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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

    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 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

  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. 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

  3. 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.

  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. 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

  19. 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

  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. 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…

  18. [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

  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. 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…

  12. 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

  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. 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.

  7. 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

  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. 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,…

  14. 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

  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. 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

  4. 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

  5. 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.

  6. 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

  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. 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 ...

  9. 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 ...

  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. 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

  13. 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

  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. 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

  1. 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

  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. 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

  7. 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

  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. 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

  16. 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

  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. 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)

  20. 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

  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. 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

  8. 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

  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

  11. Effects of Changing Atmospheric Conditions on Wind Turbine Performance (Poster)

    SciTech Connect

    Clifton, A.

    2012-12-01

    Multi-megawatt, utility-scale wind turbines operate in turbulent and dynamic winds that impact turbine performance in ways that are gradually becoming better understood. This poster presents a study made using a turbulent flow field simulator (TurbSim) and a Turbine aeroelastic simulator (FAST) of the response of a generic 1.5 MW wind turbine to changing inflow. The turbine power output is found to be most sensitive to wind speed and turbulence intensity, but the relationship depends on the wind speed with respect to the turbine's rated wind speed. Shear is found to be poorly correlated to power. A machine learning method called 'regression trees' is used to create a simple model of turbine performance that could be used as part of the wind resource assessment process. This study has used simple flow fields and should be extended to more complex flows, and validated with field observations.

  12. Enhancing the performance of BICPV systems using phase change materials

    NASA Astrophysics Data System (ADS)

    Sharma, Shivangi; Sellami, Nazmi; Tahir, Asif; Reddy, K. S.; Mallick, Tapas K.

    2015-09-01

    Building Integrated Concentrated Photovoltaic (BICPV) systems have three main benefits for integration into built environments, namely, (i) generating electricity at the point of use (ii) allowing light efficacy within the building envelope and (iii) providing thermal management. In this work, to maintain solar cell operating temperature and improve its performance, a phase change material (PCM) container has been designed, developed and integrated with the BICPV system. Using highly collimated continuous light source, an indoor experiment was performed. The absolute electrical power conversion efficiency for the module without PCM cooling resulted in 7.82% while using PCM increased it to 9.07%, thus showing a relative increase by 15.9% as compared to a non- PCM system. A maximum temperature reduction of 5.2°C was also observed when the BICPV module was integrated with PCM containment as compared to the BICPV system without any PCM containment.

  13. Change in Driving Performance following Arthroscopic Shoulder Surgery.

    PubMed

    Hasan, S; McGee, A; Weinberg, M; Bansal, A; Hamula, M; Wolfson, T; Zuckerman, J; Jazrawi, L

    2016-08-01

    The current study aimed to measure perioperative changes in driving performance following arthroscopic shoulder surgery using a validated driving simulator.21 patients who underwent arthroscopic surgery for rotator cuff or labral pathology were tested on a driving simulator preoperatively, and 6 and 12 weeks postoperatively. An additional 21 subjects were tested to establish driving data in a control cohort. The number of collisions, centerline crossings, and off-road excursions were recorded for each trial. VAS and SPADI scores were obtained at each visit.The mean number of collisions in the study group significantly increased from 2.05 preoperatively to 3.75 at 6 weeks (p<0.001), and significantly decreased to 1.95 at 12 weeks (p<0.001). Centerline crossings and off-road excursions did not significantly change from preoperative through 12 weeks, although centerline crossings were statistically different from the controls at each time point (p<0.001). Surgery on the dominant driving arm resulted in greater collisions at 6 weeks than surgery on the non-dominant driving arm (p<0.001).Preliminary data shows that driving performance is impaired for at least 6 weeks postoperatively, with a return to normal driving by 12 weeks. Driving is more profoundly affected in conditions that require avoiding a collision and when the dominant driving arm is involved. PMID:27487432

  14. Improving knowledge and changing behavior towards guideline based decisions in diabetes care: a controlled intervention study of a team-based learning approach for continuous professional development of physicians

    PubMed Central

    2013-01-01

    Background Continuing Professional Development (CPD) courses should ideally improve a physician’s knowledge and change their professional behavior in daily practice towards a best clinical practice reference model and guideline adherence. Interactive methods such as team-based learning and case-based learning, as compared to lectures, can impart sustainable knowledge and lead to high satisfaction among participants. We designed an interactive case-based CPD-seminar on diabetes care using a team-based learning approach to evaluate whether it leads to an improvement of short-term knowledge and changing of behavior towards guideline based decisions and how this learning approach is perceived by participants. Methods Questionnaires and an electronic voting system were used to evaluate motivation, acceptance and knowledge of voluntary participants. Furthermore, we analyzed data on index diagnostic tests and referrals of patients with diabetes of participating physicians over a period of six months before and after the course in comparison with a matched control group in a quasi-experimental design. Results Participants (n=103) rated the interactivity and team-based discussions as the main reasons for enhanced learning. They also expected that the course would change their professional behavior. Participants scored a mean of 43.9% right answers before and 62.6% after the course (p<0.001). The referral to diabetes specialists increased by 30.8% (p<0.001). Referral for fundoscopy also increased (8.5%, n.s.) while it dropped in the control group. Furthermore, the participating physicians tested their patients more often for microalbuminuria (7.1%, n.s.). Conclusions Our team-based learning CPD-approach was highly accepted and resulted in an increase of short-term knowledge. It significantly increased the referral to diabetes specialists in daily practice whereas all other key professional behavior indicators did change but not significantly. PMID:23320976

  15. Merger mania: physicians beware.

    PubMed

    Weil, T P; Pearl, G M

    1998-01-01

    Corporate consolidations, mergers, and acquisitions would seem to provide immense promise in furthering the development of health networking because they affect the governance of entire organizations, rather than simply establishing revised arrangements for specific services or patients. Yet, a limited number of empirical studies have been published to date that explore whether hospital mergers actually improve access, reduce cost, or improve quality of care; and, among the reports available, the conclusions are somewhat equivocal. Physicians should be cautious of these mergers, since they seem to focus either on eliminating a direct competitor or on forming a large horizontally and vertically diversified health network that then can become a major player in gaining exclusivity in managed care contracting. With either of these merger strategies, there are antitrust-type concerns that competition among physicians and other providers will be significantly curtailed, and that consumers will end up with fewer choices in obtaining cost effective, quality patient care. PMID:10180505

  16. Physician Assistant Genomic Competencies.

    PubMed

    Goldgar, Constance; Michaud, Ed; Park, Nguyen; Jenkins, Jean

    2016-09-01

    Genomic discoveries are increasingly being applied to the clinical care of patients. All physician assistants (PAs) need to acquire competency in genomics to provide the best possible care for patients within the scope of their practice. In this article, we present an updated version of PA genomic competencies and learning outcomes in a framework that is consistent with the current medical education guidelines and the collaborative nature of PAs in interprofessional health care teams. PMID:27490287

  17. Desktop and conference room VR for physicians.

    PubMed

    Ai, Zhuming; Rasmussen, Mary

    2005-01-01

    Virtual environments such as the CAVE and the ImmersaDesk, which are based on graphics supercomputers or workstations, are large and expensive. Most physicians have no access to such systems. The recent development of small Linux personal computers and high-performance graphics cards has afforded opportunities to implement applications formerly run on graphics supercomputers. Using PC hardware and other affordable devices, a VR system has been developed which can sit on a physician's desktop or be installed in a conference room. Affordable PC-based VR systems are comparable in performance with expensive VR systems formerly based on graphics supercomputers. Such VR systems can now be accessible to most physicians. The lower cost and smaller size of this system greatly expands the range of uses of VR technology in medicine. PMID:15718690

  18. Euthanasia: American attitudes toward the physician's role.

    PubMed

    Caddell, D P; Newton, R R

    1995-06-01

    This is a study of American public opinion toward euthanasia and the physician's role in performing it. The authors examine how these attributes are affected by religious affiliation, religious self-perception, political self-perception and education. The data include 8384 American respondents from years 1977, 1978, 1982, 1985 and 1988 of the General Social Survey conducted by the National Opinion Research Center. The findings suggest that highly educated, politically liberal respondents with a less religious self-perception are most likely to accept active euthanasia or suicide in the case of terminally ill patient. The data also show that Americans tend to draw a distinction between the suicide of a terminally ill patient and active euthanasia under the care of a physician, preferring to have the physician perform this role in the dying process. The tendency to see a distinction between active euthanasia and suicide was clearly affected by religious affiliation and education. PMID:7660180

  19. [Ethics and occupational physicians: ethics and mission required for occupational physicians].

    PubMed

    Fujino, Akihiro

    2013-10-01

    The ethics of occupational physicians are considered from the following three viewpoints: (1) their legal standing and ethics in job execution; (2) ethics in research in occupational medicine; and (3) ethics in the 21st century and fundamental issues. We discuss: in (1), the contract types of occupational physicians and their independency and neutrality, the protection of health information and privacy, and the use of authority and the security measures; in (2), ethical standards of medical research in Japanese and international organizations, the significance and role of ethics committees, and issues characteristic of occupational health research; and in (3), occupational physicians and politic ethics, the practical abilities and ethics necessary for occupational physicians, and the practice and philosophy of occupational medicine as an art. These considerations suggest that occupational physicians, who have a special status based on the governmental policy of the occupational physician system, should develop an ethical consciousness at the core of their duties and perform their mission with responsibility to employees and employers, all of whom are Japanese citizens. Finally, we propose that the ultimate mission of occupational physicians is "to practice occupational medicine as a branch of the humanities." PMID:24107330

  20. Physicians in literature: three portrayals.

    PubMed

    Cameron, I A

    1986-02-01

    Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients. PMID:21267273

  1. Grievances against physicians

    PubMed Central

    Halperin, Edward C

    2000-01-01

    Objective To understand causes of patient dissatisfaction that result in complaints. Design Grievances received by the grievance committee between January 1, 1989, and January 1, 2000, were reviewed. Setting A 2-county area of North Carolina. Subjects Of 29 patients who filed grievances, the 9 male (31%) and 20 female (69%) patients had a mean (±SD) age of 39 (±19) years. In 18 instances, the patient consulted the physician less than 3 times (64%) before the complaint and in 8 instances more than 4 times (29%). Main outcome measures Allegations of the grievance and the committee's findings. Results Grievances fell into 5 categories: failure to fulfill expectations for examination and treatment (38%), failure to promptly diagnose (20%), rudeness (17%), producing excessive pain or practicing beyond the area of expertise (13%), and inappropriate behavior related to billings (10%). In 45% of the grievances, the committee found no breach of practice standards. In 17% of the cases, the physician resolved the grievance by apologizing, adjusting a bill, or completing insurance forms. Conclusion Most grievances were filed by younger women against newly encountered physicians and were related to inadequate communication or alleged delay in diagnosis. PMID:11017980

  2. Woman physician stalked

    PubMed Central

    Manca, Donna P.

    2005-01-01

    OBJECTIVE To increase awareness of the stalking and harassing behaviour physicians sometimes encounter from patients and to explore how best to approach and address this behaviour. SOURCES OF INFORMATION A physician’s personal reflection of a stalking incident is combined with a review of the literature. Few studies have addressed this subject. MAIN MESSAGE Any family physician could be the victim of stalking. Physicians’ routines and schedules are often public knowledge because of their availability to their practices; thus they are particularly vulnerable to stalkers. We rarely think of women stalking female family physicians; however, it is likely more common than we realize. Increased awareness of this phenomenon and appropriate interventions could reduce escalation of harassing behaviour. Helpful strategies could include recognizing and addressing the behaviour early, seeking assistance, and documenting all incidents in a separate file that includes tape recordings or other material. CONCLUSION We should explore stalking and harassing behaviour openly and become aware of the risks so that we can identify appropriate strategies to avert problems and deal with stalkers. PMID:16805082

  3. Physician nutrition education.

    PubMed

    Kiraly, Laszlo N; McClave, Stephen A; Neel, Dustin; Evans, David C; Martindale, Robert G; Hurt, Ryan T

    2014-06-01

    Nutrition education for physicians in the United States is limited in scope, quality, and duration due to a variety of factors. As new data and quality improvement initiatives highlight the importance of nutrition and a generation of nutrition experts retire, there is a need for new physician educators and leaders in clinical nutrition. Traditional nutrition fellowships and increased didactic lecture time in school and postgraduate training are not feasible strategies to develop the next generation of physician nutrition specialists in the current environment. One strategy is the development of short immersion courses for advanced trainees and junior attendings. The most promising courses include a combination of close mentorship and adult learning techniques such as lectures, clinical experiences, literature review, curricular development, research and writing, multidisciplinary interactions, and extensive group discussion. These courses also allow the opportunity for advanced discourse, development of long-term collaborative relationships, and continued longitudinal career development for alumni after the course ends. Despite these curricular developments, ultimately the field of nutrition will not mature until the American Board of Medical Specialties recognizes nutrition medicine with specialty board certification. PMID:24690613

  4. Changing the precision of preschoolers' approximate number system representations changes their symbolic math performance.

    PubMed

    Wang, Jinjing Jenny; Odic, Darko; Halberda, Justin; Feigenson, Lisa

    2016-07-01

    From early in life, humans have access to an approximate number system (ANS) that supports an intuitive sense of numerical quantity. Previous work in both children and adults suggests that individual differences in the precision of ANS representations correlate with symbolic math performance. However, this work has been almost entirely correlational in nature. Here we tested for a causal link between ANS precision and symbolic math performance by asking whether a temporary modulation of ANS precision changes symbolic math performance. First, we replicated a recent finding that 5-year-old children make more precise ANS discriminations when starting with easier trials and gradually progressing to harder ones, compared with the reverse. Next, we show that this brief modulation of ANS precision influenced children's performance on a subsequent symbolic math task but not a vocabulary task. In a supplemental experiment, we present evidence that children who performed ANS discriminations in a random trial order showed intermediate performance on both the ANS task and the symbolic math task, compared with children who made ordered discriminations. Thus, our results point to a specific causal link from the ANS to symbolic math performance. PMID:27061668

  5. Physician-industry relations. Part 1: individual physicians.

    PubMed

    Coyle, Susan L

    2002-03-01

    This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships. PMID:11874314

  6. Physician practice management companies: should physicians be scared?

    PubMed

    Scott-Rotter, A E; Brown, J A

    1999-01-01

    Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions. PMID:10623415

  7. Physician credentialing in a consumer-centric world.

    PubMed

    van Amerongen, Derek

    2002-01-01

    As managed care responds to the rising tide of consumerism in medicine, it is necessary to reexamine the functions that health plans have performed. Chief among the activities that demand resources but return minimal value is the process of physician credentialing. As consumers are asked to assume more control in their health care decisions and to pay more for their care, the credentialing process must be changed if it is to add value for consumers. This paper discusses the role of credentialing and how it might be reconfigured to become more meaningful to consumers. PMID:12224877

  8. Developmental Changes in Adolescents' Olfactory Performance and Significance of Olfaction

    PubMed Central

    Klötze, Paula; Gerber, Friederike; Croy, Ilona; Hummel, Thomas

    2016-01-01

    Aim of the current work was to examine developmental changes in adolescents’ olfactory performance and personal significance of olfaction. In the first study olfactory identification abilities of 76 participants (31 males and 45 females aged between 10 and 18 years; M = 13.8, SD = 2.3) was evaluated with the Sniffin Stick identification test, presented in a cued and in an uncued manner. Verbal fluency was additionally examined for control purpose. In the second study 131 participants (46 males and 85 females aged between 10 and 18 years; (M = 14.4, SD = 2.2) filled in the importance of olfaction questionnaire. Odor identification abilities increased significantly with age and were significantly higher in girls as compared to boys. These effects were especially pronounced in the uncued task and partly related to verbal fluency. In line, the personal significance of olfaction increased with age and was generally higher among female compared to male participants. PMID:27332887

  9. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety.

    PubMed

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

    2011-01-01

    should not be left unsupervised to care for critically ill patients. In settings in which the acuity is high, physicians who have completed residency should provide direct supervision for resident physicians. Supervising physicians should always be physically in the hospital for supervision of resident physicians who care for critically ill patientsThe ACGME should explicitly define "good" supervision by specialty and by year of training. Explicit requirements for intensity and level of training for supervision of specific clinical scenarios should be providedCenters for Medicare and Medicaid Services (CMS) should use graduate medical education funding to provide incentives to programs with proven, effective levels of supervision. Although this action would require federal legislation, reimbursement rules would help to ensure that hospitals pay attention to the importance of good supervision and require it from their training programs. RESIDENT PHYSICIAN WORK HOURS: Although the IOM "Sleep, supervision and safety" report provides a comprehensive review and discussion of all aspects of graduate medical education training, the report's focal point is its recommendations regarding the hours that resident physicians are currently required to work. A considerable body of scientific evidence, much of it cited by the Institute of Medicine report, describes deteriorating performance in fatigued humans, as well as specific studies on resident physician fatigue and preventable medical errors. The question before this conference was what work redesign and cultural changes are needed to reform work hours as recommended by the Institute of Medicine's evidence-based report? Extensive scientific data demonstrate that shifts exceeding 12-16 hours without sleep are unsafe. Several principles should be followed in efforts to reduce consecutive hours below this level and achieve safer work schedules. The recommendations are: Limit resident physician work hours to 12-16 hour maximum shifts

  10. Factors affecting physician loyalty and exit: a longitudinal analysis of physician-hospital relationships.

    PubMed Central

    Burns, L R; Wholey, D R

    1992-01-01

    This article examines forces that influence physicians to change the percentage of their admissions to a hospital (loyalty) and to cease admitting patients to a hospital altogether (exit). Because physicians are both members of a hospital and consumers of its services, their admitting patterns can be described using models of employee commitment and consumer buying behavior. We test several hypotheses drawn from these literatures using data on physician admissions at hospitals over a two-year period. Results indicate that admitting patterns are explained primarily by convenience and inertia processes characteristic of consumer behavior. On the other hand, factors believed to influence organizational commitment (e.g., decision-making involvement, conflict, economic investments) have little effect on loyalty and exit. The findings question the utility of hospital strategies to improve the climate of physician-hospital relations, and suggest several qualifications for research on the commitment of professionals. PMID:1563950

  11. The physician's alternative career transition model: a stepwise approach.

    PubMed

    Bernard, S; Moore, D L

    1995-03-01

    The recent intense focus on marketplace reform has stimulated a reassessment of career planning options for some physicians. These socioeconomic changes have created unique opportunities beyond the traditional arenas of clinical practice and medical management for physicians to leverage their medical degrees and experiences in the business world. This paper presents three case reports of physician executives who have successfully pursued medically related business career options, each following different motivations at various stages of their medical careers. It then discusses the Physicians' Alternative Career Transition (PACT) model developed by the authors to assist other physicians who are considering making transitions into business-related careers. The PACT model is based on four critical steps for practicing physicians to make these transitions successfully: an internal self-evaluation process, an external environmental evaluation process, seeking the best "career match," and securing the career match. PMID:10161175

  12. Role of the school physician.

    PubMed

    Devore, Cynthia DiLaura; Wheeler, Lani S M

    2013-01-01

    The American Academy of Pediatrics recognizes the important role physicians play in promoting the optimal biopsychosocial well-being of children in the school setting. Although the concept of a school physician has existed for more than a century, uniformity among states and school districts regarding physicians in schools and the laws governing it are lacking. By understanding the roles and contributions physicians can make to schools, pediatricians can support and promote school physicians in their communities and improve health and safety for children. PMID:23277314

  13. Thermal performance of phase change wallboard for residential cooling application

    SciTech Connect

    Feustel, H.E.; Stetiu, C.

    1997-04-01

    Cooling of residential California buildings contributes significantly to electrical consumption and peak power demand mainly due to very poor load factors in milder climates. Thermal mass can be utilized to reduce the peak-power demand, downsize the cooling systems, and/or switch to low-energy cooling sources. Large thermal storage devices have been used in the past to overcome the shortcomings of alternative cooling sources, or to avoid high demand charges. The manufacturing of phase change material (PCM) implemented in gypsum board, plaster or other wall-covering material, would permit the thermal storage to become part of the building structure. PCMs have two important advantages as storage media: they can offer an order-of-magnitude increase in thermal storage capacity, and their discharge is almost isothermal. This allows the storage of high amounts of energy without significantly changing the temperature of the room envelope. As heat storage takes place inside the building, where the loads occur, rather than externally, additional transport energy is not required. RADCOOL, a thermal building simulation program based on the finite difference approach, was used to numerically evaluate the latent storage performance of treated wallboard. Extended storage capacity obtained by using double PCM-wallboard is able to keep the room temperatures close to the upper comfort limits without using mechanical cooling. Simulation results for a living room with high internal loads and weather data for Sunnyvale, California, show significant reduction of room air temperature when heat can be stored in PCM-treated wallboards.

  14. The physician executive and professional grief.

    PubMed

    Gill, S L

    1989-01-01

    With the introduction of competitive forces and concommitant changes in health care reimbursement programs, physicians are experiencing profound disruption in their personal expectations and career plans. This article proposes that the loss of established professional traditions is no different, in terms of emotional and psychological impact, than the loss of a loved one. Thus, many physicians may need to complete grief work before they can functionally adapt to contemporary realities. The dynamics of loss, grief work, and functional adaptation are discussed, along with recommendations for supportive interventions to help individuals adjust to a competitive health care environment. PMID:10316379

  15. Female physicians: trends and likely impacts on healthcare in Israel

    PubMed Central

    2013-01-01

    Background Female physicians have become an increasing proportion of the medical workforce in Israel. This study investigates this trend and discusses its likely impact on the quantity and quality of medical care available. Method Data on licensed physicians and new licenses issued to physicians were taken from a Ministry of Health database, and analyzed by gender, age, academic origin (Israeli graduates, immigrants, Israeli-born who studied abroad), and specialty for the years 1999–2011. Data on employed physicians, their population group, and work hours were taken from the Central Bureau of Statistics (CBS) annual Labour Force Survey for the years 2009–2011. Results The proportion of women amongst physicians aged under 65 rose from 38% in 1999 to 42% in 2011, and was even higher for younger physicians. The highest proportion of females is found amongst new immigrant physicians who studied abroad. The corresponding proportion has been rising steadily amongst Israeli-educated physicians, and is lowest amongst Israeli-born physicians who studied abroad. Similarly, among newly licensed physicians, the proportion of females has traditionally been highest among immigrants who studied abroad and lowest among Israeli-born graduates who studied abroad. Among newly-licensed physicians who studied in Israel, the proportion of females has historically been intermediate between the other two groups, but it has recently risen to 54% and now parallels the proportion of females among immigrants who studied abroad. In recent years, the mix of academic origins among newly licensed physicians has changed dramatically, with important implications for the proportion of women among newly licensed physicians. The highest percentage of females was found in family medicine followed by oncology, pediatrics and psychiatry. The greatest increase over the years in this percentage was for gynecology and internal medicine. Female physicians worked shorter hours than males, particularly at

  16. Educating Physicians for the Twenty-First Century.

    ERIC Educational Resources Information Center

    Greenlick, Merwyn R.

