The public's opinions of physicians: do perceived choice and exercised choice matter?

PubMed

Tai-Seale, Ming; Pescosolido, Bernice

2003-09-01

To assess whether the public's opinions of physicians are affected by one's perceived ability to choose providers and by past experience with switching providers or health plans. Cross-sectional survey of the American general public in 1998. Multivariate quantitative analyses of opinions according to respondents' perceived ability to choose providers, history of exercising choice of providers or plans, and health status. Exploratory factor analyses resulted in 4 scales of opinions: trusting personal physician, positive opinions of physicians as a group, negative opinions of physicians as a group, and concerns about the influence of managed care on personal physicians' practice patterns. Although 75% (879/1172) of the sample perceived that they could use any physician they wanted, only 20% had ever switched health providers or plans owing to dissatisfaction. Perceived lack of choice is associated with lower levels of trust in personal physicians and with higher levels of concern about the influence of managed care on personal physicians. Individuals who have not switched in the past are more positive about physicians as a group and are less concerned about the influence of managed care. Health status affected opinions significantly. Educational attainment is negatively associated with opinions. The public's opinions of physicians are significantly associated with one's perceived ability to choose any provider, past experience with switching health providers or plans, health status, and education. Ensuring consumer choice of providers and targeting those who have switched in the past and the sick could potentially improve the public's opinions. Meaningful provider quality information is necessary to ensure choices that can enhance consumer welfare.

Physician privacy concerns when disclosing patient data for public health purposes during a pandemic influenza outbreak

PubMed Central

2011-01-01

Background Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been argued that the public good should supersede an individual's right to privacy. The precise nature of these provider privacy concerns, and whether they are diluted in the context of a pandemic are not known. Our objective was to understand the privacy barriers which could potentially influence family physicians' reporting of patient-level surveillance data to public health agencies during the Fall 2009 pandemic H1N1 influenza outbreak. Methods Thirty seven family doctors participated in a series of five focus groups between October 29-31 2009. They also completed a survey about the data they were willing to disclose to public health units. Descriptive statistics were used to summarize the amount of patient detail the participants were willing to disclose, factors that would facilitate data disclosure, and the consensus on those factors. The analysis of the qualitative data was based on grounded theory. Results The family doctors were reluctant to disclose patient data to public health units. This was due to concerns about the extent to which public health agencies are dependable to protect health information (trusting beliefs), and the possibility of loss due to disclosing health information (risk beliefs). We identified six specific actions that public health units can take which would affect these beliefs, and potentially increase the willingness to disclose patient information for public health purposes. Conclusions The uncertainty surrounding a pandemic of a new strain of influenza has not changed the privacy concerns of physicians about disclosing patient data. It is important to address these concerns to ensure reliable reporting during future outbreaks. PMID:21658256

Physician privacy concerns when disclosing patient data for public health purposes during a pandemic influenza outbreak.

PubMed

El Emam, Khaled; Mercer, Jay; Moreau, Katherine; Grava-Gubins, Inese; Buckeridge, David; Jonker, Elizabeth

2011-06-09

Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been argued that the public good should supersede an individual's right to privacy. The precise nature of these provider privacy concerns, and whether they are diluted in the context of a pandemic are not known. Our objective was to understand the privacy barriers which could potentially influence family physicians' reporting of patient-level surveillance data to public health agencies during the Fall 2009 pandemic H1N1 influenza outbreak. Thirty seven family doctors participated in a series of five focus groups between October 29-31 2009. They also completed a survey about the data they were willing to disclose to public health units. Descriptive statistics were used to summarize the amount of patient detail the participants were willing to disclose, factors that would facilitate data disclosure, and the consensus on those factors. The analysis of the qualitative data was based on grounded theory. The family doctors were reluctant to disclose patient data to public health units. This was due to concerns about the extent to which public health agencies are dependable to protect health information (trusting beliefs), and the possibility of loss due to disclosing health information (risk beliefs). We identified six specific actions that public health units can take which would affect these beliefs, and potentially increase the willingness to disclose patient information for public health purposes. The uncertainty surrounding a pandemic of a new strain of influenza has not changed the privacy concerns of physicians about disclosing patient data. It is important to address these concerns to ensure reliable reporting during future outbreaks.

Public-on-private dual practice among physicians in public hospitals of Tigray National Regional State, North Ethiopia: perspectives of physicians, patients and managers.

PubMed

Abera, Goitom Gigar; Alemayehu, Yibeltal Kiflie; Herrin, Jeph

2017-11-10

Physicians who work in the private sector while also holding a salaried job in a public hospital, known as "dual practice," is one of the main retention strategies adopted by the government of Ethiopia. Dual practice was legally endorsed in Tigray National Regional State, Ethiopia in 2010. Therefore, the aim of this study was to explore the extent of dual practice, reasons why physicians engage in it, and its effects on public hospital services in this state in northern Ethiopia. A cross-sectional study using mixed methods was conducted from February to March 2011 in six geographically representative public hospitals of Tigray National Regional State. A semi-structured, self-administered questionnaire was distributed to all physicians working in the study hospitals, and an interviewer-administered, structured questionnaire was used to collect data from admitted patients. Focus group discussions were conducted with hospital governing boards. Quantitative and qualitative data were used in the analysis. Data were collected from 31 physicians and 449 patients in the six study hospitals. Six focus group discussions were conducted. Twenty-eight (90.3%) of the physicians were engaged in dual practice to some extent: 16 (51.6%) owned private clinics outside the public hospital, 5 (16.1%) worked part-time in outside private clinics, and 7 (22.6%) worked in the private wing of public hospitals. Income supplementation was the primary reason for engaging in dual practice, as reported by 100% of the physicians. The positive effects of dual practice from both managers' and physicians' perspectives were physician retention in the public sector. Ninety-one patients (20.3%) had been referred from a private clinic immediately prior to their current admission-a circular diversion pattern. Eighteen (19.8%) of the diverted patients reported that health workers in the public hospitals diverted them. Circular diversion pattern of referral system is the key negative consequence of dual

Polish physicians' cooperation with the pharmaceutical industry and its potential impact on public health.

PubMed

Makowska, Marta

2017-01-01

This article aims to describe how Polish physicians cooperate with the pharmaceutical industry and show how this relationship may pose a threat to public health. It considers the results of an online survey of 379 physicians. The survey was hosted by surveymonkey.com with links from a Polish physicians' website (Medycyna Praktyczna) between 29 October 2013 and 31 December 2013. The sample was purposive, respondents having to be physicians working in Poland. The majority of respondents (96.8%) said that they had talked with pharmaceutical sales representatives (PSRs) in their practice, with 85% saying that they had had regular contact with them. Despite the existing legal ban in Poland, 35% of respondents admitted that they had usually met with PSRs in their office during working hours. As many as 81.8% of surveyed doctors said that they had taken part in an educational meeting organized by the pharmaceutical industry at least once during the 12 months preceding the study. A majority of the respondents (72.3%) said they trusted the information provided by PSRs. Over one third of respondents (36.4%) claimed that Polish doctors accepted gifts of a type that they should not accept according to Polish law. The study showed that Polish physicians cooperate in different ways with pharmaceutical companies and have frequent contact with them. This can influence their knowledge and doctors whose knowledge of drugs is based mainly on information from pharmaceutical industry materials may prescribe medicines in a biased way, possibly exposing their patients to sub-optimal treatments and burdening both their patients and the state budget with unnecessary costs. Lack of trust in doctors and pharmaceutical companies have other implications too: there may be a decline of faith in the efficacy of therapy and patients may be encouraged to engage in self-diagnosis and self-treatment. For these reasons it is necessary to increase transparency and strengthen the ethical guidelines

Conscientious objection and abortion: rights and duties of public sector physicians.

PubMed

Diniz, Debora

2011-10-01

The paper analyzes conscientious objection by physicians, through the concrete situation of legal abortion in Brazil. It reviews the two main ethical frameworks about conscientious objection in public health, the incompatibility thesis and the integrity thesis, to analyze the reality of legal abortion services in the referral services of the Brazilian public health care system. From these two perspectives, a third perspective is proposed - the justification thesis, to manage the right to conscientious objection among physicians in referral services. This analysis may contribute to the organization of services for legal abortion and to the education of future physicians working in emergency obstetric care.

Assessment of physician preparedness and response capacity to bioterrorism or other public health emergency events in a major metropolitan area.

PubMed

Spranger, Cathy B; Villegas, Dorian; Kazda, Michael J; Harris, Ann Marie; Mathew, Shane; Migala, Witold

2007-01-01

The role of physicians in the detection, reporting, and response to infectious disease outbreaks, anomalous biologic events, or other public health emergencies is critical to the community's safety. In an effort to assess the level of preparedness of local physicians to respond to such events, the City of Fort Worth Public Health Department, the Fort Worth/Tarrant County Health Authority, and the Tarrant County Medical Society collaborated in designing and administering a cross-sectional study in spring 2006. The results serve as a baseline of the local clinical community's preparedness, with 91% of local physicians reporting their knowledge as "fair-poor," 80% desiring more information, and 83% favoring more training opportunities. Information obtained through this assessment is used to help cultivate educational interventions that will enhance the participation, integration, and mobilization of clinicians in the event of a community emergency.

Race-based experiences of ethnic minority health professionals: Arab physicians and nurses in Israeli public healthcare organizations.

PubMed

Keshet, Yael; Popper-Giveon, Ariela

2018-05-01

Increasing workforce diversity was found to contribute to the narrowing of disparities in health. However, racism toward ethnic minority health professionals has not been adequately researched. In Israel, public healthcare organizations that serve a mixed Jewish-Arab population employ Arab minority healthcare professionals. Instances of prejudice and manifestations of racism toward them, which frequently surface in public discussion and the media, have unfortunately gained little scholarly attention. We used the intergroup contact approach and the theory of the social process of everyday racism as a theoretical framework. The objective of the research was to study race-based experiences of Israeli Arab healthcare professionals. We used a qualitative research method that allows respondents to describe their views, experiences, beliefs and behavior in the way they think about them. During 2013 and 2014 we conducted in-depth interviews with a snowball sample of 10 Arab physicians and 13 Arab nurses who work in Israeli public hospitals. The study protocol was ethically approved. Interviewees noted institutional efforts to maintain egalitarianism and equality. However, at the micro-level, interviewees, mostly nurses, reported instances that ranged from refusal to accept treatment from an Arab nurse, through verbal abuse, to the use of physical violence against them. At the meso-level, interviewees, mostly physicians, reported experiences of institutional discrimination. At the macro-level, one physician reported policy-related discrimination in the context of the immigration of Russian Jewish physicians to Israel. We recommend combining the intergroup contact approach with the social process theory of racism to examine minorities' subjective perceptions, especially in conflictual and violent contexts; conducting broad-based quantitative research in Israeli healthcare organizations, which may have important implications for the specific strategies to be used; and

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.

Physician training rotations in a large urban health department.

PubMed

Alkon, Ellen; Kim-Farley, Robert; Gunzenhauser, Jeffrey

2014-01-01

Hospitals are the normal setting for physician residency training within the United States. When a hospital cannot provide the specific training needed, a special rotation for that experience is arranged. Linkages between clinical and public health systems are vital to achieving improvements in overall health status in the United States. Nevertheless, most physicians in postgraduate residency programs receive neither training nor practical experience in the practice of public health. For many years, public health rotations have been available within the Los Angeles County Department of Public Health (and its antecedent organizations). Arrangements that existed with local medical schools for residents to rotate with Los Angeles County Department of Health hospitals were extended to include a public health rotation. A general model for the rotation ensured that each resident received education and training relevant to the clinician in practice. Some parts of the model for experience have changed over time while others have not. Also, the challenges and opportunities for both trainees and preceptors have evolved and varied over time. A logic model demonstrates the components and changes with the public health rotation. Changes included alterations in recruitment, expectations, evaluation, formal education, and concepts related to the experience. Changes in the rotation model occurred in the context of other major environmental changes such as new electronic technology, changing expectations for residents, and evolving health services and public health systems. Each impacted the public health rotation. The evaluation method developed included content tests, assessment of competencies by residents and preceptors, and satisfaction measures. Results from the evaluation showed increases in competency and a high level of satisfaction after a public health rotation. The article includes examples of challenges and benefits to a local health department in providing a public

Putting Public Health Into Practice: A Model for Assessing the Relationship Between Local Health Departments and Practicing Physicians

PubMed Central

Perlman, Sharon E.; Koppaka, Ram; Greene, Carolyn M.

2012-01-01

The New York City (NYC) Department of Health and Mental Hygiene (Health Department) surveyed practicing NYC physicians to quantify Health Department resource use. Although the Health Department successfully reaches most physicians, and information is valued in practice, knowledge of several key resources was low. Findings suggested 3 recommendations for all local health departments seeking to enhance engagement with practicing physicians: (1) capitalize on physician interest, (2) engage physicians early and often, and (3) make interaction with the health department easy. Also, older physicians may require targeted outreach. PMID:22690968

Physician's sociodemographic profile and distribution across public and private health care: an insight into physicians' dual practice in Brazil.

PubMed

Miotto, Bruno Alonso; Guilloux, Aline Gil Alves; Cassenote, Alex Jones Flores; Mainardi, Giulia Marcelino; Russo, Giuliano; Scheffer, Mário César

2018-04-23

The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country's medical workforce. Physicians' simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services. A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based  on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians' sociodemographic characteristics and their engagement with public and private services. From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68-0.89]; PR 0.47 [0.38-0.56]), less experienced (PR 0.78 [0.73-0.94]; PR 0.44 [0.36-0.53]) and predominantly female (PR 0.79 [0.71-0.88]; PR 0.68 [0.6-0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48-0.69]) and mixed sectors (PR 0.31 [0.25-0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58-2.43]), specialized (PR 1.29 [1.17-1.42]) and male (PR 1.35 [1.21-1.51]), often working less than 20 h per week (PR 2.04 [1.4-2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16-1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1

In an Age of Open Access to Research Policies: Physician and Public Health NGO Staff Research Use and Policy Awareness.

PubMed

Moorhead, Laura L; Holzmeyer, Cheryl; Maggio, Lauren A; Steinberg, Ryan M; Willinsky, John

2015-01-01

Through funding agency and publisher policies, an increasing proportion of the health sciences literature is being made open access. Such an increase in access raises questions about the awareness and potential utilization of this literature by those working in health fields. A sample of physicians (N=336) and public health non-governmental organization (NGO) staff (N=92) were provided with relatively complete access to the research literature indexed in PubMed, as well as access to the point-of-care service UpToDate, for up to one year, with their usage monitored through the tracking of web-log data. The physicians also participated in a one-month trial of relatively complete or limited access. The study found that participants' research interests were not satisfied by article abstracts alone nor, in the case of the physicians, by a clinical summary service such as UpToDate. On average, a third of the physicians viewed research a little more frequently than once a week, while two-thirds of the public health NGO staff viewed more than three articles a week. Those articles were published since the 2008 adoption of the NIH Public Access Policy, as well as prior to 2008 and during the maximum 12-month embargo period. A portion of the articles in each period was already open access, but complete access encouraged a viewing of more research articles. Those working in health fields will utilize more research in the course of their work as a result of (a) increasing open access to research, (b) improving awareness of and preparation for this access, and (c) adjusting public and open access policies to maximize the extent of potential access, through reduction in embargo periods and access to pre-policy literature.

In an Age of Open Access to Research Policies: Physician and Public Health NGO Staff Research Use and Policy Awareness

PubMed Central

Maggio, Lauren A.; Steinberg, Ryan M.; Willinsky, John

2015-01-01

Introduction Through funding agency and publisher policies, an increasing proportion of the health sciences literature is being made open access. Such an increase in access raises questions about the awareness and potential utilization of this literature by those working in health fields. Methods A sample of physicians (N=336) and public health non-governmental organization (NGO) staff (N=92) were provided with relatively complete access to the research literature indexed in PubMed, as well as access to the point-of-care service UpToDate, for up to one year, with their usage monitored through the tracking of web-log data. The physicians also participated in a one-month trial of relatively complete or limited access. Results The study found that participants' research interests were not satisfied by article abstracts alone nor, in the case of the physicians, by a clinical summary service such as UpToDate. On average, a third of the physicians viewed research a little more frequently than once a week, while two-thirds of the public health NGO staff viewed more than three articles a week. Those articles were published since the 2008 adoption of the NIH Public Access Policy, as well as prior to 2008 and during the maximum 12-month embargo period. A portion of the articles in each period was already open access, but complete access encouraged a viewing of more research articles. Conclusion Those working in health fields will utilize more research in the course of their work as a result of (a) increasing open access to research, (b) improving awareness of and preparation for this access, and (c) adjusting public and open access policies to maximize the extent of potential access, through reduction in embargo periods and access to pre-policy literature. PMID:26200794

‘Why do an MPH?’ Motivations and intentions of physicians undertaking postgraduate public health training at the University of Cape Town

PubMed Central

Zweigenthal, Virginia E.M.; Marquez, Emma; London, Leslie

2016-01-01

Background Public health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH qualifications. Objectives This study identifies their motivations and career intentions and explored MPH programme strengths and gaps in under- and post-graduate PH training. Design A cross-sectional study using an online questionnaire was completed by physicians graduating with an MPH between 2000 and 2009 and those enrolled in the programme in 2010 at the University of Cape Town. Results Nearly a quarter of MPH students were physicians. Of the 65 contactable physicians, 48% responded. They were mid-career physicians who wished to obtain research training (55%), who wished to gain broader perspectives on health (32%), and who used the MPH to advance careers (90%) as researchers, policy-makers, or managers. The MPH widened professional opportunities, with 62% changing jobs. They believed that inadequate undergraduate exposure should be remedied by applying PH approaches to clinical problems in community settings, which would increase the attractiveness of postgraduate PH training. Conclusions The MPH allows physicians to transition from pure clinical to research, policy and/or management work, preparing them to innovate changes for effective health systems, responsive to the health needs of populations. Limited local job options and incentives are important constraining factors. Advocacy for positions requiring qualifications and benchmarking exit competencies of programmes nationally may promote enrolment. PMID:27741958

Direct-to-consumer pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship.

PubMed

Robinson, Andrew R; Hohmann, Kirsten B; Rifkin, Julie I; Topp, Daniel; Gilroy, Christine M; Pickard, Jeffrey A; Anderson, Robert J

2004-02-23

Previous studies have shown that direct-to-consumer (DTC) pharmaceutical advertising can influence consumer behavior and that many physicians have negative views of these advertisements. Physician and public opinions about these advertisements and how they may affect the physician-patient relationship are not well established. Mail survey of 523 Colorado physicians and 261 national physicians and telephone survey of 500 Colorado households asking respondents to rate their agreement with statements about DTC advertising. Most physicians tended to view DTC advertisements negatively, indicating that such advertisements rarely provide enough information on cost (98.7%), alternative treatment options (94.9%), or adverse effects (54.8%). Most also believed that DTC advertisements affected interactions with patients by lengthening clinical encounters (55.9%), leading to patient requests for specific medications (80.7%), and changing patient expectations of physicians' prescribing practices (67.0%). Only 29.0% of public respondents agreed that DTC advertising is a positive trend in health care and 28.6% indicated that advertisements make them better informed about medical problems; fewer indicated that advertisements motivated them to seek care (10.5%) or led them to request specific medications from their physicians (13.3%). Most physicians have negative views of DTC pharmaceutical advertising and see several potential effects of these advertisements on the physician-patient relationship. Many public respondents have similarly negative views, and only a few agree that they change their expectations of or interactions with physicians. While these advertisements may be influencing only a few consumers, it seems that the impact on physicians and their interactions with patients may be significant.

