  14. How Physicians Integrate Advances into Clinical Practices.

    ERIC Educational Resources Information Center

    Lockyer, Jocelyn M.; And Others

    1985-01-01

    Family physicians and specialists were asked to identify the sources of information they used in the process of making changes in their clinical practices. An average of 3.08 sources of information were utilized for each change and over 50 percent of the changes were complete in less than one year. (CT)

  15. Role Involvement: Changes During Assimilation and Relationships with Job Performance.

    ERIC Educational Resources Information Center

    Hazer, John T.

    The primary purpose of this study was to determine whether perceptions of role involvement by police patrolmen were significantly related to either future or concurrent job performance. A secondary objective was to analyze changes in the perceived role involvement of new patrolmen during their assimilation into a police organization. The perceived…

  16. Medicare physician payment rules for 2011: a primer for the neurointerventionalist.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2011-12-01

    Physicians generally have been affected by significant changes in the patterns of medical practice evolving over the past several decades. The Patient Protection and Affordable Care Act of 2010, also called ACA for short, impacts physician professional practice dramatically. Physicians are paid in the USA for their personal services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula based payment, mostly based on the Medicare payment system. Physician services are billed under part B. The Neurointerventional practice is typically performed in a hospital setting. The VA system is a frequently cited successful implementation of a government supported health care program. Availability of neurointerventional services at many VA medical centers is limited. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in medical economic index. The involvement of medical economic index failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician's charges, which also failed to curb the growth in spending. Thus, in 1998, the sustainable growth rate system was introduced. In 2009, multiple unsuccessful attempts were made by Congress to repeal the formula. The mechanism of the sustainable growth rate includes three components that are incorporated into a statutory formula: expenditure targets, growth rate period and annual adjustments of payment rates for physician services. PMID:21990479

  17. Medicare physician payment rules for 2011: a primer for the neurointerventionalist.

    PubMed

    Manchikanti, L; Hirsch, J A

    2011-01-01

    Physicians generally have been affected by significant changes in the patterns of medical practice evolving over the past several decades. The Patient Protection and Affordable Care Act of 2010, also called ACA for short, impacts physician professional practice dramatically. Physicians are paid in the USA for their personal services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula based payment, mostly based on the Medicare payment system. Physician services are billed under part B. The Neurointerventional practice is typically performed in a hospital setting. The VA system is a frequently cited successful implementation of a government supported health care program. Availability of neurointerventional services at many VA medical centers is limited. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in medical economic index. The involvement of medical economic index failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician's charges, which also failed to curb the growth in spending. Thus, in 1998, the sustainable growth rate system was introduced. In 2009, multiple unsuccessful attempts were made by Congress to repeal the formula. The mechanism of the sustainable growth rate includes three components that are incorporated into a statutory formula: expenditure targets, growth rate period and annual adjustments of payment rates for physician services. PMID:21670102

  18. Losing ground: physician income, 1995-2003.

    PubMed

    Tu, Ha T; Ginsburg, Paul B

    2006-06-01

    Between 1995 and 2003, average physician net income from the practice of medicine declined about 7 percent after adjusting for inflation, according to a national study from the Center for Studying Health System Change (HSC). The decline in physicians' real income stands in sharp contrast to the wage trends for other professionals who saw about a 7 percent increase after adjusting for inflation during the same period. Among different types of physicians, primary care physicians fared the worst with a 10.2 percent decline in real income between 1995 and 2003, while surgeons' real income declined by 8.2 percent. But medical specialists' real income essentially remained unchanged. Physicians reported working slightly fewer hours overall but spent more time on direct patient care. Flat or declining fees from both public and private payers appear to be a major factor underlying declining real incomes for physicians. The downward trend in real incomes since the mid-1990s likely is an important reason for growing physician unwillingness to undertake pro bono work, including charity care and volunteering to serve on hospital committees. PMID:16791996

  19. Health Care Workplace Discrimination and Physician Turnover

    PubMed Central

    Nunez-Smith, Marcella; Pilgrim, Nanlesta; Wynia, Matthew; Desai, Mayur M.; Bright, Cedric; Krumholz, Harlan M.; Bradley, Elizabeth H.