    1995-01-01

    Changes in medical and health care since 1935 are reviewed and factors affecting medicine and physician training in the future are examined, including technology, economic factors, role of government, physician social responsibility, and the medical culture. Oregon Health Sciences University's efforts to develop clinical and population-based…

  17. The conceptually-oriented physician.

    PubMed

    Fuller, B F; Fuller, F

    1979-07-01

    This article is based on the authors' book "Physician or Magician: The Myths and Realities of Patient Care" (McGraw Hill and Hemisphere, 1978). In this paper, the authors contend that the main problem confronting medical practice and medical education today is that there is no consensus on what physicians should be doing. Should they be technologists or should they be conceptually-oriented? The authors further state that these two types of physicians are trained in different approaches to problem solving. They conclude by saying that both types of physicians are needed if the quality of patient care is to improve while containing cost, but that the conceptually-oriented physician--the primary physician--should be in charge of all treatment patients receive. This is because the primary physicians as well as the Cartesian approach. Therefore, they would be better able to determine the risks and benefits to each patient of various technological regimens. PMID:514116

  18. Roles of the Team Physician.

    PubMed

    Kinderknecht, James

    2016-07-01

    The roles of the team physician are much more than providing medical coverage at a sport's event. The team physician has numerous administrative and medical responsibilities. The development of an emergency action plan is an essential administrative task as an example. The implementation of the components of this plan requires the team physician to have the necessary medical knowledge and skill. An expertise in returning an athlete to play after an injury or other medical condition is a unique attribute of the trained team physician. The athlete's return to participation needs to start with the athlete's safety and best medical interests but not inappropriately restrict the individual from play. The ability to communicate on numerous levels needs to be a characteristic of the team physician. There are several potential ethical conflicts the team physician needs to control. These conflicts can create unique medicolegal issues. The true emphasis of the team physician is to focus on what is best for the athlete. PMID:27322925

  19. The occupational hazards of emergency physicians.

    PubMed

    Dorevitch, S; Forst, L

    2000-05-01

    Emergency physicians are exposed to a variety of occupational hazards. Among these are infectious diseases, such the human immunodeficiency virus, hepatitis B and C viruses, and tuberculosis. Hepatitis G virus is transmissible but may not be a cause of illness. The likelihood of being exposed to these agents appears to be higher in the ED than other medical settings but estimates of the prevalence of these diseases in the ED vary, depending on the patient population served. Estimates of risk for contracting these infections are reviewed. Measures to prevent these exposures can reduce risk, but compliance is low, particularly for those involving changes in the behavior of emergency physicians (such as not recapping needles). Latex allergy is a hazard of health care workers. Its prevalence is reported to be quite high, but these findings are difficult to interpret in the absence of a universally accepted definition of the condition. Its prevalence in emergency physicians is not known. Other noninfectious hazards include workplace violence and exposure to nitrous oxide. The health effects of rotating shift work may put emergency physicians at increased risk of coronary artery disease and impaired reproductive health. Emotional stress is another hazard of emergency physicians, and may lead to burnout. PMID:10830687

  20. Physician-Hospital Alignment in Orthopedic Surgery.

    PubMed

    Bushnell, Brandon D

    2015-09-01

    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery. PMID:26375539

  1. Growth of oncology physician practice management companies.

    PubMed

    Mighion, K; Gesme, D H; Rifkin, R M; Bennett, C L

    1999-01-01

    The practice of oncology is changing dramatically, spurred on by managed care initiatives throughout the United States. As a result, physicians are faced with multiple demands from insurers, managed care organizations, and patients. In response to these demands, oncology physician practice management companies have entered the cancer market. This article describes the driving factors leading to consolidation in practice settings, the risks and benefits to oncologists of affiliating with these companies, and the organizational characteristics of four of these larger corporations. This review article is of broad interest to oncologists practicing in the United States and is meant to provide a useful reference for considering a physician practice management company as a business partner. PMID:10370365

  2. Strategies for selling and consolidating physician practices.

    PubMed

    Mancino, D M

    1997-01-01

    The changing dynamics of healthcare service delivery is forcing many physicians to consider selling their practices to hospitals or health plans or consolidating them with other practices. Besides being subject to the corporate and tax requirements that apply to the sale of any business, the sale of physician practices is also subject to Federal fraud and abuse and self-referral laws. Several sale strategies are available to physicians who desire to sell or consolidate their practices, including asset sales, stock sales, forward mergers, drop down consolidations, spinoffs, and statutory mergers. Each strategy has advantages and disadvantages, but whichever strategy is chosen, both sellers and buyers must ensure that tax issues are addressed and that the transaction complies with the requirements of Federal anti-kickback and self-referral laws. PMID:10163898

  3. Senior academic physicians and retirement considerations.

    PubMed

    Moss, Arthur J; Greenberg, Henry; Dwyer, Edward M; Klein, Helmut; Ryan, Daniel; Francis, Charles; Marcus, Frank; Eberly, Shirley; Benhorin, Jesaia; Bodenheimer, Monty; Brown, Mary; Case, Robert; Gillespie, John; Goldstein, Robert; Haigney, Mark; Krone, Ronald; Lichstein, Edgar; Locati, Emanuela; Oakes, David; Thomsen, Poul Erik Bloch; Zareba, Wojciech

    2013-01-01

    An increasing number of academic senior physicians are approaching their potential retirement in good health with accumulated clinical and research experience that can be a valuable asset to an academic institution. Considering the need to let the next generation ascend to leadership roles, when and how should a medical career be brought to a close? We explore the roles for academic medical faculty as they move into their senior years and approach various retirement options. The individual and institutional considerations require a frank dialogue among the interested parties to optimize the benefits while minimizing the risks for both. In the United States there is no fixed age for retirement as there is in Europe, but European physicians are initiating changes. What is certain is that careful planning, innovative thinking, and the incorporation of new patterns of medical practice are all part of this complex transition and timing of senior academic physicians into retirement. PMID:23621971

  4. A Model for Physician Leadership Development and Succession Planning.

    PubMed

    Dubinsky, Isser; Feerasta, Nadia; Lash, Rick

    2015-01-01

    Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders. PMID:26168389

  5. 20 CFR 725.703 - Physician defined.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Physician defined. 725.703 Section 725.703... defined. The term “physician” includes only doctors of medicine (MD) and osteopathic practitioners within the scope of their practices as defined by State law. No treatment or medical services performed...

  6. Better Physician's 'Black Bags'

    NASA Technical Reports Server (NTRS)

    1976-01-01

    The "black bag" is outgrowth of astronaut monitoring technology from NASA's Johnson Space Center. Technically known as the portable medical status system, a highly advanced physician's "black bag" weighs less than 30 pounds, yet contains equipment for monitoring and recording vital signs, electrocardiograms, and electroencephalograms. Liquid crystal displays are used to present 15 digits of data simultaneously for long periods of time without excessive use of battery power. Single printed circuit card contains all circuitry required to measure and display vital signs such as heart and respiration rate, temperature, and blood pressure.

  7. New Tools and Approaches for Family Physicians.

    PubMed

    Seehusen, Dean A; Bowman, Marjorie A; Neale, Anne Victoria

    2015-01-01

    This issue of the journal is filled with useful information for practicing family physicians. Several articles introduce new ideas for family physicians to use in the care of their patients, whereas other articles cover new approaches to old problems. Several studies report on procedures performed by family physicians: battlefield acupuncture, colonoscopy, and ultrasound. Some unique alternative care models are described and evaluated. An innovative method of delivering diabetes education seems to work well. Ways to use technology to improve patient care, an update on chronic hepatitis B, and a novel use of social media to understand a rare disease are also included. Readers will come away from this issue with many ideas to consider implementing in their own practices. PMID:26546641

  8. The Prevalence and Special Educational Requirements of Dyscompetent Physicians

    ERIC Educational Resources Information Center

    Williams, Betsy W.

    2006-01-01

    Underperformance among physicians is not well studied or defined; yet, the identification and remediation of physicians who are not performing up to acceptable standards is central to quality care and patient safety. Methods for estimating the prevalence of dyscompetence include evaluating available data on medical errors, malpractice claims,…

  9. Performance of Driver-Vehicle in Aborted Lane Change Maneuvers

    NASA Technical Reports Server (NTRS)

    Lee, Allan Y.

    1995-01-01

    A 'lane change crash' is defined as a family of collisions that occurred when a driver attempts to change lane and strikes or is struck by a vehicle in the adjacent lane. One type of maneuver that is commonly used to avert a lane change crash involved aborting the intended lane change, and returning the vehicle to the original lane of the subject vehicle.

  10. Childhood bullying: implications for physicians.

    PubMed

    Lyznicki, James M; McCaffree, Mary Anne; Robinowitz, Carolyn B

    2004-11-01

    Childhood bullying has potentially serious implications for bullies and their targets. Bullying involves a pattern of repeated aggression, a deliberate intent to harm or disturb a victim despite the victim's apparent distress, and a real or perceived imbalance of power. Bullying can lead to serious academic, social, emotional, and legal problems. Studies of successful antibullying programs suggest that a comprehensive approach in schools can change student behaviors and attitudes, and increase adults' willingness to intervene. Efforts to prevent bullying must address individual, familial, and community risk factors, as well as promote an understanding of the severity of the problem. Parents, teachers, and health care professionals must become more adept at identifying possible victims and bullies. Physicians have important roles in identifying at-risk patients, screening for psychiatric comorbidities, counseling families about the problem, and advocating for bullying prevention in their communities. PMID:15554490

  11. Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia.

    PubMed

    Wilckens, Kristine A; Hall, Martica H; Nebes, Robert D; Monk, Timothy H; Buysse, Daniel J

    2016-01-01

    The present study examined sleep features associated with cognition in older adults and examined whether sleep changes following insomnia treatment were associated with cognitive improvements. Polysomnography and cognition (recall, working memory, and reasoning) were assessed before and after an insomnia intervention (Brief Behavioral Treatment of Insomnia [BBTI] or information control [IC]) in 77 older adults with insomnia. Baseline wake-after-sleep-onset (WASO) was associated with recall. Greater NREM (nonrapid eye movement) delta power and lower NREM sigma power were associated with greater working memory and reasoning. The insomnia intervention did not improve performance. However, increased absolute delta power and decreased relative sigma power were associated with improved reasoning. Findings suggest that improvements in executive function may occur with changes in NREM architecture. PMID:26322904

  12. What Predicts Patients’ Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship

    PubMed Central

    Bidmon, Sonja; Terlutter, Ralf

    2016-01-01

    for online treatment, but it was predicted by health-related information–seeking personality (B=.127, P=.07), PU (B=–.098, P=.09), willingness to undergo online treatment (B=.391, P<.001), actual use of online communication with the GP (B=.192, P=.001), highest education level (B=.178, P<.001), monthly household net income (B=.115, P=.01), and willingness to communicate with the GP online more often in the future (B=.076, P=.03). Conclusions Age, gender, and trust in the GP were not significant predictors for either willingness to undergo online treatment or to pay additionally for online treatment. Willingness to undergo online treatment was partly determined by the actual use of online communication with the GP, willingness to communicate online with the GP, health information–seeking personality, and social motivation for such behavior. Willingness to pay extra for online treatment was influenced by the monthly household net income category and education level. The results of this study are useful for online health care providers and physicians who are considering offering online treatments as a viable number of patients would appreciate the possibility of undergoing an online treatment offered by their GP. PMID:26846162

  13. Mad scientists, compassionate healers, and greedy egotists: the portrayal of physicians in the movies.

    PubMed

    Flores, Glenn

    2002-07-01

    Cinematic depictions of physicians potentially can affect public expectations and the patient-physician relationship, but little attention has been devoted to portrayals of physicians in movies. The objective of the study was the analysis of cinematic depictions of physicians to determine common demographic attributes of movie physicians, major themes, and whether portrayals have changed over time. All movies released on videotape with physicians as main characters and readily available to the public were viewed in their entirety. Data were collected on physician characteristics, diagnoses, and medical accuracy, and dialogue concerning physicians was transcribed. The results showed that in the 131 films, movie physicians were significantly more likely to be male (p < 0.00001), White (p < 0.00001), and < 40 years of age (p < 0.009). The proportion of women and minority film physicians has declined steadily in recent decades. Movie physicians are most commonly surgeons (33%), psychiatrists (26%), and family practitioners (18%). Physicians were portrayed negatively in 44% of movies, and since the 1960s positive portrayals declined while negative portrayals increased. Physicians frequently are depicted as greedy, egotistical, uncaring, and unethical, especially in recent films. Medical inaccuracies occurred in 27% of films. Compassion and idealism were common in early physician movies but are increasingly scarce in recent decades. A recurrent theme is the "mad scientist," the physician-researcher that values research more than patients' welfare. Portrayals of physicians as egotistical and materialistic have increased, whereas sexism and racism have waned. Movies from the past two decades have explored critical issues surrounding medical ethics and managed care. We conclude that negative cinematic portrayals of physicians are on the rise, which may adversely affect patient expectations and the patient-physician relationship. Nevertheless, films about physicians can

  14. Mad scientists, compassionate healers, and greedy egotists: the portrayal of physicians in the movies.

    PubMed Central

    Flores, Glenn

    2002-01-01

    Cinematic depictions of physicians potentially can affect public expectations and the patient-physician relationship, but little attention has been devoted to portrayals of physicians in movies. The objective of the study was the analysis of cinematic depictions of physicians to determine common demographic attributes of movie physicians, major themes, and whether portrayals have changed over time. All movies released on videotape with physicians as main characters and readily available to the public were viewed in their entirety. Data were collected on physician characteristics, diagnoses, and medical accuracy, and dialogue concerning physicians was transcribed. The results showed that in the 131 films, movie physicians were significantly more likely to be male (p < 0.00001), White (p < 0.00001), and < 40 years of age (p < 0.009). The proportion of women and minority film physicians has declined steadily in recent decades. Movie physicians are most commonly surgeons (33%), psychiatrists (26%), and family practitioners (18%). Physicians were portrayed negatively in 44% of movies, and since the 1960s positive portrayals declined while negative portrayals increased. Physicians frequently are depicted as greedy, egotistical, uncaring, and unethical, especially in recent films. Medical inaccuracies occurred in 27% of films. Compassion and idealism were common in early physician movies but are increasingly scarce in recent decades. A recurrent theme is the "mad scientist," the physician-researcher that values research more than patients' welfare. Portrayals of physicians as egotistical and materialistic have increased, whereas sexism and racism have waned. Movies from the past two decades have explored critical issues surrounding medical ethics and managed care. We conclude that negative cinematic portrayals of physicians are on the rise, which may adversely affect patient expectations and the patient-physician relationship. Nevertheless, films about physicians can

  15. [Luke, evangelist and physician].

    PubMed

    Fischer, Louis-Paul; Suh-Tafaro, Nathalie

    2003-01-01

    Luke, author of the Third Gospel and the Acts of the Apostles was also a physician. As he was born in Antioch he was probably Greek. He travelled with the Apostle Paul. He was born in Antioch he as probably Greek. He travelled with the Aspostle Paul. He was the only gospel writer to have been accurate in his medical analysis, for example to locate a paralysis with precision and use Hippocratic tradition terms. He might have been chosen as the patron saint by the medical corporation at the end of the Middle Ages. From the fifteenth century, the University doctors' first day had been the eighteenth of October, that is St Luke's Day. On their seals, several French medical colleges had an invocation to Saint Luke (with a winged bull at his feet as a symbol) and to the Virgin Mary. Medical corporations and painters' guilds had chapels dedicated to Luke at the end of the fourteenth century. In the sixteenth century, Painting Academies were to be called "Saint Luke's" Apart from being famous as a doctor, Luke is known as Virgin Mary's painter. In his gospel he was speaking about her in detail and with tenderness. In Syria and in Rome some paintings were attributed to him. In some fifteenth century engravings, Luke was depicted as a writer of the Gospel or a painter, and sometimes he was dressed as a physician. Nowadays some medical centres are named after him and some French doctors celebrate the eighteenth of October. PMID:12962126

  16. Burnout, Job Satisfaction, and Medical Malpractice among Physicians

    PubMed Central

    Chen, Kuan-Yu; Yang, Che-Ming; Lien, Che-Hui; Chiou, Hung-Yi; Lin, Mau-Roung; Chang, Hui-Ru; Chiu, Wen-Ta

    2013-01-01

    Objectives: Our objective was to estimate the incidence of recent burnout in a large sample of Taiwanese physicians and analyze associations with job related satisfaction and medical malpractice experience. Methods: We performed a cross-sectional survey. Physicians were asked to fill out a questionnaire that included demographic information, practice characteristics, burnout, medical malpractice experience, job satisfaction, and medical error experience. There are about 2% of total physicians. Physicians who were members of the Taiwan Society of Emergency Medicine, Taiwan Surgical Association, Taiwan Association of Obstetrics and Gynecology, The Taiwan Pediatric Association, and Taiwan Stroke Association, and physicians of two medical centers, three metropolitan hospitals, and two local community hospitals were recruited. Results: There is high incidence of burnout among Taiwan physicians. In our research, Visiting staff (VS) and residents were more likely to have higher level of burnout of the emotional exhaustion (EE) and depersonalization (DP), and personal accomplishment (PA). There was no difference in burnout types in gender. Married had higher-level burnout in EE. Physicians who were 20~30 years old had higher burnout levels in EE, those 31~40 years old had higher burnout levels in DP, and PA. Physicians who worked in medical centers had a higher rate in EE, DP, and who worked in metropolitan had higher burnout in PA. With specialty-in-training, physicians had higher-level burnout in EE and DP, but lower burnout in PA. Physicians who worked 13-17hr continuously had higher-level burnout in EE. Those with ≥41 times/week of being on call had higher-level burnout in EE and DP. Physicians who had medical malpractice experience had higher-level burnout in EE, DP, and PA. Physicians who were not satisfied with physician-patient relationships had higher-level burnout than those who were satisfied. Conclusion: Physicians in Taiwan face both burnout and a high risk

  17. Rising hospital employment of physicians: better quality, higher costs?

    PubMed

    O'Malley, Ann S; Bond, Amelia M; Berenson, Robert A

    2011-08-01

    In a quest to gain market share, hospital employment of physicians has accelerated in recent years to shore up referral bases and capture admissions, according to the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Stagnant reimbursement rates, coupled with the rising costs of private practice, and a desire for a better work-life balance have contributed to physician interest in hospital employment. While greater physician alignment with hospitals may improve quality through better clinical integration and care coordination, hospital employment of physicians does not guarantee clinical integration. The trend of hospital-employed physicians also may increase costs through higher hospital and physician commercial insurance payment rates and hospital pressure on employed physicians to order more expensive care. To date, hospitals' primary motivation for employing physicians has been to gain market share, typically through lucrative service-line strategies encouraged by a fee-for-service payment system that rewards volume. More recently, hospitals view physician employment as a way to prepare for payment reforms that shift from fee for service to methods that make providers more accountable for the cost and quality of patient care. PMID:21853632

  18. Cancer Prevalence among Physicians in Korea: A Single Center Study

    PubMed Central

    Kim, Hye Lin; Park, Hae Jin; Sim, Yun Hye; Choi, Eun Young; Shim, Kyung Won; Lee, Sang Wha; Lee, Hong Soo

    2016-01-01

    Background There is little research regarding whether working as a physician affects cancer risk. Moreover, there is no research on cancer prevalence among physicians in Korea. This study utilized the Korea National Cancer Incidence Database to determine whether the prevalence of cancer among physicians differs from the prevalence of cancer within the general population. Methods We analyzed the medical records of a representative sample of 382 doctors who underwent a health examination between 2010 and 2013 at a health examination center in a Ewha Womans University Medical Center.Cancer incidence was measured as cases that were eventually diagnosed as cancer according to a biopsy. Results We collected medical records from 382 physicians (mean age, 51.9±8.1 years) and calculated the standardized prevalence ratios compared to the general population. Thirty physicians (9 male and 21 female) were identified as having cancer. Physicians had a significantly higher prevalence of cancer compared to the general population.Cancer prevalence in male physicians was found to be 2.47 times higher than the prevalence expected within the general population (P=0.006). Among female physicians, cancer prevalence was 3.94 times higher than that in the general population (P<0.001). Conclusion This study revealed that physicians had a higher prevalence of cancer compared to the general population in Korea, which suggests that there may be a problem present in the health care of physicians. Changes to the working environment of physicians will be needed to reduce the high prevalence of cancer among physicians. PMID:27073607

  19. Self-rated health among physicians.

    PubMed

    Baubinas, Algirdas; Gurevicius, Romualdas; Jankauskiene, Konstancija; Salyga, Jonas; Kairys, Jonas; Jurkstiene, Vilma; Kevelaitis, Egidijus

    2009-01-01

    The aim of the study was to analyze self-rated health among physicians depending on their sex, age, workplace (hospital or polyclinic), and specialty. MATERIAL AND METHODS. The studied group consisted of 377 26-70-year-old physicians randomly selected from various county hospitals and polyclinics of Lithuania. There were 85 men and 292 women. The inquiry was performed using the complemented (by the authors of the study) version of the WHO anonymous questionnaire of the quality of life (1995). Responses were evaluated based on physicians' evaluation of their own health, which was rated as very good, good, satisfactory, poor, and very poor. RESULTS. Only 8.2% of males and 5.8% of females evaluated their health as very good (P>0.05). More men, compared to women, evaluated their health as good (62.3% and 53.1%, respectively; P<0.05), whereas more females evaluated their health as satisfactory, compared to males (36.0% and 25.9%, respectively; P<0.05); 2.4% of males and 5.1% of females (p>0.05) stated that their health was poor. In most cases, physicians of different age groups presented equal evaluations of their health except for physicians in the age groups of 26-37 and 38-43 years - those who evaluated their health as very good comprised a significantly higher percentage (P<0.05), compared to other age groups. As expected, a higher percentage of older physicians evaluated their health as satisfactory. In addition to that, more hospital physicians, compared to those working in polyclinics, evaluated their health as good (12.8% and 1.8%, respectively; P<0.05) and vice versa - significantly more physicians working in polyclinics evaluated their health as satisfactory, compared to those working in hospitals (38.1% and 26.8%, respectively; P<0.05). A significantly higher percentage of surgeons, compared to general practitioners or therapists, evaluated their health as very good (15.8%, 4.5%, and 6.1%, respectively; P<0.05) and a significantly lower percentage - as

  20. Associations between Physician Characteristics and Quality of Care

    PubMed Central

    Orler, Rachel L.; Friedberg, Mark W.; Adams, John L.; McGlynn, Elizabeth A.; Mehrotra, Ateev

    2010-01-01

    BACKGROUND Physicians’ performance on measures of clinical quality is rarely available to patients. Instead, patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. In a large sample of Massachusetts physicians, we examined the relationship between physician characteristics and performance on a broad range of quality measures. METHODS We calculated overall performance scores on 124 quality measures from RAND’s Quality Assessment Tools for each of 10,408 Massachusetts physicians using claims generated by 1.13 million adult patients. The patients were continuously enrolled in 1 of 4 Massachusetts commercial health plans during 2004–2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine. Associations between physician characteristics and overall performance scores were assessed using multivariate linear regression. RESULTS The mean overall performance score was 62.5%% (5th to 95th percentile range, 48.2% to 74.9%). Three physician characteristics were independently associated with significantly higher overall performance: female gender (1.6 percentage points higher than male, p<0.001), board certification (3.3 percentage points higher than non-certified, p<0.001), and graduation from a domestic medical school (1.0 percentage points higher than international, p<0.001). There was no association between performance and malpractice claims or disciplinary action. CONCLUSION Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures. PMID:20837830

  1. Comparison of measures to assess change in diagnostic performance due to a decision support system.

    PubMed Central

    Maisiak, R. S.; Berner, E. S.