Substandard and falsified medical products are a global public health threat. A pilot survey of awareness among physicians in Sweden.

PubMed

Funestrand, H; Liu, R; Lundin, S; Troein, M

2018-06-01

Substandard and falsified medical products are a public health threat, primarily associated with low- and middle-income countries. Today, the phenomenon also exists in high-income countries. Increased Internet access has opened a global market. Self-diagnosis and self-prescription have boosted the market for unregulated websites with access to falsified medicines. To describe the state of knowledge and experience on SF medical products among emergency physicians (EPs) and general practitioners (GPs) in Sweden. An online survey with anonymous answers from 100 EPs and 100 GPs. Physicians were recruited from TNS SIFO's medical database. The term in the survey was 'illegal and falsified medicines' which was common in Sweden at that time. It corresponds well with the term 'substandard and falsified medical products' that the WHO launched shortly after our data collection. We report our results with this term. In Sweden, 78.5% of the physicians had heard the term 'illegal and falsified medicines' and 36.5% had met patients they suspected had taken it. Physicians lacked awareness of the use of the reporting system and wanted more knowledge about how to deal with patients who have possibly used falsified medicines. To meet the public health threat of SF medical products, physicians need more knowledge.

How do physicians discuss e-health with patients? the relationship of physicians' e-health beliefs to physician mediation styles.

PubMed

Fujioka, Yuki; Stewart, Erin

2013-01-01

A survey of 104 physicians examined the role of physicians' evaluation of the quality of e-health and beliefs about the influence of patients' use of e-health in how physicians discuss e-health materials with patients. Physicians' lower (poor) evaluation of the quality of e-health content predicted more negative mediation (counter-reinforcement of e-health content). Perceived benefits of patients' e-health use predicted more positive (endorsement of e-health content). Physician's perceived concerns (negative influence) regarding patients' e-health use were not a significant predictor for their mediation styles. Results, challenging the utility of restrictive mediation, suggested reconceptualizing it as redirective mediation in a medical interaction. The study suggested that patient-generated e-health-related inquiries invite physician mediation in medical consultations. Findings and implications are discussed in light of the literature of physician-patient interaction, incorporating the theory of parental mediation of media into a medical context.

Physician health and wellness.

PubMed

Taub, Sara; Morin, Karine; Goldrich, Michael S; Ray, Priscilla; Benjamin, Regina

2006-03-01

Impaired physician health can have a direct impact on patient health care and safety. In the past, problems of alcoholism and substance abuse among physicians have received more attention than other conditions-usually in the form of discipline. While patient safety is paramount, the medical profession may be more successful in achieving the required standards by fostering a culture committed to health and wellness as well as supporting impaired physicians. To develop ethical guidelines regarding physician health and wellness. The American Medical Association's (AMA's) Council on Ethical and Judicial Affairs developed recommendations based on the AMA's Code of Medical Ethics, an analysis of relevant Medline-indexed articles, and comments from experts. The report's recommendations were adopted as policy of the Association in December 2003. Individually, physicians can promote their personal health and wellness through healthy living habits, including having a personal physician. The medical profession can foster health and wellness if its members are taught to identify colleagues in need of assistance and initiate appropriate methods of intervention, including referrals to physician health programs. Physicians whose health or wellness is compromised should seek appropriate help and engage in honest self-assessment of their ability to practice. The medical profession should provide an environment that helps to maintain and restore health and wellness. Physicians need to ensure that impaired colleagues promptly modify or cease practice until they can resume professional patient care. In addition, physicians may be required to report impaired colleagues who continue to practice despite reasonable offers of assistance.

From socialist principles to motorcycle maintenance: the origin and development of the salaried physician model in the Israeli Public Health Services, 1918 to 1998.

PubMed Central

Shvarts, S; de Leeuw, D L; Granit, S; Benbassat, J

1999-01-01

For more than 70 years, physicians in the Israeli health care system have been employed on a fixed salary rather than on a fee-for-service basis. The present report is a brief review of the origin and development of this unique salaried physician model and its effect on the terms of physicians' employment. Archival documents were reviewed. The salaried physician model was introduced to ensure egalitarian health care for patients rather than equal payment for physicians. It was accepted by physicians because it guaranteed their employment and income. However, over the years, the salaried physician model has evolved into a complex wage scale, with multiple fringe benefits that bypass formal agreements in order to reward individual physicians. In addition, the salaried physician model has encouraged illegal private practice, which is viewed today as one of the major problems of the Israeli Public Health Services. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7 PMID:9949759

Family physicians' interests in special features of electronic publication

PubMed Central

Torre, Dario M.; Wright, Scott M.; Wilson, Renee F.; Diener-West, Marie; Bass, Eric B.

2003-01-01

Objective: Because many of the medical journals read by family physicians now have an electronic version, the authors conducted a survey to determine the interest of family physicians in specific features of electronic journal publications. Setting and Participants: We surveyed 175 family physicians randomly selected from the American Academy of Family Physicians. Results: The response rate was 63%. About half of family physicians reported good to excellent computer proficiency, and about one quarter used online journals sometimes or often. Many respondents reported high interest in having links to: an electronic medical text (48% for original articles, 56% for review articles), articles' list of references (52% for original articles, 56% for review articles), and health-related Websites (48% for original and review articles). Conclusion: Primary care–oriented journals should consider the interests of family physicians when developing and offering electronic features for their readers. PMID:12883561

Global health interdependence and the international physicians' movement.

PubMed

Gellert, G A

1990-08-01

International Physicians for the Prevention of Nuclear War has had an impressive public impact in the 1980s, helping to shatter the myths of surviving and medically responding to a nuclear attack. The 1990s present a new challenge for the medical community in a different social and international context characterized by increasing global interdependence. Another view of physician activism is presented to complement advocacy for nuclear disarmament in the promotion of peace. A framework for analysis is provided by "fateful visions"--accepted policy views of prospective superpower relations--drawn from practitioners of foreign policy, international relations, and security affairs. A perceptual gap may exist between physicians who wish to address underlying ethical and public health concerns on security issues and policy practitioners who are accustomed to discussion within existing policy frames of reference that can be pragmatically used. A strategy is proposed for physicians to use their specialized training and skills to evaluate trends in global health interdependence. The international physicians' movement may contribute substantively to the formulation of policy by expanding and interpreting an increasingly complex database on interdependence, and by creating a dialogue with policy formulators based on mutual recognition of the value and legitimacy of each professions' expertise and complementary contributions to international security policy.

Electronic health records: postadoption physician satisfaction and continued use.

PubMed

Wright, Edward; Marvel, Jon

2012-01-01

One goal of public-policy makers in general and health care managers in particular is the adoption and efficient utilization of electronic health record (EHR) systems throughout the health care industry. Consequently, this investigation focused on the effects of known antecedents of technology adoption on physician satisfaction with EHR technology and the continued use of such systems. The American Academy of Family Physicians provided support in the survey of 453 physicians regarding their satisfaction with their EHR use experience. A conceptual model merging technology adoption and computer user satisfaction models was tested using structural equation modeling. Results indicate that effort expectancy (ease of use) has the most substantive effect on physician satisfaction and the continued use of EHR systems. As such, health care managers should be especially sensitive to the user and computer interface of prospective EHR systems to avoid costly and disruptive system selection mistakes.

Who are more responsive? Mixed-methods comparison of public and private sector physicians in rural Bangladesh.

PubMed

Joarder, Taufique; George, Asha; Sarker, Malabika; Ahmed, Saifuddin; Peters, David H

2017-11-01

Responsiveness of physicians (ROPs) reflects the social actions by physicians to meet the legitimate expectations of health care users. Responsiveness is important since it improves understanding and care seeking by users, as well as fostering trust in health systems rather than replicating discrimination and entrenching inequality. Given widespread public and private sector health care provision in Bangladesh, we undertook a mixed-methods study comparing responsiveness of public and private physicians in rural Bangladesh. The study included in-depth interviews with physicians (n = 12, seven public, five private) and patients (n = 7, three male, four female); focus group discussions with users (four sessions, two male and two female); and observations in consultation rooms of public and private sector physicians (1 week in each setting). This was followed by structured observation of patient consultations with 195 public and 198 private physicians using the ROPs Scale, consisting of five domains (Friendliness; Respecting; Informing and guiding; Gaining trust; and Financial sensitivity). Qualitative data were analysed by framework analysis and quantitative data were analyzed using two-sample t-test, multiple linear regression, multivariate analysis of variance, and descriptive discriminant analyses. The mean responsiveness score of public sector physicians was statistically different from private sector physicians: -0.29 vs 0.29, i.e. a difference of - 0.58 (P-value < 0.01; 95% CI - 0.77, -0.39) on a normalized scale. Despite relatively higher level of responsiveness of private sector, according to qualitative findings, neither of the sectors performed optimally. Private physicians scored higher in Friendliness, Respecting and Informing and guiding; while public sector physicians scored higher in other domains. 'Respecting' domain was found as the most important. Unlike findings from other studies in Bangladesh, instead of seeing one sector as better than

Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program.

PubMed

Merlo, Lisa J; Singhakant, Supachoke; Cummings, Simone M; Cottler, Linda B

2013-01-01

Substance-related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of this study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring because of substance-related impairment, to develop better mechanisms for prevention and intervention. A total of 55 physicians (94.5% male) who were being monitored by their State physician health program because of substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from 9 separate focus groups, lasting 60 to 90 minutes each. Qualitative analyses were conducted to examine themes. All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented the following 5 primary reasons for prescription drug misuse: (1) to manage physical pain, (2) to manage emotional/psychiatric distress, (3) to manage stressful situations, (4) to serve recreational purposes, and (5) to avoid withdrawal symptoms. Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, although recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education requirements throughout the physicians' careers.

Mental health concerns among Canadian physicians: results from the 2007-2008 Canadian Physician Health Study.

PubMed

Compton, Michael T; Frank, Erica

2011-01-01

In light of prior reports on the prevalence of stress, depression, and other mental health problems among physicians in training and practice, we examined the mental health concerns of Canadian physicians using data from the 2007-2008 Canadian Physician Health Study. Among 3213 respondents, 5 variables (depressive symptoms during the past year, anhedonia in the past year, mental health concerns making it difficult to handle one's workload in the past month, problems with work-life balance, and poor awareness of resources for mental health problems) were examined in relation to sex, specialty, practice type (solo practice vs group or other practice settings), and practice setting (inner city, urban/suburban, or rural/small town/remote). Nearly one quarter of physicians reported a 2-week period of depressed mood, and depression was more common among female physicians and general practitioners/family physicians. Anhedonia was reported by one fifth; anesthesiologists were most likely to report anhedonia, followed by general practitioners/family physicians. More than one quarter reported mental health concerns making it difficult to handle their workload, which was more common among female physicians and general practitioners/family physicians and psychiatrists. Nearly one quarter reported poor work-life balance. Lack of familiarity with mental health resources was problematic, which was more prominent among female physicians and specialists outside of general practice/family medicine or psychiatry. Mental health concerns are relatively common among Canadian physicians. Training programs and programmatic/policy enhancements should redouble efforts to address depression and other mental health concerns among physicians for the benefit of the workforce and patients served by Canadian physicians. Copyright © 2011 Elsevier Inc. All rights reserved.

42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Physician fee schedule payment for services of teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN...

The Impact of Health Information on the Internet on Health Care and the Physician-Patient Relationship: National U.S. Survey among 1.050 U.S. Physicians

PubMed Central

Lo, Bernard; Pollack, Lance; Donelan, Karen; Catania, Joe; Lee, Ken; Zapert, Kinga; Turner, Rachel

2003-01-01

Background Public use of the Internet for health information is increasing but its effect on health care is unclear. We studied physicians' experience of patients looking for health information on the Internet and their perceptions of the impact of this information on the physician-patient relationship, health care, and workload. Methods Cross-sectional survey of a nationally-representative sample of United States physicians (1050 respondents; response rate 53%). Results Eighty-five percent of respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician's feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship (OR = 14.9; 95% CI, 5.5-40.5), in the quality of health care (OR = 3.4; 95% CI, 1.1-10.9), or health outcomes (OR = 5.6; 95% CI, 1.7-18.7). Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate (OR = 2.5; 95% CI, 1.5-4.4), or the physician felt challenged (OR = 3.6; 95% CI, 1.8-7.2). Conclusions The quality of information on the Internet is paramount: accurate relevant information is beneficial, while inaccurate information is harmful. Physicians appear to acquiesce to clinically-inappropriate requests generated by information from the Internet, either for fear of damaging the physician-patient relationship or because of the negative effect on time efficiency of not doing so. A minority of physicians feels challenged by patients bringing health information to the visit; reasons for this require further research. PMID:14517108

Are public health professionals prepared for public health genomics? A cross-sectional survey in Italy

PubMed Central

2014-01-01

Background Public health genomics is an emerging multidisciplinary approach, which aims to integrate genome-based knowledge in a responsible and effective way into public health. Despite several surveys performed to evaluate knowledge, attitudes and professional behaviors of physicians towards predictive genetic testing, similar surveys have not been carried out for public health practitioners. This study is the first to assess knowledge, attitudes and training needs of public health professionals in the field of predictive genetic testing for chronic diseases. Methods A self-administered questionnaire was used to carry out a cross-sectional survey of a random sample of Italian public health professionals. Results A response rate of 67.4% (797 questionnaires) was achieved. Italian public health professionals have the necessary attitudinal background to contribute to the proper use of predictive genetic testing for chronic diseases, but they need additional training to increase their methodological knowledge. Knowledge significantly increases with exposure to predictive genetic testing during postgraduate training (odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.05–2.88), time dedicated to continuing medical education (OR = 1.53, 95% CI = 1.14–2.04) and level of English language knowledge (OR = 1.36, 95% CI = 1.07–1.72). Adequate knowledge is the strongest predictor of positive attitudes from a public health perspective (OR = 3.98, 95% CI = 2.44–6.50). Physicians show a lower level of knowledge and more public health attitudes than other public health professionals do. About 80% of public health professionals considered their knowledge inadequate and 86.0% believed that it should be improved through specific postgraduate training courses. Conclusions Specific and targeted training initiatives are needed to develop a skilled public health workforce competent in identifying genomic technology that is ready for use in

Public health preparedness of health providers: meeting the needs of diverse, rural communities.

PubMed

Hsu, Chiehwen Ed; Mas, Francisco Soto; Jacobson, Holly E; Harris, Ann Marie; Hunt, Victoria I; Nkhoma, Ella T

2006-11-01

Meeting the needs of public health emergency and response presents a unique challenge for health practitioners with primary responsibilities for rural communities that are often very diverse. The present study assessed the language capabilities, confidence and training needs of Texas rural physicians in responding to public health emergencies. In the first half of year 2004, a cross-sectional, semistructured survey questionnaire was administered in northern, rural Texas. The study population consisted of 841 practicing or retired physicians in the targeted area. One-hundred-sixty-six physicians (30%) responded to the survey. The responses were geographically referenced in maps. Respondents reported seeing patients with diverse cultural backgrounds. They communicated in 16 different languages other than English in clinical practice or at home, with 40% speaking Spanish at work. Most were not confident in the diagnosis or treatment of public health emergency cases. Geographic information systems were found useful in identifying those jurisdictions with expressed training and cultural needs. Additional efforts should be extended to involve African-American/Hispanic physicians in preparedness plans for providing culturally and linguistically appropriate care in emergencies.

Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups

PubMed Central

Smith, Maureen A.; Wright, Alexandra; Queram, Christopher; Lamb, Geoffrey C.

2012-01-01

Public reporting on the quality of ambulatory health care is growing, but knowledge of how physician groups respond to such reporting has not kept pace. We examined responses to public reporting on the quality of diabetes care in 409 primary care clinics within seventeen large, multispecialty physician groups. We determined that a focus on publicly reported metrics, along with participation in large or externally sponsored projects, increased a clinic’s implementation of diabetes improvement interventions. Clinics were also more likely to implement interventions in more recent years. Public reporting helped drive both early implementation of a single intervention and ongoing implementation of multiple simultaneous interventions. To fully engage physician groups, accountability metrics should be structured to capture incremental improvements in quality, thereby rewarding both early and ongoing improvement activities. PMID:22392668

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

Marijuana Legalization: Impact on Physicians and Public Health.

PubMed

Wilkinson, Samuel T; Yarnell, Stephanie; Radhakrishnan, Rajiv; Ball, Samuel A; D'Souza, Deepak Cyril

2016-01-01

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health.

Public Health and Social Ideas in Modern Brazil

PubMed Central

Lima, Nísia Trindade

2007-01-01

Public health in Brazil achieved remarkable development at the turn of the 20th century thanks in part to physicians and social thinkers who made it central to their proposals for “modernizing” the country. Public health was more than a set of medical and technical measures; it was fundamental to the project of nation building. I trace the interplay between public health and social ideas in the late 19th and early 20th centuries. Physicians and social thinkers challenged the traditional belief that Brazil’s sociocultural and ethnic diversity was an obstacle to modernization, and they promoted public health as the best prescription for national unity. Public health ideas in developing countries such as Brazil may have a greater impact when they are intertwined with social thought and with the processes of nation building and construction of a modern society. PMID:17538074

Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators.

PubMed

Heponiemi, Tarja; Kuusio, Hannamaria; Sinervo, Timo; Elovainio, Marko

2011-08-01

The present study examined whether there are differences in job-related attitudes and well-being among physicians working in private sector and public sector. In addition, we examined whether psychosocial factors (organizational justice and job control) could mediate these possible differences in different sectors. Cross-sectional survey data from the Finnish Health Professional Study was used. A random sample of Finnish physicians included 1522 women and 1047 men aged 25-65 years. Outcome variables were job satisfaction, organizational commitment, psychological distress, work ability and sleeping problems. Job control and organizational justice were measured using established questionnaires. Series of regression analyses were performed and the mediational effects were tested following the procedures outlined by Baron and Kenny. Physicians working in private sector had higher levels of job satisfaction and organizational commitment and lower levels of psychological distress and sleeping problems when compared with physicians working in public sector. Private physicians also had higher levels of organizational justice, which acted as a mediator behind more positive attitudes and better well-being in private sector. Private physicians had higher levels of job control but it did not act as a mediator. Private physicians feel better than public physicians and this is partly due to higher organizational justice in private sector. Public health care organizations should invest effort to increase the fairness in their organizations and management and pay more attention in improving the well-being of their employees, which could possibly increase the attractiveness of public sector as a career option.

Is the public healthcare sector a more strenuous working environment than the private sector for a physician?

PubMed

Heponiemi, Tarja; Kouvonen, Anne; Sinervo, Timo; Elovainio, Marko

2013-02-01

The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

Health practices of Canadian physicians.

PubMed

Frank, Erica; Segura, Carolina

2009-08-01

To study the health and health practices of Canadian physicians, which can often influence patient health. Mailed survey. Canada. A random sample of 8100 Canadian physicians; 7934 were found to be eligible and 3213 responded (40.5% response rate). Factors that influence health, such as consumption of fruits and vegetables, amount of exercise and alcohol consumption, smoking status, body mass idex, and participation in preventive health screening measures, as well as work-life balance and emotional stability. Canadian physicians are healthy. More than 90% reported being in good to excellent health, and only 5% reported that poor physical or mental health made it difficult to handle their workload more than half the time in the previous month (although a quarter had reduced work activity because of long-term health conditions). Eight percent were obese, 3% currently smoked cigarettes, and 1% typically consumed 5 drinks or more on days when they drank alcohol. Physicians averaged 4.7 hours of exercise per week and ate fruits and vegetables 4.8 times a day. Their personal screening practices were largely compliant with Canadian Task Force on Preventive Health Care recommendations. They averaged 38 hours per week on patient care and 11 hours on other professional activities. Fifty-seven percent agreed that they had a good work-life balance, and 11% disagreed with the statement "If I can, I work when I am ill." Compared with self-reports from the general Canadian population, Canadian physicians, like American physicians, seem to be healthy and to have generally healthy behaviour. There is, however, room for improvement in physicians' personal and professional well-being, and improving their personal health practices could be an efficient and beneficent way to improve the health of all Canadians.