    2013-01-01

    Objective To examine the association between physician race/ethnicity, workplace discrimination, and physician job turnover. Methods Cross-sectional, national survey conducted in 2006–2007 of practicing physicians [n = 529] randomly identified via the American Medical Association Masterfile and The National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and χ2 statistics, and multivariate logistic regression modeling to evaluate these associations. Results Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover [adjusted odes ratio, 2.7; 95% CI, 1.4–4.9]. Among physicians who experienced work-place discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value < .01], and 40% were con-templating a career change (vs 10% among those who had not experienced workplace discrimination, p value < .001). Conclusion Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist. PMID:20070016

  20. An analysis of China's physician salary payment system.

    PubMed

    Ran, Li-mei; Luo, Kai-jian; Wu, Yun-cheng; Yao, Lan; Feng, You-mei

    2013-04-01

    Physician payment system (PPS) is a principal incentive system to motivate doctors to provide excellent care for patients. During the past decade, physician remuneration in China has not been in proportional to physician's average work load and massive responsibilities. This paper reviewed the constitution of the PPS in China, and further discussed the problems and issues to be addressed with respect to pay for performance. Our study indicated that the lower basic salary and bonus distribution tied to "profits" was the major contributor to the physician's profit-driven incentive and the potential cause for the speedy growth of health expenditures. We recommend that government funding to hospitals should be increased to fully cover physicians' basic salary, a flexible human resource and talent management mechanism needs to be established that severs personal interest between physicians and hospitals, and modern performance assessment and multiplexed payment systems should be piloted to encourage physicians to get the more legitimate compensation. PMID:23592149

  1. Physician, heal thyself

    PubMed Central

    Blais, Régis; Safianyk, Catherine; Magnan, Anne; Lapierre, André

    2010-01-01

    ABSTRACT OBJECTIVE To document the opinions of the users of the Quebec Physicians Health Program (QPHP) about the services they received. DESIGN Mailed questionnaire. SETTING Quebec. PARTICIPANTS A total of 126 physicians who used QPHP services between 1999 and 2004. MAIN OUTCOME MEASURES Users’ overall rating of the QPHP services, their opinions about the program, and whether their situations improved as a result of accessing QPHP services. RESULTS Ninety-two of the 126 physicians surveyed returned their completed questionnaires, providing a response rate of 73%. Most respondents thought that the QPHP services were good or excellent (90%), most would use the program again (86%) or recommend it (96%), and most thought the Quebec physician associations and the Collège des médecins du Québec should continue funding the QPHP (97%). Most respondents thought the service confidentiality was excellent (84%), as was staff professionalism (82%), and 62% thought the quality of the services they were referred to was excellent. However, only 57% believed their situations had improved with the help of the QPHP. CONCLUSION The QPHP received good marks from its users. Given the effects of physician burnout on patients and on the health care system, it is not only a personal problem, but also a collective problem. Thus, actions are needed not only to set up programs like the QPHP for those suffering from burnout, but also to prevent these types of problems. Because family physicians are likely to be the first ones consulted by their physician patients in distress, they play a key role in acknowledging these problems and referring those colleagues to the appropriate help programs when needed. PMID:20944027

  2. [Physician practice patterns and attitudes to euthanasia in Germany. A representative survey of physicians].

    PubMed

    Kirschner, R; Elkeles, T

    1998-04-01

    Growing life expectancy and increasing pharmaceutical and technical methods in medicine are leading to more and more discussions among the general population and among physicians as to whether methods to shorten the sufferings of mortally ill persons should be legalised further. In Australia 60% of physicians wish to be able to perform active euthanasia if this would be legal. In the Netherlands physicians do not commit an offence if they perform euthanasia on the basis of ethically consented rules. In the FRG the National Board of Physicians (Bundesärztekammer) still rejects any liberalisation concerning active euthanasia. However, little is known of the attitudes and behaviour of physicians concerning the questions of active and passive euthanasia. Sponsored by Gruner and Jahr publishers for a magazine "Stern" publication we conducted a representative study among physicians working in hospitals and their colleagues in free practices concerning this topic. Beginning with qualitative interviews with 50 physicians we tested the questionnaire developed and looked for the data production method best fitting for this difficult matter resulting in telephone interviews or a self-administered questionnaire. In the main study a representative sample of n = 282 physicians in free practices and n = 191 physicians in hospitals were interviewed. The response rates were 94% and 51% respectively. Analysis of non-responses did not indicate any bias. Half of the physicians think that a broader discussion on euthanasia is necessary, 34% disagree and 17% consider even a discussion already dangerous. 6% of the physicians in hospitals and 11% in free practices have already experienced methods of active euthanasia. Half of the physicians have seen patients who strongly wished euthanasia, a situation which happens once in every two years. The majority of physicians feel a deep understanding but only a minority of 4% comply with the wish. The vast majority of physicians advocate