    2000-01-01

    Little has been done to examine the relative merit of measures used to assess the impact of diagnostic decision support systems (DDSS) on physician performance. In this study, 10 different single-measures of diagnostic performance were compared empirically. The measures were of three types: rank-order, all-or-none, and appropriateness. The responsiveness (RESP) of each measure was estimated under two repeated-measures experimental conditions. RESP is the degree to which a measure could detect differences between conditions of low and high performance. The diagnostic performance of 108 physicians was compared on medical cases of varying diagnostic difficulty and with or without a high level of assistance from a DDSS. The results showed that the RESP among the measures varied nearly tenfold. The rank-order measures tended to provide the highest RESP values (maximum = 2.14) while appropriateness measures provided the lowest RESP values (maximum = 1.41). The most responsive measures were rank-orders of the correct diagnosis within the top 5 to 10 listed diagnoses. PMID:11079940

  2. Primary-care physician compensation.

    PubMed

    Olson, Arik

    2012-01-01

    This article reviews existing models of physician compensation and presents information about current compensation patterns for primary-care physicians in the United States. Theories of work motivation are reviewed where they have relevance to the desired outcome of satisfied, productive physicians whose skills and expertise are retained in the workforce. Healthcare reforms that purport to bring accountability for healthcare quality and value-rather than simply volume-bring opportunities to redesign primary-care physician compensation and may allow for new compensation methodologies that increase job satisfaction. Physicians are increasingly shunning the responsibility of private practice and choosing to work as employees of a larger organization, often a hospital. Employers of physicians are seeking compensation models that reward both productivity and value. PMID:22786738

  3. Communication in the physician-patient relationship.

    PubMed Central

    Rees, A M

    1993-01-01

    Political, legal, ethical, social, economic, and technological changes in the twentieth century have produced a profound effect on the health care and health status of Americans and the way in which physicians and patients communicate. In the latter half of this century, the responsibility for individual health care has shifted from a physician-oriented, paternalistic approach to a patient-centered one. Patients now assume two identities: health consumers and active participants in the medical decision-making process. This phenomenon has created an environment where consumer demand for information has shifted from a single focus on symptoms, diagnosis, and treatment of diseases to an increasing preoccupation with cost, quality, and access to health care. This shift emphasizes the critical role played by medical librarians in the dissemination of needed information, and it challenges librarians to take a leadership role in opening newer channels of communication between physicians and patients. The 1992 Janet Doe Lecture analyzes the evolutionary change in the physician-patient relationship and its modes of communication, projects future roles for medical librarians, and provides an extensive list of references for further reading. PMID:8428183

  4. Effect of a Triage-based E-mail System on Clinic Resource Use and Patient and Physician Satisfaction in Primary Care

    PubMed Central

    Katz, Steven J; Moyer, Cheryl A; Cox, Douglas T; Stern, David T

    2003-01-01

    OBJECTIVES E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care. DESIGN AND PATIENTS/PARTICIPANTS Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication. RESULTS E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P < .01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P = .45) or rates of patient no-shows (5% in both groups; P = .77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general. CONCLUSIONS E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians' attitudes toward electronic communication were improved, but physicians' and patients' attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care. PMID:12950483

  5. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

    PubMed Central

    Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

    2016-01-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

  6. Consolidation guidelines for physician practices.

    PubMed

    Bigalke, J T; Garbrecht, G H; McBee, D

    1998-03-01

    The trend of acquiring and consolidating physician practices is expected to continue for some time. The growth of physician practice management companies (PPMCs) has created accounting and financial reporting issues for these new physician organizations. The type of management arrangement ultimately affects the decision of whether or not to consolidate practices. In analyzing consolidation opportunities, PPMCs should consider the terms of the management agreement, which determine who controls the practice, and the advantages and disadvantages of consolidation. PMID:10177404

  7. Physician resource planning in Canada: the need for a stronger behavioural foundation.

    PubMed

    Jeon, Sung-Hee; Hurley, Jeremiah

    2010-01-01

    An effective solution to the problem of access to physician services in Canada must extend beyond an over-exclusive focus on the number of providers to consider the behaviour of physicians in greater depth. The amount of labour and associated services supplied by physicians depends importantly on their attitudes regarding work, on practice and non-practice income opportunities, and on the policy environment in which they practise. Hence, the amount of labour supplied by a given stock of physicians can change over time. Only by considering the full range of factors that affect the labour supply of physicians can we effectively plan for physician resources. PMID:20939138

  8. Physician acceptance of new medical information systems: the field of dreams.

    PubMed

    Treister, N W

    1998-01-01

    Physicians often fail to embrace a complex information system, may not see its relevance to their practices, and are characteristically reluctant to invest the time and energy to be trained in its use. Why is widespread physician buy-in so difficult to achieve? From physicians overwhelmed with change to failing to begin with an adequate physician base of support, this article explores some of the reasons that physicians demonstrate little buy-in to this process and offers suggestions to help create a more successful implementation. Ways to build acceptance include acknowledging the importance of physicians as customers and training them early and often. PMID:10180969

  9. Physician order entry of ultrasound examination with handheld wireless terminal

    NASA Astrophysics Data System (ADS)

    Matsuya, Shiro; Onogi, Yuzo; Shinohara, Nobuo; Yamaguchi, Izumi; Watanabe, Hiroki; Ohe, Kazuhiko; Yamaguchi, Kenichi; Niidome, Takuro; Oyama, Hiroshi

    2004-04-01

    Although our hospital has an electronic order entry system, physician order entries must be performed using one of a limited number of terminals which are located in places like nurse stations. Due to this limitation, the mobility of the ultrasound machine cannot be fully exploited if a physician wants to perform a mobile ultrasound examination far from an entry terminal. In addition, this situation increases the possibility that a physician will fail to issue a paper voucher of the examination. In an attempt to resolve these problems, we have developed a mobile physician order entry system that incorporates ultrasound machines equipped with handheld wireless terminals, which use the 802.11b standard and the bandwidth is 11 Mbps. This is an efficient way to order ultrasound examination entries because physicians can register entries at any location in a hospital ward. In addition, the proposed system is a reliable method by which to attach images upon ultrasound examination entry.

  10. Building the right physician platform.

    PubMed

    Pizzo, James J; Sullivan, Luke; Ryan, Debra L

    2015-07-01

    The challenges health systems often face in aligning physicians with organizational cost and quality goals related to the delivery of value-based care differ between employed and independent physicians. With employed physicians, the focus should be on right-sizing the service delivery network and employed medical group, building a sustainable compensation program, enhancing the revenue cycle, increasing use of midlevel providers, and implementing a common technology platform. With independent physicians, the focus should be on understanding available contracting models, participating in shared-savings arrangements, considering alternative payment distribution models, choosing the right metrics, and exploring shared branding options. PMID:26376510

  11. Performance of Thermal Insulation Containing Microencapsulated Phase Change Material

    SciTech Connect

    Kosny, Jan; Yarbrough, David; Syed, Azam M

    2007-01-01

    The objective of this study is dynamic thermal performance microencapsulated phase change material (PCM) blended with loose-fill cellulose insulation. Dynamic hot-box testing and heat-flux measurements have been made for loose-fill cellulose insulation with and without uniformly distributed microencapsulated PCM. The heat flux measurements were made with a heat-flow-meter (HFM) apparatus built in accordance with ASTM C 518. Data were obtained for 1.6 lb{sub m}/ft{sup 3} cellulose insulation containing 0 to 40 wt% PCM. Heat-flux data resulting from a rapid increase in the temperature on one side of a test specimen initially at uniform temperature were analyzed to access the effect of PCM on total heat flow. The heat flux was affected by the PCM for about 100 minutes after the temperature increase. The total heat flow during this initial period decreased linearly with PCM content from 6.5 Btu/ft{sup 2} at 0% PCM to 0.89 Btu/ft{sup 2} for 40 wt% PCM. The cellulose insulation with PCM discharged heat faster than the untreated cellulose when the hot-side temperature of the test specimen was reduced. In addition, hot-box apparatus built in accordance with ASTM C 1363 was utilized for dynamic hot-box testing of a wood stud wall assembly containing PCM-enhanced cellulose insulation. Experimental data obtained for wood-frame wall cavities containing cellulose insulation with PCM was compared with results obtained from cavities containing only cellulose insulation.

  12. Age-related changes in the performance of forward reach.

    PubMed

    Lin, S I; Liao, C F

    2011-01-01

    Aging is widely considered to be associated with limited balance capacity. It is not clear if forward reach ability is also affected by aging. The purpose of this study was to determine if aging was associated with reduced ability of forward reach or changes in movement patterns. Thirty-three young and 31 older adults were instructed to reach forward as far as possible without losing balance. A motion analysis system was used to record the body kinematics to calculate the joint angle and estimate the motion of center of mass (COM) using a five-segment model. Reach distance (measured from the finger marker), COM displacement, and the distance that the COM exceeded the 2nd toe marker (COM-toe) were used to represent reach performance. The movement patterns were classified as hip, ankle or mixed strategies based upon joint kinematics. It was found that the initial location of the COM was significantly more anterior in the older adults. Older adults were found to have significantly smaller COM displacement and greater hip flexion, but did not differ from young adults in reach distance or COM-toe. Older adults overwhelmingly adopted a hip strategy, but none adopted an ankle strategy. The distribution of the different strategies also differed significantly between groups. These findings suggest that aging appears to be associated with modifications in movement patterns, but not necessarily with a reduction in the ability to approach the boundary of stability. Clinically, balance training for older adults may include the exploration and instruction of atypical movement patterns. PMID:20951591

  13. Ophidia: high performance data analytics for climate change

    NASA Astrophysics Data System (ADS)

    Fiore, S.; Williams, D. N.; Foster, I.; Aloisio, G.

    2013-12-01

    This work presents the most relevant results related to the Ophidia project, a big data analytics research effort applied to climate change. It combines together high perfomance computing and database management systems to provide users with an efficient and climate-oriented data analytics platform. Ophidia extends, in terms of both Structured Query Language (SQL) primitives and data types, current relational database systems to enable efficient data analysis tasks on scientific array-based data. It exploits a proprietary storage model jointly with a parallel software framework based on the Message Passing Interface (MPI) to run from single tasks to more complex dataflows. The current version of the Ophidia framework includes more than 60 array-based primitives and about 25 operators (16 parallel and 9 sequential). Among others, the available array-based functions allow to perform data sub-setting, data aggregation, array concatenation, algebraic expressions and predicate evaluation. Nesting is also supported. On the other hand, some relevant examples related to the parallel operators include (i) data sub-setting (slicing and dicing), (ii) data aggregation, (iii) array-based primitives, (iv) dataset duplication, (v) NetCDF-import and export. The Ophidia framework is being tested on NetCDF data produced in the context of the international Coupled Model Intercomparison Project Phase 5 (CMIP5) and available through the Earth System Grid Federation infrastructure. The current set of use cases includes: 1) data subsetting (e.g. slicing an dicing); 2) time series analysis (e.g. data summary and statistics); 3) data reduction (e.g. from daily to monthly, annual data); 4) data transformation (e.g. re-gridding); 5) data intercomparison (e.g. model and scenario intercomparison) 6) a composition of the aforementioned tasks. This work will highlight the most relevant architectural and infrastructural aspects of the Ophidia project, the parallel framework, the current set of

  14. Hospital-Physician Collaboration: Landscape of Economic Integration and Impact on Clinical Integration

    PubMed Central

    Burns, Lawton Robert; Muller, Ralph W

    2008-01-01

    Context Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). Methods This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. Findings The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. Conclusions Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously. PMID:18798884

  15. Refocusing the hospital/physician relationship. It's time for physicians to share the risk.

    PubMed

    Rosenfield, R H

    1988-01-01

    Market forces are destroying the traditional hospital/physician relationship and replacing it with something far better suited to a price-sensitive environment marked by severe excess capacity. Many hospitals are exploring ways to alter a hospital/physician relationship that has survived--more of less unchanged--for nearly 70 years. Managing change of this magnitude is a difficult task and many hospital/physician communities have been seriously divided by resulting conflicts. On the other hand, a price competitive environment frequently rewards innovation and leadership and penalizes conservatism. Charting a course in these troubled waters is a challenge for healthcare executives, but if we are successful in managing this change, our facilities, our communities and our patients will benefit. PMID:10303128

  16. Physicians and foundation hospitals.

    PubMed

    Cooper, John; Black, Carol

    2003-01-01

    Foundation NHS Trusts will be constituted in the same way as Mutual Societies, and local people and patients will be invited to become subscribers. Subscribers will elect a board of governors who will appoint the non-executive directors of the Trusts. Foundation Trusts will be outside the performance management system, but will be subject to a regulator and to inspection. Contracts with commissioners will be legally enforceable. Issues discussed in the article include: financial borrowing; whether competition is being reintroduced; poaching staff; fears of a two-tier health service; fragmentation of the NHS; the impact on research and teaching; and the impact on the current 'target culture'. Local communities and patient groups may welcome involvement with their local hospitals, but special interest groups could be a danger. Foundation Trusts may bring back some of the better features of NHS Trusts as originally conceived, and offer better opportunities for clinicians to influence local policies and priorities. Fears of yet another organisational change are an important issue. Only time will tell whether the outcome will justify the effort the changes will involve. PMID:14703035

  17. Physician Reimbursement: From Fee-for-Service to MACRA, MIPS and APMs.

    PubMed

    Miller, Phillip; Mosley, Kurt

    2016-01-01

    To a significant degree, "healthcare reform" is a movement to change how both physicians and healthcare facilities are compensated, with value replacing volume as the key compensation metric. The goal of this movement has not yet been accomplished, but the process is accelerating. In this article, we track how the arc of physician compensation is bending, how the Medicare Access and CHIP Reauthorization Act will drive further changes to physician compensation models, and how these changes may affect physician practice patterns and physician staffing in the future. PMID:27249873

  18. Veterans as physician assistants.

    PubMed

    Brock, Douglas; Evans, Timothy; Garcia, Drew; Bester, Vanessa; Gianola, F J

    2015-11-01

    The physician assistant (PA) profession emerged nearly 50 years ago to leverage the healthcare experience of Vietnam-era military trained medics and corpsmen to fill workforce shortages in medical care. In 2009, the American Recovery and Reinvestment Act Primary Care Training and Enhancement program was established to improve access to primary care. Training military veterans as PAs was again identified as a strategy to meet provider access shortages. However, fewer than 4% of veterans with military healthcare training are likely to apply to PA school and little is known regarding the factors that predict acceptance to training. In 2012, we surveyed all veteran applicants and a stratified random sample of nonveterans applying to PA training. We compare the similarities and differences between veteran and nonveteran applicants, application barriers, and the factors predicting acceptance. We conclude with a discussion of the link between modern veterans and the PA profession. PMID:26501578

  19. Arise the systems physician.

    PubMed

    Scott, I; Phelps, G; Dalton, S

    2014-12-01

    Healthcare in Australia faces significant challenges. Variations in care, suboptimal safety and reliability, fragmentation of care and unsustainable cost increases are compounded by substantial overuse and underuse of clinical interventions. These problems arise not from intentional actions of individual clinicians, but from deficiencies in the design, operations and governance of systems of care. Physicians play an important role in optimising systems of care and, in doing so, must rely on enhanced skills in a range of domains. These include: how to evaluate and improve quality and safety of clinical processes; analyse and interpret clinical and administrative data in ways that can be used to enhance care delivery; build and lead cohesive multidisciplinary teams capable of solving operational defects and inefficient workarounds; and implement new and effective innovations in clinical service delivery. While clinical skills are essential in individual patient care, skills that improve systems of care targeting whole patient populations will become increasingly desirable and recognised as core skills. PMID:25442761

  20. Medical schools and physicians

    PubMed Central

    Troupin, James L.

    1955-01-01

    Statistics have been compiled to show the relation of the numbers of physicians, medical schools, and students to areas and populations throughout the world. Some of the figures are estimates and assumptions, and because of this the author repeatedly warns against tempting deductions and conclusions. This quantitative survey is intended to assist those responsible for over-all planning of health and medical services and indicates the needs, adequacy of numbers and future potential attainments compared to the size of the population served. In many countries an increase in the numbers of doctors is indicated and in this connexion the problem of the intake and output of medical schools is discussed. A plea is made for improved methods of collecting and recording these statistics. PMID:20604000

  1. Writing to Heal Thyself: Physician as Person & Person as Physician

    ERIC Educational Resources Information Center

    Kasman, Deborah L.

    2006-01-01

    An experienced physician-teacher shares her own experiences with loss in medicine and loss in her personal life. Through personal writings during her divorce, she exemplifies the healing effect writing can have during difficult transformations that occur in life. She shares her bias that physicians need to accept and own their emotions and can use…

  2. Five things physicians should know about physician assistants.

    PubMed

    Keizer, Tracy

    2012-11-01

    Physician assistants (PAs) have become integral members of the health care team. They are expected to play an even larger role as health care delivery evolves. This article highlights some of the facts physicians should know about PAs and the role they play in the health care system. PMID:23243755

  3. When Does Changing Representation Improve Problem-Solving Performance?

    NASA Technical Reports Server (NTRS)

    Holte, Robert; Zimmer, Robert; MacDonald, Alan

    1992-01-01

    The aim of changing representation is the improvement of problem-solving efficiency. For the most widely studied family of methods of change of representation it is shown that the value of a single parameter, called the expulsion factor, is critical in determining (1) whether the change of representation will improve or degrade problem-solving efficiency and (2) whether the solutions produced using the change of representation will or will not be exponentially longer than the shortest solution. A method of computing the expansion factor for a given change of representation is sketched in general and described in detail for homomorphic changes of representation. The results are illustrated with homomorphic decompositions of the Towers of Hanoi problem.

  4. Length of stay and hospital costs among patients admitted to hospital by family physicians

    PubMed Central

    Wen, Chuck K.; Chambers, Catharine; Fang, Dianne; Mazowita, Garey; Hwang, Stephen W.

    2012-01-01

    Abstract Objective To compare length of stay and total hospital costs among patients admitted to hospital under the care of family physicians who were their usual health care providers in the community (group A) and patients admitted to the same inpatient service under the care of family physicians who were not their usual health care providers (group B). Design Retrospective observational study. Setting A large urban hospital in Vancouver, BC. Participants All adult admissions to the family practice inpatient service between April 1, 2006, and June 30, 2008. Main outcome measures Ratio of length of stay to expected length of stay and total hospital costs per resource intensity weight unit. Multivariate linear regression was performed to determine the effect of admitting group (group A vs group B) on the natural logarithm transformations of the outcomes. Results The median acute length of stay was 8.0 days (interquartile range [IQR] 4.0 to 13.0 days) for group A admissions and 8.0 days (IQR 4.0 to 15.0 days) for group B admissions. The median (IQR) total hospital costs were $6498 ($4035 to $11 313) for group A admissions and $6798 ($4040 to $12 713) for group B admissions. After adjustment for patient characteristics, patients admitted to hospital under the care of their own family physicians did not significantly differ in terms of acute length of stay to expected length of stay ratio (percent change 0.6%, P = .942) or total hospital costs per resource intensity weight unit (percent change −2.0%, P = .722) compared with patients admitted under the care of other family physicians. Conclusion These findings suggest that having networks of family physicians involved in hospital care for patients is not less efficient than having family physicians provide care for their own patients. PMID:22518905

  5. A new, but old business model for family physicians: cash.

    PubMed

    Weber, J Michael

    2013-01-01

    The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making. PMID:23924222

  6. Potential Effects of Health Care Policy Decisions on Physician Availability

    NASA Technical Reports Server (NTRS)

    Garcia, Christopher; Goodrich, Michael

    2011-01-01

    Many regions in America are experiencing downward trends in the number of practicing physicians and the number of available physician hours, resulting in a worrisome decrease in the availability of health care services. Recent changes in American health care legislation may induce a rapid change in the demand for health care services, which in turn will result in a new supply-demand equilibrium . In this paper we develop a system dynamics model linking physician availability to health care demand and profitability. We use this model to explore scenarios based on different initial conditions and describe possible outcomes for a range of different policy decisions.

  7. Assessing the Impact of Continuing Medical Education through Structured Physician Dialogue.

    ERIC Educational Resources Information Center

    Wergin, Jon F.; And Others

    A method for evaluating physicians' practice behavior after undertaking continuing medical education (CME) conducted by the American College of Cardiology (ACC) was developed and tested during 1983-1985. The literature on CME effectiveness and physician behavior change was reviewed. Physicians who were trained interviewers conducted telephone…

  8. Behavioral Change and Building Performance: Strategies for Significant, Persistent, and Measurable Institutional Change

    SciTech Connect

    Wolfe, Amy K.; Malone, Elizabeth L.; Heerwagen, Judith H.; Dion, Jerome P.

    2014-04-01

    The people who use Federal buildings — Federal employees, operations and maintenance staff, and the general public — can significantly impact a building’s environmental performance and the consumption of energy, water, and materials. Many factors influence building occupants’ use of resources (use behaviors) including work process requirements, ability to fulfill agency missions, new and possibly unfamiliar high-efficiency/high-performance building technologies; a lack of understanding, education, and training; inaccessible information or ineffective feedback mechanisms; and cultural norms and institutional rules and requirements, among others. While many strategies have been used to introduce new occupant use behaviors that promote sustainability and reduced resource consumption, few have been verified in the scientific literature or have properly documented case study results. This paper documents validated strategies that have been shown to encourage new use behaviors that can result in significant, persistent, and measureable reductions in resource consumption. From the peer-reviewed literature, the paper identifies relevant strategies for Federal facilities and commercial buildings that focus on the individual, groups of individuals (e.g., work groups), and institutions — their policies, requirements, and culture. The paper documents methods with evidence of success in changing use behaviors and enabling occupants to effectively interact with new technologies/designs. It also provides a case study of the strategies used at a Federal facility — Fort Carson, Colorado. The paper documents gaps in the current literature and approaches, and provides topics for future research.

  9. Family Physicians and Teaching Hospitals: A Litany of Woes

    PubMed Central

    Hansen, Niels H.

    1984-01-01

    Retreat of family physicians from caring for their patients in teaching hospitals has been partly imposed and partly passively accepted. Confusion of patient, family doctor and consultant relationships has resulted. Town/gown and family physician/specialist communication problems disrupt a proper model of care. Family physicians need to take individual and group action to initiate change, but little action has been evident. Everyone is the loser. We should reinstitute a model in which family physicians are the closest professionals to their patients, wherever they are in the health care system. Demonstrating the value of family physician coordination of care and continuity of care will positively affect the current financial `loss leader' status of this work. PMID:21279057

  10. Automated Data Mining of A Proprietary Database System for Physician Quality Improvement

    SciTech Connect

    Johnstone, Peter Crenshaw, Tim; Cassels, Diane G.; Fox, Timothy H.

    2008-04-01

    Purpose: Physician practice quality improvement is a subject of intense national debate. This report describes using a software data acquisition program to mine an existing, commonly used proprietary radiation oncology database to assess physician performance. Methods and Materials: Between 2003 and 2004, a manual analysis was performed of electronic portal image (EPI) review records. Custom software was recently developed to mine the record-and-verify database and the review process of EPI at our institution. In late 2006, a report was developed that allowed for immediate review of physician completeness and speed of EPI review for any prescribed period. Results: The software extracted >46,000 EPIs between 2003 and 2007, providing EPI review status and time to review by each physician. Between 2003 and 2007, the department EPI review improved from 77% to 97% (range, 85.4-100%), with a decrease in the mean time to review from 4.2 days to 2.4 days. The initial intervention in 2003 to 2004 was moderately successful in changing the EPI review patterns; it was not repeated because of the time required to perform it. However, the implementation in 2006 of the automated review tool yielded a profound change in practice. Using the software, the automated chart review required {approx}1.5 h for mining and extracting the data for the 4-year period. Conclusion: This study quantified the EPI review process as it evolved during a 4-year period at our institution and found that automation of data retrieval and review simplified and facilitated physician quality improvement.