Marijuana Legalization: Impact on Physicians and Public Health

PubMed Central

Wilkinson, Samuel T.; Yarnell, Stephanie; Radhakrishnan, Rajiv; Ball, Samuel A.; D'Souza, Deepak Cyril

2016-01-01

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health. PMID:26515984

42 CFR 483.40 - Physician services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... may alternate between personal visits by the physician and visits by a physician assistant, nurse... 42 Public Health 5 2014-10-01 2014-10-01 false Physician services. 483.40 Section 483.40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...

42 CFR 483.40 - Physician services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... may alternate between personal visits by the physician and visits by a physician assistant, nurse... 42 Public Health 5 2013-10-01 2013-10-01 false Physician services. 483.40 Section 483.40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...

42 CFR 483.40 - Physician services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... may alternate between personal visits by the physician and visits by a physician assistant, nurse... 42 Public Health 5 2012-10-01 2012-10-01 false Physician services. 483.40 Section 483.40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...

42 CFR 483.40 - Physician services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... may alternate between personal visits by the physician and visits by a physician assistant, nurse... 42 Public Health 5 2011-10-01 2011-10-01 false Physician services. 483.40 Section 483.40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...

Public health medicine: the constant dilemma.

PubMed

Eskin, Frada

2002-03-01

There is a well-known quotation by the nineteenth-century sociologist Virchow (quoted in Ref. 1) that aptly captures the dilemma that has confronted public health medicine since the specialty was created as a discrete entity in 1848. Virchow said: 'Medicine is politics and social medicine is politics writ large!' What does this mean in relation to effective public health medicine practice and how is it likely to affect its future? There is increasingly limited freedom of expression within the current context of political correctness, central control and a rapidly burgeoning litigious climate. The purpose of this paper is to explore these issues and to propose a means of maintaining public health medicine integrity within a working environment where action is becoming rapidly constrained by political rigidity. An additional factor to be included in the dialogue is the current context within which public health physicians work. Because the majority of public health doctors are employed within the National Health Service (NHS), they are finding themselves being expected to take on tasks and responsibilities marginal to their essential purpose and function. For example, public health physicians spend a great deal of time involved in detailed deliberations about health service provision. Although there is a great deal of evidence to show that good quality health care provision positively affects the health of the individual, there is no evidence to show that this activity has any effect on the population's health status. The essence of public health medicine practice is the prevention of ill-health and the promotion of the health of the population and, consequently, attention needs to be focused on the root causes of disease. However, as these are outside the aegis of the NHS, public health medicine involvement in such issues as education, nutrition, housing, transport and poverty is regarded as marginal to the NHS corporate agenda.

Sex Differences in Physician Salary in US Public Medical Schools.

PubMed

Jena, Anupam B; Olenski, Andrew R; Blumenthal, Daniel M

2016-09-01

Limited evidence exists on salary differences between male and female academic physicians, largely owing to difficulty obtaining data on salary and factors influencing salary. Existing studies have been limited by reliance on survey-based approaches to measuring sex differences in earnings, lack of contemporary data, small sample sizes, or limited geographic representation. To analyze sex differences in earnings among US academic physicians. Freedom of Information laws mandate release of salary information of public university employees in several states. In 12 states with salary information published online, salary data were extracted on 10 241 academic physicians at 24 public medical schools. These data were linked to a unique physician database with detailed information on sex, age, years of experience, faculty rank, specialty, scientific authorship, National Institutes of Health funding, clinical trial participation, and Medicare reimbursements (proxy for clinical revenue). Sex differences in salary were estimated after adjusting for these factors. Physician sex. Annual salary. Among 10 241 physicians, female physicians (n = 3549) had lower mean (SD) unadjusted salaries than male physicians ($206 641 [$88 238] vs $257 957 [$137 202]; absolute difference, $51 315 [95% CI, $46 330-$56 301]). Sex differences persisted after multivariable adjustment ($227 783 [95% CI, $224 117-$231 448] vs $247 661 [95% CI, $245 065-$250 258] with an absolute difference of $19 878 [95% CI, $15 261-$24 495]). Sex differences in salary varied across specialties, institutions, and faculty ranks. For example, adjusted salaries of female full professors ($250 971 [95% CI, $242 307-$259 635]) were comparable to those of male associate professors ($247 212 [95% CI, $241 850-$252 575]). Among specialties, adjusted salaries were highest in orthopedic surgery ($358 093 [95% CI, $344 354-$371 831]), surgical subspecialties ($318 760 [95

Toward accommodating physicians' conscientious objections: an argument for public disclosure.

PubMed

Harter, Thomas D

2015-03-01

This paper aims to demonstrate how public disclosure can be used to balance physicians' conscientious objections with their professional obligations to patients--specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. The argument for publicly disclosing physicians' conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians' conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians' conscientious objections are briefly addressed--potential harassment of physicians, workplace discrimination, and mischaracterising physicians' professional aptitude--concluding that each of these concerns requires further deliberation in the realm of business ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Physicians' working conditions, health and working capacity].

PubMed

Elovainio, Marko; Virtanen, Marianna; Oksanen, Tuula

2017-01-01

Changes in the working environment will also influence the work of physicians. The greatest of these changes on the Finnish scale, the SOTE reform (the reform in social welfare and public health services), still lies ahead. Labor shortage, on-call duties and patient record systems providing little support to work add to the burden. In surveys related to psychosocial working conditions, physicians' greatest work load factors have been rush, forced working pace and poor communication despite the fact that, on average, they consider their working conditions to be good, frequently better than those of other professional groups, and are committed to carry on with their work until retirement age. Although psychic symptoms and sleep disturbances are common among physicians, there are fewer disability pensions due to e.g. depression among physicians than in other professional groups. Among the municipal professions, physicians have nearly the lowest rate of job absenteeism due to sickness. Challenges brought about by the changes in physician's work can be met with fair management, development of the social capital of the work community, organization of tasks and flexibility of working hours.

Are specialist physicians missing out on the e-Health boat?

PubMed

Osborn, M; Day, R; Westbrook, J

2009-10-01

Nationally health systems are making increasing investments in the use of clinical information systems. Little is known about current computer use by specialist physicians, particularly outside the hospital setting. To identify the extent and reasons physician Fellows of the Royal Australasian College of Physicians (RACP) use computers in their work. A self-administered survey was emailed from the RACP to all practising physicians in 2007 that were living in Australia and New Zealand who had consented to email contact with the College. The survey was sent to a total of 7445 eligible physicians, 2328 physicians responded (31.3% response rate), but only 1266 responses (21.0%) were able to be analysed. Most 97.5% had access to computers at work and 96.5% used home computers for work purposes. Physicians in public hospitals (72.6%) were more likely to use computers for work (65.6%) than those in private hospitals (12.6%) or consulting rooms (27.3%). Overall physicians working in public hospitals used a wider range of applications with 70.5% using their computers for searching the internet, 53.7% for receiving results and 52.7% used their computers to engage in specific educational activities. Physicians working from their consulting rooms (33.6%) were more likely to use electronic prescribing (11%) compared with physicians working in public hospitals (5.7%). Fellows have not incorporated computers into their consulting rooms over which they have control. This is in contrast to general practitioners who have embraced computers after the provision of various incentives. The rate of use of computers by physicians for electronic prescribing in consulting rooms (11%) is very low in comparison with general practitioners (98%). One reason may be that physicians work in multiple locations whereas general practitioners are more likely to work from one location.

The public health impact of training physicians to become obstetricians and gynecologists in Ghana.

PubMed

Anderson, Frank W J; Obed, Samuel A; Boothman, Erika L; Opare-Ado, Henry

2014-02-01

We assessed the public health effect of creating and sustaining obstetrics and gynecology postgraduate training in Ghana, established in 1989 to reverse low repatriation of physicians trained abroad. All 85 certified graduates of 2 Ghanaian university-based postgraduate training programs from program initiation in 1989 through June 2010 were identified and eligible for this study. Of these, 7 were unable to be contacted, inaccessible, declined participation, or deceased. Of the graduates, 83 provide clinical services in Ghana and work in 33 sites in 8 of 10 regions; 15% were the first obstetrician and gynecologist at their facility, 25% hold clinical leadership positions, 50% practice in teaching hospitals, and 14% serve as academic faculty. Creating capacity for university-based postgraduate training in obstetrics and gynecology is effective and sustainable for a comprehensive global approach to reduce maternal and neonatal morbidity and mortality. Policies to support training and research capacity in obstetrics and gynecology are an integral part of a long-term national plan for maternal health.

The physician's role in suicide prevention: lessons learned from a public awareness campaign.

PubMed

Boeke, Melissa; Griffin, Tom; Reidenberg, Daniel J

2011-01-01

The suicide rate in Minnesota has increased every year since 2000, making suicide a serious public health problem. In the spring and summer of 2009, the nonprofit organization Suicide Awareness Voices of Education (SAVE) launched a public awareness campaign targeting four populations at high risk of suicidal behavior and suicide: adult men, seniors, teens, and American Indians. The goals of the campaign were to increase awareness about suicide in general and to let people know how they could help someone who may be at risk. In their evaluation of the campaign, researchers found a need to provide physicians and other health care professionals with appropriate information about suicide and resources that are available for those who may need help.They also learned the importance of engaging physicians in planning future campaigns.

Factors associated with job satisfaction among public-sector physicians in Belo Horizonte, Brazil.

PubMed

Ribeiro, Rafael Brito Nery; Assunção, Ada Avila; de Araújo, Tânia Maria

2014-01-01

Evidence indicates an association between job satisfaction and illness among physicians. There are also negative consequences of physician dissatisfaction on the quality of medical services. With this in view, a cross-sectional study of a stratified random sample of physicians (n = 266) was conducted in the municipal public health care system in Belo Horizonte, Brazil. Participants answered a questionnaire about job satisfaction, sociodemographic and lifestyle characteristics, work and employment conditions, and health status. Of the 232 respondents, 150 (64.94%) declared themselves satisfied with the work, with no significant difference between male and female physicians (66.4% vs. 64.2%; p = 0.74). The number of physicians satisfied with their work was significantly higher among those who experienced a high level of social support at work (p < 0.01) and was significantly lower among those working under high-strain conditions (p = 0.01) and those who screened positive for the presence of common mental disorders (p < 0.01). These findings suggest that policies to promote social support and mental health in the workplace, as well as the implementation of strategies to increase physicians' control over their work activities, can have a positive effect on the job satisfaction of these professionals.

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance

PubMed Central

Lamb, Geoffrey C.; Smith, Maureen; Weeks, William B.; Queram, Christopher

2014-01-01

Public reporting of performance on quality measures is increasingly common but little is known about the impact, especially among physician groups. The Wisconsin Collaborative for Healthcare Quality (Collaborative) is a voluntary consortium of physician groups which has publicly reported quality measures since 2004, providing an opportunity to study the effect of this effort on participating groups. Analyses included member performance on 14 ambulatory measures from 2004–2009, a survey regarding reporting and its relationship to improvement efforts, and use of Medicare billing data to independently compare Collaborative members to the rest of Wisconsin, neighboring states and the rest of the United States. Faced with limited resources, groups prioritized their efforts based on the nature of the measure and their performance compared to others. The outcomes demonstrated that public reporting was associated with improvement in health quality and that large physician group practices will engage in improvement efforts in response. PMID:23459733

Back to school: using physicians to teach middle school health.

PubMed

Friedland, Allen; Bianchetta, Tony; Elliott, Daniel

2011-09-01

To assess the ability of a lecture presentation by physicians to increase short-term knowledge about healthy lifestyles and behaviors among seventh grade students in the state of Delaware. The School Health Committee of the Medical Society of Delaware sponsored an educational project aimed at seventh grade students in the form of a slide presentation covering issues in physical health, mental health and safety, and social health. Attending and resident physicians from multiple specialties presented this standard 30-minute lecture to the students in six Delaware public middle schools. This was followed by a question and answer period. We administered a questionnaire immediately before and after the talk to assess the acquisition of short-term knowledge. We compared the results using the ranksum test for paired, non-parametric data. Nine hundred fifty eight seventh grade students from six schools participated in the presentation. Eight hundred eighty two students (92 percent) completed the pre and post test. Overall for all students, the average number of questions answered correctly increased from 2.5 to 3.1 (p < 0.001) out of five. Those students with improved scores (50 percent of students) improved from 2.0 to 3.7 correct answers (p < 0.001). Students had significant improvements (p < 0.001) in three questions related to healthy lifestyle, tanning and depression. There was no significant improvement with questions related to drug abuse (p = 0.6445) and internet safety (p = 0.3353). Lecture presentations by local physicians to Delaware public school seventh grade students increased short-term knowledge on various health topics. Future studies should include control groups (for the content and mode of presentation), assessment of long-term knowledge, and evaluation of attitudes of student participants. WHAT'S NEW: This pilot project demonstrated the feasibility of a physician-led initiative to teach health topics to seventh grade students.

Canadian physicians' responses to cross border health care.

PubMed

Runnels, Vivien; Labonté, Ronald; Packer, Corinne; Chaudhry, Sabrina; Adams, Owen; Blackmer, Jeff

2014-04-03

The idea for this survey emanated from desk research and two meetings for researchers that discussed medical tourism and out-of-country health care, which were convened by some of the authors of this article (VR, CP and RL). A Cross Border Health Care Survey was drafted by a number of the authors and administered to Canadian physicians via the Canadian Medical Association's e-panel. The purpose of the survey was to gain an understanding of physicians' experiences with and views of their patients acquiring health care out of country, either as medical tourists (paying out-of-pocket for their care) or out-of-country care patients funded by provincial/territorial public health insurance plans. Quantitative and qualitative results of the survey were analyzed. 631 physicians responded to the survey. Diagnostic procedures were the top-ranked procedure for patients either as out-of-country care recipients or medical tourists. Respondents reported that the main reason why patients sought care abroad was because waiting times in Canada were too long. Some respondents were frustrated with a lack of information about out-of-country procedures upon their patients' return to Canada. The majority of physician respondents agreed that it was their responsibility to provide follow-up care to medical travellers on return to Canada, although a substantial minority disagreed that they had such a responsibility. Cross-border health care, whether government-sanctioned (out-of-country-care) or patient-initiated (medical tourism), is increasing in Canada. Such flows are thought likely to increase with aging populations. Government-sanctioned outbound flows are less problematic than patient-initiated flows but are constrained by low approval rates, which may increase patient initiation. Lack of information and post-return complications pose the greatest concern to Canadian physicians. Further research on both types of flows (government-sanctioned and patient-initiated), and how they affect

Aligning incentives in health care: physician practice and health system partnership.

PubMed

Levin, L Scott; Gustave, Lori

2013-06-01

The key to successfully aligning hospitals and physicians is financial integration and joint incentives for academic, quality, and clinical productivity. Many physician practices and health systems are moving toward closer integration, but mainly through consolidation and employment strategies. We describe a fully integrated physician and hospital relationship including an overview of an aligned funds flow process that affords the department support for clinical services and teaching, research, and administrative activity. We also describe a physician compensation model that provides incentive not only for increased clinical performance, but also quality and academic objectives. The content of this article was acquired through our own experience in managing the Department of Orthopaedic Surgery at the University of Pennsylvania Health System including the health system's funds flow process. Based on input from both health system leaders and the faculty, the department's compensation plan was totally redesigned to create a line-of-sight plan that credits clinical performance and academic productivity. Our model is multifactorial and provides sustainable support for the department and a compensation plan that is competitive within the local market and nationally. The health system's funds flow process has enhanced alignment of the faculty and hospitals by providing compensation for nonclinical time and assists the department's growth strategies by providing funding for new faculty and gain-sharing of improved hospital margin. The implementation of the compensation plan increased productivity by 8% in its first year with no additional resources. Academic productivity in that same year was arguably at or above any other year in the department's history in terms of accepted publications, national presentations, and research grants awarded. A model of complete integration between an academic department and a health system is achievable through a systematic process of

Physicians' fees and public medical care programs.

PubMed Central

Lee, R H; Hadley, J

1981-01-01

In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

42 CFR 410.20 - Physicians' services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Physicians' services. 410.20 Section 410.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.20 Physicians' services...

[History of occupational health physician and industrial safety and health law].

PubMed

Horie, Seichi

2013-10-01

In Japan, an employer of a workplace with 50 or more employees is legally required to assign an occupational health physician. The assignment rate in 2010 was reported as 87.0%. This policy started with the provision of "factory physician"in the Factory Law in 1938, then the Labour Standard Law stipulated "physician hygienist" in 1947, and finally the Industrial Safety and Health Law defined "occupational health physician" in 1972. In 1996, a revision of the law then required those physicians to complete training courses in occupational medicine, as designated by an ordinance. Historically, an on-site physician was expected to cure injuries and to prevent communicable diseases of factory workers. The means of occupational hygienic management by working environment measurements, etc., and of health management by health examinations, etc., were developed. Localized exhaust ventilation and personal protection equipment became widely utilized. Qualification systems for non-medical experts in occupational hygiene were structured, and relationships between employers and occupational health physicians were stipulated in the legislative documents. Currently, the Japan Medical Association and the University of Occupational and Environmental Health, Japan educate and train occupational health physicians, and the Japan Society for Occupational Health maintains a specialized board certification system for these physicians. In the future, additional efforts should be made to strengthen the expertise of occupational health physicians, to define and recognize the roles of non-medical experts in occupational hygiene, to incorporate occupational health services in small enterprises, to promote occupational health risk assessment in the workplace, and to reorganize the current legislation, amended repeatedly over the decades.

[Physicians and occupational health: a qualitative study in south-eastern France].

PubMed

Saliba, M-L; Iarmarcovai, G; Souville, M; Viau, A; Arnaud, S; Verger, P

2007-10-01

Occupational health is a major public health problem in France. However, the level of investment of general practitioners and specialist physicians in this field is not well documented. We aimed at studying elements moving closer or differentiating groups of professionals (notably physicians) in the field of occupational health in terms of conceptions of their roles (prevention and care) and of practices (in particular detection and notification of occupational diseases and perceived barriers). We conducted a qualitative study in south-eastern France which consisted of in-depth interviews of physicians and actors involved in the prevention of occupational hazards or in their indemnification. Then discourse analysis was carried out on the corpus collected. Content analysis grouped the data into themes. Several reasons could explain the low investment of physicians in the field of occupational health: insufficient detection of occupational causes of diseases, complexity of administrative procedures of declaration and bias of causal interpretation for the patients exposed to other risk factors such as smoking. The fear that notifying an occupational disease might have repercussions on patients' socio-professional situations places physicians in a situation of ethical dilemma: inducing a social risk on one side, ignoring his rights on the other. Physicians are not sufficiently prepared to deal with these situations, because they lack appropriate knowledge and support from specialists in the field, due to an important bulk-heading of actors and their practices. To sensitize and train physicians to occupational health and to support multi-field practices are essential.