  3. Physician uncertainty and the art of persuasion.

    PubMed

    Rizzo, J A

    1993-12-01

    Incomplete information is a chronic feature of medica markets. Much attention has focused on information asymmetries between physicians and their patients. In contrast, physician uncertainty has received far less attention. This is a significant omission. Physician uncertainty may be an even more important reason than consumer uncertainty for the high cost of health care. This paper reviews and evaluates major approaches for managing physician uncertainty. We argue that quantitative approaches alone, such as scientific advancement and the application of decision analysis to clinical reasoning, are insufficient for dealing with uncertainty. Qualitative approaches, such as forging consensus through expert panels, and teaching physicians to accept and cope with uncertainty, will play a valuable role in promoting more effective clinical decision-making under conditions of uncertainty. The current tensions between those who would eradicate physician uncertainty through quantitative approaches and those who favor qualitative methods has parallels in many other fields, including economics and mathematics. These tensions are unfortunate, since the most promising initiative to promote better clinical decision-making will likely need to draw upon both approaches. The recent initiative to implement medical practice guidelines is one example of a broad-based approach to improve clinical decision-making. Guidelines draw upon available scientific evidence, but typically involve consensus-building as well. They seek to persuade and educate physicians about appropriate treatments, without mandating changes in physician treatment patterns. Given the persistent uncertainties physicians will undoubtedly confront regarding appropriate clinical decision-making, this flexible approach may be the best way to mitigate market failures resulting from inappropriate clinical decisions.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8303329

  4. Physician outcome measurement: review and proposed model.

    PubMed

    Siha, S

    1998-01-01

    As health care moves from a free-for-service environment to a capitated arena, outcome measurements must change. ABC Children's Medical Center is challenged with developing comprehensive outcome measures for an employed physician group. An extensive literature review validates that physician outcomes must move beyond revenue production and measure all aspects of care delivery. The proposed measurement model for this physician group is a trilogy model. It includes measures of cost, quality, and service. While these measures can be examined separately, it is imperative to understand their integration in determining an organization's competitive advantage. The recommended measurements for the physician group must be consistent with the overall organizational goals. The long-term impact will be better utilization of resources. This will result in the most cost effective, quality care for the health care consumer. PMID:10339092

  5. [Sponsoring of physicians in private practice].

    PubMed

    Rieger, Hans-Jürgen

    2005-04-01

    The financing of advanced medical training for physicians by the pharmaceutical industry has been the subject of legal discussions for more than two decades. Recent legal changes have renewed the importance of industry sponsoring. At the 106th national convention of the German physicians, the model ordinance for the German medical profession ("Musterberufsordnung für die deutschen Arztinnen und Arzte-MBO-A") has been reformed, and for the first time individual physicians are now permitted, under certain circumstances, to receive financial support from sponsors to participate in medical-training events. A recent legal reform to modernize the healthcare system ("GKV-Modernisierungsgesetz"--GMG) obliges physicians to observe the law that regulates advertising of medicinal products ("Heilmittelwerbegesetz"--HWG); consequently, the physicians can commit a misdemeanor when accepting prohibited financial support. This essay discusses the implications of this legal reform for the most important types of commercially-sponsored medical training. The GMG reform has introduced an obligation for physicians to absolve continuous medical training, however the resulting legal situation has not changed the requirement that this training remain free of commercial interests. PMID:15957664