  11. Physician-assisted death and the anesthesiologist.

    PubMed

    Mottiar, Miriam; Grant, Cameron; McVey, Mark J

    2016-03-01

    Although physician-assisted death (PAD) is established in certain countries, the legality and ethics of this issue have been debated for decades in Canada. The Supreme Court of Canada has now settled the issue of legality nationally, and as a result of the decision in Carter v. Canada, PAD (which includes both physician-assisted suicide and euthanasia) will become legal on February 6, 2016. It is difficult to predict the potential demand for PAD in Canada. This paper highlights other countries' experiences with PAD in order to shed light on this question and to forecast issues that Canadian physicians will face once the change to the law comes into effect. At present, there is no legislative scheme in place to regulate the conduct of PAD. Physicians and their provincial colleges may find themselves acting as the de facto regulators of PAD if a regulatory vacuum persists. With their specialized knowledge of pharmacology and interdisciplinary leadership, anesthesiologists may be called upon to develop protocols for the administration of PAD as well as to administer euthanasia. Canadian anesthesiologists currently have a unique opportunity to consider the complex ethical issues they will face when PAD becomes legal and to contribute to the creation of a regulatory structure that will govern PAD in Canada. PMID:26739697

  12. Physician-patient communication: a lost art?

    PubMed

    Frymoyer, John W; Frymoyer, Nan P

    2002-01-01

    In the face of rapid advances in technology, there has been a progressive deterioration of effective physician-patient communication. The American Academy of Orthopaedic Surgeons has identified that patients rate the orthopaedic profession as high in technical and low in communication skills. Poor communication, especially patient-interviewing skills, has been identified in medical students as well as in practicing physicians. Effective communication is associated with improved patient and physician satisfaction, better patient compliance, improved health outcomes, better-informed medical decisions, and reduced malpractice suits, and it likely contributes to reduced costs of care. Recognition of the importance of communication has influenced medical schools to revise curricula and to teach communication skills in residency training and continuing medical education programs. National certifying examinations also are being designed to incorporate these skills. Although written material is useful in increasing awareness of the importance of good physician-patient communication, behavioral change is more likely to occur in a workshop environment. The American Academy of Orthopaedic Surgeons is taking leadership in designing and implementing such an approach for its membership. PMID:11929204

  13. Physician Education in Sleep Disorders.

    ERIC Educational Resources Information Center

    Orr, William C.; And Others

    1980-01-01

    The lack of physician knowledge in the diagnosis and management of sleep disorders is discussed. An examination of physicians demonstrated knowledge deficiencies and a survey of medical schools showed that 46 percent offered no training in the area of sleep physiology or disorders. Recommendations for addressing the situation are offered. (JMD)

  14. Physician Requirements-1990. For Cardiology.

    ERIC Educational Resources Information Center

    Tracy, Octavious; Birchette-Pierce, Cheryl

    Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…

  15. Physician payment outlook for 2012.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A; Barr, Robert M; Donovan, William D; Nicola, Greg N

    2012-11-01

    Physician spending is complex and intrinsically related to national health care spending, government regulations, health care reform, private insurers, physician practice and patient utilization patterns. Consequently, since the inception of Medicare programs in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. The sustainable growth rate (SGR) was enacted in 1997 to determine physician payment updates under Medicare part B with an intent to reduce Medicare physician payment updates to offset the growth and utilization of physician services that exceeds the gross domestic product growth. This is achieved by setting an overall target amount of spending for physicians' services and adjusting payment rates annually to reflect differences between actual spending and the spending target. Since 2002, the SGR has annually recommended reductions in Medicare reimbursements. Payments were cut by 4.8% in 2002. Since then, Congress has intervened on 13 separate occasions to prevent additional cuts from being imposed. This manuscript describes certain important aspects of the 2012 physician fee schedule. PMID:22717919

  16. Abortion and compelled physician speech.

    PubMed

    Orentlicher, David

    2015-01-01

    Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. PMID:25846035

  17. Multi-factor climate change effects on insect herbivore performance

    PubMed Central

    Scherber, Christoph; Gladbach, David J; Stevnbak, Karen; Karsten, Rune Juelsborg; Schmidt, Inger Kappel; Michelsen, Anders; Albert, Kristian Rost; Larsen, Klaus Steenberg; Mikkelsen, Teis Nørgaard; Beier, Claus; Christensen, Søren

    2013-01-01

    The impact of climate change on herbivorous insects can have far-reaching consequences for ecosystem processes. However, experiments investigating the combined effects of multiple climate change drivers on herbivorous insects are scarce. We independently manipulated three climate change drivers (CO2, warming, drought) in a Danish heathland ecosystem. The experiment was established in 2005 as a full factorial split-plot with 6 blocks × 2 levels of CO2 × 2 levels of warming × 2 levels of drought = 48 plots. In 2008, we exposed 432 larvae (n = 9 per plot) of the heather beetle (Lochmaea suturalis Thomson), an important herbivore on heather, to ambient versus elevated drought, temperature, and CO2 (plus all combinations) for 5 weeks. Larval weight and survival were highest under ambient conditions and decreased significantly with the number of climate change drivers. Weight was lowest under the drought treatment, and there was a three-way interaction between time, CO2, and drought. Survival was lowest when drought, warming, and elevated CO2 were combined. Effects of climate change drivers depended on other co-acting factors and were mediated by changes in plant secondary compounds, nitrogen, and water content. Overall, drought was the most important factor for this insect herbivore. Our study shows that weight and survival of insect herbivores may decline under future climate. The complexity of insect herbivore responses increases with the number of combined climate change drivers. PMID:23789058

  18. Physician Labor Market in Croatia

    PubMed Central

    Bagat, Mario; Sekelj Kauzlarić, Katarina

    2006-01-01

    Aim To analyze the physician labor market in Croatia with respect to the internship and employment opportunities, Croatian needs for physicians and specialists, and trends in physician labor market in the European Union (EU) in the context of EU enlargement. Methods Data were collected from the Ministry of Health and Social Welfare, the Croatian Employment Service, and the Croatian Institute for Public Health. We compared the number of physicians waiting for internship before and 14 months after the implementation of the State Program for Intern Employment Stimulation. Also, the number of employed specialists in internal medicine, general surgery, gynecology and obstetrics, and pediatrics was compared with estimated number of specialists that will have been needed by the end of 2007. Average age of hospital physicians in the four specialties was determined and the number of Croatian physicians compared with the number of physicians in EU countries. Results The number of unemployed physicians waiting for internship decreased from 335 in 2003 to 82 in 2004, while a total number of unemployed physicians decreased from 436 to 379 (χ2 = 338, P<0.001). In October 2004, 79.3% of unemployed physicians waited for internship <6 months; of them, 89.2% waited for internship <3 months. In February 2005, 365 unemployed physicians were registered at the Croatian Employment Service and that number has been decreasing in the last couple of years. The number of employed specialists was lower than the estimated number of specialists needed in the analyzed specialists, as defined by the prescribed standards. A shortage of 328 internists, 319 surgeons, 209 gynecologists, and 69 pediatricians in Croatian hospitals is expected in 2007. Conclusion The lack of employment incentive seems to be the main reason for the large number of unemployed physicians waiting for internship before the implementation of the Employment Stimulation Program. According to the number of physicians per 100

  19. Physician retirement: a case for concern in Canadian hospitals.

    PubMed Central

    Gillies, J H; Ross, L C

    1984-01-01

    Mandatory retirement is being challenged on the basis of age discrimination, and physicians are not divorced from this social trend. In January 1982 legal precedent was set by the Manitoba Court of Appeal concerning the retirement policy for physicians in Canada. Currently, Canadian hospital bylaws include clauses that require a change in membership status once a physician reaches 65 years of age. The main arguments in favour of this change include easier physician manpower management, ensured public safety and, in some instances, greater productivity. The main arguments against this change include loss of income to physicians, loss of skilled manpower to the profession and adverse effects on the mental and physical health of retiring physicians. In an effort to resolve this conflict some Canadian hospitals are developing strategies for reviewing the specific privileges and responsibilities physicians will retain once they reach age 65. The medical staff of the Victoria General Hospital in Halifax, NS have addressed this issue through their annual reappointment process. PMID:6744174

  20. Physicians and euthanasia: a Canadian print-media discourse analysis of physician perspectives

    PubMed Central

    Wright, David Kenneth; Karsoho, Hadi; Sandham, Sarah; Macdonald, Mary Ellen

    2015-01-01

    Background Recent events in Canada have mobilized public debate concerning the controversial issue of euthanasia. Physicians represent an essential stakeholder group with respect to the ethics and practice of euthanasia. Further, their opinions can hold sway with the public, and their public views about this issue may further reflect back upon the medical profession itself. Methods We conducted a discourse analysis of print media on physicians’ perspectives about end-of-life care. Print media, in English and French, that appeared in Canadian newspapers from 2008 to 2012 were retrieved through a systematic database search. We analyzed the content of 285 articles either authored by a physician or directly referencing a physician’s perspective. Results We identified 3 predominant discourses about physicians’ public views toward euthanasia: 1) contentions about integrating euthanasia within the basic mission of medicine, 2) assertions about whether euthanasia can be distinguished from other end-of-life medical practices and 3) palliative care advocacy. Interpretation Our data showed that although some medical professional bodies appear to be supportive in the media of a movement toward the legalization of euthanasia, individual physicians are represented as mostly opposed. Professional physician organizations and the few physicians who have engaged with the media are de facto representing physicians in public contemporary debates on medical aid in dying, in general, and euthanasia, in particular. It is vital for physicians to be aware of this public debate, how they are being portrayed within it and its potential effects on impending changes to provincial and national policies. PMID:26389090

  1. Can a hospital benefit from partnering with physicians?

    PubMed

    Fine, Allan; Frazier, Brandon

    2011-05-01

    The prospect of accountable care organizations gives hospitals good reason today to consider the benefits of developing an ambulatory surgery center (ASC) as a joint venture with physicians, as well as the risks of not pursuing such a strategy. A key potential benefit that such an ASC can offer a hospital is the ability to enhance a hospital's physician recruitment efforts and increase surgical volume. Another important consideration is whether the hospital and physicians possess the collective expertise, performance track record, capital, tenacity, perseverance, resources, and credibility to perform the necessary functions of the ASC on their own. PMID:21634270

  2. Changes in College Student Health:Implications for Academic Performance

    ERIC Educational Resources Information Center

    Ruthig, Joelle C.; Marrone, Sonia; Hladkyj, Steve; Robinson-Epp, Nancy

    2011-01-01

    This study investigated the longitudinal associations of health perceptions and behaviors with subsequent academic performance among college students. Multiple health perceptions and behaviors were assessed for 203 college students both at the beginning and end of an academic year. Students' academic performance was also measured at the end of the…

  3. Unexpected Directions of Change in Student Writing Performance.

    ERIC Educational Resources Information Center

    Keech, Catharine Lucas

    In examining why performance scores on writing tests so often fail to improve in neat positive intervals for individuals and groups, testers have sought the answer in differences in test conditions on progressive retestings. Two other sources of performance variation are possible: the U-shaped learning curve or phenomenon of apparent regression…

  4. Attitudes of Washington State physicians toward health care reform.

    PubMed Central

    Malter, A D; Emerson, L L; Krieger, J W

    1994-01-01

    Attitudes of Washington State physicians about health care reform and about specific elements of managed competition and single-payer proposals were evaluated. Opinions about President Clinton's reform plan were also assessed. Washington physicians (n = 1,000) were surveyed from October to November 1993, and responses were collected through January 1994; responses were anonymous. The response rate was 80%. Practice characteristics of respondents did not differ from other physicians in the state. Of physicians responding, 80% favored substantial change in the current system, 43% favored managed competition, and 40% preferred a single-payer system. Of physicians responding, 64% thought President Clinton's proposal would not adequately address current problems. Reduced administrative burden, a central element of single-payer plans, was identified by 89% of respondents as likely to improve the current system. Other elements of reform plans enjoyed less support. More procedure-oriented specialists than primary care physicians favored leaving the current system unchanged (28% versus 8%, P < .001). While physicians favor health care reform, there is no consensus on any single plan. It seems unlikely that physicians will be able to speak with a single voice during the current debates on health care reform. PMID:7941503

  5. Views of oral cancer prevention and early detection: Maryland physicians.

    PubMed

    Canto, Maria Teresa; Horowitz, Alice M; Child, Wendy L

    2002-06-01

    The purpose of this study was to obtain in-depth information on Maryland physicians' knowledge, opinions and practices about oral cancer examinations. The qualitative descriptive study used one focus group conducted in a conference facility and nine one-on-one interviews at private medical offices. A criterion-purposeful sampling was used for selection of participants. Generally, we found low awareness of, and surprise about, Maryland's high oral cancer mortality rates. Physicians were not surprised that they detect more lesions than dentists, although most physicians did not provide oral cancer examinations on a routine basis. Physicians were interested in attending continuing medical education (CME) courses on oral cancer prevention and early detection but only if worked into other CME programs on cancer. They were very interested in having hands-on training on performing an oral cancer examination. These findings will be used to implement educational interventions for Maryland physicians to help increase early detection of oral cancers. PMID:12076702

  6. Episiotomy in Low-Risk Deliveries: Physician Factors

    PubMed Central

    Arroll, Bruce; Giles, Anne; Sheps, Samuel B.

    1990-01-01

    From 376 randomly selected nulliparous women who delivered at the Grace Hospital in 1986, we selected 133 low-risk women and performed a retrospective chart review to ascertain the episiotomy rate for physicians by sex, years since graduation, and specialty status. There was a statistically significant difference between the rate for specialists (65%) and general practitioners (38%). A non-significant difference was found between male physicians (41%) and female physicians (56%) and between physicians who had graduated within 15 years (42%) and those who graduated more than 15 years ago (52%). Subgroup analysis of the general practitioner data revealed different patterns for male and female physicians according to their graduation cohort. PMID:21233977

  7. Forecasting Japan's Physician Shortage in 2035 as the First Full-Fledged Aged Society

    PubMed Central

    Yamaguchi, Rui; Matsumura, Tomoko; Murashige, Naoko; Kodama, Yuko; Minayo, Satoru; Imai, Kohzoh; Kami, Masahiro

    2012-01-01

    Introduction Japan is rapidly becoming a full-fledged aged society, and physician shortage is a significant concern. The Japanese government has increased the number of medical school enrollments since 2008, but some researchers warn that this increase could lead to physician surplus in the future. It is unknown how many physicians will be required to accommodate future healthcare needs. Materials and Methods We simulated changes in age/sex composition of the population, fatalities (the number of fatalities for the consecutive five years), and number of physicians from 2010 to 2035. Two indicators were defined: fatalities per physician and fatalities by physician working hour, based on the data of the working hours of physicians for each tuple of sex and age groups. We estimated the necessary number of physicians in 2035 and the number of new physicians to maintain the indicator levels in 2010. Results The number of physicians per 1,000 population is predicted to rise from 2·00 in 2010 to 3·14 in 2035. The number of physicians aged 60 years or older is expected to increase from 55,375 (20% of physicians) to 141,711 (36%). In 2010 and 2035, fatalities per physician were 23·1 and 24·0 for the total population, and 13·9 and 19·2 for 75 years or older, respectively. Fatalities per physician working hour are predicted to rise from 0·128 to 0·138. If working hours are limited to 48 hours per week in 2035, the number of fatalities per physician working hour is expected to be 0·196, and the number of new physicians must be increased by 53% over the current pace. Discussion The number of physicians per population continues to rise, but the estimated supply will not fulfill the demand for healthcare in the aging society. Strategies to increase the number of physicians and improve working conditions are urgently needed. PMID:23233868

  8. 42 CFR 418.304 - Payment for physician and nurse practitioner services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for physician and nurse practitioner... Payment for physician and nurse practitioner services. (a) The following services performed by hospice physicians and nurse practitioners are included in the rates described in § 418.302: (1) General...

  9. Physician recruitment programs--fraud and abuse, tax, and antitrust considerations.

    PubMed

    Andressen, D C

    1988-01-01

    In today's competitive environment, physician recruitment incentive programs perform a valuable function for both hospitals and physicians, but fraud and abuse, tax, and antitrust laws impose significant restrictions on such programs. This article addresses some of the issues that hospitals and physicians must consider before participating in recruitment incentive programs. PMID:10302569

  10. The Physician's Life Cycle: Picketing the Outposts

    PubMed Central

    McSherry, J. A.

    1981-01-01

    The changes which occur in a physician's life relate to stages of personal and professional development. The balance between the demands of practice and the needs of self and family is critical. Early establishment of personal goals and priorities makes it easy to avoid specific hazards which would otherwise compromise enjoyment of a full life and a productive career. A lifelong personal program of medical education nourishes the professional interest which sustains a busy practitioner throughout a demanding career.

  11. Physicians' strikes and the competing bases of physicians' moral obligations.

    PubMed

    MacDougall, D Robert

    2013-09-01

    Many authors have addressed the morality of physicians' strikes on the assumption that medical practice is morally different from other kinds of occupations. This article analyzes three prominent theoretical accounts that attempt to ground such special moral obligations for physicians--practice-based accounts, utilitarian accounts, and social contract accounts--and assesses their applicability to the problem of the morality of strikes. After critiquing these views, it offers a fourth view grounding special moral obligations in voluntary commitments, and explains why this is a preferable basis for understanding physicians' moral obligations in general and especially as pertaining to strikes. PMID:24199524

  12. Developing physician referrals for the new physician: techniques to market your physician's practice.

    PubMed

    Schwarz, Chad; Baum, Neil

    2011-01-01

    New physicians will need to be proactive to market and promote their practices. Generating referrals from colleagues is one of the best ways to attract new patients to a start-up practice. This article will provide techniques that will help new physicians enhance their relationships with their colleagues in the community. PMID:21815560

  13. Top 20 Research Studies of 2014 for Primary Care Physicians.

    PubMed

    Ebell, Mark H; Grad, Roland

    2015-09-01

    A team of primary care clinicians with expertise in evidence-based medicine performed monthly surveillance of more than 110 English-language clinical research journals during 2014, and identified 255 studies that had the potential to change how family physicians practice. Each study was critically appraised and summarized, focusing on its relevance to primary care practice, validity, and likelihood that it could change practice. A validated tool was used to obtain feedback from members of the Canadian Medical Association about the clinical relevance of each POEM (patient-oriented evidence that matters) and the benefits they expect for their practice. This article, the fourth installment in this annual series, summarizes the 20 POEMs based on original research studies judged to have the greatest impact on practice for family physicians. Key studies for this year include advice on symptomatic management and prognosis for acute respiratory infections; a novel and effective strengthening treatment for plantar fasciitis; a study showing that varenicline plus nicotine replacement is more effective than varenicline alone; a network meta-analysis concluding that angiotensin-converting enzyme inhibitors are preferred over angiotensin II receptor blockers; the clear benefits of initial therapy with metformin over other agents in patients with diabetes mellitus; and important guidance on the use of anticoagulants. PMID:26371571

  14. Comparison of burnout pattern between hospital physicians and family physicians working in Suez Canal University Hospitals

    PubMed Central

    Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed

    2014-01-01

    Introduction The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. Methods This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a “high“ score on at least 2 of the three dimensions of MBI. Results In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. Conclusion There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout. PMID:25422682

  15. Temporal Coordination and Adaptation to Rate Change in Music Performance

    ERIC Educational Resources Information Center

    Loehr, Janeen D.; Large, Edward W.; Palmer, Caroline

    2011-01-01

    People often coordinate their actions with sequences that exhibit temporal variability and unfold at multiple periodicities. We compared oscillator- and timekeeper-based accounts of temporal coordination by examining musicians' coordination of rhythmic musical sequences with a metronome that gradually changed rate at the end of a musical phrase…

  16. Procurement change in Canada: an opportunity for improving system performance.

    PubMed

    Arshoff, Larry; Henshall, Chris; Juzwishin, Don; Racette, Ray

    2012-01-01

    The Canadian healthcare system is undergoing restructuring of how goods and services are purchased. A conference "Navigating Hospital and Health System Procurement" was organized by MEDEC and the Canadian College of Health Leaders to examine the issues. This paper describes the implications and opportunities these changes present for healthcare policy, regulation, practice, and the supplier marketplace. PMID:22931011

  17. Human Performance Optimization: Culture Change and Paradigm Shift.

    PubMed

    Deuster, Patricia A; OʼConnor, Francis G

    2015-11-01

    The term "Human Performance Optimization" (HPO) emerged across the Department of Defense (DoD) around 2006 when the importance of human performance for military success on the battlefield was acknowledged. Likewise, the term Total Force Fitness (TFF) arose as a conceptual framework within DoD in response to the need for a more holistic approach to the unparalleled operational demands with multiple deployments and strains on the United States Armed Forces. Both HPO and TFF are frameworks for enhancing and sustaining the health, well-being, and performance among our warriors and their families; they are fundamental to accomplishing our nation's mission. A demands-resources model for HPO is presented within the context of TFF to assist in operationalizing actions to enhance performance. In addition, the role leaders can serve is discussed; leaders are uniquely postured in the military chain of command to directly influence a culture of fitness for a ready force, and promote the concept that service members are ultimately responsible for their fitness and performance. PMID:26506199

  18. Physician-assessment and physician-enhancement programs in Canada.

    PubMed

    Page, G G; Bates, J; Dyer, S M; Vincent, D R; Bordage, G; Jacques, A; Sindon, A; Kaigas, T; Norman, G R; Kopelow, M; Moran, J

    1996-01-01

    In the mid-1980s, the licensing authorities in Quebec, Ontario and Manitoba have introduced programs to conduct in-depth assessments of the clinical skills and abilities of physicians with suspected deficiencies. These assessments are intended to supplement the provincial licensing authorities' existing peer review or patient-complaint mechanisms by confirming the physicians' overall level of competence and identifying specific clinical strengths and weaknesses. An "educational prescription", based on the results of the assessment, focuses on aspects of clinical practice in which the physicians need or wish to enhance their skills. In some situations, licensure decisions are based on the assessment information. This article describes the programs in Quebec, Ontario and Manitoba. Each program comprises a different process of personal assessment and individualized continuing medical education to help physicians improve their clinical competence, and each is built on sound principles of clinical competence assessment and educational planning. PMID:23511980

  19. Physician-assessment and physician-enhancement programs in Canada.

    PubMed

    Page, G G; Bates, J; Dyer, S M; Vincent, D R; Bordage, G; Jacques, A; Sindon, A; Kaigas, T; Norman, G R; Kopelow, M

    1995-12-15

    Since the mid-1980s, the licensing authorities in Quebec, Ontario and Manitoba have introduced programs to conduct in-depth assessments of the clinical skills and abilities of physicians with suspected deficiencies. These assessments are intended to supplement the provincial licensing authorities' existing peer review or patient-complaint mechanisms by confirming the physicians' overall level of competence and identifying specific clinical strengths and weaknesses. An "educational prescription," based on the results of the assessment, focuses on aspects of clinical practice in which the physicians need or wish to enhance their skills. In some situations, licensure decisions are based on the assessment information. This article describes the programs in Quebec, Ontario and Manitoba. Each program comprises a different process of personal assessment and individualized continuing medical education to help physicians improve their clinical competence, and each is built on sound principles of clinical-competence assessment and educational planning. PMID:8529186

  20. Effect of Physician Tutorials on Prescribing Patterns of Graduate Physicians.

    ERIC Educational Resources Information Center

    Klein, Lawrence E.; And Others

    1981-01-01

    Physicians in an experimental group were surveyed to assess their knowledge of the effectiveness, cost, and side effects of antibiotics, and a tutorial was developed to modify some prescribing patterns. Prescribing patterns were statistically different. (Author/MLW)

  1. How patient-centered do female physicians need to be? Analogue patients' satisfaction with male and female physicians' identical behaviors.

    PubMed

    Hall, Judith A; Roter, Debra L; Blanch-Hartigan, Danielle; Mast, Marianne Schmid; Pitegoff, Curtis A

    2015-01-01

    Previous research suggests that female physicians may not receive appropriate credit in patients' eyes for their patient-centered skills compared to their male counterparts. An experiment was conducted to determine whether a performance of higher (versus lower) verbal patient-centeredness would result in a greater difference in analogue patient satisfaction for male than female physicians. Two male and two female actors portrayed physicians speaking to a patient using high or low patient-centered scripts while not varying their nonverbal cues. One hundred ninety-two students served as analogue patients by assuming the patient role while watching one of the videos and rating their satisfaction and other evaluative responses to the physician. Greater verbal patient-centeredness had a stronger positive effect on satisfaction and evaluations for male than for female physicians. This pattern is consistent with the hypothesis that the different associations between patient-centeredness and patients' satisfaction for male versus female physicians occur because of the overlap between stereotypical female behavior and behaviors that comprise patient-centered medical care. If this is the case, high verbal patient-centered behavior by female physicians is not recognized as a marker of clinical competence, as it is for male physicians, but is rather seen as expected female behavior. PMID:25175277

  2. Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences

    PubMed Central

    Fuß, Isabelle; Nübling, Matthias; Hasselhorn, Hans-Martin; Schwappach, David; Rieger, Monika A

    2008-01-01

    Background Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict – namely work interfering with family conflict (WIF) – which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Methods Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April–July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9%) participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ), work interfering with family conflict scale (WIF), and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. Results German hospital physicians reported elevated levels of WIF (mean = 74) compared to the general German population (mean = 45, p < .01). No significant gender difference was found. Predictors for the WIF were lower age, high quantitative demands at work, elevated number of days at work despite own illness, and consequences of short-notice changes in the duty roster. Good sense of community at work was a protective factor. Compared to the general German population, we observed a significant higher level of quantitative work demands among hospital physicians (mean = 73 vs. mean = 57, p < .01). High values of WIF were significantly correlated to higher rates of personal burnout, behavioural and cognitive stress symptoms, and the intention to leave the job. In contrast

  3. [Peculiarity of the occupational physician].