The Public Health Impact of Training Physicians to Become Obstetricians and Gynecologists in Ghana

PubMed Central

Obed, Samuel A.; Boothman, Erika L.; Opare-Ado, Henry

2014-01-01

Objectives. We assessed the public health effect of creating and sustaining obstetrics and gynecology postgraduate training in Ghana, established in 1989 to reverse low repatriation of physicians trained abroad. Methods. All 85 certified graduates of 2 Ghanaian university-based postgraduate training programs from program initiation in 1989 through June 2010 were identified and eligible for this study. Of these, 7 were unable to be contacted, inaccessible, declined participation, or deceased. Results. Of the graduates, 83 provide clinical services in Ghana and work in 33 sites in 8 of 10 regions; 15% were the first obstetrician and gynecologist at their facility, 25% hold clinical leadership positions, 50% practice in teaching hospitals, and 14% serve as academic faculty. Conclusions. Creating capacity for university-based postgraduate training in obstetrics and gynecology is effective and sustainable for a comprehensive global approach to reduce maternal and neonatal morbidity and mortality. Policies to support training and research capacity in obstetrics and gynecology are an integral part of a long-term national plan for maternal health. PMID:24354828

42 CFR 476.102 - Involvement of health care practitioners other than physicians.

Code of Federal Regulations, 2010 CFR

2010-10-01

... physicians. 476.102 Section 476.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL... determinations regarding medical necessity of services or the quality of the services they furnish, these...

Public health communications for safe motherhood.

PubMed

Kessel, E

1994-03-30

Public health communication aims to influence health practices of large populations, including maternal health care providers (traditional birth attendants, (TBAs), nurse-midwives, other indigenous practitioners, and physicians). A quality assurance process is needed to give public sector health providers feedback. Computerized record keeping is needing for quality assurance of maternal health programs. The Indian Rural Medical Association has trained more than 20,000 rural indigenous practitioners in West Bengal. Training of TBAs is expensive and rarely successful. However, trained health professional leading group discussions of TBAs is successful at teaching them about correct maternity care. Health education messages integrated into popular songs and drama is a way to reach large illiterate audiences. Even though a few donor agencies and governments provide time and technical assistance to take advantage of the mass media as a means to communicate health messages, the private sector has most of the potential. Commercial advertisements pay for Video on Wheels, which, with 100 medium-sized trucks each fitted with a 100-inch screen, plays movies for rural citizens of India. They are exposed to public and family planning messages. Jain Satellite Television (JST) broadcasts 24 hours a day and plans to broadcast programs on development, health and family planning, women's issues, and continuing education for all health care providers (physicians, nurses, TBAs, community workers, and indigenous practitioners). JST and the International Federation for Family Health plan to telecast courses as part of an Open University of Health Sciences.

Identifying public health competencies relevant to family medicine.

PubMed

Harvey, Bart J; Moloughney, Brent W; Iglar, Karl T

2011-10-01

Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

An Interprofessional Evaluation of Health Literacy Communication Practices of Physicians, Pharmacists, and Nurses at Public Hospitals in Penang, Malaysia.

PubMed

Rajah, Retha; Hassali, Mohamed Azmi; Lim, Ching-Jou

2018-04-01

Health care practitioners carry a tremendous responsibility to differentiate the varying need of information and customized communication according to a patient's health literacy (HL) level. To assess and compare the HL communication practices among physicians, pharmacists, and nurses serving at public hospitals in Penang, Malaysia. A pretested, self-administered questionnaire was used to collect data from study participants of 6 public hospitals using stratified sampling. Descriptive and inferential statistics used to analyze the data with level of significance was set at P < 0.05. Of 600 distributed questionnaires, 526 (87.6%) were adequately filled and returned. Almost 19.0% (n = 98) of the respondents admitted that they did not frequently use simple language and avoid medical jargon during communication with patients. Only about half of the respondents reported frequently using other HL communication practices that include handing out education material to patients (52.2%, n = 275), asking the patient to repeat information (58.9%, n = 310), and asking patients' caregivers to be present during explanation (57.4%, n = 302). Comparatively, drawing pictures to ease patients' understanding (40.1%, n = 211) was the less-frequently practiced HL communication techniques. Health practitioners in the age group >41 years ( P = 0.046), serving 10 years and more ( P = 0.03) and those who have heard the term or concept of HL ( P = 0.004) have statistically significantly higher mean score of HL communication practices than other groups. The gap in the HL communication practices among physicians, pharmacists, and nurses warrants educational intervention, and standardized HL communication techniques guidelines are needed in the near future.

Retail Health Clinics: A Policy Position Paper From the American College of Physicians.

PubMed

Daniel, Hilary; Erickson, Shari

2015-12-01

Retail health clinics are walk-in clinics located in retail stores or pharmacies that are typically staffed by nurse practitioners or physician assistants. When they entered the marketplace in the early 2000s, retail clinics offered a limited number of services for low-acuity conditions that were paid for out of pocket by the consumer. Over the past decade, business models for these clinics have evolved to accept public and private health insurance, and some are expanding their services to include diagnosis, treatment, and management of chronic conditions. Retail health clinics are one of several methods of health care delivery that challenge the traditional primary care delivery model. The positions and recommendations offered by the American College of Physicians in this paper are intended to establish a framework that underscores patient safety, communication, and collaboration among retail health clinics, physicians, and patients.

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.

[Economic Crisis and Portuguese National Health Service Physicians: Findings from a Descriptive Study of Their Perceptions and Reactions from Health Care Units in the Greater Lisbon Area].

PubMed

Rego, Inês; Russo, Giuliano; Gonçalves, Luzia; Perelman, Julian; Pita Barros, Pedro

2017-04-28

In Europe, scant scientific evidence exists on the impact of economic crisis on physicians. This study aims at understanding the adjustments made by public sector physicians to the changing conditions, and their perceptions on the market for medical services in the Lisbon metropolitan area. A random sample of 484 physicians from São José Hospital and health center groups in Cascais and Amadora, to explore their perceptions of the economic crisis, and the changes brought to their workload. This paper provides a descriptive statistical analysis of physicians' responses. In connection to the crisis, our surveyed physicians perceived an increase in demand but a decrease of supply of public health services, as well as an increase in the supply of health services by the private sector. Damaging government policies for the public sector, and the rise of private services and insurance providers were identified as game changers for the sector. Physicians reported a decrease in public remuneration (- 30.5%) and a small increase of public sector hours. A general reduction in living standard was identified as the main adaptation strategy to the crisis. Passion for the profession, its independence and flexibility, were the most frequently mentioned compensating factors. A percentage of 15% of physicians declared considering migration as a possibility for the near future. The crisis has brought non-negligible changes to physicians' working conditions and to the wider market for medical services in Portugal. The physicians' intrinsic motivation for the professions helped counterbalance salary cuts and deteriorating working conditions.

Physician job satisfaction as a public health issue.

PubMed

Kravitz, Richard L

2012-12-14

In Hirschman's classic formulation, physicians can signal discontent with their conditions of work by "exiting" (leaving the profession or not entering it in the first place) or by giving "voice" to their concerns (e.g. complaining, protesting, bargaining collectively, or conducting work actions and strikes). This Commentary reviews the findings of a survey of Israeli neonatologists by Moshe et al. Survey respondents were satisfied with their careers but not with salary, patient care demands, and leisure time, a pattern that has been seen in other countries, particularly within "small, acute care specialties" (SACS). One question for policymakers is how to help physicians in SACS maintain work-life balance and avoid burnout while providing superb patient care. The Commentary considers several possible solutions while advocating for rigorous and comprehensive monitoring of physician satisfaction over time.

Gun Violence, mental health, and Connecticut physicians.

PubMed

Dodds, Peter R; Anderson, Caitlyn O; Dodds, Jon H

2014-01-01

While there is a public perception that gun violence is associated with mental illness we present evidence that it is a complex public health problem which defies simple characterizations and solutions. Only a small percentage of individuals with mental illness are at risk for extreme violence and they account for only a small percentage of gun-related homicides. Individuals who are at risk for gun violence are difficult to identify and successfully treat. The incidence, and perhaps the demographics, of gun violence vary substantially from state to state. We make a case for Connecticut physicians to study gun violence at the state level. We recommend that Connecticut physicians promote and expand upon the American Academy of Pediatrics' recommendation for creating a "safe home environment. "We suggest that guns be secured in all homes in which there are children. In addition we suggest that guns be voluntarily removed from homes in which there are individuals with a history of violence, threats of violence, depression, drug and/or alcohol abuse, and individuals with major mental illnesses who are not cooperating with therapy.

Integration of public health and primary care: A systematic review of the current literature in primary care physician mediated childhood obesity interventions.

PubMed

Bhuyan, Soumitra S; Chandak, Aastha; Smith, Patti; Carlton, Erik L; Duncan, Kenric; Gentry, Daniel

2015-01-01

Childhood obesity, with its growing prevalence, detrimental effects on population health and economic burden, is an important public health issue in the United States and worldwide. There is need for expansion of the role of primary care physicians in obesity interventions. The primary aim of this review is to explore primary care physician (PCP) mediated interventions targeting childhood obesity and assess the roles played by physicians in the interventions. A systematic review of the literature published between January 2007 and October 2014 was conducted using a combination of keywords like "childhood obesity", "paediatric obesity", "childhood overweight", "paediatric overweight", "primary care physician", "primary care settings", "healthcare teams", and "community resources" from MEDLINE and CINAHL during November 2014. Author name(s), publication year, sample size, patient's age, study and follow-up duration, intervention components, role of PCP, members of the healthcare team, and outcomes were extracted for this review. Nine studies were included in the review. PCP-mediated interventions were composed of behavioural, education and technological interventions or a combination of these. Most interventions led to positive changes in Body Mass Index (BMI), healthier lifestyles and increased satisfaction among parents. PCPs participated in screening and diagnosing, making referrals for intervention, providing nutrition counselling, and promoting physical activity. PCPs, Dietitians and nurses were often part of the healthcare team. PCP-mediated interventions have the potential to effectively curb childhood obesity. However, there is a further need for training of PCPs, and explain new types of interventions such as the use of technology. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

PubMed

Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

2016-01-01

State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

Nurse practitioners, certified nurse midwives, and physician assistants in physician offices.

PubMed

Park, Melissa; Cherry, Donald; Decker, Sandra L

2011-08-01

The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing health care. Projections of the future physician workforce predict declines in the supply of physicians and decreasing physician work hours for primary care. An expansion of care delivered by nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) is often cited as a solution to the predicted surge in demand for health care services and calls for an examination of current reliance on these providers. Using a nationally based physician survey, we have described the employment of NPs, CNMs, and PAs among office-based physicians by selected physician and practice characteristics. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Exploring public sector physicians' resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal's capital city area.

PubMed

Russo, Giuliano; Pires, Carlos André; Perelman, Julian; Gonçalves, Luzia; Barros, Pedro Pita

2017-03-15

Evidence is accumulating on the impact of the recent economic crisis on health and health systems across Europe. However, little is known about the effect this is having on physicians - a crucial resource for the delivery of healthcare services. This paper explores the adaptation to the crisis of public sector physicians and their ability to keep performing their functions, with the objective of gaining a better understanding of health workers' resilience under deteriorating conditions. We conducted a survey among 484 public primary care and hospital physicians in Portugal's capital city area and explored their perceptions of the crisis, adaptation and coping strategies. We used ordinal and logistic regression models to link changes in hours worked and intentions to migrate with physicians' characteristics and specific answers. We found little evidence of physicians changing their overall allocation of working time before and after the crisis, with their age, types of specialisation, valuation of job flexibility and independence significantly associated with changes in public sector hours between 2010 and 2015. Being divorced, not Portuguese, of younger age, and working a high number of hours per week, were found to increase the probability of physicians considering migration, the same as having a poor opinion of recent government health policies. On the other hand, enjoying their current working environment, not wanting to disrupt provision of service, and leisure time were found to protect against scaling down public sector hours or considering migration. Our work on Portuguese physicians contributes to the debate on health workers' resilience, showing the value of understanding the influence of personal characteristics and opinions on their adaptation to changing circumstances, before designing policies to improve their working conditions and retention.

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

PubMed

Crowley, Ryan A

2016-05-03

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.

A View from the Professional Schools: Public Health.

ERIC Educational Resources Information Center

Gemmell, Michael K.

1987-01-01

Issues and trends affecting professional education for public health careers are examined, including specialization shortages, physician faculty shortages, declining federal support, and changing student demographics. (MSE)

Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system.

PubMed

Grande, David; Shea, Judy A; Armstrong, Katrina

2012-03-01

Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system. Cross sectional random digit dial telephone survey. African-American and White adults in 40 large metropolitan areas. Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust. Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-3.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62). Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.

Health Care Austerity Measures in Times of Crisis: The Perspectives of Primary Health Care Physicians in Madrid, Spain.

PubMed

Heras-Mosteiro, Julio; Sanz-Barbero, Belén; Otero-Garcia, Laura

2016-01-01

The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health. © The Author(s) 2016.

42 CFR 414.90 - Physician Quality Reporting System.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Physician Quality Reporting System. 414.90 Section 414.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians and Other...

CRISPR, Patents, and the Public Health.

PubMed

Sherkow, Jacob S

2017-12-01

Patent issues surrounding CRISPR, the revolutionary genetic editing technology, may have important implications for the public health. Patents maintain high prices for novel therapies, limiting patient access. Relatedly, insurance coverage for expensive therapies is waning. Patents also misallocate research and development resources to profitable disease indications rather than those that necessarily impinge on the public health. And it is unclear how CRISPR therapies will figure into the current regulatory framework for biosimilars. Policy makers and physicians should consider these issues now, before CRISPR therapies become widely adopted-and entrenched-in the marketplace.

Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators.

PubMed

Von Pressentin, Klaus B; Mash, Bob J; Esterhuizen, Tonya M

2017-04-28

The supply of appropriate health workers is a key building block in the World Health Organization's model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. All 52 South African health districts were included as units of analysis. An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician's circle of control may be better positioned to demonstrate a measurable impact in the short term.

Negotiating markets for health: an exploration of physicians' engagement in dual practice in three African capital cities.

PubMed

Russo, Giuliano; McPake, Barbara; Fronteira, Inês; Ferrinho, Paulo

2014-09-01

Scarce evidence exists on the features, determinants and implications of physicians' dual practice, especially in resource-poor settings. This study considered dual practice patterns in three African cities and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physicians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and inferential statistics were employed to explore differences in physicians' engagement in dual practice across the three locations. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private practice. The remaining 55% indicated that they engaged in some form of dual practice, 31% 'outside' public facilities, 8% 'inside' and 16% both 'outside' and 'inside'. Local health system governance and the structure of the markets for physician services were linked to the forms of dual practice found in each location, and to their prevalence. Our analysis suggests that physicians' decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and efficiency implications for service provision. The study shows the value of analysing health markets to understand physicians' engagement in

Oral Health Practices Among Pakistani Physicians

PubMed Central

Fatima, Syeda H; Naseem, Sajida; Ghazanfar, Haider; Ali, Zainab; Khan, Najeeb A

2018-01-01

Introduction In most healthcare models, the first interaction of a patient is with a general physician. The inspection of the oral cavity is a mandatory component of the general physical examination performed by a physician. This helps detect any oral pathology and make suitable referrals. Therefore, adequate oral health awareness is essential for physicians. Our study aimed at evaluating the oral health practices among physicians working in a private teaching setup in Islamabad, Pakistan. Methods A cross-sectional study involving 144 physicians teaching undergraduate medical students at Shifa College of Medicine and its affiliated hospital, Shifa International Hospital, was conducted. Participants were interviewed through a self-designed questionnaire. Later, each participant demonstrated their teeth brushing technique on a standard model of the oral cavity, which was assessed against a checklist conforming to the modified bass technique. A video clip showing the aforementioned brushing technique was shown at the end of the interview. The collected data was analyzed on IBM's statistical package for the social sciences (SPSS) version 21.  Results Toothpaste was the top choice (97.2%) of teeth cleaning tool with 69% participants brushing their teeth two times a day and 56.9% using toothbrushes with bristles of medium texture. The use of mouthwash (32.6%) and dental floss (11.1%) was considerably low. Dental caries and teeth discoloration were seen in 46.5% and 43.8% physicians, respectively. An alarmingly low number of physicians (31.9%) claimed to have read guidelines regarding oral health. This translated into most participants (78.5%) visiting a dentist only when needed. Only 4.9% participants performed all components of the modified bass technique to clean teeth on the oral cavity model, with up to 22.9% unable to perform a single step accurately.  Conclusion The oral health knowledge and practices of physicians were found to be suboptimal and

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…

Perceived risks from radiation and nuclear testing near Semipalatinsk, Kazakhstan: a comparison between physicians, scientists, and the public.

PubMed

Purvis-Roberts, Kathleen L; Werner, Cynthia A; Frank, Irene

2007-04-01

Determining the difference in perception of risk between experts, or more educated professionals, and laypeople is important so that a potential hazard can be effectively communicated to the public. Many surveys have been conducted to better understand the difference between expert and public opinions, and often laypeople exhibit higher perceptions of risk to hazards in comparison to experts. This is especially true when health risk is due to radiation, nuclear power, and nuclear waste. This article focuses on one section of a risk perception survey given to two groups of individuals with a more specialized education (scientists and physicians) and laypeople (villagers) in the Semipalatinsk region of Kazakhstan. All of these groups live near the former Soviet nuclear test site. Originally, it was expected that the scientists and physicians would have similar perceptions of radiation risk, while the public perceptions would be higher, but this was not always the case. For example, when perceptions of risk pertain to the health impacts of nuclear testing or the dose-response nature of radiation exposure, the physicians tend to agree with the laypeople, not the scientists. The villagers are always the most risk-averse group, followed by the physicians and then the scientists. These differences are likely due to different frames of reference for each of the populations.

Lead and cadmium in public health in Nigeria: physicians neglect and pitfall in patient management.

PubMed

Orisakwe, Orish Ebere

2014-02-01

Low-level heavy metals exposure may contribute much more toward the causation of chronic disease and impaired functioning than previously thought. Among the suggested preventive and intervention measures for the control of renal diseases are the reduction in the exposure to heavy metals. Although these indicate knowledge and awareness of possible role of some heavy metals in the etiogenesis of some chronic diseases by Nigerian Physicians, heavy metal assay as diagnostic guide in patient management is often omitted in most healthcare settings. This is a synoptic capture of the increased incidence and prevalence of some metabolic disorders where heavy metals may be implicated. A search of the terms heavy metal exposure, source, toxicity, metabolic disorders, poisoning in Nigeria, in bibliographical databases (in English language) such as PubMed, Scopus, Google Scholar, and Africa Journal Online (AJOL) digital library was conducted. Leaded gasoline, refuse dumping, absence of poison information centers, and poor record keeping characterize environmental health in Nigeria. Lead and cadmium are of most significant public health importance in Nigeria. The recognition and inclusion of heavy metals assays in the diagnosis of metabolic disorders may ensure early diagnosis and improve management.