  6. Case study of physician leaders in quality and patient safety, and the development of a physician leadership network.

    PubMed

    Hayes, Chris; Yousefi, Vandad; Wallington, Tamara; Ginzburg, Amir

    2010-01-01

    There is increasing recognition of the need for physician leadership in quality and patient safety, and emerging evidence that physician leadership contributes to improved care. Hospitals are beginning to establish physician leader positions; however, there is little guidance on how to define these roles and the strategies physician leaders can use toward improving care. This case study examines the roles of four physician leaders, describes their contribution to the design and implementation of hospital quality and patient safety agendas and discusses the creation of a physician network to support these activities. The positions were established between July 2006 and April 2009. All are corporate roles with varying reporting and accountability structures. The physician leads are involved in strategic planning, identifying and leading quality and safety initiatives, physician engagement and culture change. All have significantly contributed to the implementation of hospital improvement activities and are seen as influential among their peers as resources and mentors for local project success. Despite their accomplishments, these physician leads have been challenged by ambiguous role descriptions and difficulty identifying effective improvement strategies. As such, an expanding physician network was created with the goal of sharing approaches and tools and creating new strategies. Physician leaders are an important factor in the improvement of safety and quality within hospitals. This case study provides a template for the creation of such positions and highlights the importance of networking as an effective strategy for improving local care and advancing professional development of physician leaders in quality and patient safety. PMID:20959733

  7. Flexible shift scheduling of physicians.

    PubMed

    Brunner, Jens O; Bard, Jonathan F; Kolisch, Rainer

    2009-09-01

    This research addresses a shift scheduling problem in which physicians at a German university hospital are assigned to demand periods over a planning horizon that can extend up to several weeks. When performing the scheduling it is necessary to take into account a variety of legal and institutional constraints that are imposed by a national labor agreement, which governs all physicians in German university hospitals. Currently, most medical departments develop their staff schedules manually at great cost and time. To solve the problem, a new modeling approach is developed that requires shifts to be generated implicitly. Rather than beginning with a predetermined number of shift types and start times, shifts are allowed to start at every pre-defined period in the planning horizon and extend up to 13 h with an hour-long break included. The objective is to find an assignment such that the total hours that have to be paid out as overtime are minimal under the restrictions given by the labor agreement. The problem is formulated as a mixed-integer program and solved with CPLEX. During the solution process individual lines-of-work are constructed for each physician. Using data from an anesthesia department, computational results indicate that high quality schedules can be obtained much more quickly than by current practice. PMID:19739361

  8. Family physician perceptions of working with LGBTQ patients: physician training needs

    PubMed Central

    Beagan, Brenda; Fredericks, Erin; Bryson, Mary

    2015-01-01

    Background Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. Method In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Results Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women. PMID:26451226

  9. Determinants of physicians' prescribing behaviour of methylphenidate for cognitive enhancement.

    PubMed

    Ponnet, Koen; Wouters, Edwin; Van Hal, Guido; Heirman, Wannes; Walrave, Michel

    2014-01-01

    The non-medical use of methylphenidate for cognitive enhancement becomes a more and more common practice among college and university students. Although physicians are a source of access, little is known about the underlying mechanisms that might lead to physicians' intention and behaviour of prescribing methylphenidate to improve students' academic performance. Applying Ajzen's theory of planned behaviour (TPB), we tested whether attitudes, subjective norms (controllability and self-efficacy) and perceived behavioural control predicted the intention and the prescribing behaviour of physicians. Participants were 130 physicians (62.3% males). Structural equation modelling was used to test the ability of TPB to predict physicians' behaviour. Overall, the present study provides support for the TPB in predicting physicians' prescribing behaviour of methylphenidate for cognitive enhancement. Subjective norms, followed by attitudes, are the strongest predictors of physicians' intention to prescribe methylphenidate. To a lesser extent, controllability predicts the intention of physicians, and self-efficacy predicts the self-reported behaviour. Compared to their male colleagues, female physicians seem to have more negative attitudes towards prescribing methylphenidate for cognitive enhancement, feel less social pressure and perceive more control over their behaviour. Intervention programmes that want to decrease physicians' intention to prescribe methylphenidate for improving academic performance should primarily focus on alleviating the perceived social pressure to prescribe methylphenidate and on converting physician neutral or positive attitudes towards prescribing methylphenidate into negative attitudes. PMID:23713799