    PubMed

    Pagliaro, G; Simonini, S; del Bufalo, P; Serra, A; Ramistella, E

    2011-01-01

    Aim of this contribution is to consider, although in a concise way, the peculiarity of the Occupational Physician's activity operating in Health care sector, that employs about 5% of Italian workers. Particularly, we bring into focus the global roll that the Occupational Physician must fulfil in a reality where he is the protagonist towards the safeguard of the worker's safe, already submitted to several occupational risks, and about the safety of the third parties, which is more important than in other sectors. Shared elaboration in this article shows that Occupational Physician of the Health care sector has the same problems and expectations everywhere, in our Country. PMID:23393851

  4. Turnaround distressed physician practices. 20 tips for success.

    PubMed

    Wolper, L F

    1999-01-01

    Physician practices are restructuring through merger and acquisition, and sale to practice management companies and to hospital systems. Many also are expanding internally by recruiting new physicians and opening additional offices. For many these strategies are working, but many others are experiencing operational and financial distress and failure that arise from rapid organizational growth without concomitant infrastructural change. Further, in the last several months, many national and regional practice management companies have decided to withdraw from the business, and others have declared bankruptcy. The number of physician practices that are in financial and operational distress is unprecedented. These groups require a solution, as proposed in this article. PMID:10662463

  5. For Medicare's New Approach To Physician Payment, Big Questions Remain.

    PubMed

    Wynne, Billy

    2016-09-01

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established a new framework for Medicare physician payment. Designed to stabilize uncertain payment rates for Medicare's fee-for-service (FFS) system and incentivize physicians to move into new alternative payment systems, MACRA contains several uncertainties of its own. In a textbook illustration of why it's important to be careful what you wish for, it's increasingly easy to predict that implementation of MACRA will be delayed as a result of both regulatory and legislative breaches of its statutory timeline. This article traces the contemporary history of the Medicare physician payment system and efforts to implement additional changes. PMID:27605645

  6. The Need For Ongoing Surveys About Physician Practice Costs.

    PubMed

    Berk, Marc L

    2016-09-01

    Physicians continue to be the subject of many survey efforts asking them about a wide range of issues including training, retirement plans, satisfaction with practice, practice organization, and practice costs. The resources dedicated to the collection of different types of data have changed over time. Collection efforts have both expanded and contracted. Here I discuss this phenomenon for several types of physician surveys, with particular focus on the reduction in ongoing survey efforts about physician practice costs. The diminution of efforts to collect information about these costs represents an important challenge since the lack of timely, high-quality data could impair the correct calculation of reimbursement rates. PMID:27605646

  7. The Development of a Physician Vitality Program: A Brief Report.

    PubMed

    Hernandez, Barbara Couden; Thomas, Tamara L

    2015-10-01

    We describe the development of an innovative program to support physician vitality. We provide the context and process of program delivery which includes a number of experimental support programs. We discuss a model for intervention and methods used to enhance physician resilience, support work-life balance, and change the culture to one that explicitly addresses the physician's biopsychosocial-spiritual needs. Recommendations are given for marriage and family therapists (MFTs) who wish to develop similar support programs for healthcare providers. Video Abstract. PMID:25109396

  8. Job Satisfaction and Performance in a Changing Environment.

    ERIC Educational Resources Information Center

    Siggins, Jack A.

    1992-01-01

    Discusses the nature of job satisfaction, its relationship to performance, and associated organizational factors, such as commitment, in research libraries. Symptoms of job dissatisfaction are outlined, and a framework for improving job satisfaction provides suggestions in the areas of hiring, professional development, job design, empowerment, and…

  9. Does Manipulating Stereotype Threat Condition Change Performance Goal State

    ERIC Educational Resources Information Center

    Simmons, Cecil Max

    2010-01-01

    This study tested whether the Stereotype Threat effect is mediated by achievement goals, in particular performance-avoidance goals. Threat level was altered before a difficult math test to observe how the endorsement by females of various achievement goal dimensions was affected. 222 people (96 females) in a pre-calculus class at a Mid-Western…

  10. ALIS through the Looking Glass: Changing Perceptions of Performance Indicators.

    ERIC Educational Resources Information Center

    Williamson, John; And Others

    1992-01-01

    Follows up on a Williamson and Fitz-Gibbon article (1990) focusing on the impact of a performance indicator project, COMBSE (Confidential Measurement Based Self-Evaluation), on secondary school English departments. This article describes COMBSE's metamorphosis into another system, ALIS (A Level Information System), that has transcended the…

  11. Qualitative study of employment of physician assistants by physicians

    PubMed Central

    Taylor, Maureen T.; Wayne Taylor, D.; Burrows, Kristen; Cunnington, John; Lombardi, Andrea; Liou, Michelle

    2013-01-01

    Abstract Objective To explore the experiences and perceptions of Ontario physician assistant (PA) employers about the barriers to and benefits of hiring PAs. Design A qualitative design using semistructured interviews. Setting Rural and urban eastern and southwestern Ontario. Participants Seven family physicians and 7 other specialists. Methods The 14 physicians participated in semistructured interviews, which were audiorecorded and transcribed verbatim. An iterative approach using immersion and crystallization was employed for analysis. Main findings Physician-specific benefits to hiring PAs included increased flexibility, the opportunity to expand practice, the ability to focus more time on complex patients, overall reduction in work hours and stress, and an opportunity for professional fellowship. Physicians who hired PAs without government financial support said PAs were affordable as long as they were able to retain them. Barriers to hiring PAs included uncertainty about funding, the initial need for intensive supervision and training, and a lack of clarity around delegation of acts. Conclusion Physicians are motivated to hire PAs to help deal with long wait times and long hours, but few are expecting to increase their income by taking on PAs. Governments, medical colleges, educators, and regulators must address the perceived barriers to PA hiring in order to expand and optimize this profession. PMID:24235209

  12. Performance issues for a changing electric power industry

    SciTech Connect

    Not Available

    1995-01-01

    Extremely cold weather created record demands for electricity in the eastern two-thirds of the United States during the week of January 16, 1994. Fuel-related problems, mostly the result of transportation constraints resulting from ice accumulation on roads and water-ways, and unexpected generating capacity outages at utilities and nonutilities resulted in demand not being met. Some utilities asked nonessential customers along with State governments and a portion of the Federal Government to shut down. Two electric control areas, the Pennsylvania-New Jersey-Maryland Interconnection (PJM) and Virginia Electric & Power Company (VEPCO), instituted rolling blackouts. This disturbance was reported widely in the press and, along with other disturbances, peaked renewed interest in the reliability of the electric power system. The renewed interest in reliability has coincided with substantial changes that are beginning to occur in the structure and competitiveness of the electric power industry. Juxtaposing the question of reliability and the issue of changing industry structure leads to the central concern of this report: What effect, if any, will the changing structure of the industry have on the reliability of the system?

  13. Eye Lens Opacities Among Physicians Occupationally Exposed to Ionizing Radiation.

    PubMed

    Auvinen, Anssi; Kivelä, Tero; Heinävaara, Sirpa; Mrena, Samy

    2015-08-01

    We compared the frequency of lens opacities among physicians with and without occupational exposure to ionizing radiation, and estimated dose-response between cumulative dose and opacities. We conducted ophthalmologic examinations of 21 physicians with occupational exposure to radiation and 16 unexposed physicians. Information on cumulative radiation doses (mean 111 mSv) was based on dosimeter readings recorded in a national database on occupational exposures. Lens changes were evaluated using the Lens Opacities Classification System II, with an emphasis on posterior subcapsular (PSC) and cortical changes. Among the exposed physicians, the prevalences of cortical and PSC changes were both 11% (3/21), and the corresponding frequencies in the unexposed group were 44% (n = 7) and 6% (n = 1). For dose-response analysis, the data were pooled with 29 exposed physicians from our previous study. No association of either type of lens changes with cumulative recorded dose was observed. Our findings do not indicate an increased frequency of lens opacities in physicians with occupational exposure to ionizing radiation. However, the subjects in this study have received relatively low doses and therefore the results do not exclude small increases in lens opacities or contradict the studies reporting increases among interventional cardiologists with materially higher cumulative doses. PMID:25868644

  14. [The occupational physician in France].

    PubMed

    Matsuda, Shinya

    2013-10-01

    The French Labor law defines the role and its allocation criteria of the occupational physician (OP) the same as in Japan. In France, occupational medicine is one of the medical specialties. The OP resident must follow the 4 years clinical training before certification. After having finished their residency, they are entitled to work for the occupational health service office of a company or company association (in the case of small and medium sized companies). The most important characteristics of the French system is that they cover all workers regardless of company size. The main role of the OP is prevention of work related diseases and accidents. They are not allowed to do clinical services except for emergency cases. Their main activities are health examinations, health education, patrol and advice for better working condition. Formerly, it was rather difficult to attract the medical students for OP resident course because of its prevention oriented characteristics. A growing concern about the importance of health management at the work site, however, has changed the situation. Now, the number of candidates for OP resident course is increasing. Their task has expanded to cover mental health and other life style related diseases. The 2011 modification of law redefines the role of the OP as a director of an occupational health service office who has a total responsibility of multidisciplinary services. The French and Japanese occupational health systems have many of similarities. A comparative study by researchers of UOEH is expected to yield useful information. PMID:24107336

  15. Kinder and gentler: physicians and managed care, 1997-2001.

    PubMed

    Strunk, Bradley C; Reschovsky, James D

    2002-11-01

    Despite the managed care backlash, an overwhelming majority of U.S. physicians continue to contract with managed care health plans. In fact, according to a new Center for Studying Health System Change (HSC) study, between 1997 and 2001 physicians reported a modest increase in the proportion of practice revenue from managed care contracts and the average number of contracts. At the same time, the nature of physicians' relationships with health plans changed, with a significant decrease in plans' use of capitation, or fixed monthly payments for each patient regardless of the amount of care provided. Meanwhile, physician practices moved away from using direct financial incentives to influence doctors' clinical decision making, but did experience an increase in the overall influence of treatment guidelines and other practices commonly associated with managed care. PMID:12532972

  16. Physician adaptation to health maintenance organizations and implications for management.

    PubMed Central

    Schulz, R; Scheckler, W E; Girard, C; Barker, K

    1990-01-01

    The growth of health maintenance organizations (HMOs) and other forms of managed care presents a challenge to traditional patterns of private practice. In Dane County, Wisconsin (Madison Metropolitan Area), the proportion of the population enrolled in closed-panel HMOs increased dramatically, from 10 percent in 1983 to over 40 percent by 1986. This study surveyed 850 practicing physicians regarding their expectations before, and experiences after this rapid change to competitive HMOs. Although most physicians expected a loss of earnings and lower-quality care, the majority reported that neither declined. However, most physicians expected and reported a decline in their autonomy. Primary care physicians were most supportive of the change to HMOs. The implications of these findings for management practices are discussed. PMID:2329049

  17. Divided loyalties for physicians: social context and moral problems.

    PubMed

    Murray, T H

    1986-01-01

    An examination of the notion of divided loyalties dilemmas in medicine, situated within their social contexts, yields insight into the contemporary social and moral position of medicine in the United States. In a review of the literature, the author identifies four concepts important to gaining an understanding of the position that divided loyalties play in medicine and the physician-patient relationship. After describing some of the situations in which these dilemmas affect physicians' responses to patients' health care needs, interests, and choices, the author argues that divided loyalties dilemmas are not rare, and will probably increase with the changes in U.S. medicine. Candor and awareness of the importance of the public belief in physician loyalty are seen as necessary in preventing these changes from becoming destructive of the physician-patient relationship. PMID:3798163

  18. How should managed care physicians be paid?

    PubMed

    Pagano, R

    1994-09-01

    When paying a physician for medical or surgical services, most patients expect the traditional bill or charge for that encounter or visit. While most people also pay health insurance premiums, few patients expect to prepay for their health care. But that is the foundation of most managed health care systems-prepaid medicine. PPOs, IPAs, and HMOs are typically health care providers linked together to provide services to a set population for a specific prepaid fee or "capitation" payment. Other providers contract with these managed care insurers to receive a predetermined and often "discounted" professional fee for services. These managed care organizations have already gone through a number of stages in determining how physicians are to be compensated for their services, and further changes loom on the horizon. PMID:10139077

  19. The Adolescent, the Family and the Physician

    PubMed Central

    Brennan, Michael

    1971-01-01

    The family physician is the ideal medical practitioner to treat the adolescent, since he has to retain a holistic concept of the person in his family and in society. We have to remember that each person has his or her own rate of development, so that what might be obnoxious to one teenager is still acceptable to another. An understanding of the psychological and social aspects of separation from the parent is necessary in treating the conflicts that arise within the adolescent. There is no point in attempting to use teenage jargon to gain confidence, because the young will find this phoney and the physician will not be able to keep up with the rapid rate of change in slang. PMID:20468670

  20. Time for physicians to reconfigure.

    PubMed

    Miller, K; Eliastam, M

    1999-06-01

    The days when medical professionals made unilateral patient-care decisions are gone. Accelerating trends are converging to create a climate for what we call "consumer-centric healthcare," and that raises new and unsettling questions for physicians. PMID:10538221

  1. Role of the Physician Anesthesiologist

    MedlinePlus

    ... an anesthesia plan, taking into consideration the patient’s medical history and physical condition. During surgery : Physician anesthesiologists use advanced technology to monitor the body’s functions and determine how ...

  2. Family Homeostasis and the Physician

    PubMed Central

    Jackson, Don D.

    1965-01-01

    Physical illness, including psychosomatic disorders, often play an unexpected role in maintaining emotional balances within the family. The outbreak of such disorders, conversely, can be utilized by the physician as a barometer of family emotional difficulties. PMID:5828172

  3. [Physicians' strikes--ethical considerations].

    PubMed

    Glick, Shimon; Schwarzfuchs, Dan

    2012-01-01

    Strikes in general represent a solution based on a form of coercion. Historically, the striker caused direct damage to his employer, who was responsible for the perceived unfair treatment of the employee. In the case of strikes in the public sector, the employer is generally not harmed, but innocent citizens suffer in order to pressure the government agencies, a questionable practice from an ethical viewpoint. Physicians' strikes have more serious ethical problems. They cause suffering and death to innocent citizens. They violate the ethical codes to which physicians have committed themselves as professionals, and they seriously impair the trust of the public in physicians. Better and more ethical ways to provide fair compensation for physicians must be employed, perhaps like those used for judges and members of the IDF. PMID:22670493

  4. American College of Emergency Physicians

    MedlinePlus

    ... Career Center is where you can find your dream job Search Jobs Now Updated Zika Resources Available ... Emergency Care For You emCareers.org Copyright © 2016 American College of Emergency Physicians EM Career Central Terms ...

  5. A recurring theme: the need for minority physicians.

    PubMed

    Reede, Joan Y

    2003-01-01

    There is compelling evidence for the need to increase diversity within the physician workforce to ensure high-quality medical education, access to health care for the underserved, advances in research, and improved business performance. To have enough physicians to meet the future needs of the general public, as well as of minority citizens, we must recruit from diverse populations. The need for physicians, particularly under-represented minorities, will continue to grow. Addressing shortages requires inventive efforts to counter obstacles created by the anti-affirmative action movement, as well as strategies to encourage institutions to become more engaged in diversity efforts. PMID:12889755

  6. Contributions of Medieval Islamic physicians to the history of tracheostomy.

    PubMed

    Golzari, Samad E J; Khan, Zahid Hussain; Ghabili, Kamyar; Hosseinzadeh, Hamzeh; Soleimanpour, Hassan; Azarfarin, Rasoul; Mahmoodpoor, Ata; Aslanabadi, Saeid; Ansarin, Khalil

    2013-05-01

    Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936-1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheostomy, there is evidence that many prominent Islamic surgeons did practice this lifesaving procedure during medieval times. Throughout the Islamic Golden Age, Muslim physicians advanced the practice of tracheostomy with many modifications of the procedure, instrumentation, and adjuvant medicinal prescriptions. PMID:23492962

  7. Resource allocation and physician liability

    PubMed Central

    Capen, K

    1997-01-01

    Lawyer Karen Capen says funding cutbacks that have affected the services physicians can provide may cause legal problems for Canada's doctors. If cutbacks affect the care that is being provided, they should be discussed with the patient and noted on the chart. She says physicians have "good reason to be concerned" about increasing pressures that create an imbalance between health care resources and the demand and need for services. For some doctors, these have resulted in court cases. PMID:9033422

  8. Office Management of Chemical Dependency by Family Physicians

    PubMed Central

    Baker, Ray

    1991-01-01

    Family physicians are in an ideal position to identify, intervene with, and treat substance use disorders. If family physicians position themselves to reflect objective evidence of consequences of substance use and offer suggestions for change while leaving responsibility for recovery with the patient, patients often choose to recover. Because the disease is characterized by exacerbations, remissions, and relapses, continued involvement with the recovering patient ensures the greatest chance of recovery. PMID:21228969

  9. Use of spirometry among chest physicians and primary care physicians in India

    PubMed Central

    Vanjare, Nitin; Chhowala, Sushmeeta; Madas, Sapna; Kodgule, Rahul; Gogtay, Jaideep; Salvi, Sundeep

    2016-01-01

    Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value <0.01), 18% among GenPs (P value=0.01), 20% among GPs (P value: not significant) and 224% among Ps (P value <0.01). The reasons for not using spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice. PMID:27385406

  10. Use of spirometry among chest physicians and primary care physicians in India.

    PubMed

    Vanjare, Nitin; Chhowala, Sushmeeta; Madas, Sapna; Kodgule, Rahul; Gogtay, Jaideep; Salvi, Sundeep

    2016-01-01

    Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value <0.01), 18% among GenPs (P value=0.01), 20% among GPs (P value: not significant) and 224% among Ps (P value <0.01). The reasons for not using spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice. PMID:27385406

  11. Performance management tools motivate change at the frontlines.

    PubMed

    Smith, Christopher; Christiansen, Tanya; Dick, Don; Howden, Jane Squire; Wasylak, Tracy; Werle, Jason

    2014-01-01

    Performance management tools commonly used in business, such as incentives and the balanced scorecard, can be effectively applied in the public healthcare sector to improve quality of care. The province of Alberta applied these tools with the Institute for Health Improvement Learning Collaborative method to accelerate adoption of a clinical care pathway for hip and knee replacements. The results showed measurable improvements in all quality dimensions, including shorter hospital stays and wait times, higher bed utilization, earlier patient ambulation, and better patient outcomes. PMID:25109132

  12. Sex role ideology among physicians.

    PubMed Central

    Leichner, P.; Harper, D.

    1982-01-01

    Physicians have been accused by some feminist writers of having traditional views on sex roles that make them part of society's oppressive power structure and therefore responsible in part for the high incidence of psychologic problems and drug dependency among women. To assess whether physicians' attitudes towards women are indeed polarized in a traditional fashion, a sex role ideology questionnaire was given to all practising physicians belonging to the Manitoba Medical Association. Overall the physicians were found to be more feminist than male college students and a group of women with traditional beliefs. Psychiatrists, who had the highest adjusted group mean score on a sex role ideology scale (high indicating feminist beliefs), were found to be significantly more feminist than family practitioners, surgeons, and obstetricians and gynecologists, although not more so than internists, radiologists, pediatricians and anesthesiologists. These findings do not support the assumption that physicians have traditional views that reflect those of society. However, the significant differences between specialties emphasize the need for educating physicians and medical students in the behaviour of women. PMID:7104916

  13. Obesity-related changes in prolonged repetitive lifting performance.

    PubMed

    Ghesmaty Sangachin, Mahboobeh; Cavuoto, Lora A

    2016-09-01

    Despite the rising prevalence of obesity, little is known about its moderating effects on injury risk factors, such as fatigue, in occupational settings. This study investigated the effect of obesity, prolonged repetitive lifting and their interaction on lifting performance of 14 participants, 7 obese (mean body mass index (BMI): 33.2 kg m(-2)) and 7 non-obese (mean BMI: 22.2 kg m(-2)) subjects. To present a physically challenging task, subjects performed repetitive lifting for 1 h at 120% of their maximum acceptable weight of lift. Generalized linear mixed models were fit to posture and acceleration data. The obese group bent to a ∼10° lower peak trunk sagittal flexion angle, had 17% lower root mean square (RMS) jerk and took 0.8 s longer per lift. Over time, the obese group increased their trunk transverse and sagittal posterior accelerations while the non-obese maintained theirs. Although the majority of lifting variables were unaffected by BMI or its interaction with prolonged lifting duration, the observed differences, combined with a greater upper body mass, necessitate a more cautious use of existing psychophysical lifting limits for individuals who are obese, particularly when fatigued. PMID:27184307

  14. Scheduling and performance limits of networks with constantly changing topology

    SciTech Connect

    Tassiulas, L.