Lead and Cadmium in Public Health in Nigeria: Physicians Neglect and Pitfall in Patient Management

PubMed Central

Orisakwe, Orish Ebere

2014-01-01

Low-level heavy metals exposure may contribute much more toward the causation of chronic disease and impaired functioning than previously thought. Among the suggested preventive and intervention measures for the control of renal diseases are the reduction in the exposure to heavy metals. Although these indicate knowledge and awareness of possible role of some heavy metals in the etiogenesis of some chronic diseases by Nigerian Physicians, heavy metal assay as diagnostic guide in patient management is often omitted in most healthcare settings. This is a synoptic capture of the increased incidence and prevalence of some metabolic disorders where heavy metals may be implicated. A search of the terms heavy metal exposure, source, toxicity, metabolic disorders, poisoning in Nigeria, in bibliographical databases (in English language) such as PubMed, Scopus, Google Scholar, and Africa Journal Online (AJOL) digital library was conducted. Leaded gasoline, refuse dumping, absence of poison information centers, and poor record keeping characterize environmental health in Nigeria. Lead and cadmium are of most significant public health importance in Nigeria. The recognition and inclusion of heavy metals assays in the diagnosis of metabolic disorders may ensure early diagnosis and improve management. PMID:24696827

[Attitudes of physicians and nurses towards health prevention and promotion activities in Primary Care].

PubMed

Ramos-Morcillo, Antonio Jesús; Ruzafa-Martínez, María; Fernández-Salazar, Serafín; del-Pino-Casado, Rafael; Armero Barranco, David

2014-11-01

To determine the attitudes of physicians and registered nurses in the Andalusian Public Health System towards preventive and health promotion (PHP) interventions in the context of Primary Health Care and the relationship with occupational variables and self-reported competence in PHP. Multicenter, observational, descriptive study. Primary Health Care (PHC), Andalusia, Spain. A total of 282 professionals (physicians and nurses) from 22 Healthcare centers of the Andalusian public health system and who participated in the validation of CAPPAP were included. The attitude of physicians and registered nurses towards PHP activities consisted of five dimensions: improvements necessary, perception of peers attitude, importance, obstacles, and improvement opportunities. The validated CAPPAP questionnaire was used. Occupational variables and questions about self-reported competence in PHP were also included. All dimensions of CAPPAP exceeded the midpoint of the scale (2.5), with their values varying between 3.06 (SD: 0.76) in "improvement necessary", and 4.39 (SD: 0.49) in "importance". The self-declared social, occupational, and competences variables have a statistically significant relationship with the dimensions of the attitude of the professionals except: job experience in PHC, training and implementation of scheduled PHP activities. The attitudes of physicians and registered nurses towards PHP activities are acceptable, and work must be done to sustain it. Healthcare organizations should implement interventions adapted to different professional profiles. They should also increase activities to improve professional skills in order to provide the appropriate care. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Mobile health apps in Sweden: what do physicians recommend?

PubMed

Zhang, Yiping; Koch, Sabine

2015-01-01

Currently over 50,000 mobile health apps are available worldwide. In general, they are considered as innovations potentially delivering benefits to patients. Physicians are considered as potential channels to disseminate these innovations to patients. However, physicians' behavior in this regard has not been studied. To capture physicians' attitudes towards recommending health apps to patients and to describe factors influencing physicians' behavior, taking the specifics of an early adopter country, Sweden, into account. Diffusion of Innovation theory, the Health App Maturity Model and the Six Hurdles Model were used to construct a web-based survey that was answered by 44 Swedish physicians. Survey results were followed up with 2 individual interviews. Descriptive statistics were used for quantitative data analysis and recursive abstraction for qualitative data analysis. Only a small group of physicians currently recommend mobile health apps to their patients. However, most physicians have a positive attitude and perceive improvement of patients' self-management ability as main benefit of health apps. Main perceived weaknesses include the lack of evidence-based content and lack of multi-language support. Regulation of health apps under the Medical Device Directive is asked for to assure quality and patient safety. Innovators and early adopters play an important role in the diffusion of mobile health apps. Interpersonal communication is seen as the most effective way for physicians gaining information and also motivates them to recommend mobile health apps to their patients. Physicians' knowledge about certified websites to ensure quality is however low.

US public opinion regarding proposed limits on resident physician work hours

PubMed Central

2010-01-01

Background In both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine. In 2008, the Institute of Medicine (IOM) recommended a reduction in resident physician work hours. We sought to assess the American public perspective on this issue. Methods We conducted a national survey of 1,200 representative members of the public via random digit telephone dialing in order to describe US public opinion on resident physician work hour regulation, particularly with reference to the IOM recommendations. Results Respondents estimated that resident physicians currently work 12.9-h shifts (95% CI 12.5 to 13.3 h) and 58.3-h work weeks (95% CI 57.3 to 59.3 h). They believed the maximum shift duration should be 10.9 h (95% CI 10.6 to 11.3 h) and the maximum work week should be 50 h (95% CI 49.4 to 50.8 h), with 1% approving of shifts lasting >24 h (95% CI 0.6% to 2%). A total of 81% (95% CI 79% to 84%) believed reducing resident physician work hours would be very or somewhat effective in reducing medical errors, and 68% (95% CI 65% to 71%) favored the IOM proposal that resident physicians not work more than 16 h over an alternative IOM proposal permitting 30-h shifts with ≥5 h protected sleep time. In all, 81% believed patients should be informed if a treating resident physician had been working for >24 h and 80% (95% CI 78% to 83%) would then want a different doctor. Conclusions The American public overwhelmingly favors discontinuation of the 30-h shifts without protected sleep routinely worked by US resident physicians and strongly supports implementation of restrictions on resident physician work hours that are as strict, or stricter, than those proposed by the IOM. Strong support exists to restrict resident physicians' work to 16 or fewer consecutive hours, similar to current limits in New Zealand, the UK and the rest of Europe. PMID:20515479

US public opinion regarding proposed limits on resident physician work hours.

PubMed

Blum, Alexander B; Raiszadeh, Farbod; Shea, Sandra; Mermin, David; Lurie, Peter; Landrigan, Christopher P; Czeisler, Charles A

2010-06-01

In both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine. In 2008, the Institute of Medicine (IOM) recommended a reduction in resident physician work hours. We sought to assess the American public perspective on this issue. We conducted a national survey of 1,200 representative members of the public via random digit telephone dialing in order to describe US public opinion on resident physician work hour regulation, particularly with reference to the IOM recommendations. Respondents estimated that resident physicians currently work 12.9-h shifts (95% CI 12.5 to 13.3 h) and 58.3-h work weeks (95% CI 57.3 to 59.3 h). They believed the maximum shift duration should be 10.9 h (95% CI 10.6 to 11.3 h) and the maximum work week should be 50 h (95% CI 49.4 to 50.8 h), with 1% approving of shifts lasting >24 h (95% CI 0.6% to 2%). A total of 81% (95% CI 79% to 84%) believed reducing resident physician work hours would be very or somewhat effective in reducing medical errors, and 68% (95% CI 65% to 71%) favored the IOM proposal that resident physicians not work more than 16 h over an alternative IOM proposal permitting 30-h shifts with > or =5 h protected sleep time. In all, 81% believed patients should be informed if a treating resident physician had been working for >24 h and 80% (95% CI 78% to 83%) would then want a different doctor. The American public overwhelmingly favors discontinuation of the 30-h shifts without protected sleep routinely worked by US resident physicians and strongly supports implementation of restrictions on resident physician work hours that are as strict, or stricter, than those proposed by the IOM. Strong support exists to restrict resident physicians' work to 16 or fewer consecutive hours, similar to current limits in New Zealand, the UK and the rest of Europe.

Health perceptions of African HIV-infected patients and their physicians.

PubMed

Dominicé Dao, Melissa I; Ferreira, Jackeline F; Vallier, Nathalie; Roulin, Dominique; Hirschel, Bernard; Calmy, Alexandra

2010-08-01

We explored how patients from Sub Saharan Africa (SSA) infected with HIV and living in Switzerland, and their treating physicians perceived their health, whether these perceptions correlated with biological markers, and what organisational changes participants considered likely to improve quality of care. A prospective standardized questionnaire was submitted to HIV-infected patients from SSA and their physicians. Results were correlated with biological data. While physicians deduced improved health status from laboratory results, these did not provide an adequate surrogate marker of good health for patients. Patients experienced important social and economical difficulties with adverse consequences on their mental health. They requested social assistance, whereas physicians sought improved cultural competency. Patients and physicians did not agree in their evaluation of patients' health status. Patients did not perceive their health through biological markers, but linked their mental health with their socioeconomic context. Physicians underestimated patients' biological health and their evaluation of global health. Exploring difficulties perceived by physicians with specific patients lead to identification of structural weaknesses, resulting in suggestions to improve physicians' medical training and patients' care. This illustrates the importance of accessing patients' perspective and not relying solely on physicians' perception of the problem. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Public Trust in Physicians—Health Care Commodification as a Possible Deteriorating Factor: Cross-sectional Analysis of 23 Countries

PubMed Central

Huang, Ellery Chih-Han; Pu, Christy; Chou, Yiing-Jenq; Huang, Nicole

2018-01-01

Trust in physicians has declined, and surveys of public opinion show a poor level of public trust in physicians. Commodification of health care has been speculated as a plausible driving force. We used cross-national data of 23 countries from the International Social Survey Programme 2011 to quantify health care commodification and study its role in the trust that patients generally place in physicians. A modified health care index was used to quantify health care commodification. There were 34 968 respondents. A question about the level of general trust in physicians and a 4-item “general trust in physicians” scale were used as our major and minor outcomes. The results were that compared with those in the reference countries, the respondents in the health care–commodified countries were approximately half as likely to trust physicians (odds ratio: 0.47, 95% confidence interval [CI]: 0.31-0.72) and scored 1.13 (95% CI: 1.89-0.37) less on the general trust scale. However, trust in physicians in the health care–decommodified countries did not differ from that in the reference countries. In conclusion, health care commodification may play a meaningful role in the deterioration of public trust in physicians. PMID:29502479

Water Safety and Lead Regulation: Physicians' Community Health Responsibilities.

PubMed

Jennings, Bruce; Duncan, Leslie Lyons

2017-10-01

This article reviews the regulation of lead in drinking water, highlighting its epidemiological, engineering, and ethical aspects with a focus on the Flint water crisis. We first discuss water quality policy and its implementation with a focus on lead contamination of water, primarily from pipe systems between a water treatment facility and a tap. We then discuss physicians' roles and ethical responsibilities regarding safe drinking water using a human rights framework. We argue that physicians can play an important role in safeguarding drinking water in their communities by being vigilant, honoring the community's trust in them, and warning, educating, and empowering patients and broader communities so as to protect tap water safety and public health. © 2017 American Medical Association. All Rights Reserved.

Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators

PubMed Central

Mash, Robert J.

2017-01-01

Background The supply of appropriate health workers is a key building block in the World Health Organization’s model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. Aim This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. Setting All 52 South African health districts were included as units of analysis. Methods An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Results Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. Conclusion The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician’s circle of control may be better positioned to demonstrate a measurable impact in the short term. PMID:28470076

Neuroticism and Physicians' and Self-Ratings of Health.

ERIC Educational Resources Information Center

Stock, William A.; And Others

Although self-rated health is an important topic in social gerontology, relatively few studies have examined the predictors of these self-evaluations. Data from the Second Duke Longitudinal Study were used to examine the relationships among neuroticism, physician-rated health, and self-rated health. Physicians' ratings of health were used to…

Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians

PubMed Central

Eyal, Nir; Cancedda, Corrado; Kyamanywa, Patrick; Hurst, Samia A.

2016-01-01

Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of non-physician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system. PMID:26927585

The education of physicians: a CDC perspective.

PubMed

Koo, Denise; Thacker, Stephen B

2008-04-01

The Centers for Disease Control and Prevention (CDC) strongly supports integrating population health perspectives into the education of physicians. Physicians with critical-thinking skills, a commitment to the health of a community, and a systems-based approach are critical partners for the agency in its mission to protect and promote the public's health. To cultivate such physicians, integrating population health concepts solely into undergraduate medical education would be inadequate. A multipronged approach that establishes and maintains population health concepts with physicians at all stages of their education is needed: before medical school, during medical school, during residency and fellowship, and in research and practice (particularly for faculty who train the next generation). The authors describe relevant, CDC-conducted or CDC-supported activities that support such physician education during all these stages. Based in part on recent, cutting-edge trends assimilating community health particularly into primary care residencies, the authors also offer ideas for new ways that CDC can participate in the development of physicians who are truly competent at both medicine and population health in an integrated fashion -- physicians who focus on and care for individual patients but who also take a broader population or community perspective and can act effectively in either arena. Physicians who take such a systems approach -- who view and understand medicine and public health as a continuum rather than as distinct arenas -- are sorely needed to help solve the current health system crisis and to contribute to improving health in other ways.

Providing primary health care with non-physicians.

PubMed

Chen, P C

1984-04-01

The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

The Delivery of Health Promotion and Environmental Health Services; Public Health or Primary Care Settings?

PubMed

Bjørn Jensen, Lene; Lukic, Irena; Gulis, Gabriel

2018-05-07

The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO). Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state) with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services.

[Scientific publications: a resource for the physician's intellectual development].

PubMed

Zárate, Arturo

2013-01-01

The physician's professional life involves reading and analysis of scientific journals, regardless of the specialization field. The hospital and academic areas lead to the scientific-literary activity development. The aim of this editorial is to make some reflections about the way a physician reaches intellectual development, through the creation of a culture of writing and reading scientific publications.

Sentinel Health Events (occupational): a basis for physician recognition and public health surveillance.

PubMed Central

Rutstein, D D; Mullan, R J; Frazier, T M; Halperin, W E; Melius, J M; Sestito, J P

1983-01-01

A Sentinel Health Event (SHE) is a preventable disease, disability, or untimely death whose occurrence serves as a warning signal that the quality of preventive and/or therapeutic medical care may need to be improved. A SHE (Occupational) is a disease, disability, or untimely death which is occupationally related and whose occurrence may: 1) provide the impetus for epidemiologic or industrial hygiene studies; or 2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required. The present SHE(O) list encompasses 50 disease conditions that are linked to the workplace. Only those conditions are included for which objective documentation of an associated agent, industry, and occupation exists in the scientific literature. The list will serve as a framework for developing a national system for occupational health surveillance that may be applied at the state and local level, and as a guide for practicing physicians caring for patients with occupational illnesses. We expect to update the list periodically to accommodate new occupational disease events which meet the criteria for inclusion. PMID:6881402

Utilization of Rural Primary Care Physicians' Visit Services for Diabetes Management of Public Health in Southwestern China: A Cross-Sectional Study from Patients' View.

PubMed

Miao, Yudong; Ye, Ting; Qian, Dongfu; Li, Jinlong; Zhang, Liang

2014-06-01

Primary care physicians' visit services for diabetes management are now widely delivered in China's rural public health care. Current studies mainly focus on supply but risk factors from patients' view have not been previously explored. This study aims to present the utilization of rural primary care physicians' visit services for diabetes management in the last 12 months in southwestern China, and to explore risk factors from patients' view. This cross sectional study selected six towns at random and all 385 diabetics managed by primary care physicians were potential participants. Basing on the inclusion and exclusion criteria, 374 diabetics were taken as valid subjects and their survey responses formed the data resource of analyses. Descriptive indicators, χ2 contingency table analyses and Logistic regression were used. 54.8% respondents reported the utilization of visit services. According to the multivariate analysis, the positive factors mainly associated with utilization of visit services include disease duration (OR=1.654), use of diabetic drugs (OR=1.869), consulting diabetes care knowledge (OR=1.602), recognition of diabetic complications (OR=1.662), needs of visit services (OR=2.338). The utilization of rural primary care physicians' visit services still remains unsatisfactory. Mass rural health policy awareness, support, and emphasis are in urgent need and possible risk factors including disease duration, use of diabetic drugs, consulting diabetes care knowledge, recognition of diabetic complications and needs of visit services should be taken into account when making rural health policy of visit services for diabetes management in China and many other low- and middle-income countries.

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 PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Rural Health Clinic and Federally Qualified...

Patient Education: A Challenge to Physicians

PubMed Central

Schatz, Douglas L.

1972-01-01

There is an increasing responsibility for the physician to participate in health care beyond the conventional doctor-patient relationships. The layman's ability to cope with health problems is directly proportional to his knowledge of the area. As physicians we must be prepared to provide leadership and cooperation in the area of community health education. A description of one suburban hospital's contribution to this area of patient education is presented. North York General Hospital prepared and delivered in the spring of 1972, a series of health forums for the public. These forums were intended to entertain as well as inform community members, on important health issues. Many alternative methods for public health education are available to the physician and hospital; positive action must be taken by the medical profession to improve liaison with the community. PMID:20468807

Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians.

PubMed

Eyal, Nir; Cancedda, Corrado; Kyamanywa, Patrick; Hurst, Samia A

2015-12-30

Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of non-physician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary - for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system. © 2016 by Kerman University of Medical Sciences.

Health-care reform's great expectations and physician reality.

PubMed

Van Mol, Andre

2010-09-01

The Patient Protection and Affordable Care Act will not prove to be the reform for which physicians were long hoping. Private insurance rates will climb sharply, forcing people onto government programs; physician reimbursement will plummet; the physician shortage will worsen; rationing in the form of waiting lists is certain; health care as a whole will worsen; and once fully engaged, nationalization of health care will be irreversible.

Prevalence of Health-Related Behaviors among Physicians and Medical Trainees

ERIC Educational Resources Information Center

Hull, Sharon K.; DiLalla, Lisabeth F.; Dorsey, J. Kevin

2008-01-01

Objective: The authors studied the prevalence of health-promoting and health-risking behaviors among physicians and physicians-in-training. Given the significant potential for negative outcomes to physicians' own health as well as the health and safety of their patients, examination of the natural history of this acculturation process about…

Physician participation in alternative health plans

PubMed Central

Rosenbach, Margo L.; Harrow, Brooke S.; Hurdle, Sylvia

1988-01-01

In this article, physician participation in alternative health plans is examined, using cross-sectional data from the Physicians' Practice Costs and Income Survey, 1983-85. Overall, about one-third of physicians participated in one or more plans, ranging from 18 percent of general practitioners to 46 percent of medical subspecialists. Only 19 percent, however, received income from prepaid sources, averaging $5,275 per physician. Reasons for joining or not joining are also examined. Participants joined most often to maintain or increase workload, while nonparticipants most often declined to join because they would be giving up independence. PMID:10312633

Public Awareness of and Contact With Physicians Who Receive Industry Payments: A National Survey.

PubMed

Pham-Kanter, Genevieve; Mello, Michelle M; Lehmann, Lisa Soleymani; Campbell, Eric G; Carpenter, Daniel

2017-07-01

The Physician Payments Sunshine Act, part of the Affordable Care Act, requires pharmaceutical and medical device firms to report payments they make to physicians and, through its Open Payments program, makes this information publicly available. To establish estimates of the exposure of the American patient population to physicians who accept industry payments, to compare these population-based estimates to physician-based estimates of industry contact, and to investigate Americans' awareness of industry payments. Cross-sectional survey conducted in late September and early October 2014, with data linkage of respondents' physicians to Open Payments data. A total of 3542 adults drawn from a large, nationally representative household panel. Respondents' contact with physicians reported in Open Payments to have received industry payments; respondents' awareness that physicians receive payments from industry and that payment information is publicly available; respondents' knowledge of whether their own physician received industry payments. Among the 1987 respondents who could be matched to a specific physician, 65% saw a physician who had received an industry payment during the previous 12 months. This population-based estimate of exposure to industry contact is much higher than physician-based estimates from the same period, which indicate that 41% of physicians received an industry payment. Across the six most frequently visited specialties, patient contact with physicians who had received an industry payment ranged from 60 to 85%; the percentage of physicians with industry contact in these specialties was much lower (35-56%). Only 12% of survey respondents knew that payment information was publicly available, and only 5% knew whether their own doctor had received payments. Patients' contact with physicians who receive industry payments is more prevalent than physician-based measures of industry contact would suggest. Very few Americans know whether their own doctor

Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study.