  10. Physician health and wellness.

    PubMed

    McClafferty, Hilary; Brown, Oscar W

    2014-10-01

    Physician health and wellness is a critical issue gaining national attention because of the high prevalence of physician burnout. Pediatricians and pediatric trainees experience burnout at levels equivalent to other medical specialties, highlighting a need for more effective efforts to promote health and well-being in the pediatric community. This report will provide an overview of physician burnout, an update on work in the field of preventive physician health and wellness, and a discussion of emerging initiatives that have potential to promote health at all levels of pediatric training. Pediatricians are uniquely positioned to lead this movement nationally, in part because of the emphasis placed on wellness in the Pediatric Milestone Project, a joint collaboration between the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Updated core competencies calling for a balanced approach to health, including focus on nutrition, exercise, mindfulness, and effective stress management, signal a paradigm shift and send the message that it is time for pediatricians to cultivate a culture of wellness better aligned with their responsibilities as role models and congruent with advances in pediatric training. Rather than reviewing programs in place to address substance abuse and other serious conditions in distressed physicians, this article focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Examples of positive progress and several programs designed to promote physician health and wellness are reviewed. Areas where more research is needed are highlighted. PMID:25266440

  11. Involving and educating base station physicians in paramedic programs.

    PubMed

    Cooper, M A; Ornato, J P

    1980-10-01

    There is often misunderstanding and conflict between the emergency physician and paramedic team, particularly as a new system is being implemented. This paper outlines a four-pronged approach to reduce this conflict: 1) community physician involvement in protocol development by means of a Paramedic Policy and Procedures Committee; 2) clinical training of paramedics in community hospitals; 3) involvement of community physicians in primary training and by riding rescue squads; and 4) formulation of a base station physician course to familiarize physicians with radio technique, system operation, and paramedic field work. An outline of the base station physician course is given and discussed. The reactions and outcome of the course and the positive changes it made in both physician and paramedic attitudes are discussed. PMID:7425406

  12. Leasing physician office space.

    PubMed

    Murray, Charles

    2009-01-01

    When leasing office space, physicians should determine the effective lease rate (ELR) for each building they are considering before making a selection. The ELR is based on a number of factors, including building quality, building location, basic form of lease agreement, rent escalators and add-on factors in the lease, tenant improvement allowance, method of square footage measurement, quality of building management, and other variables. The ELR enables prospective physician tenants to accurately compare lease rates being quoted by building owners and to make leasing decisions based on objective criteria. PMID:19743715

  13. Wanted: Well-Rounded Physicians.

    PubMed

    Sorrel, Amy Lynn

    2015-10-01

    The Association of American Medical Colleges has revamped the MCAT for the first time in nearly three decades. While the new exam retains the science-based testing historically included, it adds new topics and approaches meant to keep up with a rapidly changing health care delivery system. It aims to test and train aspiring physicians based less on memorizing scientific facts and more on competency: putting that scientific knowledge into practice. Questions on the new MCAT pertain to concepts such as self-identity, social stratification, and multiculturalism and ask students to apply them to certain scenarios. PMID:26457841

  14. Estimating endogenous changes in task performance from EEG

    PubMed Central

    Touryan, Jon; Apker, Gregory; Lance, Brent J.; Kerick, Scott E.; Ries, Anthony J.; McDowell, Kaleb

    2014-01-01

    Brain wave activity is known to correlate with decrements in behavioral performance as individuals enter states of fatigue, boredom, or low alertness.Many BCI technologies are adversely affected by these changes in user state, limiting their application and constraining their use to relatively short temporal epochs where behavioral performance is likely to be stable. Incorporating a passive BCI that detects when the user is performing poorly at a primary task, and adapts accordingly may prove to increase overall user performance. Here, we explore the potential for extending an established method to generate continuous estimates of behavioral performance from ongoing neural activity; evaluating the extended method by applying it to the original task domain, simulated driving; and generalizing the method by applying it to a BCI-relevant perceptual discrimination task. Specifically, we used EEG log power spectra and sequential forward floating selection (SFFS) to estimate endogenous changes in behavior in both a simulated driving task and a perceptual discrimination task. For the driving task the average correlation coefficient between the actual and estimated lane deviation was 0.37 ± 0.22 (μ ± σ). For the perceptual discrimination task we generated estimates of accuracy, reaction time, and button press duration for each participant. The correlation coefficients between the actual and estimated behavior were similar for these three metrics (accuracy = 0.25 ± 0.37, reaction time = 0.33 ± 0.23, button press duration = 0.36 ± 0.30). These findings illustrate the potential for modeling time-on-task decrements in performance from concurrent measures of neural activity. PMID:24994968

  15. Black physicians and the struggle for civil rights: lessons from the Mississippi experience: part 1: the forces for and against change.