    1997-01-01

    A communication network with time-varying topology is considered. The network consists of M receivers and N transmitters that may access in principle every receiver. An underlying network state process with Markovian statistics is considered, that reflects the physical characteristics of the network affecting the link service capacity. The transmissions are scheduled dynamically, based on information about the link capacities and the backlog in the network. The region of achievable throughputs is characterized. A transmission scheduling policy is proposed, that utilizes current topology state information and achieves all throughput vectors achievable by any anticipative policy. The changing topology model applies to networks of Low Earth Orbit (LEO) satellites, meteor-burst communication networks and networks with mobile users. {copyright} {ital 1997 American Institute of Physics.}

  15. THE GENERAL RELATIONS OF CHANGES IN PERSONALITY AND INTEREST IN CHANGES IN SCHOOL PERFORMANCE, AN EXPLORATORY STUDY.

    ERIC Educational Resources Information Center

    CATTELL, RAYMOND B.; SEALY, A. PHILIP

    EXPLORED WERE THE RELATION OF CHANGES IN PERSONALITY TO CHANGES IN ACHIEVEMENT OVER A 1-YEAR PERIOD, THE RELATIONSHIP OF PERSONALITY AND MOTIVATION, AND MEASURES OF INTRAFAMILIAL ATTITUDES IN OBJECTIVE TESTS AS BASES FOR DISCOVERING THE PREDICTIVE POWER OF FAMILY ATTITUDES WITH REGARD TO THE CHILD'S SCHOOL PERFORMANCE. CHILDREN WERE STUDIES FROM…

  16. Traumatized by practice: PTSD in physicians.

    PubMed

    Lazarus, Arthur

    2014-01-01

    Posttraumatic stress disorder (PTSD) is underrecognized in physicians, even though it may be more prevalent in physicians than in the general population in the United States. Five types of physicians appear to be particularly prone to developing PTSD: (1) emergency physicians; (2) physicians practicing in underserved and remote areas; (3) physicians in training (i.e., medical residents); (4) physicians involved in malpractice litigation; and (5) physicians who are "second victims" in the sense that they are indirectly exposed to trauma. In addition to experiencing trauma, the cumulative stress of practice may cause PTSD. The road to recovery for physicians with PTSD entails proper diagnosis and treatment, which includes maintaining a high index of suspicion for the occurrence of PTSD in predisposed physicians, and individual or group therapy. Physicians in leadership positions should advocate for effective support programs for their colleagues with PTSD. PMID:25807606

  17. Physician leadership: influence on practice-based learning and improvement.

    PubMed

    Prather, Stephen E; Jones, David N

    2003-01-01

    In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in other high-risk fields. This reluctance may be attributable to traditional medical training, which encourages controlling leadership styles that magnify the resistance common to all change efforts. To overcome this resistance, physicians must develop the same leadership skills that have proven to be critical to success in other service and high-performance industries. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in practice only if they are taught. A dramatic shift away from control and blame has become a requirement for achieving success in other industries based on complex group process. This approach is so mainstream that the burden of proof that cooperative leadership is not a requirement for medical improvement falls to those institutions perpetuating the outmoded paradigm of the past. Cooperative leadership skills that have proven central to implementing change in the information era are suggested as a core cultural support for practice-based learning and improvement. Complex adaptive systems theory, long used as a way to understand evolutionary biology, and more recently computer science and economics, predicts that behavior emerging among some groups of providers will be selected for duplication by the competitive environment. A curriculum framework needed to teach leadership skills to expand the influence of practice-based learning and improvement is offered as a guide to accelerate change. PMID:14666834

  18. The physician as writer.

    PubMed Central

    Selzer, R A

    1990-01-01

    A surgeon, turned writer, discusses his experiences and the perils of changing professions. He reminisces about his early formative years, growing up in Troy, New York, and investigates the beauty of language and the pitfalls of misuse. PMID:2295008

  19. Establishing a 'Physician's Spiritual Well-being Scale' and testing its reliability and validity.

    PubMed

    Fang, C K; Li, P Y; Lai, M L; Lin, M H; Bridge, D T; Chen, H W

    2011-01-01

    The purpose of this study was to develop a Physician's Spiritual Well-Being Scale (PSpWBS). The significance of a physician's spiritual well-being was explored through in-depth interviews with and qualitative data collection from focus groups. Based on the results of qualitative analysis and related literature, the PSpWBS consisting of 25 questions was established. Reliability and validity tests were performed on 177 subjects. Four domains of the PSpWBS were devised: physician's characteristics; medical practice challenges; response to changes; and overall well-being. The explainable total variance was 65.65%. Cronbach α was 0.864 when the internal consistency of the whole scale was calculated. Factor analysis showed that the internal consistency Cronbach α value for each factor was between 0.625 and 0.794 and the split-half reliability was 0.865. The scale has satisfactory reliability and validity and could serve as the basis for assessment of the spiritual well-being of a physician. PMID:21059633

  20. TRMM On-Orbit Performance Reassessed After Control Change

    NASA Technical Reports Server (NTRS)

    Bilanow, Stephen

    2006-01-01

    The Tropical Rainfall Measuring Mission (TRMM) spacecraft, a joint mission between the U.S. and Japan, launched onboard an H-I1 rocket on November 27, 1997, and transitioned in August, 2001, from an average operating altitude of 350 kilometers to 402.5 kilometers. Due to problems using the Earth Sensor Assembly (ESA) at the higher altitude, TRMM switched to a backup attitude control mode. Prior to the orbit boost TRMM controlled pitch and roll to the local vertical using ESA measurements while using gyro data to propagate yaw attitude between yaw updates from the Sun sensors. After the orbit boost, a Kalman filter used 3-axis gyro data with Sun sensor and magnetometers to estimate onboard attitude. While originally intended to meet a degraded attitude accuracy of 0.7 degrees, the new control mode met the original 0.2 degree attitude accuracy requirement after improving onboard ephemeris prediction and adjusting the magnetometer calibration onboard. Independent roll attitude checks using a science instrument, the Precipitation Radar (PR) which was built in Japan, provided a novel insight into the pointing performance. The PR data helped identify the pointing errors after the orbit boost, track the performance improvements, and show subtle effects from ephemeris errors and gyro bias errors. It also helped identify average bias trends throughout the mission. Roll errors tracked by the PR from sample orbits pre-boost and post-boost are shown in Figure 1. Prior to the orbit boost, the largest attitude errors were due to occasional interference in the ESA. These errors were sometime larger than 0.2 degrees in pitch and roll, but usually less, as estimated from a comprehensive review of the attitude excursions using gyro data. Sudden jumps in the onboard roll show up as spikes in the reported attitude since the control responds within tens of seconds to null the pointing error. The PR estimated roll tracks well with an estimate of the roll history propagated using gyro

  1. [Physicians conscience and Zeitgeist].

    PubMed

    Helmchen, H

    2015-03-01

    According to Luhmann conscience is understood as a value-neutral function for forming identity. Its background is biological in nature but receives its values from the normative context of family and society. In an evolutionary perspective group congruent behavior could offer a survival advantage that will be stabilized by an emotional bonding to a group. This bonding makes the individual dependent on the sociocultural context, including its normative content and its change.This influence becomes clear in different individual as well as time-dependent judgments of a specific moral problem in multicultural societies and with changes of the zeitgeist. Such influences are illustrated by numerous examples and lead to the question whether at all and by which criteria changes of conscience will be recognized by the person concerned. This article aims at a sensitization for questions of formation and vulnerability of the conscience. PMID:25331215

  2. The Medical Home: Locus of Physician Formation

    PubMed Central

    Daaleman, Timothy P.

    2013-01-01

    Family medicine is currently undergoing a transformation and, amid such change, the medical home has emerged as the new polestar. This article examines the medical home through the lens of philosopher Alasdair MacIntyre and offers a perspective, informed by Hubert Dreyfus and Peter Senge, about medical homes as practical sites of formation for family physicians. The intellectual past of family medicine points to contextually sensitive patient care as a practice that is particular to the discipline, with the virtue of “placing patients within contexts over time” as a commonly held virtue. Dreyfus provides a model of knowledge and skill acquisition that is relevant to the training of family physicians in practical wisdom. In this model, there is a continuum from novice to more advanced stages of professional formation that is aided by rules that not only must be learned, but must be applied in greater contextually informed situations. Senge’s emphasis on learning organizations— organizations where people are continually learning how to learn together—presents a framework for evaluating the extent to which future medical homes facilitate or retard the formation of family physicians. PMID:18772299

  3. Physician-Assisted Death in Canada.

    PubMed

    Browne, Alister; Russell, J S

    2016-07-01

    The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection. PMID:27348822

  4. Physician burnout: coaching a way out.

    PubMed

    Gazelle, Gail; Liebschutz, Jane M; Riess, Helen

    2015-04-01

    Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture that emphasizes perfectionism, denial of personal vulnerability, and delayed gratification. Professional coaching, long utilized in the business world, provides a results-oriented and stigma-free method to address burnout, primarily by increasing one's internal locus of control. Coaching enhances self-awareness, drawing on individual strengths, questioning self-defeating thoughts and beliefs, examining new perspectives, and aligning personal values with professional duties. Coaching utilizes established techniques to increase one's sense of accomplishment, purpose, and engagement, all critical in ameliorating burnout. Coaching presumes that the client already possesses strengths and skills to handle life's challenges, but is not accessing them maximally. Although an evidence base is not yet established, the theoretical basis of coaching's efficacy derives from the fields of positive psychology, mindfulness, and self-determination theory. Using a case example, this article demonstrates the potential of professional coaching to address physician burnout. PMID:25527340

  5. Women physicians as healthcare leaders: a qualitative study.

    PubMed

    Roth, Virginia R; Theriault, Anne; Clement, Chris; Worthington, Jim

    2016-06-20

    Purpose - The purpose of this paper is to explore the under-representation of women physicians in clinical leadership by examining the issue from their perspective. Design/methodology/approach - The authors used large group engagement methods to explore the experiences and perceptions of women physicians. In order to capture common themes across this group as a whole, participants were selected using purposeful sampling. Data were analysed using a structured thematic analysis procedure. Findings - This paper provides empirical insights into the influences affecting women physicians' decision to participate in leadership. The authors found that they often exclude themselves because the costs of leadership outweigh the benefits. Potential barriers unique to healthcare include the undervaluing of leadership by physician peers and perceived lack of support by nursing. Research limitations/implications - This study provides an in-depth examination of why women physicians are under-represented in clinical leadership from the perspective of those directly involved. Further studies are needed to confirm the generalizability of these findings and potential differences between demographic groups of physicians. Practical implications - Healthcare organizations seeking to increase the participation of women physicians in leadership should focus on modifying the perceived costs of leadership and highlighting the potential benefits. Large group engagement methods can be an effective approach to engage physicians on specific issues and mobilize grass-roots support for change. Originality/value - This exploratory study provides insights on the barriers and enablers to leadership specific to women physicians in the clinical setting. It provides a reference for healthcare organizations seeking to develop and diversify their leadership talent. PMID:27296884

  6. Impending challenges in the hematopoietic stem cell transplantation physician workforce.

    PubMed

    Gajewski, James L; LeMaistre, C Frederick; Silver, Samuel M; Lill, Michael C; Selby, George B; Horowitz, Mary M; Rizzo, J Douglas; Heslop, Helen E; Anasetti, Claudio; Maziarz, Richard T

    2009-12-01

    With increasing use of high dose chemotherapy with autologous and allogeneic transplants the need for the transplant physician workforce requires reassessment. The types of transplants and patients are also shifting toward transplants being done in patients with more comorbidities and more commonly these types of patients require more work effort per patient from the transplant physician. Additionally, HSCT survivors often require ongoing care at the transplant center due to the inability of the primary care workforce or the hematology/oncology workforce to absorb caring for post complex post transplant patients. The adult transplant workforce has had very few physicians join under age 40. Nearly 50% of adult transplant physicians are over age 50 whereas only 28% of pediatric transplant physicians are over age 50. By 2020, it is projected that we will need 1,264 new adult transplant physicians and 94 pediatric transplant physicians. Training time for a physician is approximately 15 years. The capping of both medical school slots and residency slots since the early '80s is now having a very big impact on supply, but other factors are also affecting supplies such as generational differences, lifestyle expectations, and the change of the medical workforce from being mostly men. Workforce shortages are being reported for many specialities. Workforce problems are also present for nurses, pharmacists and medical technologists. So increasing use of general internists and mid-level providers may not exist as a solution. Transplant physicians must be actively engaged in the medical education process to show young medical students and residents who are not committed to another sub specialty career the excitement and challenges of a career in bone marrow transplantation, so that our field will have providers for the future. PMID:19781658

  7. Physician recruitment success: how to acquire top physician talent.

    PubMed

    Rosman, Judy

    2011-01-01

    This article provides step-by-step instructions on how to complete the strategic planning needed to ensure success in physician recruitment efforts, outlines how to build a successful recruitment team, and provides helpful advice to avoid common recruiting mistakes that can sabotage the recruitment efforts of even the best practices. This article discusses the role of the in-house hospital recruiter in the recruitment process, how to evaluate independent search firms, how to make use of the physicians in your group to ensure success during a site visit, and how to ensure that your new hire will be able to successfully develop a practice. The article also discusses how to find and use benchmarking data to ensure that your compensation package is competitive, and provides advice on how to help your new physician hit the ground running. PMID:21506458

  8. Physicians beware: revisiting the physician practice acquisition frenzy.

    PubMed

    Eichmiller, Judith Riley

    2014-01-01

    This commentary compares the current physician practice acquisition frenzy to that of the mid-1990s and reflects on lessons learned. The bottom line: Physicians must understand that there were no "white knights" in the 1990s, and there really aren't any today. This article delineates five main factors that both physicians and hospital executives should thoroughly explore and agree on before an alignment or acquisition. Agreement on these issues is the glue that holds the deal together after the merger. These factors eliminate both buyer and seller remorse and delve into the true cultural alignment that must take place as the healthcare industry addresses the challenges of the future. PMID:25108989

  9. The Relationship between Low Back Magnetic Resonance Imaging, Surgery, and Spending: Impact of Physician Self-Referral Status

    PubMed Central

    Shreibati, Jacqueline Baras; Baker, Laurence C

    2011-01-01

    Objective To examine the relationship between use of magnetic resonance imaging (MRI) and receipt of surgery for patients with low back pain. Data Sources Medicare claims for a 20 percent sample of beneficiaries from 1998 to 2005. Study Design We identify nonradiologist physicians who appear to begin self-referral arrangements for MRI between 1999 and 2005, as well as their patients who have a new episode of low back pain care during this time. We focus on regression models that identify the relationship between receipt of MRI and subsequent use of back surgery and health care spending. Receipt of MRI may be endogenous, so we use physician acquisition of MRI as an instrument for receipt of MRI. The models adjust for demographic and socioeconomic covariates as well as month, year, and physician fixed effects. Data Collection/Extraction Methods We include traditional, fee-for-service Medicare beneficiaries with a visit to an orthopedist or primary care physician for nonspecific low back pain, and no claims for low back pain in the year prior. Principal Findings In the first stage, acquisition of MRI equipment is a strongly correlated with patients receiving MRI scans. Among patients of orthopedists, receipt of an MRI scan increases the probability of having surgery by 34 percentage points. Among patients of primary care physicians, receiving a low back MRI is not statistically significantly associated with subsequent surgery receipt. Conclusions Orthopedists and primary care physicians who begin billing for the performance of MRI procedures, rather than referring patients outside of their practice for MRI, appear to change their practice patterns such that they use more MRI for their patients with low back pain. These increases in MRI use appear to lead to increases in low back surgery receipt and health care spending among patients of orthopedic surgeons, but not of primary care physicians. PMID:21517834

  10. Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

    PubMed Central

    Arnetz, Bengt B.; Christensen, John F.; Homer, Louis

    2007-01-01

    BACKGROUND Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. DESIGN AND PARTICIPANTS From 2000 to 2005, 22–32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. MEASUREMENTS Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. RESULTS Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. CONCLUSIONS A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk. PMID:17891503

  11. Physician Recommendation of Diabetes Clinical Protocols.

    PubMed

    McMaughan, Darcy K; Huber, John C; Forjuoh, Samuel N; Vuong, Ann M; Helduser, Janet; Ory, Marcia G; Bolin, Jane N

    2016-01-01

    The authors examined the responses of 63 primary care physicians to diabetes clinical protocols (DCPs) for the management of type II diabetes (T2DM). We measured physician demographics, current diabetes patient loads, and responses to DCPs (physician attitudes, physician familiarity, and physician recommendation of DCPs) using a 20-question electronic survey. Results of the survey indicate that primary care physicians may be unfamiliar with the benefits of diabetes clinical protocols for the self-management of T2DM. Given the importance of diabetes self-management education in controlling T2DM, those interested in implementing DCPs should address the beliefs and attitudes of primary care physicians. PMID:26980203

  12. E-health: transforming the physician/patient relationship.

    PubMed

    Ball, M J; Lillis, J

    2001-04-01

    Healthcare delivery is being transformed by advances in e-health and by the empowered, computer-literate public. Ready to become partners in their own health and to take advantage of online processes, health portals, and physician web pages and e-mail, this new breed of consumer is slowly redefining the physician/patient relationship. Such changes can effect positive results like improved clinical decision-making, increased efficiency, and strengthened communication between physicians and patients. First, however, physicians and the organizations that support them must fully understand their role in the e-health revolution. Both must advance their awareness of the new consumers and their needs and define specific action items that will help them realize the benefits of e-health. Through a combination of timely research and advice, this article will aid them in fulfilling both tasks. PMID:11248599

  13. Marriage and Medicine: The Physician as Partner, Parent, and Person

    PubMed Central

    Christie-Seely, J.

    1986-01-01

    Physicians are beginning to see the need to heal themselves, and to change the statistics on their morbidity, mortality, and marital distress. Stress for physicians comes from five sources: the nature of the work, their training, their public image, their families, and themselves. Medical school stress as an ‘initiation rite’ is discussed. Three theoretical frameworks are described which will enable family physicians to take a closer look at their own marriages and families as well as those of patients. A systems orientation will help avoid blame of self or partner or parents; object relations theory clarifies the human tendency to repeat history; a theory connecting self-esteem and communication styles will allow physicians to be more open at work and with their families. The importance of developing priorities and meaningful interests outside medicine is also discussed. PMID:21267270

  14. Psychiatric rehabilitation education for physicians.

    PubMed

    Rudnick, Abraham; Eastwood, Diane

    2013-06-01

    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011). PMID:23750768

  15. Recruiting physicians without inviting trouble.

    PubMed

    Hoch, L J

    1989-05-01

    Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review. PMID:10303456

  16. Predicting plasticity: acute context-dependent changes to vocal performance predict long-term age-dependent changes.

    PubMed

    James, Logan S; Sakata, Jon T

    2015-10-01

    Understanding the factors that predict and guide variation in behavioral change can lend insight into mechanisms of motor plasticity and individual differences in behavior. The performance of adult birdsong changes with age in a manner that is similar to rapid context-dependent changes to song. To reveal mechanisms of vocal plasticity, we analyzed the degree to which variation in the direction and magnitude of age-dependent changes to Bengalese finch song could be predicted by variation in context-dependent changes. Using a repeated-measures design, we found that variation in age-dependent changes to the timing, sequencing, and structure of vocal elements ("syllables") was significantly predicted by variation in context-dependent changes. In particular, the degree to which the duration of intersyllable gaps, syllable sequencing at branch points, and fundamental frequency of syllables within spontaneous [undirected (UD)] songs changed over time was correlated with the degree to which these features changed from UD song to female-directed (FD) song in young-adult finches (FDyoung). As such, the structure of some temporal features of UD songs converged over time onto the structure of FDyoung songs. This convergence suggested that the FDyoung song could serve as a stable target for vocal motor plasticity. Consequently, we analyzed the stability of FD song and found that the temporal structure of FD song changed significantly over time in a manner similar to UD song. Because FD song is considered a state of heightened performance, these data suggest that age-dependent changes could reflect practice-related improvements in vocal motor performance. PMID:26311186

  17. Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior.

    PubMed

    Polen, Lauren A; Rossi, Jennifer K; Berg, Cameron K; Balise, Raymond R; Herfkens, Robert J; Auerbach, Paul S

    2016-01-01

    Objectives  To determine whether real-time passive notification of patient radiation exposure via a computerized physician order entry system would alter the number of computed tomography scans ordered by physicians in the Emergency Department (ED) setting. Methods  When a practitioner ordered a computed tomography scan, a passive notification was immediately and prominently displayed via the computerized physician order entry system. The notification stated the following: the amount of estimated radiation in millisieverts (mSv), the equivalent number of single-view chest radiographs, and equivalent days of average environmental background radiation to which a patient during a specific computed tomography scan would be exposed. The primary outcome was changed in the number of computed tomography scans ordered when comparing data collected before and after the addition of the notification. Results  Before the dosimetry notification ("intervention") was instituted, 1,747 computed tomography scans were performed on patients during 11,709 Emergency Department visits (14.9% computed tomography scan rate). After the intervention had been instituted, 1,827 computed tomography scans were performed on patients during 11,582 Emergency Department patient visits (15.8% computed tomography scan rate). No statistically significant difference was found for all chief complaints combined (p = 0.17), or for any individual chief complaint, between the number of computed tomography scans performed on Emergency Department patients before versus after the intervention. Conclusions  Passive real-time notification of patient radiation exposure displayed in a computerized physician order entry system at the time of computed tomography scan ordering in the Emergency Department did not significantly change the number of ordered scans. PMID:27570716

  18. Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior

    PubMed Central

    Polen, Lauren A; Rossi, Jennifer K; Berg, Cameron K; Balise, Raymond R; Herfkens, Robert J

    2016-01-01

    Objectives  To determine whether real-time passive notification of patient radiation exposure via a computerized physician order entry system would alter the number of computed tomography scans ordered by physicians in the Emergency Department (ED) setting. Methods  When a practitioner ordered a computed tomography scan, a passive notification was immediately and prominently displayed via the computerized physician order entry system. The notification stated the following: the amount of estimated radiation in millisieverts (mSv), the equivalent number of single-view chest radiographs, and equivalent days of average environmental background radiation to which a patient during a specific computed tomography scan would be exposed. The primary outcome was changed in the number of computed tomography scans ordered when comparing data collected before and after the addition of the notification. Results  Before the dosimetry notification (“intervention”) was instituted, 1,747 computed tomography scans were performed on patients during 11,709 Emergency Department visits (14.9% computed tomography scan rate). After the intervention had been instituted, 1,827 computed tomography scans were performed on patients during 11,582 Emergency Department patient visits (15.8% computed tomography scan rate). No statistically significant difference was found for all chief complaints combined (p = 0.17), or for any individual chief complaint, between the number of computed tomography scans performed on Emergency Department patients before versus after the intervention. Conclusions  Passive real-time notification of patient radiation exposure displayed in a computerized physician order entry system at the time of computed tomography scan ordering in the Emergency Department did not significantly change the number of ordered scans.  PMID:27570716

  19. Physician business deals: surveying the new landscape.

    PubMed

    Harris, John M; Kaplan, Karin Chernoff

    2009-05-01

    Strong hospitals and health systems should be on the lookout for opportunities today to acquire physician businesses at depressed fair market values. In some instances, an outright purchase of physicians' interest in a physician-hospital joint venture may be preferable; in others, the hospital may benefit more from simply increasing its interest in the venture. A critical part of the strategy should be taking steps to ensure the physicians remain engaged, including addressing physicians' income goals and need for control. PMID:19445398

  20. Time-trend of melanoma screening practice by primary care physicians: A meta-regression analysis

    PubMed Central

    Mauri, Davide; Karampoiki, Vassiliki; Polyzos, Nikolaos P; Cortinovis, Ivan; Koukourakis, Georgios; Zacharias, Georgios; Xilomenos, Apostolos; Tsappi, Maria; Casazza, Giovanni

    2009-01-01

    Objective To assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time. Methods Meta-regression analyses of available data. Data Sources: MEDLINE, ISI, Cochrane Central Register of Controlled Trials. Results Fifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%–82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening tended to decrease by 1.72% per year (P =0.086). Corresponding annual changes in European, North American, and Australian settings were −0.68% (P =0.494), −2.02% (P =0.044), and +2.59% (P =0.010), respectively. Changes were not influenced by national guide-lines. Conclusions Considering the increasing incidence of melanoma and other skin malignancies, as well as their relative potential consequences, the FBSE implementation time-trend we retrieved should be considered a worrisome phenomenon. PMID:19242870

  1. Marshfield Clinic, physician networks, and the exercise of monopoly power.

    PubMed Central

    Greenberg, W

    1998-01-01

    OBJECTIVE: Antitrust enforcement can improve the performance of large, vertically integrated physician-hospital organizations (PHOs). Objective: To examine the recent court decisions in the Blue Cross and Blue Shield United of Wisconsin v. Marshfield Clinic antitrust case to understand better the benefits and costs of vertical integration in healthcare. SUMMARY AND CONCLUSIONS: Vertical integration in the Marshfield Clinic may have had the benefits of reducing transactions and uncertainty costs while improving the coordination between ambulatory and inpatient visits, but at the cost of Marshfield Clinic's monopolizing of physician services and foreclosing of HMO entry in northwest Wisconsin. The denial of hospital staff privileges to non-Marshfield Clinic physicians combined with certificate-of-need regulations impeded physician entry and solidified Marshfield Clinic's monopoly position. Enforcement efforts of recent antitrust guidelines by the U.S. Department of Justice and the Federal Trade Commission will need to address carefully the benefits and costs of vertically integrated systems. PMID:9865229

  2. Ten Reasons to be Glad You Are a Physician.

    PubMed

    Hultman, Jon; Baum, Neil

    2015-01-01

    There is no shortage of topics for physicians to complain about: a decrease in reimbursements, rising overhead costs, and decreasing physician incomes, to list just a few. The variables also may include patient dissatisfaction, the risk of litigation, deterioration in staff morale, and poor financial decisions, including poor performance in the doctor's stock market portfolio. However, the number of applicants for medical schools has not decreased, even though physicians graduate with an average of $250,000 of debt. We suggest that physicians take a good look at what our profession offers and reflect on why healthcare (i.e., medical practice) is such a desirable occupation, and show that we should be more grateful and thankful rather than griping and resentful. PMID:26856030

  3. In tepid defense of population health: physicians and antibiotic resistance.

    PubMed

    Saver, Richard S

    2008-01-01

    Antibiotic resistance menaces the population as a dire public health threat and costly social problem. Recent proposals to combat antibiotic resistance focus to a large degree on supply side approaches. Suggestions include tinkering with patent rights so that pharmaceutical companies have greater incentives to discover novel antibiotics as well as to resist overselling their newer drugs already on market. This Article argues that a primarily supply side emphasis unfortunately detracts attention from physicians' important demand side influences. Physicians have a vital and unavoidably necessary role to play in ensuring socially optimal access to antibiotics. Dismayingly, physicians' management of the antibiotic supply has been poor and their defense of population health tepid at best. Acting as a prudent steward of the antibiotic supply often seems to be at odds with a physician's commonly understood fiduciary duties, ethical obligations, and professional norms, all of which traditionally emphasize the individual health paradigm as opposed to population health responsibilities. Meanwhile, physicians face limited incentives for antibiotic conservation from other sources, such as malpractice liability, regulatory standards, and reimbursement systems. While multifaceted efforts are needed to combat antibiotic resistance effectively, physician gatekeeping behavior should become a priority area of focus. This Article considers how health law and policy tools could favorably change the incentives physicians face for antibiotic conservation. A clear lesson from the managed care reform battles of the recent past is that interventions, to have the best chance of success, need to respect physician interest in clinical autonomy and individualized medicine even if, somewhat paradoxically, vigorously promoting population health perspectives. Also, physicians' legal and ethical obligations need to be reconceptualized in the antibiotic context in order to better support

  4. Talent management and physician leadership training is essential for preparing tomorrow's physician leaders.

    PubMed

    Satiani, Bhagwan; Sena, John; Ruberg, Robert; Ellison, E Christopher

    2014-02-01

    Talent management and leadership development is becoming a necessity for health care organizations. These leaders will be needed to manage the change in the delivery of health care and payment systems. Appointment of clinically skilled physicians as leaders without specific training in the areas described in our program could lead to failure. A comprehensive program such as the one described is also needed for succession planning and retaining high-potential individuals in an era of shortage of surgeons. PMID:24360239

  5. Teacher Perceptions of What Needs to Be Changed in Low-Performing Schools

    ERIC Educational Resources Information Center

    Duke, Daniel L.; Konold, Timothy R.; Salmonowicz, Michael J.