PubMed

Emmert, Martin; Meier, Florian; Pisch, Frank; Sander, Uwe

2013-08-28

Over the past decade, physician-rating websites have been gaining attention in scientific literature and in the media. However, little knowledge is available about the awareness and the impact of using such sites on health care professionals. It also remains unclear what key predictors are associated with the knowledge and the use of physician-rating websites. To estimate the current level of awareness and use of physician-rating websites in Germany and to determine their impact on physician choice making and the key predictors which are associated with the knowledge and the use of physician-rating websites. This study was designed as a cross-sectional survey. An online panel was consulted in January 2013. A questionnaire was developed containing 28 questions; a pretest was carried out to assess the comprehension of the questionnaire. Several sociodemographic (eg, age, gender, health insurance status, Internet use) and 2 health-related independent variables (ie, health status and health care utilization) were included. Data were analyzed using descriptive statistics, chi-square tests, and t tests. Binary multivariate logistic regression models were performed for elaborating the characteristics of physician-rating website users. Results from the logistic regression are presented for both the observed and weighted sample. In total, 1505 respondents (mean age 43.73 years, SD 14.39; 857/1505, 57.25% female) completed our survey. Of all respondents, 32.09% (483/1505) heard of physician-rating websites and 25.32% (381/1505) already had used a website when searching for a physician. Furthermore, 11.03% (166/1505) had already posted a rating on a physician-rating website. Approximately 65.35% (249/381) consulted a particular physician based on the ratings shown on the websites; in contrast, 52.23% (199/381) had not consulted a particular physician because of the publicly reported ratings. Significantly higher likelihoods for being aware of the websites could be

Sex differences in physician salary in U.S. public medical schools

PubMed Central

Jena, Anupam B.; Olenski, Andrew R.; Blumenthal, Daniel M.

2017-01-01

Importance Limited evidence exists on salary differences between male and female academic physicians, largely due to difficulty obtaining data on salary and factors influencing salary. Existing studies have been limited by reliance on survey-based approaches to measuring sex differences in earnings, lack of contemporary data, small sample sizes, or limited geographic representation. Objective To analyze sex differences in earnings among U.S. academic physicians. Design, setting, and participants Freedom of Information laws mandate release of salary information of public university employees in several states. In 12 states with salary information published online, we extracted salary data on 10,241 academic physicians at 24 public medical schools. We linked this data to a unique physician database with detailed information on sex, age, years of experience, faculty rank, specialty, scientific authorship, NIH funding, clinical trial participation, and Medicare reimbursements (proxy for clinical revenue). We estimated sex differences in salary adjusting for these factors. Exposure Physician sex Main outcome measures Annual salary Results Female physicians had lower unadjusted salaries than male physicians ($206,641 vs. $257,957; difference $51,315; 95% CI $46,330–$56,301). Sex differences persisted after multivariable adjustment ($227,782 vs. $247,661; difference $19,878; 95% CI $15,261–$24,495). Sex differences in salary varied across specialties, institutions, and faculty ranks. Female full and associate professors had comparable adjusted salaries to those of male associate and assistant professors, respectively. Conclusions and relevance Among physicians with faculty appointments at 24 U.S. public medical schools, significant sex differences in salary exist even after accounting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue. PMID:27400435

How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?

PubMed

Ruitenburg, Martijn M; Frings-Dresen, Monique H W; Sluiter, Judith K

2016-03-01

A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps should be taken to determine the content of a job-specific WHS for hospital physicians and outlines that content. Based on four questions, decision trees were developed for physical and psychological job demands and for biological, chemical, and physical exposures to decide whether or not to include work-related health effects related to occupational exposures or aspects of health reflecting insufficient job requirements. Information was gathered locally through self-reporting and systematic observations at the workplace and from evidence in international publications. Information from the decision trees on the prevalence and impact of the health- or work-functioning effect led to inclusion of occupational exposures (e.g., biological agents, emotionally demanding situations), job requirements (e.g., sufficient vision, judging ability), or health effects (e.g., depressive symptoms, neck complaints). Additionally, following the Dutch guideline for occupational physicians and based on specific job demands, screening for cardiovascular diseases, work ability, drug use, and alcohol consumption was included. Targeted interventions were selected when a health or work functioning problem existed and were chosen based on evidence for effectiveness. The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.

Reforms are needed to increase public funding and curb demand for private care in Israel's health system.

PubMed

Chernichovsky, Dov

2013-04-01

Historically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel's health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

Physician burnout: contributors, consequences and solutions.

PubMed

West, C P; Dyrbye, L N; Shanafelt, T D

2018-06-01

Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders

The Dynamics of Community Health Care Consolidation: Acquisition of Physician Practices

PubMed Central

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-01-01

Context Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. Methods We used key informant interviews, supplemented by document analysis. Findings The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. Conclusions In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. PMID:25199899

The dynamics of community health care consolidation: acquisition of physician practices.

PubMed

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-09-01

Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. We used key informant interviews, supplemented by document analysis. The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. © 2014 Milbank Memorial Fund.

[Perceptions of primary care physicians in Madrid on the austerity measures in the health care system].

PubMed

Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María

2016-01-01

To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Physician Migration, Education, and Health Care

ERIC Educational Resources Information Center

Norcini, John J.; Mazmanian, Paul E.

2005-01-01

Physician migration is a complex and multifaceted phenomenon that is intimately intertwined with medical education. Imbalances in the production of physicians lead to workforce shortages and surpluses that compromise the ability to deliver adequate and equitable health care to large parts of the world's population. In this overview, we address a…

Physicians' Involvement with the New York State Health Care Proxy

ERIC Educational Resources Information Center

Heyman, Janna C.; Sealy, Yvette M.

2011-01-01

This study examined physicians' attitude, involvement, and perceived barriers with the health care proxy. A cross sectional, correlational design was used to survey practicing physicians (N = 70). Physicians had positive attitudes toward the health care proxy and indicated that the most significant barriers to health care proxy completion were…

42 CFR 410.74 - Physician assistants' services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Physician assistants' services. 410.74 Section 410... Physician assistants' services. (a) Basic rule. Medicare Part B covers physician assistants' services only... physically present when the physician assistant is performing the services unless required by State law...

42 CFR 410.74 - Physician assistants' services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Physician assistants' services. 410.74 Section 410... Physician assistants' services. (a) Basic rule. Medicare Part B covers physician assistants' services only... physically present when the physician assistant is performing the services unless required by State law...

42 CFR 410.74 - Physician assistants' services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Physician assistants' services. 410.74 Section 410... Physician assistants' services. (a) Basic rule. Medicare Part B covers physician assistants' services only... physically present when the physician assistant is performing the services unless required by State law...

42 CFR 410.74 - Physician assistants' services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Physician assistants' services. 410.74 Section 410... Physician assistants' services. (a) Basic rule. Medicare Part B covers physician assistants' services only... physically present when the physician assistant is performing the services unless required by State law...

42 CFR 410.74 - Physician assistants' services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Physician assistants' services. 410.74 Section 410... Physician assistants' services. (a) Basic rule. Medicare Part B covers physician assistants' services only... physically present when the physician assistant is performing the services unless required by State law...

Complaint handling in healthcare: expectation gaps between physicians and the public; results of a survey study.

PubMed

Friele, R D; Reitsma, P M; de Jong, J D

2015-10-01

Patients who submit complaints about the healthcare they have received are often dissatisfied with the response to their complaints. This is usually attributed to the failure of physicians to respond adequately to what complainants want, e.g. an apology or an explanation. However, expectations of complaint handling among the public may colour how they evaluate the way their own complaint is handled. This descriptive study assesses expectations of complaint handling in healthcare among the public and physicians. Negative public expectations and the gap between these expectations and those of physicians may explain patients' dissatisfaction with complaints procedures. We held two surveys; one among physicians, using a panel of 3366 physicians (response rate 57 %, containing all kinds of physicians like GP's, medical specialist and physicians working in a nursing home) and one among the public, using the Dutch Healthcare Consumer Panel (n = 1422, response rate 68 %). We asked both panels identical questions about their expectations of how complaints are handled in healthcare. Differences in expectation scores between the public and the physicians were tested using non-parametric tests. The public have negative expectations about how complaints are handled. Physician's expectations are far more positive, demonstrating large expectation gaps between physicians and the public. The large expectation gap between the public and physicians means that when they meet because of complaint, they are likely to start off with opposite expectations of the situation. This is no favourable condition for a positive outcome of a complaints procedure. The negative public preconceptions about the way their complaint will be handled will prove hard to change during the process of complaints handling. People tend to see what they thought would happen, almost inevitably leading to a negative judgement about how their complaint was handled.

42 CFR Appendix B to Part 130 - Confidential Physician or Nurse Practitioner Affidavit

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Confidential Physician or Nurse Practitioner Affidavit B Appendix B to Part 130 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... 130—Confidential Physician or Nurse Practitioner Affidavit ER31MY00.002 ER31MY00.003 ...

42 CFR Appendix B to Part 130 - Confidential Physician or Nurse Practitioner Affidavit

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Confidential Physician or Nurse Practitioner Affidavit B Appendix B to Part 130 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... 130—Confidential Physician or Nurse Practitioner Affidavit ER31MY00.002 ER31MY00.003 ...

Forgiven but not Relieved: US Physician Workforce Consequences of Changes to Public Service Loan Forgiveness.

PubMed

Friedman, Ari B; Grischkan, Justin A; Dorsey, E Ray; George, Benjamin P

2016-10-01

Public Service Loan Forgiveness (PSLF) was established in 2007 for public sector and nonprofit enterprise employees to pursue educational loan forgiveness. Under PSLF, graduates are offered complete loan forgiveness after 120 qualifying monthly payments while employed at public or nonprofit institutions, including payments made during residency for physicians. In response to concerns that PSLF will heavily subsidize lawyers, doctors, and other professionals, the President's 2017 budget proposes limiting maximum forgiveness. Using data from the Association of American Medical Colleges Graduation Questionnaire (n = 55,905; response rate of 80 %), we found that intended participation in PSLF among medical school graduates grew 20 % per year since 2010. Future primary care physicians intend to use PSLF more than programs that were historically designed to promote primary care, such as the National Health Service Corp (NHSC). The federal government's projected cost of PSLF will reach over $316 million for 2014 graduates (net present value), approximately seven times the annual contributions from the NHSC. The proposed cap will reduce the total anticipated forgiveness by nearly two-thirds and substantially reduce subsidies for physicians. More targeted measures of loan forgiveness could be considered, such as making forgiveness contingent on pursuing specialties that society needs or practicing in shortage areas.

Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care.

PubMed

Aalto, Anna-Mari; Heponiemi, Tarja; Keskimäki, Ilmo; Kuusio, Hannamaria; Hietapakka, Laura; Lämsä, Riikka; Sinervo, Timo; Elovainio, Marko

2014-06-01

Although international migration of physicians is increasing, research information on their adjustment to working in a new country is scarce. This study examined the differences in employment, perceptions of psychosocial work environment and well-being between migrant and native physicians in Finland. A cross-sectional survey was sent to a random sample of physicians in Finland (N = 7000) and additionally to all foreign-born physicians licensed to practice in Finland (N = 1292). The final response rates were 56% (n = 3646) among native Finns and 43% (n = 553) among foreign-born physicians. Migrant physicians worked more often in primary care and on-call services and less often in leadership positions than native Finns. They more often experienced lack of professional support and lower work-related well-being compared with native Finns. Those migrant physicians who had lived for a shorter time in Finland perceived less stress related to electronic patient records systems and higher organizational justice compared with native physicians or those foreign physicians who had migrated earlier. Foreign-born physicians are more often employed in the primary care sector, where there are most difficulties in recruiting from the native workforce in Finland. Attention should be paid to enhancing equitable career opportunities and well-being among foreign-born physicians working in Finnish health care. Although migrant physicians are relatively well adjusted to Finnish health care in terms of perceptions of psychosocial work environment, their lower well-being calls for attention. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Medicare and Medicaid Physician Payment Incentives

PubMed Central

Burney, Ira L.; Schieber, George J.; Blaxall, Martha O.; Gabel, Jon R.

1979-01-01

The incentives in the Medicare and Medicaid physician payment systems and their effects on six interrelated aspects of health care costs and beneficiary access to care were analyzed. Research results and data presented indicate that Medicare and Medicaid physician payment incentives are inconsistent with current public policy goals of (1) containing inflation in fees and expenditures, (2) encouraging physician participation in public programs, (3) improving the geographic and specialty distributions of physicians, (4) encouraging primary care instead of surgery, and also outpatient rather than inpatient treatment. PMID:10309053

[Health care economics, uncertainty and physician-induced demand].

PubMed

Domenighetti, G; Casabianca, A

1995-10-21

The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

National findings regarding health IT use and participation in health care delivery reform programs among office-based physicians.

PubMed

Heisey-Grove, Dawn; Patel, Vaishali

2017-01-01

Our objective was to characterize physicians' participation in delivery and payment reform programs over time and describe how participants in these programs were using health information technology (IT) to coordinate care, engage patients, manage patient populations, and improve quality. A nationally representative cohort of physicians was surveyed in 2012 (unweighted N = 2567) and 2013 (unweighted N = 2399). Regression analyses used those survey responses to identify associations between health IT use and participation in and attrition from patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and pay-for-performance programs (P4Ps). In 2013, 45% of physicians participated in PCMHs, ACOs, or P4Ps. While participation in each program increased (P < .05) between 2012 and 2013, program attrition ranged from 31-40%. Health IT use was associated with greater program participation (RR = 1.07-1.16). PCMH, ACO, and P4P participants were more likely than nonparticipants to perform quality improvement and patient engagement activities electronically (RR = 1.09-1.14); only ACO participants were more likely to share information electronically (RR = 1.07-1.09). Participation in delivery and payment reform programs increased between 2012 and 2013. Participating physicians were more likely to use health IT. There was significant attrition from and switching between PCMHs, ACOs, and P4Ps. This work provides the basis for understanding physician participation in and attrition from delivery and payment reform programs, as well as how health IT was used to support those programs. Understanding health IT use by program participants may help to identify factors enabling a smooth transition to alternative payment models. Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the United States.

The organizational commitment of emergency physicians in Spanish public hospitals

PubMed

Noval de la Torre, A; Bulchand Gidumal, J; Melián González, S

2016-12-30

Background. There are not too many studies that deal with the organizational commitment of emergency physicians. This commitment has been shown to impact organizational performance. The aim of this paper is to analyse the degree of commitment of the emergency physicians in Spanish public hospitals and the factors that may influence it. Method. Online survey using SurveyMonkey to emergency physicians in Spanish public hospitals. Results. Two hundred and five questionnaires were received, 162 from physicians and 43 from heads of the emergency service. Results show an intermediate level of commitment, with affective commitment showing the lowest level and continuance commitment showing the highest level. The capabilities of the physician have an influence on their affective commitment; specific training in emergency procedures and seniority has an influence on their continuance commitment; and the opinion they hold about the organization of their service influences affective commitment. Conclusions. Emergency physicians show an average involvement in the hospital in which they work (average 3.8 on a range of 1 to 5), feel an average affection for it (3.4), and have a high intention to keep working there (4.0). The resources the hospital has due to its level do not have an influence on this commitment, while the training and perceptions of the service do have an influence.

Preventive, Lifestyle, and Personal Health Behaviors among Physicians

ERIC Educational Resources Information Center

Bazargan, Mohsen; Makar, Marian; Bazargan-Hejazi, Shahrzad; Ani, Chizobam; Wolf, Kenneth E.

2009-01-01

Objective: This study examines personal health behaviors and wellness, health-related lifestyles, and prevention screening practices among licensed physicians. Methods: An anonymous questionnaire was mailed to a random sample of 1,875 physicians practicing in California. Data from 763 returned questionnaires (41%) were analyzed. Results: Our data…

Physician leadership in e-health? A systematic literature review.

PubMed

Keijser, Wouter; Smits, Jacco; Penterman, Lisanne; Wilderom, Celeste

2016-07-04

Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.

Improved de-identification of physician notes through integrative modeling of both public and private medical text

PubMed Central

2013-01-01

Background Physician notes routinely recorded during patient care represent a vast and underutilized resource for human disease studies on a population scale. Their use in research is primarily limited by the need to separate confidential patient information from clinical annotations, a process that is resource-intensive when performed manually. This study seeks to create an automated method for de-identifying physician notes that does not require large amounts of private information: in addition to training a model to recognize Protected Health Information (PHI) within private physician notes, we reverse the problem and train a model to recognize non-PHI words and phrases that appear in public medical texts. Methods Public and private medical text sources were analyzed to distinguish common medical words and phrases from Protected Health Information. Patient identifiers are generally nouns and numbers that appear infrequently in medical literature. To quantify this relationship, term frequencies and part of speech tags were compared between journal publications and physician notes. Standard medical concepts and phrases were then examined across ten medical dictionaries. Lists and rules were included from the US census database and previously published studies. In total, 28 features were used to train decision tree classifiers. Results The model successfully recalled 98% of PHI tokens from 220 discharge summaries. Cost sensitive classification was used to weight recall over precision (98% F10 score, 76% F1 score). More than half of the false negatives were the word “of” appearing in a hospital name. All patient names, phone numbers, and home addresses were at least partially redacted. Medical concepts such as “elevated white blood cell count” were informative for de-identification. The results exceed the previously approved criteria established by four Institutional Review Boards. Conclusions The results indicate that distributional differences between

Improved de-identification of physician notes through integrative modeling of both public and private medical text.

PubMed

McMurry, Andrew J; Fitch, Britt; Savova, Guergana; Kohane, Isaac S; Reis, Ben Y

2013-10-02

Physician notes routinely recorded during patient care represent a vast and underutilized resource for human disease studies on a population scale. Their use in research is primarily limited by the need to separate confidential patient information from clinical annotations, a process that is resource-intensive when performed manually. This study seeks to create an automated method for de-identifying physician notes that does not require large amounts of private information: in addition to training a model to recognize Protected Health Information (PHI) within private physician notes, we reverse the problem and train a model to recognize non-PHI words and phrases that appear in public medical texts. Public and private medical text sources were analyzed to distinguish common medical words and phrases from Protected Health Information. Patient identifiers are generally nouns and numbers that appear infrequently in medical literature. To quantify this relationship, term frequencies and part of speech tags were compared between journal publications and physician notes. Standard medical concepts and phrases were then examined across ten medical dictionaries. Lists and rules were included from the US census database and previously published studies. In total, 28 features were used to train decision tree classifiers. The model successfully recalled 98% of PHI tokens from 220 discharge summaries. Cost sensitive classification was used to weight recall over precision (98% F10 score, 76% F1 score). More than half of the false negatives were the word "of" appearing in a hospital name. All patient names, phone numbers, and home addresses were at least partially redacted. Medical concepts such as "elevated white blood cell count" were informative for de-identification. The results exceed the previously approved criteria established by four Institutional Review Boards. The results indicate that distributional differences between private and public medical text can be used to

Physicians' professional performance: an occupational health psychology perspective.