    PubMed

    deShazo, Richard D; Smith, Robert; Skipworth, Leigh Baldwin

    2014-10-01

    The roles of black physicians in the South in the period leading up to the Civil Rights Act of 1964 and the Voting Rights Act of 1965 have not been fully disclosed. In Mississippi and elsewhere in the South, it is a story of disenfranchised professionals who risked life, limb, and personal success to improve the lot of those they served. This first of 2 articles on the subject provides an overview of the forces for and against the struggle for civil rights and social justice in medicine in the South. We use newly available data from Mississippi as a prime example. An understanding of these forces is essential to an understanding of medical education and medical practice in this period and helps explain why the South remains in last place in most indicators of health today. PMID:24941459

  16. Changes in cognitive task performance across the menstrual cycle.

    PubMed

    Broverman, D M; Vogel, W; Klaiber, E L; Majcher, D; Shea, D; Paul, V

    1981-08-01

    Menstrual-cycle-related changes in estrogen were expected to differentially affect various cognitive tests. Specifically, the estrogen peak occurring at midcycle in ovulatory women was expected to facilitate performance of highly practiced "automatized" tasks and to impair performance of "perceptual-restructuring" tasks, compared with performance of these tasks in the postovulatory phase of the cycle when progesterone is thought to counteract the action of estrogen. Perceptual-restructuring tasks are defined as tasks in which the initial percepts to obvious stimulus attributes are wrong and must be set aside in favor of percepts to less obvious stimulus attributes. Eight-seven regularly menstruating undergraduate women were studied. Odd-numbered subjects were tested first on or about Day 10 of their cycle and then again on Day 20; even-numbered subjects, in the reverse sequence. Daily basal body temperature records were obtained. These temperature records suggested that 21, or 24%, of the subjects did not ovulate in the cycle(s) studied. No main effect of Day 10 versus Day 20 occurred for any task in the 66 women who did appear to ovulate. However, the magnitude of predicted shifts in performance was significantly correlated with proximity of the "Day 10" testing day to the thermal nadir of the basal body temperature record, the presumed preovulatory estrogen peak; and to the "Day 20" proximity to the basal body temperature thermal peak, the presumed progesterone peak. Subjects tested 3 or fewer days before the thermal nadir and on or after the thermal peak had the predicted significant changes on three of the four administered tasks. No other temporally defined group produced significant changes. The results of the study support the experimental hypotheses and also indicate that precise timing is essential to demonstrate the phenomena. PMID:7276285

  17. The Value of Physician Leaders to Nonphysician Coworkers.

    PubMed

    Lazarus, Arthur

    2015-01-01

    With few exceptions, physician leaders are perceived as valuable to their organizations, helping to define goals, set priorities, and plan future direction. In some cases, however, physician leaders are misunderstood or devalued by senior business leaders. There could be several reasons for this observation: (1) the roles and responsibilities of physician leaders may be unclear to business leaders; (2) nonmedical leaders may question the business relevance of the activities performed by physician leaders; and (3) some business executives may believe (erroneously) that the activities performed by physician leaders are nonessential, or could be performed equally well by lesser trained healthcare professionals. Under such circumstances, physicians may become demoralized and indignant, but they should never lose sight of their importance to the everyday coworkers who are the most valuable asset of any organization. PMID:26223099

  18. [The physician in the Greek city].

    PubMed

    Koelbing, H M

    1989-01-01

    In the cities of ancient Greece, as well as later in Rome, the doctor's responsibility was already a controversial subject. The practice of healing was not subject to any official regulation: no protection of good physicians, no punishment of malpractice. While physicians often lead an itinerant life, cities endeavoured to secure the presence of a good one by appointing him town or public physician on the basis of a one-year contract. This did not mean, however, a "health service" free of charge for patients. The variety of healing persons including midwives and medicals slaves is reviewed. Some short texts which were added in later times to the "Works of Hippocrates" ("Physician", "Precepts", "Decorum") provide us with some information on a physician's daily life (see also H.M. Koelbing, The Hippocratic physician at his patient's bedside, in Practitioner 224, 1980, 551-554). From Hippocrates ("Prognostic") to the hellenistic period ("Decorum"), we note an important change as to the revelation of a bad prognosis: Hippocrates advocates the blunt information of the patient when there is no hope for him; but his follower in a later century takes into consideration the patient's psychology. He hides the cruel truth from him while informing openly his relatives and near friends. This is the first time in history we come across the principle of the doctor's double truth, strongly, advocated e.g. by Thomas Percival in his "Medical Ethics" (1803), but much disputed today. PMID:2673940