    2011-01-01

    This study investigated teachers' beliefs about the changes needed to improve student learning in low-performing schools. The study employed a new instrument, the Need for Change Assessment (NCA), which solicited teachers' perceptions of the need for change in areas such as reading and math programs, classroom instruction, and school policies.…

  6. The Effect of Concurrent Music Reading and Performance on the Ability to Detect Tempo Change.

    ERIC Educational Resources Information Center

    Ellis, Mark Carlton

    1989-01-01

    Measures the ability of three groups of musicians to detect tempo change while reading and performing music. Compares this ability with that of the same musicians to detect tempo change while listening only. Found that for all groups the ability to detect tempo changes was inhibited by the playing task, although to different degrees for each…

  7. Theatre for Change: An Analysis of Two Performances by Women in Mundemba Sub-Division.

    ERIC Educational Resources Information Center

    Tanyi-Tang, Anne

    2001-01-01

    Contends that theatre has the power to induce oppressors to change their attitudes permanently towards the groups they oppress. Describes theatrical performances by women in Mundemba Sub-Division, Cameroon, which created lasting changes in men's attitudes. Concludes that theatre calls for sociocultural and economic changes and it has the power to…

  8. [The pharmacist-physician collaboration for IPW: from physician's perspective].

    PubMed

    Son, Daisuke; Kawamura, Kazumi; Nakashima, Mitsuko; Utsumi, Miho

    2015-01-01

    Interprofessional work (IPW) is increasingly important in various settings including primary care, in which the role of pharmacists is particularly important. Many studies have shown that in cases of hypertension, diabetes, dyslipidemia, and metabolic syndrome, physician-pharmacist collaboration can improve medication adherence and help to identify drug-related problems. Some surveys and qualitative studies revealed barriers and key factors for effective physician-pharmacist collaboration, including trustworthiness and role clarification. In Japan, some cases of good collaborative work between pharmacists and physicians in hospitals and primary care settings have been reported. Still, community pharmacists in particular have difficulties collaborating with primary care doctors because they have insufficient medical information about patients, they feel hesitant about contacting physicians, and they usually communicate by phone or fax rather than face to face. Essential competencies for good interprofessional collaboration have been proposed by the Canadian Interprofessional Health Collaborative (CIHC): interprofessional communication; patient/client/family/community-centered care; role clarification; team functioning; collaborative leadership; and interprofessional conflict resolution. Our interprofessional education (IPE) team regularly offers educational programs to help health professionals learn interprofessional collaboration skills. We expect many pharmacists to learn those skills and actively to facilitate interprofessional collaboration. PMID:25743907

  9. [The physician in criminal court].

    PubMed

    Durigon, Michel

    2002-04-01

    A physician may find himself in front of a criminal court in the context of a number of situations: as a spectator, a witness, the accused, the victim, or as an expert witness. These different situations provoke variable reactions where the problem of medical confidence, the public nature of the debate, and their inherent contradiction arise. The physician is little used to these situations. In the concern for justice and the protection of victims, he must know the rules of this court. PMID:12032961

  10. A physician's exposure to defamation.

    PubMed

    Mandell, W J

    1992-01-01

    The article defines defamation, discusses how to avoid a defamation action, and suggests defenses against a defamation action. Several examples are given that demonstrate common situations where liability exists and how a physician should respond. The article explains that at times we have a duty to speak and differentiates between our legal, moral, and ethical duty. Defamation should not be a concern for those involved in the peer review process, as long as they are truthful or act in a good faith belief that what they are saying is true. The article should enhance peer review by encouraging physicians to participate without fear of a retaliatory law suit. PMID:1603860

  11. [Sherlock Holmes as amateur physician].

    PubMed

    Madsen, S

    1998-03-30

    The medical literature contains numerous articles dealing with Sherlock Holmes and his companion Dr. Watson. Some of the articles are concerned with the medical and scientific aspects of his cases. Other articles adopt a more philosophical view: They compare the methods of the master detective with those of the physician--the ideal clinician should be as astute in his profession as the detective must be in his. It this article the author briefly reviews the abilities of Sherlock Holmes as an amateur physician. Often Holmes was brilliant, but sometimes he made serious mistakes. In one of his cases (The Adventure of the Lion's Mane) he misinterpreted common medical signs. PMID:9599503

  12. Building trust and collaboration between physicians and administrators.

    PubMed

    O'Connor, Edward J; Annison, Michael H

    2002-01-01

    If you think someone else's behavior is blocking you from achieving a goal, think again. As a physician leader, there may be something you can do to take responsibility for a situation and make the necessary changes. Learn how you can help build the trust and cooperation needed to make change happen. PMID:11957411

  13. Informed consent: law, clinical reality, and the role of the family physician.

    PubMed

    Cotsonas, C E

    1992-01-01

    Informed consent is typically seen as most relevant to surgical and other invasive specialties. Although family physicians perform fewer high-risk procedures, they are nonetheless extensively involved in the informed consent process because of the comprehensive and continuing nature of the family physician-patient relationship. Family physicians have a particularly important role in helping their patients to understand what diagnostic or therapeutic alternatives are available. Family physicians have an independent role in the informed consent process, as well as a collaborative role in the context of consultation and referral. Legal rules that require disclosure of alternatives to the patient by the treating physician are examined in the context of the family physician's role as a coordinator of patient care. Practical suggestions regarding discussion of alternatives, extent of disclosure, coordination with consulting physicians, and encouragement of patients' participation in discussions are offered. PMID:1575073

  14. The Rural Physician Associate Program: The Value of Immersion Learning for Third-Year Medical Students

    ERIC Educational Resources Information Center

    Zink, Therese; Halaas, Gwen W.; Finstad, Deborah; Brooks, Kathleen D.

    2008-01-01

    Context: Changes in health care and new theories of learning have prompted significant changes in medical education. Some US medical schools employ immersion learning in rural communities to increase the number of physicians who choose to practice in these areas. Founded in 1971, the rural physician associate program (RPAP) is a longitudinal…

  15. 76 FR 64073 - Announcement of Changes to the Membership of the Performance Review Board

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ... Performance Review Board appointees in the Federal Register before their service begins. In accordance with... appointees pursuant to the regulations at 5 CFR 430.310 (74 FR 51261). The purpose of the Performance Review... Senior Executive Service. ITA publishes this notice to announce changes to the Performance Review...

  16. Physician reported perception in the treatment of high blood pressure does not correspond to practice

    PubMed Central

    Wexler, Randy; Elton, Terry; Taylor, Christopher A; Pleister, Adam; Feldman, David

    2009-01-01

    Background High blood pressure is a significant health problem world-wide. Physician factors play a significant role in the suboptimal control of hypertension in the United States. We sought to better understand primary care physician's opinions regarding use of hypertension guidelines, patient and physician related barriers to treatment and physician treatment decision making in the management of hypertension as part of a first step in developing research tools and interventions designed to address these issues. Methods An IRB approved survey pertaining to physician opinion regarding the treatment of hypertension. Items consisted of questions regarding: 1) knowledge of hypertension treatment guidelines; 2) barriers to hypertension control (physician vs. patient); and 3) self-estimation of physician treatment of hypertension. Descriptive Statistics were used to describe results. Results All physicians were board certified in family or general internal medicine (n = 28). Practices were located in urban (n = 12), suburban (n = 14) and inner city locations (n = 1). All physicians felt they did a good job of treating hypertension. Most physicians felt the biggest barrier to hypertension control was patient non-compliance. Half of physicians would fail to intensify treatment for hypertension when blood pressure was above recommended levels for all disease states studied (essential hypertension, heart disease, diabetes, and renal disease). Conclusion Physician ability to assess personal performance in the treatment of hypertension and physician opinion that patient noncompliance is the greatest barrier to optimal hypertension control is contradictory to reported practice behavior. Optimal blood pressure control requires increased physician understanding on the evaluation and management of blood pressure. These data provide crucial formative data to enhance the content validity of physician education efforts currently underway to improve the treatment of blood pressure in

  17. Costs of Physician-Hospital Integration

    PubMed Central

    Cho, Na-Eun

    2015-01-01

    Abstract Given that the enactment of the Patient Protection and Affordable Care Act of 2010 is expected to generate forces toward physician-hospital integration, this study examined an understudied, albeit important, area of costs incurred in physician-hospital integration. Such costs were analyzed through 24 semi-structured interviews with physicians and hospital administrators in a multiple-case, inductive study. Two extreme types of physician-hospital arrangements were examined: an employed model (ie, integrated salary model, a group of physicians integrated by a hospital system) and a private practice (ie, a physician or group of physicians who are independent of economic or policy control). Interviews noted that integration leads to 3 evident costs, namely, monitoring, coordination, and cooperation costs. Improving our understanding of the kinds of costs that are incurred after physician-hospital integration will help hospitals and physicians to avoid common failures after integration. PMID:26496300

  18. Costs of Physician-Hospital Integration.

    PubMed

    Cho, Na-Eun

    2015-10-01

    Given that the enactment of the Patient Protection and Affordable Care Act of 2010 is expected to generate forces toward physician-hospital integration, this study examined an understudied, albeit important, area of costs incurred in physician-hospital integration. Such costs were analyzed through 24 semi-structured interviews with physicians and hospital administrators in a multiple-case, inductive study. Two extreme types of physician-hospital arrangements were examined: an employed model (ie, integrated salary model, a group of physicians integrated by a hospital system) and a private practice (ie, a physician or group of physicians who are independent of economic or policy control). Interviews noted that integration leads to 3 evident costs, namely, monitoring, coordination, and cooperation costs. Improving our understanding of the kinds of costs that are incurred after physician-hospital integration will help hospitals and physicians to avoid common failures after integration. PMID:26496300

  19. Attitudes toward physician advertising among rural consumers.

    PubMed

    Kviz, F J

    1984-04-01

    The issue of whether physicians should advertise their services has been the subject of much debate among health policymakers. This study reports data from a survey of rural residents in Illinois regarding attitudes toward physician advertising and reasons for opposition or support of the practice. The results indicate neither strong opposition nor strong support for physician advertising. While those who are opposed are largely nonspecific regarding their reasons, those in favor primarily expect that it will aid in the selection of a physician. However, few respondents indicate a predisposition to shop for a physician. Although the major concern about physician advertising is a danger of false advertising by some physicians, it appears that the respondents are not trusting of advertising in general rather than of advertising by physicians in particular. These findings suggest that regardless of its potential advantages, physician advertising may be relatively ineffective because consumers may be inattentive, unresponsive, or distrusting . PMID:6717113

  20. Physician-hospital joint venture addresses mutual needs.

    PubMed

    Gleason, S C; Sullivan, P C

    1986-12-01

    Establishing a system of family practice clinics with physicians from its medical staff enabled Mercy Hospital Medical Center, Des Moines, IA, not only to meet consumers' changing needs and wants but also to develop a long-term strategy for survival. The joint venture, which has grown to 9 clinics and 30 physicians since its inception in 1983, does not restrict the hospital from entering into similar relationships with other physician groups. Neither does it restrict physicians from entering new arrangements or using other hospitals. Each clinic operates quasi-autonomously in serving its own patients, and issues such as hiring, firing, hours of operation, and local public relations are handled in a decentralized manner. Other matters--insurance coverage, marketing programs, accounting and data processing systems--are standardized throughout the organization. Challenges involved in undertaking such a project include overcoming resistance from employees, building public awareness of the project, and creating an open, trusting relationship between physicians and administrators. It is particularly important to foster the support of physicians "outside" the partnership and to include those who remain in private practice in marketing efforts. PMID:10279793

  1. Early Islamic physicians and thorax.

    PubMed

    Batirel, H F

    1999-02-01

    Modern anatomic knowledge has developed throughout centuries with transfer of knowledge from generations to generations. Ibn-i Sina (980-1037), Razi (850-923), Davud El-Antaki (?-1008), Ali ibn Abbas (?-982), Ahmed bin Mansur (14th century), Semseddin-i Itaki (1570-1640), and Ibn-i Nafis (1210-1288) were Islamic physicians who all contributed to the understanding of anatomy. They benefited from Greek and Roman pioneers, as well as from each other. To show the situation of thoracic anatomy in early Islamic physicians, we analyzed two original manuscripts in the Süleymaniye Library and some contemporary texts. There were original drawings of the trachea, lung, and vascular system in Semseddin-i Itaki's and Ahmed bin Mansur's anatomy texts. Ibn-i Nafis's writings revealed that he was the first person to describe the pulmonary circulation. Also Ali ibn Abbas wrote that the pulmonary artery wall had two layers and these layers may have a role in constriction and relaxation of this vessel. He also stated that pulmonary veins branched together with the bronchial tree. Ahmed bin Mansur, Ali ibn Abbas, and Ibn-i Nafis each wrote that the heart has two cavities. They also added that the wall of the septum is very thick and there are no passages in between. These show that Islamic physicians had important contributions to thoracic anatomy and physiology. European physicians benefited from these contributions till the end of the 16th century. PMID:10197707

  2. Legal aspects of physician recruitment.

    PubMed

    Roediger, Joan M

    2005-01-01

    It's no secret that recruiting a new physician to your practice is a difficult task. Depending on your medical specialty, it may take two years and possibly longer to recruit the right person. This article addresses some of the key steps you can take now to overcome obstacles in the recruiting process. PMID:16095079

  3. Physician's Guide to Air Pollution.

    ERIC Educational Resources Information Center

    Weisburd, Mel

    Prepared at the request of the American Medical Association Council on Environmental and Public Health, this pamphlet on air pollution is one of a series of publications published by the Council as part of its continuing responsibility to provide current information on environmental health problems to the physician, the medical society, the…

  4. Physician Migration: Donor Country Impact

    ERIC Educational Resources Information Center

    Aluwihare, A. P. R.

    2005-01-01

    Physician migration from the developing to developed region of a country or the world occurs for reasons of financial, social, and job satisfaction. It is an old phenomenon that produces many disadvantages for the donor region or nation. The difficulties include inequities with the provision of health services, financial loss, loss of educated…

  5. [The tragic fate of physicians].

    PubMed

    Ohry, Avi

    2013-10-01

    Physicians and surgeons were always involved in revolutions, wars and political activities, as well as in various medical humanities. Tragic fate met these doctors, whether in the Russian prisons gulags, German labor or concentration camps, pogroms or at the hands of the Inquisition. PMID:24450039

  6. Physician Requirements-1990. For Nephrology.

    ERIC Educational Resources Information Center

    Rosenbach, Joan K.

    Professional requirements for physicians specializing in nephrology were estimated to assist policymakers in developing guidelines for graduate medical education. In estimating service requirements for nephrology, a nephrology Delphi panel reviewed reference and incidence-prevalence and utilization data for 34 conditions that are treated in the…

  7. Internet resources for family physicians.

    PubMed Central

    Anthes, D. L.; Berry, R. E.; Lanning, A.

    1997-01-01

    PROBLEM BEING ADDRESSED: The internet has experienced tremendous growth over the past few years and has many resources in the field of family medicine. However, many family physicians remain unaware of how the Internet can be used to enhance their practice and of how to gain access to this powerful tool. OBJECTIVE OF PROGRAM: To characterize components of the Internet, to explore how family physicians can use the Internet to enhance practice, and to increase awareness of how to gain access to Internet sites relevant to family medicine. MAIN COMPONENTS OF THE PROGRAM: An on-line search through the World Wide Web was conducted using multiple search engines including Lycos, WebCrawler, OpenText, and Yahoo as well as a conventional MEDLINE search of Internet publications for the past 5 years. A website containing an evolving selection of resources can be found at http:@dfcm 18.med.utoronto.ca/anthes/hpgdfcm1.htm. CONCLUSION: The Internet has useful applications and resources for family physicians including rapid communication between physicians, access to medical literature, continuing medical education programs, and lists of patient support and discussion groups. PMID:9189299

  8. The Mindful Physician and Pooh

    ERIC Educational Resources Information Center

    Winter, Robin O.

    2013-01-01

    Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the…

  9. Physicians Training Project. Final Report.

    ERIC Educational Resources Information Center

    Bruder, Mary Beth

    This final report describes the accomplishments and activities of a project which developed, implemented, and evaluated training activities for medical students, pediatric residents, and practicing physicians to enhance their understanding of and involvement with early intervention and the special education system in Connecticut. The training…

  10. Training Physicians in Palliative Care.

    ERIC Educational Resources Information Center

    Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.

    1999-01-01

    Describes the elements of a program in hospice and palliative medicine that may serve as a model of an effective system of physician education. Topics for the palliative-care curriculum include hospice medicine, breaking bad news, pain management, the process of dying, and managing personal stress. (JOW)

  11. Hitler’s Jewish Physicians

    PubMed Central

    Weisz, George M.

    2014-01-01

    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

  12. Thinking Styles and Regret in Physicians

    PubMed Central

    Djulbegovic, Mia; Beckstead, Jason; Elqayam, Shira; Reljic, Tea; Kumar, Ambuj; Paidas, Charles; Djulbegovic, Benjamin

    2015-01-01

    Background Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper. Methods A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection) were administered through a web-based survey to physicians of the University of South Florida. Bonferroni’s adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni’s correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret. Results 165 trainees and 56 attending physicians (age range 25 to 69) participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; p<0.001) and alternate search strategy (r=0.239; p=0.002). When Bonferroni’s correction was not applied, we also found a negative relationship between satisficing tendency and regret (r=-0.156; p=0.021). In trainees, but not faculty, regret negatively correlated with rational-analytical thinking (r=-0.422; p<0.001), need for cognition (r=-0.340; p<0.001), and objectivism (r=-0.309; p=0.003) and positively correlated with ambiguity intolerance (r=0.285; p=0.012). However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001), while it was

  13. Physician, Practice, and Patient Characteristics Related to Primary Care Physician Physical and Mental Health: Results from the Physician Worklife Study

    PubMed Central

    Williams, Eric S; Konrad, Thomas R; Linzer, Mark; McMurray, Julia; Pathman, Donald E; Gerrity, Martha; Schwartz, Mark D; Scheckler, William E; Douglas, Jeff

    2002-01-01

    Objective To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Data Sources Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. Study Design A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. Principle Findings The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. Conclusions These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both “physician friendly” and “family friendly” seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

  14. Evaluating a physician leadership development program - a mixed methods approach.

    PubMed

    Throgmorton, Cheryl; Mitchell, Trey; Morley, Tom; Snyder, Marijo

    2016-05-16

    Purpose - With the extent of change in healthcare today, organizations need strong physician leaders. To compensate for the lack of physician leadership education, many organizations are sending physicians to external leadership programs or developing in-house leadership programs targeted specifically to physicians. The purpose of this paper is to outline the evaluation strategy and outcomes of the inaugural year of a Physician Leadership Academy (PLA) developed and implemented at a Michigan-based regional healthcare system. Design/methodology/approach - The authors applied the theoretical framework of Kirkpatrick's four levels of evaluation and used surveys, observations, activity tracking, and interviews to evaluate the program outcomes. The authors applied grounded theory techniques to the interview data. Findings - The program met targeted outcomes across all four levels of evaluation. Interview themes focused on the significance of increasing self-awareness, building relationships, applying new skills, and building confidence. Research limitations/implications - While only one example, this study illustrates the importance of developing the evaluation strategy as part of the program design. Qualitative research methods, often lacking from learning evaluation design, uncover rich themes of impact. The study supports how a PLA program can enhance physician learning, engagement, and relationship building throughout and after the program. Physician leaders' partnership with organization development and learning professionals yield results with impact to individuals, groups, and the organization. Originality/value - Few studies provide an in-depth review of evaluation methods and outcomes of physician leadership development programs. Healthcare organizations seeking to develop similar in-house programs may benefit applying the evaluation strategy outlined in this study. PMID:27119393

  15. Physician career satisfaction within specialties

    PubMed Central

    Leigh, J Paul; Tancredi, Daniel J; Kravitz, Richard L

    2009-01-01

    Background Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options. Methods We analyzed cross-sectional data from 6,590 physicians (response rate, 53%) in Round 4 (2004-2005) of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions Results After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349); geriatric medicine (0.323); other pediatric subspecialties (0.270); neonatal/prenatal medicine (0.266); internal medicine and pediatrics (combined practice) (0.250); pediatrics (0.250); dermatology (0.249);and child and adolescent psychiatry (0.203). The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707); pulmonary critical care medicine (-0.273); nephrology (-0.206); and obstetrics and gynecology (-0.188). We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites. Conclusion Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they appear to be in

  16. Physician attitudes and family planning in Nigeria.

    PubMed

    Covington, D L; Otolorin, E O; Janowitz, B; Gates, D S; Lamptey, P; Ladipo, O A

    1986-01-01

    This study examines family planning attitudes and practices of 681 Nigerian physicians selected from cities in which large university teaching hospitals are located. About half of the physicians were practicing family planning; the method of choice was the IUD. Obstetrician/gynecologists and general practitioners were more likely to provide methods to their patients than were other types of physicians. The physicians were concerned about population growth and favored family planning, yet a substantial minority believed that family planning is foreign to the culture and that it promotes promiscuity. Physicians were reluctant to promote family planning on a wide scale; many disapproved of non-physicians providing oral contraceptives or IUDs. PMID:3750358

  17. Gender and the professional career of primary care physicians in Andalusia (Spain)

    PubMed Central

    2011-01-01

    Background Although the proportion of women in medicine is growing, female physicians continue to be disadvantaged in professional activities. The purpose of the study was to determine and compare the professional activities of female and male primary care physicians in Andalusia and to assess the effect of the health center on the performance of these activities. Methods Descriptive, cross-sectional, and multicenter study. Setting: Spain. Participants: Population: urban health centers and their physicians. Sample: 88 health centers and 500 physicians. Independent variable: gender. Measurements: Control variables: age, postgraduate family medicine specialty (FMS), patient quota, patients/day, hours/day housework from Monday to Friday, idem weekend, people at home with special care, and family situation. Dependent variables: 24 professional activities in management, teaching, research, and the scientific community. Self-administered questionnaire. Descriptive, bivariate, and multilevel logistic regression analyses. Results Response: 73.6%. Female physicians: 50.8%. Age: female physicians, 49.1 ± 4.3 yrs; male physicians, 51.3 ± 4.9 yrs (p < 0.001). Female physicians with FMS: 44.2%, male physicians with FMS: 33.3% (p < 0.001). Female physicians dedicated more hours to housework and more frequently lived alone versus male physicians. There were no differences in healthcare variables. Thirteen of the studied activities were less frequently performed by female physicians, indicating their lesser visibility in the production and diffusion of scientific knowledge. Performance of the majority of professional activities was independent of the health center in which the physician worked. Conclusions There are gender inequities in the development of professional activities in urban health centers in Andalusia, even after controlling for family responsibilities, work load, and the effect of the health center, which was important in only a few of the activities under study

  18. Comparison of Evidence-Based Practice between Physicians and Nurses: A National Survey of Regional Hospitals in Taiwan

    ERIC Educational Resources Information Center

    Chiu, Ya-Wen; Weng, Yi-Hao; Lo, Heng-Lien; Hsu, Chih-Cheng; Shih, Ya-Hui; Kuo, Ken N.