PubMed

Scheepers, Renée A

2017-12-01

Physician work engagement is considered to benefit physicians' professional performance in clinical teaching practice. Following an occupational health psychology perspective, this PhD report presents research on how physicians' professional performance in both doctor and teacher roles can be facilitated by work engagement and how work engagement is facilitated by job resources and personality traits. First, we conducted a systematic review on the impact of physician work engagement and related constructs (e. g. job satisfaction) on physicians' performance in patient care. We additionally investigated physician work engagement and job resources in relation to patient care experience with physicians' performance at ten outpatient clinics covering two hospitals. In a following multicentre survey involving 61 residency training programs of 18 hospitals, we studied associations between physician work engagement and personality traits with resident evaluations of physicians' teaching performance. The findings showed that physician work engagement was associated with fewer reported medical errors and that job satisfaction was associated with better communication and patient satisfaction. Autonomy and learning opportunities were positively associated with physician work engagement. Work engagement was positively associated with teaching performance. In addition, physician work engagement was most likely supported by personality trait conscientiousness (e. g. responsibility). Given the reported associations of physician work engagement with aspects of their professional performance, hospitals could support physician work engagement in service of optimal performance in residency training and patient care. This could be facilitated by worker health surveillance, peer support or promoting job crafting at the individual or team level.

Using Timely Survey-Based Information Networks to Collect Data on Best Practices for Public Health Emergency Preparedness and Response: Illustrative Case From the American College of Emergency Physicians' Ebola Surveys.

PubMed

Abir, Mahshid; Moore, Melinda; Chamberlin, Margaret; Koenig, Kristi L; Hirshon, Jon Mark; Singh, Cynthia; Schneider, Sandra; Cantrill, Stephen

2016-08-01

Using the example of surveys conducted by the American College of Emergency Physicians (ACEP) regarding the management of Ebola cases in the United States, we aimed to demonstrate how survey-based information networks can provide timely data to inform best practices in responding to public health emergencies. ACEP conducted 3 surveys among its members in October to November 2014 to assess the state of Ebola preparedness in emergency departments. We analyzed the surveys to illustrate the types of information that can be gleaned from such surveys. We analyzed qualitative data through theme extraction and collected quantitative results through cross-tabulations and logistic regression examining associations between outcomes and potential contributing factors. In the first survey, most respondents perceived their hospital as being reasonably prepared for Ebola. The second survey revealed significant associations between a hospital's preparedness and its perceived ability to admit Ebola patients. The third survey identified 3 hospital characteristics that were significantly and independently associated with perceived ability to admit Ebola patients: large size, previous Ebola screening experience, and physician- and nurse-led hospital preparedness. Professional associations can use their member networks to collect timely survey data to inform best practices during and immediately after public health emergencies. (Disaster Med Public Health Preparedness. 2016;10:681-690).

Measuring physicians' trust: A scoping review with implications for public policy.

PubMed

Wilk, Adam S; Platt, Jodyn E

2016-09-01

Increasingly, physicians are expected to work in productive, trusting relationships with other health system stakeholders to improve patient and system outcomes. A better understanding of physicians' trust is greatly needed. This study assesses the state of the literature on physicians' trust in patients, other health care providers, institutions, and data systems or technology, and identifies key themes, dimensions of trust considered, quantitative measures used, and opportunities for further development via a scoping review. Peer-reviewed, English-language research articles were identified for inclusion in this study based on systematic searches of the Ovid/Medline, Pubmed, Proquest, Scopus, Elsevier, and Web of Science databases. Search terms included "trust" along with "physician," "doctor," "primary care provider," "family practitioner," "family practice," "generalist," "general practitioner," "general practice," "internist," "internal medicine," or "health professional," and plausible variants. Among the relevant articles identified (n = 446), the vast majority focused on patient trust in physicians (81.2%). Among articles examining physicians' trust, rigorous investigations of trust are rare, narrowly focused, and imprecise in their discussion of trust. Robust investigations of the effects of trust or distrust-as opposed to trust's determinants-and studies using validated quantitative trust measures are particularly rare. Studies typically measured trust using the language of confidence, effective communication, or cooperation, rarely or never capturing other important dimensions of trust, such as fidelity, the trustee's reputation, social capital, vulnerability, and acceptance. Research employing new, validated measures of physicians' trust, especially trust in institutions, may be highly informative to health system leaders and policymakers seeking to hone and enhance tools for improving the effectiveness and efficiency of the health care system

Physician Interactions with Electronic Health Records in Primary Care

PubMed Central

Montague, Enid; Asan, Onur

2013-01-01

Objective It is essential to design technologies and systems that promote appropriate interactions between physicians and patients. This study explored how physicians interact with Electronic Health Records (EHRs) to understand the qualities of the interaction between the physician and the EHR that may contribute to positive physician-patient interactions. Study Design Video-taped observations of 100 medical consultations were used to evaluate interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. Methods Ten primary care physicians and 100 patients from five clinics participated in the study. Clinical encounters were recorded with video cameras and coded using a validated objective coding methodology in order to examine how physicians interact with electronic health records. Results Three distinct styles were identified that characterize physician interactions with the EHR: technology-centered, human-centered, and mixed. Physicians who used a technology-centered style spent more time typing and gazing at the computer during the visit. Physicians who used a mixed style shifted their attention and body language between their patients and the technology throughout the visit. Physicians who used the human-centered style spent the least amount of time typing and focused more on the patient. Conclusion A variety of EHR interaction styles may be effective in facilitating patient-centered care. However, potential drawbacks of each style exist and are discussed. Future research on this topic and design strategies for effective health information technology in primary care are also discussed. PMID:24009982

Socioeconomic patterns in use of private and public health services in Spain and Britain: implications for equity in health care.

PubMed

Lostao, Lourdes; Blane, David; Gimeno, David; Netuveli, Gopalakrishnan; Regidor, Enrique

2014-01-01

This paper estimates the pattern of private and public physician visits and hospitalisation by socioeconomic position in two countries in which private healthcare expenditure constitutes a different proportion of the total amount spent on health care: Britain and Spain. Private physician visits and private hospitalisations were quantitatively more important in Spain than in Britain. In both countries, the use of private services showed a direct socioeconomic gradient. In Spain, the use of public GPs and public specialists tends to favour the worst-off, but no significant differences were observed in public hospitalisation. In Britain, with some exceptions, no significant socioeconomic differences were observed in the use of public health care services. The different pattern observed in the use of public specialist services may be due to the high frequency of visits to private specialists in Spain. © 2013 Published by Elsevier Ltd.

Satisfaction with organizational aspects of health care provision among Lithuanian physicians.

PubMed

Kairys, Jonas; Zebiene, Egle; Sapoka, Virginijus; Zokas, Ignas

2008-03-01

Physician satisfaction is considered an important factor influencing quality of health care provision, patient compliance, and costs to health care systems. Dissatisfaction leads to an increase in turnover of physicians and early retirement, which has a negative impact on continuity and quality of health care. Physician dissatisfaction with certain aspects of health care provision may also help to identify potential weaknesses in satisfactory functioning of health care systems. The aim of the current research project is to study the satisfaction with different organizational aspects of health care provision in Lithuania as judged by a selection of physicians. The study was conducted in Lithuania in June 2004. Physicians in randomly selected health care centers were invited to take part in the survey, 505 primary and secondary care physicians were interviewed by external interviewers during the study period. Physicians were asked to express their satisfaction on items presented in a questionnaire. The questionnaire consisted of 22 questions, evaluating different aspects of health care services - working conditions, workload, financial remuneration, organization of health care infrastructure and availability of laboratory services. Answers were presented by the 5 point Likert type scale, ranging from "very satisfied" (5) to "very dissatisfied" (1). Physicians who were most satisfied with their working conditions were working in private primary health care practices (91.1% satisfied or very satisfied), as compared with 54% of physicians working in state-owned primary care institutions and 49.7% in hospitals. Physicians working in cities and regional centers or towns were more satisfied with organizational aspects of health care services than physicians working in rural health care centers. Satisfaction with their financial remuneration showed that 74% of respondents stated they were "dissatisfied" or "very dissatisfied". While asked about potential deficiencies in

Confidentiality and physicians' health. A cross-sectional study of University Hospital Physicians in four European cities (the HOUPE-study).

PubMed

Løvseth, Lise Tevik; Aasland, Olaf Gjerløw; Fridner, Ann; Jónsdottir, Lilja Sigrun; Marini, Massimo; Linaker, Olav Morten

2010-01-01

To investigate how the subjective burden of confidentiality can act as a stressor that affects physicians' psychological health and wellbeing. Cross-sectional survey data from a sample of university hospital physicians (N=1,956) in four European countries (Sweden, Norway, Iceland and Italy) who participated in the HOUPE (Health and Organization among University hospital Physicians in Europe) study was analysed. About 25% of the participants reported that confidentiality impedes emotional support to a considerable degree. An index of confidentiality as a barrier to seeking support (ICBS) had a negative effect on physicians' health and wellbeing. The effect of ICBS was confirmed and slightly increased when controlled for variables known to buffer the adverse mental and physical effects of stress. Though the physicians in Iceland and in Norway found confidentiality the most challenging, it was the physicians in Italy and Sweden who showed a significant effect of ICBS on their health and wellbeing. Whether confidentiality is a stressor in its own right or an amplifier of stressful situations in medical practice should be further investigated to gain a better understanding of the effect of confidentiality on physicians' coping, stress and health. In addition, there is a need to investigate how physicians can balance coping with the inevitable emotional demands of medical practice and maintaining the ethics of confidentiality in a way that protects both patients' privacy rights and physicians' health and wellbeing.

Generalized public health and industrial nurses work together. 1949.

PubMed

Schwem, Margaret A

2009-01-01

Occupational health has been considered a subset of public health nursing for years. The first industrial or occupational health nurses were employed by large companies in the 1890s but the role evolved quickly in the early 20(th) century. By mid-century, many large companies employed a physician and nurse(s) to provide examinations, screenings, episodic care, and trauma intervention for workers. Occupational health nurses faced different problems than community-based public health nurses in generalized nursing service. The intersection of public health and employee health was apparent, though, because large industries often constituted the main workplace for a smaller community and sickness could spread throughout a town if the occupational health nurse was not well-prepared in principles of infection control and health promotion. Excerpts from this July 1949 article about building relationship between public health and industrial nurses illustrate the benefits hoped for when they were formally connected to one another through cross-training and in-service education. The author, Margaret Schwem, was a supervisor at the Rensselaer County Department of Health in Troy, New York. In the original article, Schwem included a list of reference materials for those interested in public health and industrial nursing.

The effect of message type on physician compliance with disease reporting requirements.

PubMed

Brissette, Ian; Gelberg, Kitty H; Grey, Anthony J

2006-01-01

Despite the existence of mandatory reporting laws, the underreporting of disease conditions to public health authorities is widespread. This article describes an evaluation of the effects of using different appeals to promote complete and timely reporting to the New York State Occupational Lung Disease Registry (NYS OLDR). Three-hundred sixty-eight physicians who had not reported patients were randomly assigned to receive correspondence emphasizing either the legal obligation to report, the public health benefits of reporting, or both. Chi-square tests were used to determine if the proportion of physicians who subsequently reported patients differed by message group. Chi-square tests and the Kruskall Wallis rank sum test were used to test for differences in the completeness and timeliness of reports received from physicians in the three message groups. Physicians receiving correspondence describing the legal obligation to report were more likely to report patients than those receiving only the benefit message, while those receiving correspondence describing the public health benefits of reporting submitted more complete reports than those receiving only the obligation message. To maximize physician reporting, it is important for public health agencies to emphasize both the legal and public health basis for reporting conditions in correspondence to physicians.

Opinions of Polish occupational medicine physicians on workplace health promotion.

PubMed

Puchalski, Krzysztof; Korzeniowska, Elzbieta; Pyzalski, Jacek; Wojtaszczyk, Patrycja

2005-01-01

According to the current Polish legislation on occupational health services, occupational medicine physicians should perform workplace health promotion (WHP) activities as a part of their professional work. The concept of workplace health promotion or health promotion programs, however, has not been defined in this legislation in any way. Therefore, two essential questions arise. First, what is the physicians' attitude towards workplace health issues and second, what is actually carried out under the label of health promotion? The main objective of the research described in this paper was to answer these questions. The survey was carried out by the National Center for Workplace Health Promotion in 2002. A questionnaire prepared by the Center for the purpose of this survey was sent to a random sample of occupational medicine physicians. The results of the survey showed that 53% of occupational medicine physicians consider WHP just as a new name for prophylactics. On the other hand almost all of the respondents (94%) agree that occupational medicine physicians should perform WHP activities and find them useful in improving patients' health (78%). The main obstacle for the development of this activity in the perception of physicians is the lack of interest in workplace health promotion among employers (86%). In the modern understanding of workplace health promotion concept this type of intervention includes not only safety measures and health education, but also a profound organizational change that allows employers, employees and social partners to improve wellbeing of people at work. Each of such projects should facilitate changes necessary to create a health promoting workplace. It also needs a skilled leader--well trained and aware of a multidisciplinary dimension of WHP interventions. Occupational medicine specialists should become natural partners of employers and employees. The majority of the occupational medicine physicians, however, are not sufficiently

42 CFR 405.2414 - Nurse practitioner and physician assistant services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Nurse practitioner and physician assistant services... Clinic and Federally Qualified Health Center Services § 405.2414 Nurse practitioner and physician... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who is...

Routine immunization of adults by pharmacists: Attitudes and beliefs of the Canadian public and health care providers

PubMed Central

MacDougall, D.; Halperin, B. A.; Isenor, J.; MacKinnon-Cameron, D.; Li, L.; McNeil, S. A.; Langley, J. M.; Halperin, S. A.

2016-01-01

Abstract Vaccine coverage among adults for recommended vaccines is generally low. In Canada and the US, pharmacists are increasingly becoming involved in the administration of vaccines to adults. This study measured the knowledge, attitudes, beliefs, and behaviors of Canadian adults and health care providers regarding pharmacists as immunizers. Geographically representative samples of Canadian adults (n = 4023) and health care providers (n = 1167) were surveyed, and 8 focus groups each were conducted nationwide with adults and health care providers. Provision of vaccines by pharmacists was supported by 64.6% of the public, 82.3% of pharmacists, 57.4% of nurses, and 38.9% of physicians; 45.7% of physicians opposed pharmacist-delivered vaccination. Pharmacists were considered a trusted source of vaccination information by 75.0% of the public, exceeding public health officials (68.3%) and exceeded only by doctors and nurses (89.2%). Public concerns about vaccination in pharmacies centered on safety (management of adverse events), record keeping (ensuring their family physician was informed), and cost (should be no more expensive than vaccination at public health or physicians' offices). Concerns about the logistics of vaccination delivery were expressed more frequently in regions where pharmacists were not yet immunizing than in jurisdictions with existing pharmacist vaccination programs. These results suggest that the expansion of pharmacists' scope of practice to include delivery of adult vaccinations is generally accepted by Canadian health care providers and the public. Acceptance of this expanded scope of pharmacist practice may contribute to improvements in vaccine coverage rates by improving vaccine accessibility. PMID:26810485

Prescribing Practices of Physicians at Different Health Care Institutions

PubMed Central

Mollahaliloglu, Salih; Alkan, Ali; Donertas, Basak; Ozgulcu, Senay; Akici, Ahmet

2013-01-01

Objective: Irrational pharmacotherapy is a widespread health care problem, and knowing the prescription practices of physicians at an institutional level can present solutions. This study aimed to investigate whether physicians’ prescribing patterns showed differences at the level of the health care institution. Materials and Methods: Photocopies of 3201 prescriptions written at primary health care centers (PHCs), public hospitals, private hospitals, and university hospitals (UHs) were collected from 10 provinces in Turkey. The prescriptions were evaluated according to prescribing indicators, and the details of drug utilization were compared for different health care institutions. Results: The average number of medicines per prescription was 2.83, and the highest average was noted in PHCs (2.96). The average cost per prescription was US $51.57, and the highest average cost was found in UHs (US $166.10). The most frequently prescribed drug group was different among health care institutions. With the exception of UHs, the “cold-cough medicines” were the most frequently prescribed medicines at all of the institutions. Thirty-nine percent of the prescriptions included antibiotics. Conclusion: Despite the similarities between the distributions of diagnoses on prescriptions by health care institutions, the contents of the prescriptions showed differences. The high levels of prescriptions for “cold-cough medicines,” whose use is widely debated, and the widespread tendency of physicians to prescribe antibiotics suggest that there is a growing need for disseminating the principles of rational pharmacotherapy. Furthermore, institutional differences must be considered when conducting rational pharmacotherapy programs. PMID:25610260

Utilization and Impact of Electronic and Print Media on the Patients' Health Status: Physicians' Perspectives.

PubMed

Shakeel, Sadia; Nesar, Shagufta; Rahim, Najia; Iffat, Wajiha; Ahmed, Hafiza Fouzia; Rizvi, Mehwish; Jamshed, Shazia

2017-01-01

Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors' opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. The current research is a cross-sectional study conducted from January 2015 to July 2015. The study population comprised physicians rendering their services in different hospitals of Karachi, Pakistan, selected by the nonprobability convenience sampling technique. In this study, 500 questionnaires were distributed through email or direct correspondence. Physicians' perception toward the impact of electronic and print media on the health status of patients was assessed with a 20-item questionnaire. Different demographic characteristics, such as age, gender, institution, position, and experience of respondents, were recorded. Quantitative data were analyzed with the use of Statistical Package for Social Sciences, version 20.0 (SPSS, Chicago, IL). The association of the demographic characteristics of the responses of physicians was determined by one-way ANOVA using 0.05 level of significance. In this study, 254 physicians provided consent to show their responses for research purposes. A response rate of 50.8% was obtained. Nearly one-third of the respondents negated that patients get health benefit using electronic and print media. The majority did not consider electronic and print media as lifestyle-modifying factors. Physicians thought that patients particularly do not rely on mass media for acquiring health information and consider healthcare professionals as unswerving information resource. Mass media can be productive resources to augment awareness among patients, although physicians seem unconvinced about the extended usage of print/electronic media.

[Mobility of physicians in Europe: health policies and health care provision].

PubMed

Jourdain, Alain; Pham, Tam

2017-03-06

Objective: To define the place of geographical mobility of physicians in medical demography policies in EU countries. Methods: Review of international migration assumptions in national projection models of numbers of physicians by broad categories of social protection systems in the EU. Results: Some countries fail to achieve medium-term projections of the number of physicians and those that do adopt the assumption of net migration, assume that they converge to zero. Migration is not considered to be a solution to the expected shortage of physicians, but rather a problem to be solved. Discussion: Three approaches to labour mobility are discussed: liberal, normative and ethical. The last approach appears to be the most popular by combining preservation of national interests with the World Health Organisation Global Code of Practice on the International Recruitment of Health Personnel.

Attitudes of Nigerian physicians toward a National Health Service.

PubMed

Umeh, J C; Freeman, R A; Garner, D D; Blevins, D E

1986-01-01

Despite efforts to improve health services in Nigeria, considerable problems in distribution and access persist. At present, the health care system in Nigeria is organized and financed at the states' level rather than at the national level. A severe maldistribution of resources exists, as does a lack of coordination among states. An alternative system, albeit expensive, is a National Health Service (NHS). The purpose of this research is to quantify physicians' attitudes towards the concept of NHS. Although physicians in Nigeria are mandated to provide government-funded support, a substantial private practice thrives. Accordingly, physicians' attitudes that may be transferred into behavior are a major determinate of a potential NHS' long term success. In summary, Hausa physicians from the north tended to be more favorable to NHS than did others. Also, younger physicians and those who believed Nigeria's present system to be inadequate favored NHS. There was no association between a physician's gender, locus of medical education, and source of support for medication education and attitude. Finally, physicians in private practice and those in urban areas held more negative attitudes. In spite of Nigeria's present difficulties, a NHS may become a viable alternative. At this point, the overall concept is not opposed by physicians.

Physician, heal thyself: Survey of users of the Quebec Physicians Health Program.