  19. Physicians and Insider Trading.

    PubMed

    Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven

    2015-12-01

    Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information. PMID:26457747

  20. Counties Without a Physician.

    ERIC Educational Resources Information Center

    Getz, Virginia

    1982-01-01

    Uses a budgeting technique to determine if free-market incentives or forces would provide an economic base sufficient to support medical professionals who might practice in the approximately 140 U.S. counties that lack a physician (located mainly in a narrow band from west Texas north through South Dakota). (AH)

  1. Hitler's Jewish Physicians.

    PubMed

    Weisz, George M

    2014-07-01

    The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler. PMID:25120923

  2. Information for Travellers' Physicians

    PubMed Central

    Allison, David J.; Blinco, Kimberley

    1990-01-01

    Physicians can obtain advice about international travel for their patients from many different sources of information. The authors review some of the most common sources based on their experience at the International Travellers' Clinic operated by the New Brunswick Department of Health and Community Services in Fredericton. They identify readily available handbooks and periodicals and compare two computer software programs. PMID:21233910

  3. Developing physician leaders in academic medical centers.

    PubMed

    Bachrach, D J

    1997-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.* PMID:10164266

  4. Longevity of Thai physicians.

    PubMed

    Sithisarankul, Pornchai; Piyasing, Veera; Boontheaim, Benjaporn; Ratanamongkolgul, Suthee; Wattanasirichaigoon, Somkiat

    2004-10-01

    The objectives of this study were to explore characteristics of the long-lived Thai physicians. We sent 983 posted questionnaires to 840 male and 143 female physicians. We obtained 327 of them back after 2 rounds of mailing, yielding a response rate of 33.3 percents. The response rate of male physicians was 32.4 percents and that of female physicians was 38.5 percents. Their ages were between 68-93 years (75.1 +/- 4.86 years on average). The majority were married, implying that their spouses were also long-lived. Around half of them still did some clinical work, one-fourth did some charity work, one-fourth did various voluntary works, one-fifth did some business, one-fifth did some academic work, and some did more than one type of work. Most long-lived physicians were not obese, with BMI of 16.53-34.16 (average 23.97 +/- 2.80). Only 8 had BMI higher than 30. BMIs were not different between male and female physicians. However, four-fifths of them had diseases that required treatment, and some of them had more than one disease. The five most frequent diseases were hypertension, diabetes, ischemic heart disease, dyslipidemia, and benign prostate hypertrophy, respectively. Most long-lived physicians did exercise (87.8%), and some did more than one method. The most frequent one was walking (52.3%). Most did not drink alcohol or drank occasionally, only 9.0% drank regularly. Most of them slept 3-9 hours per night (average 6.75 +/- 1.06). Most (78.3%) took some medication regularly; of most were medicine for their diseases. Most did not eat macrobiotic food, vegetarian food, or fast food regularly. Most long-lived physicians practiced some religious activities by praying, paying respect to Buddha, giving food to monks, practicing meditation, and listening to monks' teaching. They also used Buddhist practice and guidelines for their daily living and work, and also recommended these to their younger colleagues. Their recreational activities were playing musical instruments

  5. Reservoir performance under uncertainty in hydrologic impacts of climate change

    NASA Astrophysics Data System (ADS)

    Raje, Deepashree; Mujumdar, P. P.