    2010-01-01

    Introduction: Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance. Methods: A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551…

  19. 75 FR 58411 - Medicare Program; Town Hall Meeting on the Physician Compare Web Site, October 27, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... Physician Compare Web Site, October 27, 2010 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... 2010, ``Public Reporting of Performance Information'' requires CMS to establish a Physician Compare Web site by January 1, 2011. This notice announces a Town Hall meeting to discuss the Physician Compare...

  20. How to develop breakthrough physician-to-physician relationships.

    PubMed

    Ramirez, Lito

    2008-01-01

    In today's highly competitive marketplace, specialty practices must strive to distinguish themselves from the competition. One key strategy is to provide exceptional levels of service based on fundamentals already in play among many non-healthcare service providers. The problem is that too many practices are failing to deliver. This article outlines precautionary principles that will enable specialty practices, and even hospitals, to develop stronger, more positive physician relationships that increase loyalty and keep your patient pipeline filled. PMID:18754246

  1. Physician supply and medical education in California. A comparison with national trends.

    PubMed Central

    Grumbach, K; Coffman, J M; Young, J Q; Vranizan, K; Blick, N

    1998-01-01

    Concerns have been voiced about an impending oversupply of physicians in the United States. Do these concerns also apply to California, a state with many unique demographic characteristics? We examined trends in physician supply and medical education in California and the United States between 1980 and 1995 to better inform the formulation of workforce policies appropriate to the state's requirements for physicians. We found that similar to the United States, California has more than an ample supply of physicians in the aggregate, but too many specialists, too few underrepresented racial/ethnic minority physicians, and poor distribution of physicians across the state. However, recent growth in the supply of practicing physicians and resident physicians per capita in California has been much less dramatic than in the country overall. The state's unusually high rate of population growth has enabled California, unlike the United States as a whole, to absorb large increases in the number of practicing physicians and residents during 1980 to 1995 without substantially increasing the physician-to-population ratio. Due to a projected slowing of the state's rate of population growth, the supply of physicians per capita in the state will begin to rise steeply in coming years unless the state implements prompt reductions in the production of specialists. An immediate 25% reduction in specialist residency positions would be necessary to bring the state's supply of practicing specialists in line with projected physician requirements for the state by 2020. We conclude that major changes will be required if the state's residency programs and medical schools are to produce the number and mix of physicians the state requires. California's medical schools and residency programs will need to act in concert with federal and state government to develop effective policies to address the imbalance between physician supply and state requirements. Images Figure 2. Figure 3. Figure 4. PMID

  2. Challenges of Forecasting Physician Workforce Needs Amid Delivery System Transformation.

    PubMed

    Cunningham, Rob

    2015-09-29

    As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these and other factors for physician workforce policies. PMID:26761958

  3. Asymmetry of the Modified Illinois Change of Direction Test Impacts Young Elite Soccer Players’ Performance

    PubMed Central

    Rouissi, Mehdi; Chtara, Moktar; Berriri, Ahmed; Owen, Adam; Chamari, Karim

    2016-01-01

    Background The modified Illinois change of direction test (MICODT) is an asymmetrical test because the numbers of changes of direction performed to the right and to the left are unequal. Therefore, it is possible that the asymmetry of this test may influence agility performance testing. Objectives The aim of this study was to compare two opposite/mirrored versions of the modified Illinois change of direction test. Patients and Methods Forty-six right-footed soccer players (17.2 ± 1.6 years-old) participated in the study. Players performed a modified Illinois change of direction test and a mirrored version of this test “inverted modified Illinois change of direction test” (I/MICODT) in a randomized and counter-balanced order. Paired t-test was used to determine whether significant differences existed between time performances of the tests as a within-subjects measure. Players were thereafter stratified into MICODT group or I/MICODT group according to their best performance and independent t-tests were used to determine differences between groups. Results The analysis revealed no significant difference in time performance between the two versions of test as a within-subjects measure (P > 0.05, ES = 0.05). However, significant better time performances among inverted modified Illinois change of direction group (52% of players) were found when compared to the modified Illinois change of direction group (48% of players) (P < 0.04, ES = 0.66). Conclusions The modified Illinois change of direction test must be considered as an asymmetrical test because it underestimates more than half of the players’ agility performances. Therefore, fitness coaches should take these results into account when using this test. PMID:27625760

  4. Unraveling mysteries of personal performance style; biomechanics of left-hand position changes (shifting) in violin performance.

    PubMed

    Visentin, Peter; Li, Shiming; Tardif, Guillaume; Shan, Gongbing

    2015-01-01

    Instrumental music performance ranks among the most complex of learned human behaviors, requiring development of highly nuanced powers of sensory and neural discrimination, intricate motor skills, and adaptive abilities in a temporal activity. Teaching, learning and performing on the violin generally occur within musico-cultural parameters most often transmitted through aural traditions that include both verbal instruction and performance modeling. In most parts of the world, violin is taught in a manner virtually indistinguishable from that used 200 years ago. The current study uses methods from movement science to examine the "how" and "what" of left-hand position changes (shifting), a movement skill essential during violin performance. In doing so, it begins a discussion of artistic individualization in terms of anthropometry, the performer-instrument interface, and the strategic use of motor behaviors. Results based on 540 shifting samples, a case series of 6 professional-level violinists, showed that some elements of the skill were individualized in surprising ways while others were explainable by anthropometry, ergonomics and entrainment. Remarkably, results demonstrated each violinist to have developed an individualized pacing for shifts, a feature that should influence timing effects and prove foundational to aesthetic outcomes during performance. Such results underpin the potential for scientific methodologies to unravel mysteries of performance that are associated with a performer's personal artistic style. PMID:26557431

  5. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...

  6. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...

  7. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...

  8. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...

  9. AMA Physician Select: Online Doctor Finder

    MedlinePlus

    ... Membership | JAMA Network | AMA Store DoctorFinder This online physician Locator helps you find a perfect match for ... with basic professional information on virtually every licensed physician in the United States. This includes more than ...

  10. Physician equity alliances: attractive alternatives to PHOs.

    PubMed

    Goldstein, D

    1997-04-01

    Physician equity alliances are becoming attractive alternatives to PHOs as integrative models for partnering with physicians, securing managed care contracts and increasing revenue. Unlike many PHOs, these alliances provide mechanisms for asset integration and long-term relationships along with utilization management, sophisticated information systems, access to capital and opportunities for physicians to integrate clinically. There are six major types of physician equity alliances: majority physician-owned, clinic without walls, health system joint venture, publicly held physician practice management company, specialty network, and venture capital. The type of alliance that a physician group practice ultimately develops depends on vision, values, method of capitalization, initial organizer of the alliance, level of involvement of physicians in business issues, corporate structure desired, and characteristics of the managed care market in which the alliance will operate. PMID:10166285

  11. Diagnosis and therapy for the disruptive physician.

    PubMed

    Kissoon, Niranjan; Lapenta, Susan; Armstrong, George

    2002-01-01

    A disruptive physician can alienate staff, drive away patients, and even land your organization in a lawsuit. Consider some practical advice on how to identify and deal with disruptive physicians. PMID:11806231

  12. Service and collaboration keys to physician control.

    PubMed

    Bujak, Joseph S

    2002-01-01

    Discover what physicians must do to regain power and half health care's slide from a profession toward a trade. The solutions lie in better customer service and improved physician collaboration. PMID:12055949

  13. How many physicians can we afford?

    PubMed

    Grumbach, K; Lee, P R

    1991-05-01

    We project physician costs for the year 2,000 under several alternative scenarios, using different assumptions about the future supply of physicians and gross income (or expenditures) per physician. The supply of active, posttraining patient-care physicians is projected to increase from a ratio of 144 per 100,000 population in 1986 to 176 per 100,000 in 2,000. Depending on whether expenditures per physician increase at the rate of the consumer price index, the gross national product, or the historical 1982 through 1987 expenditure trends, there will be an additional cost (in constant 1986 dollars) of $21 billion, $30 billion, or $40 billion, respectively, compared with projected physician costs under a scenario of a constant physician-to-population ratio. The disproportionate growth of costs for practice overhead will pose a particular problem for efforts to restrain inflation of expenditures per physician. PMID:1901922

  14. Stresses on women physicians: consequences and coping techniques.

    PubMed

    Robinson, Gail Erlick

    2003-01-01

    We review current data on types of stressors acting on women physicians, the consequences of these stressors and methods of coping with them. We undertook a systematic review of original articles published in the last 15 years and registered mainly on Medline and on the internet websites focusing on these issues. In addition to the pressures acting on all physicians, women physicians face specific stressors related to discrimination, lack of role models and support, role strain, and overload. The depression rate in women physicians does not vary from that of the general public but the rates of successful suicide and divorce are much higher. Women in academic settings are promoted more slowly, have lower salaries, receive fewer resources, and suffer from a range of micro-inequities. They often lack mentors to provide advice and guidance. They must cope with the pressures of choosing when to have a child and conflicts between being a wife and mother and having a career. Despite these pressures, they report a high degree of career satisfaction. Although women physicians suffer from a variety of stressors that can lead to career impediments, stress reactions, and psychiatric problems, generally they are satisfied with their careers. Personal coping techniques can help women deal with these stressors. Pressures will continue until attitudes and practices change in institutional settings. Some institutions are initiating changes to end discrimination against women faculty. PMID:12768652

  15. The Cost of Cancer-Related Physician Services to Medicare

    PubMed Central

    Maroongroge, Sean; Kim, Simon P.; Mougalian, Sarah; Johung, Kimberly; Decker, Roy H.; Soulos, Pamela R.; Long, Jessica B.; Gross, Cary P.; Yu, James B.

    2015-01-01

    Although physician services represent a substantial portion of cancer care costs, little is known about trends in the costs of physician cancer services in the fee-for-service Medicare program. We analyzed aggregated data from all Part B Medicare claims for physician and supplier services attributed to cancer patients from 1999 to 2012 to characterize how billing and payments have changed over time for the most common cancer types. Billing and expenditure data are from the Medicare Statistical Supplement, and age-adjusted incidence data are from SEER. Physician services for cancer patients grew from $7.6 billion in 1999 to $12.3 billion in 2012 (60 percent increase). Reimbursements for physician and supplier services for cancer treatment in Medicare Part B beneficiaries steadily grew from 1999 to 2005 and then plateaued through 2012, led by a decrease in reimbursements for prostate cancer care. These trends may reflect shifts toward hospital-based care or changes in aggressiveness of care. PMID:26029009

  16. Performance evaluation of supervised change detection tool on DubaiSat-2 multispectral and pansharp images

    NASA Astrophysics Data System (ADS)

    Almatroushi, Hessa R.

    2014-10-01

    Supervised Change Detection Tool (SCDT) is an in-house developed tool in Emirates Institution for Advanced Science and Technology (EIAST). The developed tool is based on Algebra Change Detection algorithm and multi-class Support Vector Machine classifier and is capable of highlighting the areas of change, describing them, and discarding any falsedetections that result from shadow. Further, it can collect the analysis results, which include the change of class an area went through and the overall change percentage of each class defined, in a Microsoft Word document automatically. This paper evaluates the performance of the SCDT, which was initially developed for DubaiSat-1 multispectral images, on DubaiSat-2 multispectral and pansharp images. Moreover, it compares its performance opposed to Change Detection Analysis (i.e. Post-Classification) in ENVI.

  17. The Relationship between Performance and Trunk Movement During Change of Direction.

    PubMed

    Sasaki, Shogo; Nagano, Yasuharu; Kaneko, Satoshi; Sakurai, Takakuni; Fukubayashi, Toru

    2011-01-01

    The purpose of this study was to obtain the trunk kinematics data during a change-of-direction task and to determine the relationship between trunk kinematics and the change-of-direction performance. The design of this investigation was a descriptive laboratory study. Twelve healthy male collegiate soccer players (age: 21.3 ± 1.0 yrs, body mass: 67. 7 ± 6.7 kg, and height: 1.75 ± 0.05 m) participated in this study. Participants performed a shuttle run cutting task with a 180 degree pivot as quickly as possible. The shuttle run cutting time, ground contact time during a change-of-direction, and trunk inclination angle were measured. The shuttle run cutting time tends to correlate positively with ground contact time. During the change- of-direction task, the trunk forward inclination angle gradually increased during the first 50% of the stance phase and decreased subsequently whereas the trunk flexed, maintaining a left inclination during the first 40% of the stance phase and changing exponentially in the opposite direction. Forward angular displacement of the trunk between foot-contact and maximum trunk inclination correlated positively with the shuttle run cutting time (r = 0.61, p < 0.05) and ground contact time (r = 0.65, p < 0.05). These findings suggest that the change-of-direction performance could be related to the small angular displacement of the trunk during a change of direction. Moreover, it was considered that there might be optimal inclination angles related to change-of-direction performance. Therefore, coaches in field sports should check body posture and trunk movements during changes of direction. Key pointsSmall forward angular displacement of the trunk during a direction change is related to the change-of-direction performance.Trunk stability during a change of direction is an important factor in the change-of-direction performance.There might be a range of optimal angles of trunk inclination during a change of direction.Coaches in field

  18. Age-Related Visual Changes and Their Impications for the Motor Skill Performance of Older Adults.

    ERIC Educational Resources Information Center

    Haywood, Kathleen M.; Trick, Linda R.

    Physical changes in and conditions of the eye associated with the normal aging process are discussed with reference to their impact on performance in physical and recreational activities. Descriptions are given of characteristic changes in visual acuity in the areas of: (1) presbyopia (inability to clearly focus near images); (2) sensitivity to…

  19. Changes in Sensory Evoked Responses Coincide with Rapid Improvement in Speech Identification Performance

    ERIC Educational Resources Information Center

    Alain, Claude; Campeanu, Sandra; Tremblay, Kelly

    2010-01-01

    Perceptual learning is sometimes characterized by rapid improvements in performance within the first hour of training (fast perceptual learning), which may be accompanied by changes in sensory and/or response pathways. Here, we report rapid physiological changes in the human auditory system that coincide with learning during a 1-hour test session…

  20. Distributed Leadership and Organizational Change: Implementation of a Teaching Performance Measure

    ERIC Educational Resources Information Center

    Sloan, Tine

    2013-01-01

    This article explores leadership practice and change as evidenced in multiple data sources gathered during a self-study implementation of a teaching performance assessment. It offers promising models of distributed leadership and organizational change that can inform future program implementers and the field in general. Our experiences suggest…

  1. Examining the Relationship between Learning Organization Characteristics and Change Adaptation, Innovation, and Organizational Performance

    ERIC Educational Resources Information Center

    Kontoghiorghes, Constantine; Awbre, Susan M.; Feurig, Pamela L.

    2005-01-01

    The main purpose of this exploratory study was to examine the relationship between certain learning organization characteristics and change adaptation, innovation, and bottom-line organizational performance. The following learning organization characteristics were found to be the strongest predictors of rapid change adaptation, quick product or…

  2. Exploring the Effects of Changes in Future Time Perspective and Perceived Instrumentality on Graded Performance

    ERIC Educational Resources Information Center

    Eren, Altay

    2009-01-01

    Introduction: This study aimed to explore the possible changes in the Future Time Perspective (FTP) and Perceived Instrumentality (PI) over time as long as one academic semester, as well as to explore whether those changes in FTP and PI explained students' Graded Performance (GP) with regard to a specific course; educational psychology. Method: A…

  3. The Cost of Performance? Students' Learning about Acting as Change Agents in Their Schools

    ERIC Educational Resources Information Center

    Kehoe, Ian

    2015-01-01

    This paper explores how performance culture could affect students' learning about, and disposition towards, acting as organisational change agents in schools. This is based on findings from an initiative aimed to enable students to experience acting as change agents on an aspect of the school's culture that concerned them. The initiative…

  4. Children's Sleep and Cognitive Performance: A Cross-Domain Analysis of Change over Time

    ERIC Educational Resources Information Center

    Bub, Kristen L.; Buckhalt, Joseph A.; El-Sheikh, Mona

    2011-01-01

    Relations between changes in children's cognitive performance and changes in sleep problems were examined over a 3-year period, and family socioeconomic status, child race/ethnicity, and gender were assessed as moderators of these associations. Participants were 250 second- and third-grade (8-9 years old at Time 1) boys and girls. At each…

  5. Differences in incomes of physicians in the United States by race and sex: observational study

    PubMed Central

    Ly, Dan P; Seabury, Seth A

    2016-01-01

    Objectives To estimate differences in annual income of physicians in the United States by race and sex adjusted for characteristics of physicians and practices. Design Cross sectional survey study. Setting Nationally representative samples of US physicians. Participants The 2000-13 American Community Survey (ACS) included 43 213 white male, 1698 black male, 15 164 white female, and 1252 black female physicians. The 2000-08 Center for Studying Health System Change (HSC) physician surveys included 12 843 white male, 518 black male, 3880 white female, and 342 black female physicians. Main outcome measures Annual income adjusted for age, hours worked, time period, and state of residence (from ACS data). Income was adjusted for age, specialty, hours worked, time period, years in practice, practice type, and percentage of revenue from Medicare/Medicaid (from HSC physician surveys). Results White male physicians had a higher median annual income than black male physicians, whereas race was not consistently associated with median income among female physicians. For example, in 2010-13 in the ACS, white male physicians had an adjusted median annual income of $253 042 (95% confidence interval $248 670 to $257 413) compared with $188 230 ($170 844 to $205 616) for black male physicians (difference $64 812; P<0.001). White female physicians had an adjusted median annual income of $163 234 ($159 912 to 166 557) compared with $152 784 ($137 927 to $167 641) for black female physicians (difference $10 450; P=0.17). $100 000 is currently equivalent to about £69 000 (€89 000). Patterns were unaffected by adjustment for specialty and characteristics of practice in the HSC physician surveys. Conclusions White male physicians earn substantially more than black male physicians, after adjustment for characteristics of physicians and practices, while white and black female physicians earn similar incomes to each other, but significantly

  6. Health data and the physician.

    PubMed

    Leighton, E

    1968-08-01

    California Health Data Corporation was formed to create better health data resources under the direction of hospitals and medicine. Highest priority is being given to developing information systems that will serve physicians, as well as those who are usually considered health data users. This is illustrated in CHD's first major activity, sponsorship of a medical record information system for California hospitals. This system is designed first of all to provide better information for medical staff committees, and as a byproduct to provide data flow into a CHD data bank. For the practicing physician, the significance of CHD is that the organization will attempt to develop information systems that will help the medical profession maintain its central role in guiding the present and future patterns of health care. PMID:5673991

  7. Monitoring changes in physical performance with heart rate measures in young soccer players.

    PubMed

    Buchheit, M; Simpson, M B; Al Haddad, H; Bourdon, P C; Mendez-Villanueva, A

    2012-02-01

    The aim of the present study was to verify the validity of using exercise heart rate (HRex), HR recovery (HRR) and post-exercise HR variability (HRV) during and after a submaximal running test to predict changes in physical performance over an entire competitive season in highly trained young soccer players. Sixty-five complete data sets were analyzed comparing two consecutive testing sessions (3-4 months apart) collected on 46 players (age 15.1 ± 1.5 years). Physical performance tests included a 5-min run at 9 km h(-1) followed by a seated 5-min recovery period to measure HRex, HRR and HRV, a counter movement jump, acceleration and maximal sprinting speed obtained during a 40-m sprint with 10-m splits, repeated-sprint performance and an incremental running test to estimate maximal cardiorespiratory function (end test velocity V (Vam-Eval)). Possible changes in physical performance were examined for the players presenting a substantial change in HR measures over two consecutive testing sessions (greater than 3, 13 and 10% for HRex, HRR and HRV, respectively). A decrease in HRex or increase in HRV was associated with likely improvements in V (Vam-Eval); opposite changes led to unclear changes in V (Vam-Eval). Moderate relationships were also found between individual changes in HRR and sprint [r = 0.39, 90% CL (0.07;0.64)] and repeated-sprint performance [r = -0.38 (-0.05;-0.64)]. To conclude, while monitoring HRex and HRV was effective in tracking improvements in V (Vam-Eval), changes in HRR were moderately associated with changes in (repeated-)sprint performance. The present data also question the use of HRex and HRV as systematic markers of physical performance decrements in youth soccer players. PMID:21656232

  8. Revealing a Child's Pathology: Physicians' Experiences

    ERIC Educational Resources Information Center

    Scelles, Regine; Aubert-Godard, Anne; Gargiulo, Marcela; Avant, Monique; Gortais, Jean

    2010-01-01

    In this study, 12 physicians and 12 care-givers were interviewed using semi-structured interviews. We explored physicians' experiences when they revealed a diagnosis. We also tried to understand which family members the physician was thinking of, with whom they identified themselves, and their first choice of the person to whom they prefer to…

  9. 38 CFR 52.150 - Physician services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.150 Physician services. As a condition of enrollment in adult day health care program, a participant must obtain a written physician order for enrollment. Each participant must remain under the care of a physician. (a)...

  10. 38 CFR 52.150 - Physician services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.150 Physician services. As a condition of enrollment in adult day health care program, a participant must obtain a written physician order for enrollment. Each participant must remain under the care of a physician. (a)...

  11. Physician's Death Anxiety and Patient Outcomes.

    ERIC Educational Resources Information Center

    Schulz, Richard; Aderman, David

    1978-01-01

    It was shown that terminal patients of physicians with high death anxiety survive longer during their final hospital stay than terminal patients of physicians with low death anxiety. Physicians high in death anxiety seem to be less willing to accept patients' terminality and use heroic measures to keep them alive. (Author)

  12. 42 CFR 405.2412 - Physicians' services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Physicians' services. 405.2412 Section 405.2412 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... Health Center Services § 405.2412 Physicians' services. (a) Physicians' services are...

  13. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...

  14. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...

  15. Physician Incentives in Health Maintenance Organizations

    ERIC Educational Resources Information Center

    Gaynor, Martin; Rebitzer, James B.; Taylor, Lowell J.

    2004-01-01

    Managed care organizations rely on incentives that encourage physicians to limit medical expenditures, but little is known about how physicians respond to these incentives. We address this issue by analyzing the physician incentive contracts in use at a health maintenance organization. By combining knowledge of the incentive contracts with…

  16. Opinion and Special Articles: "Physician debtor".

    PubMed

    Scharf, Eugene L; Jones, Lyell K

    2016-01-19

    The increasing cost of attending medical school has contributed to increasing physician indebtedness. The burden of medical school debt has implications for physician career choice, professional satisfaction, and burnout. This opinion discusses the impact of physician indebtedness, the importance of improving debt awareness among neurology trainees, and program- and policy-level solutions to the debt crisis. PMID:26783273

  17. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...

  18. 42 CFR 405.2412 - Physicians' services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Physicians' services. 405.2412 Section 405.2412 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... Health Center Services § 405.2412 Physicians' services. (a) Physicians' services are...

  19. 42 CFR 405.2412 - Physicians' services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Physicians' services. 405.2412 Section 405.2412 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... Health Center Services § 405.2412 Physicians' services. (a) Physicians' services are...

  20. 42 CFR 405.2412 - Physicians' services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Physicians' services. 405.2412 Section 405.2412 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... Health Center Services § 405.2412 Physicians' services. (a) Physicians' services are...