    2010-03-01

    Relatively few studies have addressed water management and adaptation measures in the face of changing water balances due to climate change. The current work studies climate change impact on a multipurpose reservoir performance and derives adaptive policies for possible future scenarios. The method developed in this work is illustrated with a case study of Hirakud reservoir on the Mahanadi river in Orissa, India, which is a multipurpose reservoir serving flood control, irrigation and power generation. Climate change effects on annual hydropower generation and four performance indices (reliability with respect to three reservoir functions, viz. hydropower, irrigation and flood control, resiliency, vulnerability and deficit ratio with respect to hydropower) are studied. Outputs from three general circulation models (GCMs) for three scenarios each are downscaled to monsoon streamflow in the Mahanadi river for two future time slices, 2045-65 and 2075-95. Increased irrigation demands, rule curves dictated by increased need for flood storage and downscaled projections of streamflow from the ensemble of GCMs and scenarios are used for projecting future hydrologic scenarios. It is seen that hydropower generation and reliability with respect to hydropower and irrigation are likely to show a decrease in future in most scenarios, whereas the deficit ratio and vulnerability are likely to increase as a result of climate change if the standard operating policy (SOP) using current rule curves for flood protection is employed. An optimal monthly operating policy is then derived using stochastic dynamic programming (SDP) as an adaptive policy for mitigating impacts of climate change on reservoir operation. The objective of this policy is to maximize reliabilities with respect to multiple reservoir functions of hydropower, irrigation and flood control. In variations to this adaptive policy, increasingly more weightage is given to the purpose of maximizing reliability with respect to

  6. Using Item Response Theory to Assess Changes in Student Performance Based on Changes in Question Wording

    ERIC Educational Resources Information Center

    Schurmeier, Kimberly D.; Atwood, Charles H.; Shepler, Carrie G.; Lautenschlager, Gary J.

    2010-01-01

    Five years of longitudinal data for general chemistry student assessments at the University of Georgia have been analyzed using item response theory (IRT). Our analysis indicates that minor changes in question wording on exams can make significant differences in student performance on assessment questions. This analysis encompasses data from over…

  7. Criteria for selection of future physicians.

    PubMed Central

    Sade, R M; Stroud, M R; Levine, J H; Fleming, G A

    1985-01-01

    Academic achievement correlates poorly with clinical performance of physicians, so it is probably more important to select college students for medical school admission who will be superior physicians than to select those who will be excellent medical students. Before such selection criteria can be developed, a valid description of a superior physician must be determined. The relative importance of 87 characteristics of a superior physician, based on a previously published list, was determined by asking medical school faculty members to rate them. The resulting description of a superior physician is valid, because it correlated very highly (r = 0.87, p less than 0.001) with the published ratings of the same characteristics from decades earlier in another part of the country, and because it was constant across many subgroups. The faculty was also asked to rate how easily each characteristic could be taught, and those ratings were validated by high correlations across several subgroups. The importance and the teachability ratings were combined into a nonteachable-important index (NTII) that provides a rank order of traits that are important but cannot be taught easily. These are the characteristics that should be used in selecting future physicians. PMID:3970604

  8. How to perform a tracheostomy dressing and inner cannula change.

    PubMed

    Credland, Nicola

    2016-03-23

    Rationale and key points Proactive tracheostomy management increases patient safety and reduces adverse events. ▶ A cleaning regimen performed every four hours reduces the risk of a blocked tracheostomy cannula, complete tube occlusion and respiratory arrest. ▶ Sterile tracheostomy dressings allow secretions from the stoma to be absorbed and prevent pressure damage from the tracheostomy tube. ▶ Regular dressing changes and skin inspection permit timely identification of inflammatory processes and skin excoriation, enabling prompt treatment to be instigated. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice. 2. How you intend to develop your knowledge and skills regarding tracheostomy management. Subscribers can upload their reflective accounts at: rcni.com/portfolio . PMID:27008151

  9. Physician Self-Audit: A Scoping Review

    ERIC Educational Resources Information Center

    Gagliardi, Anna R.; Brouwers, Melissa C.; Finelli, Antonio; Campbell, Craig E.; Marlow, Bernard A.; Silver, Ivan L.

    2011-01-01

    Introduction: Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The…

  10. Physician Leadership: A Central Strategy to Transforming Healthcare.

    PubMed

    Oostra, Randall D

    2016-01-01

    As the role of the physician leader becomes increasingly important in the transformation of healthcare, how hospitals, health systems, and other healthcare organizations define that role is undergoing radical change. Traditional physician leadership roles no longer are effective, and the independent medical staff approach is changing to a collaborative, team-oriented model. The dyad relationship between physician leaders and operational leaders is shifting from a rigid, siloed set of responsibilities to a model characterized by a distributed, situational framework of accountabilities, and the scope of influence of the physician leader and operational leader fluctuates depending on the situation and individuals involved. In addition, the focus of the physician leader is moving to one founded in servant leadership, with an increased emphasis on creating supportive models to enhance physicians' success and place them in the roles of leader and integrator of health. PMID:27125046