PubMed

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

2010-10-01

To document the opinions of the users of the Quebec Physicians Health Program (QPHP) about the services they received. Mailed questionnaire. Quebec. A total of 126 physicians who used QPHP services between 1999 and 2004. Users' overall rating of the QPHP services, their opinions about the program, and whether their situations improved as a result of accessing QPHP services. 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. 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.

The impact of health information technology and e-health on the future demand for physician services.

PubMed

Weiner, Jonathan P; Yeh, Susan; Blumenthal, David

2013-11-01

Arguably, few factors will change the future face of the American health care workforce as widely and dramatically as health information technology (IT) and electronic health (e-health) applications. We explore how such applications designed for providers and patients will affect the future demand for physicians. We performed what we believe to be the most comprehensive review of the literature to date, including previously published systematic reviews and relevant individual studies. We estimate that if health IT were fully implemented in 30 percent of community-based physicians' offices, the demand for physicians would be reduced by about 4-9 percent. Delegation of care to nurse practitioners and physician assistants supported by health IT could reduce the future demand for physicians by 4-7 percent. Similarly, IT-supported delegation from specialist physicians to generalists could reduce the demand for specialists by 2-5 percent. The use of health IT could also help address regional shortages of physicians by potentially enabling 12 percent of care to be delivered remotely or asynchronously. These estimated impacts could more than double if comprehensive health IT systems were adopted by 70 percent of US ambulatory care delivery settings. Future predictions of physician supply adequacy should take these likely changes into account.

[Economics, politics, and public health in Porfirian Mexico (1876-1910)].

PubMed

Carrillo, Ana María

2002-01-01

The article examines the scientific, political, and economic elements that permitted the birth of modern public health in Mexico under the Porfirio Díaz administration (1876-1910). Firstly, a portion of Mexican physicians were open to the discoveries of microbiology, immunology, and epidemiology. Secondly, the State's growing concentration of power in public health matters ran parallel to its concentration of disciplinary political power and enabled this new knowledge to be placed at the service of collective health problem prevention. Lastly, both imperialism and the Porfirian elite needed to protect their business interests. The article evaluates public health achievements and limitations during the Porfirian period, abruptly interrupted by the revolution begun in 1910.

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…

Hospital physician payment mechanisms in Austria: do they provide gateways to institutional corruption?

PubMed

Sommersguter-Reichmann, Margit; Stepan, Adolf

2017-12-01

Institutional corruption in the health care sector has gained considerable attention during recent years, as it acknowledges the fact that service providers who are acting in accordance with the institutional and environmental settings can nevertheless undermine a health care system's purposes as a result of the (financial) conflicts of interest to which the service providers are exposed. The present analysis aims to contribute to the examination of institutional corruption in the health sector by analyzing whether the current payment mechanism of separately remunerating salaried hospital physicians for treating supplementary insured patients in public hospitals, in combination with the public hospital physician's possibility of taking up dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals, has the potential to undermine the primary purposes of the Austrian public health care system. Based on the analysis of the institutional design of the Austrian public hospital sector, legal provisions and directives have been identified, which have the potential to promote conduct on the part of the public hospital physician that systematically undermines the achievement of the Austrian public health system's primary purposes.

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

PubMed

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

2014-11-28

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.

Relationships between nurse- and physician-to-population ratios and state health rankings.

PubMed

Bigbee, Jeri L

2008-01-01

To evaluate the relationship between nurse-to-population ratios and population health, as indicated by state health ranking, and to compare the findings with physician-to-population ratios. Secondary analysis correlational design. The sample consisted of all 50 states in the United States. Data sources included the United Health Foundation's 2006 state health rankings, the 2004 National Sample Survey for Registered Nurses, and the U.S. Health Workforce Profile from the New York Center for Health Workforce Studies. Significant relationships between nurse-to-population ratio and overall state health ranking (rho=-.446, p tf?>=.001) and 11 of the 18 components of that ranking were found. Significant components included motor vehicle death rate, high school graduation rate, violent crime rate, infectious disease rate, percentage of children in poverty, percentage of uninsured residents, immunization rate, adequacy of prenatal care, number of poor mental health days, number of poor physical health days, and premature death rate, with higher nurse-to-population ratios associated with higher health rankings. Specialty (public health and school) nurse-to-population ratios were not as strongly related to state health ranking. Physician-to-population ratios were also significantly related to state health ranking, but were associated with different components than nurses. These findings suggest that greater nurses per capita may be uniquely associated with healthier communities; however, further multivariate research is needed.

A Randomized Controlled Trial of the Effectiveness of Traditional and Mobile Public Health Communications With Health Care Providers.

PubMed

Baseman, Janet; Revere, Debra; Painter, Ian; Oberle, Mark; Duchin, Jeffrey; Thiede, Hanne; Nett, Randall; MacEachern, Dorothy; Stergachis, Andy

2016-02-01

Health care providers play an essential role in public health emergency preparedness and response. We conducted a 4-year randomized controlled trial to systematically compare the effectiveness of traditional and mobile communication strategies for sending time-sensitive public health messages to providers. Subjects (N=848) included providers who might be leveraged to assist with emergency preparedness and response activities, such as physicians, pharmacists, nurse practitioners, physician's assistants, and veterinarians. Providers were randomly assigned to a group that received time-sensitive quarterly messages via e-mail, fax, or cell phone text messaging (SMS) or to a no-message control group. Follow-up phone interviews elicited information about message receipt, topic recall, and perceived credibility and trustworthiness of message and source. Our main outcome measures were awareness and recall of message content, which was compared across delivery methods. Per-protocol analysis revealed that e-mail messages were recalled at a higher rate than were messaged delivered by fax or SMS, whereas the as-treated analysis found that e-mail and fax groups had similar recall rates and both had higher recall rates than the SMS group. This is the first study to systematically evaluate the relative effectiveness of public health message delivery systems. Our findings provide guidance to improve public health agency communications with providers before, during, and after a public health emergency.

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

Nongovernment Philanthropic Spending on Public Health in the United States.

PubMed

Shaw-Taylor, Yoku

2016-01-01

The objective of this study was to estimate the dollar amount of nongovernment philanthropic spending on public health activities in the United States. Health expenditure data were derived from the US National Health Expenditures Accounts and the US Census Bureau. Results reveal that spending on public health is not disaggregated from health spending in general. The level of philanthropic spending is estimated as, on average, 7% of overall health spending, or about $150 billion annually according to National Health Expenditures Accounts data tables. When a point estimate of charity care provided by hospitals and office-based physicians is added, the value of nongovernment philanthropic expenditures reaches approximately $203 billion, or about 10% of all health spending annually.

Nongovernment Philanthropic Spending on Public Health in the United States

PubMed Central

2016-01-01

The objective of this study was to estimate the dollar amount of nongovernment philanthropic spending on public health activities in the United States. Health expenditure data were derived from the US National Health Expenditures Accounts and the US Census Bureau. Results reveal that spending on public health is not disaggregated from health spending in general. The level of philanthropic spending is estimated as, on average, 7% of overall health spending, or about $150 billion annually according to National Health Expenditures Accounts data tables. When a point estimate of charity care provided by hospitals and office-based physicians is added, the value of nongovernment philanthropic expenditures reaches approximately $203 billion, or about 10% of all health spending annually. PMID:26562104

Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland

PubMed Central

Busato, André; Künzi, Beat

2008-01-01

Background The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. Methods The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Results Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. Conclusion The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted

Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland.

PubMed

Busato, André; Künzi, Beat

2008-01-11

The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds

Occupational and public health considerations for work-hour limitations policy regarding public health workers during response to natural and human-caused disasters.

PubMed

Berkowitz, Murray R

2012-01-01

This article examines the occupational health considerations that might impact the health and wellbeing of public health workers during responses to natural (eg, floods and hurricanes) and human-caused (eg, terrorism, war, and shootings) disasters. There are a number of articles in the medical literature that argue the impact of how working long hours by house staff physicians, nurses, and first-responders may pose health and safety concerns regarding the patients being treated. The question examined here is how working long hours may pose health and/or safety concerns for the public health workers themselves, as well as to those in the communities they serve. The health problems related to sleep deprivation are reviewed. Current policies and legislations regarding work-hour limitations are examined. Policy implications are discussed.

HIPAA for physicians in the information age.

PubMed

Kavoussi, Shaheen C; Huang, John J; Tsai, James C; Kempton, James E

2014-08-01

The increased prominence of electronic health records, email, mobile devices, and social media has transformed the health care environment by providing both physicians and patients with opportunities for rapid communication and knowledge exchange. However, these technological advances require increased attention to patient privacy under the Health Insurance Portability and Accountability Act (HIPAA). Instant access to large amounts of electronic protected health information (PHI) merits the highest standard of network security and HIPAA training for all staff members. Physicians are responsible for protecting PHI stored on portable devices. Personal, residential, and public wireless connections are not certified with HIPAA-compliant Business Associate Agreements and are unsuitablefor PHI. A professional and privacy-oriented approach to electronic communication, online activity, and social media is imperative to maintaining public trust in physician integrity. As new technologies are integrated into health care practice, the assurance of privacy will encourage patients to continue to seek medical care.

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

Proficiency in personal selling: prescription for physician marketing.

PubMed

Friedman, M L

1990-01-01

In a highly competitive and dynamic environment health care providers are turning to marketing techniques to compete. To date, the majority of marketing efforts in the health care industry have revolved around the use of promotional tools, mainly advertising, publicity and public relations. It is proposed here that personal selling is a neglected, but important, promotional tool for health care marketers, especially physicians. The analogy between physician and salesperson is drawn, various influence techniques commonly used in personal selling situations are discussed, and a methodology proposed for the systematic study of how physicians might adjust their use of such personal influence techniques to the situation so as to be more effective in terms of patient satisfaction and compliance.

Veterinary medicine and public health at CDC.

PubMed

King, Lonnie J

2006-12-22

People readily associate the role of veterinarians with private veterinary practice focused on pets and farm animals, but the true dimensions and contributions of veterinary medicine are much broader and reflect expanding societal needs and contemporary challenges to animal and human health and to the environment. Veterinary medicine has responsibilities in biomedical research; ecosystem management; public health; food and agricultural systems; and care of companion animals, wildlife, exotic animals, and food animals. The expanding role of veterinarians at CDC reflects an appreciation for this variety of contributions. Veterinarians' educational background in basic biomedical and clinical sciences compare with that of physicians. However, unlike their counterparts in human medicine, veterinarians must be familiar with multiple species, and their training emphasizes comparative medicine. Veterinarians are competent in preventive medicine, population health, parasitology, zoonoses, and epidemiology, which serve them well for careers in public health. The history and tradition of the profession always have focused on protecting and improving both animal health and human health.

MENTAL HEALTH OF PHYSICIANS--NATIONWIDE REPRESENTATIVE STUDY FROM HUNGARY.

PubMed

Győrffy, Zsuzsa; Girasek, Edmond

2015-07-30

Somatic and mental health and stress factors of physicians became an issue of growing interest in both national and international investigations. Our aim is to give an overview of the mental state of Hungarian physicians. Cross-sectional, quantitative survey on a representative sample of Hungarian physicians (n = 4784). The control group was formed by the population group of a national survey conducted by "Hungarostudy 2013" (n = 2000). Suicidal thoughts (18.8% vs. 9.6%, p < 0.001), the scores of Somatic Symptom Scale (PHQ-10, 20.4% vs. 13.6%, p < 0.001) were significantly higher among physicians. The suicidal attempts (1.9% vs. 3.5%, p = 0.053) and BDI depression scores (7.9% vs. 29.5%, p < 0.001) were significantly higher in the control group. High Perceived Stress Scale (PPS) scores occurred in 43.3% of the physicians sample, and 43.4% of them had high scores in the Athenian Insomnia Scale (AIS). The young (< 35) female physicians showed significantly higher rates of suicidal thoughts, higher scores of PHQ and PPS. In the young female cohort, the AIS scores were significantly higher than of the other physicians. Mental health of physicians (sleep disorders, suicidal thoughts and psychosomatic symptoms) showed poorer results than the population data. BDI scores and the rate of suicidal attempts showed favourable trends. The next step in the research of physicians' mental health is to investigate the most serious risk factors, and to refine the preventive tools.

Should physicians' dual practice be limited? An incentive approach.

PubMed

González, Paula

2004-06-01

We develop a principal-agent model to analyze how the behavior of a physician in the public sector is affected by his activities in the private sector. We show that the physician will have incentives to over-provide medical services when he uses his public activity as a way of increasing his prestige as a private doctor. The health authority only benefits from the physician's dual practice when it is interested in ensuring a very accurate treatment for the patient. Our analysis provides a theoretical framework in which some actual policies implemented to regulate physicians' dual practice can be addressed. In particular, we focus on the possibility that the health authority offers exclusive contracts to physicians and on the implications of limiting physicians' private earnings. Copyright 2004 John Wiley & Sons, Ltd.

Democratic and Republican physicians provide different care on politicized health issues.

PubMed

Hersh, Eitan D; Goldenberg, Matthew N

2016-10-18

Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians' own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians' political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues-and only on such issues-Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician's political attitudes might affect patient care is important to physicians and patients alike.

From primary care to public health: using Problem-based Learning and the ecological model to teach public health to first year medical students.

PubMed

Hoover, Cora R; Wong, Candice C; Azzam, Amin

2012-06-01

We investigated whether a public health-oriented Problem-Based Learning case presented to first-year medical students conveyed 12 "Population Health Competencies for Medical Students," as recommended by the Association of American Medical Colleges and the Regional Medicine-Public Health Education Centers. A public health-oriented Problem-Based Learning case guided by the ecological model paradigm was developed and implemented among two groups of 8 students at the University of California, Berkeley-UCSF Joint Medical Program, in the Fall of 2010. Using directed content analysis, student-generated written reports were coded for the presence of the 12 population health content areas. Students generated a total of 29 reports, of which 20 (69%) contained information relevant to at least one of the 12 population health competencies. Each of the 12 content areas was addressed by at least one report. As physicians-in-training prepare to confront the challenges of integrating prevention and population health with clinical practice, Problem-Based Learning is a promising tool to enhance medical students' engagement with public health.

Responsibilities and resources of on-call public health doctors.

PubMed

Sarangi, J; Mackenzie, I; Pearson, N

1995-01-01

We investigated the resource available for public health doctors to carry out statutory responsibilities out-of-hours by a postal questionnaire survey of consultants in communicable disease control (CsCDC) in England and Wales. The questionnaire requested details of local District Health Authority (DHA) population profile, major incident and outbreak policies, the background of the CCDC, out-of-hours communication, access and resources, reference materials and medical equipment carried by the public health doctor on duty. The CsCDC from 96% (121/126) DHAs in England and Wales responded. Whilst 85% (101/119) of public health doctors carried policies on infectious disease when on duty, only 28% (32/116) carried policies on dealing with chemical incidents and 25% (28/111) carried the District policy to deal with radiation hazards. Twenty-six per cent (32/121) of public health physicians had no access to their District headquarters. There is a wide variation in the standard of resources available to on-call public health doctors in England and Wales; following Department of Health and Department of the Environment guidance, Health Authorities need to ensure that they have adequate arrangements in the event of any major incident or outbreak.

Physicians as Executives: Opportunities and Strategies for Health-System Pharmacy Leaders

PubMed Central

Harvin, Andre; Griffith, Niesha; Weber, Robert J.

2014-01-01

To deal with the pressures in health care that stress clinical excellence and profitability, health systems are increasingly recruiting physician executives or physicians in leadership and management positions. Physicians occupy less than 5% of all hospital leadership positions, but there is an apparent increase in the recruitment of physician executives. With the growth in the number of physician executives, pharmacy leaders must capitalize on their existing clinical relationship and apply it to health care leadership and management. By focusing on developing an executive presence, by clearly describing a patient-centered strategy and vision for pharmacy, and by nurturing the existing clinical relationships, the pharmacy director can work with physician executives to promote patient-centered pharmacy services. PMID:25477571

Time to address gender inequalities against female physicians.

PubMed

Hannawi, Suad; Al Salmi, Issa

2017-11-10

Although the health care system depends heavily on female physicians, it discriminates against women and tends to concentrate female physicians' work in lower status occupations. Gender discrimination has structural, social, and cultural dimensions. Such discrimination is perceived differently by various stakeholders and the public. In addition, there is reluctance to publicly acknowledge gender discrimination, especially in the culturally conservative Middle East region. Gender discrimination leads to underrepresentation of female physicians in leadership roles and certain specialties and hence leads to less attention and understanding of the working conditions of female physicians and their roles in the health care system. The lack of accessible data in the region regarding gender discrimination among physicians leads to stakeholders failing to recognize the existence and magnitude of this type of discrimination. This article takes up the relatively neglected issue of gender discrimination in the health care workforce among the stakeholders of the Ministry of Health and Prevention of the United Arab Emirates. Future research should explore the extent of gender discrimination among physicians and the gender remuneration gap, together with other sorts of discrimination, perception of equal opportunity, and dominant stereotypes of men and women working in health care in relation to job obligation, promotion, retention, remuneration, and education. Copyright © 2017 John Wiley & Sons, Ltd.

Physician equity in health care delivery systems: three alternative models.

PubMed

Kennedy, K M; Wofford, D A

1998-01-01

The 1990s have seen many health care organizations attempting to merge, acquire, or affiliate with physician groups. Many have failed to provide physicians a stake in the success of the newly formed enterprise, frequently resulting in declining physician productivity, poor morale, and large operating losses. These problems warrant a reexamination of the traditional acquisition model of growth in favor of structures that retain a physician ownership component. This article examines three models of health care organization in which physicians share in the success of the enterprise and compares them in terms of ownership structure, governance, and funds flow.

Collaboration between family physicians and psychologists

PubMed Central

Grenier, Jean; Chomienne, Marie-Hélène; Gaboury, Isabelle; Ritchie, Pierre; Hogg, William

2008-01-01

OBJECTIVE To explore factors affecting collaboration between family physicians and psychologists. DESIGN Mailed French-language survey. SETTING Eastern Ontario. PARTICIPANTS Family physicians practising in the area of the Réseau des services de santé en français de l’Est de l’Ontario. MAIN OUTCOME MEASURES Physicians’ knowledge and understanding of the qualifications of psychologists and the regulations governing their profession; beliefs regarding the effectiveness of psychological treatments; views on the integration of psychologists into primary care; and factors affecting referrals to psychologists. RESULTS Of 457 surveys sent, 118 were returned and analyzed (27% of surveys delivered). Most family physicians were well aware that there were evidence-based psychological interventions for mental health and personal difficulties, and some knew that psychological interventions could help with physical conditions. Physicians had some knowledge about the qualifications and training of psychologists. Many physicians reported being uncomfortable providing counseling themselves owing to time constraints, the perception that they were inadequately trained for such work, and personal preferences. The largest barrier to referring patients to psychologists was cost, since services were not covered by public health insurance. Some physicians were deterred from referring by previous experience of not receiving feedback on patients from psychologists. Increased access to clinical psychologists through collaborative care was considered a desirable goal for primary health care. CONCLUSIONS Family physicians know that there are evidence-based psychological interventions for mental health issues. Psychologists need to communicate better about their credentials and what they can offer, and share their professional opinions and recommendations on referred patients. Physicians would welcome practice-based psychological services and integrated interdisciplinary collaboration

Health Literacy-Related Knowledge, Attitude, and Perceived Barriers: A Cross-sectional Study among Physicians, Pharmacists, and Nurses in Public Hospitals of Penang, Malaysia.

PubMed

Rajah, Retha; Hassali, Mohamed Azmi; Lim, Ching Jou

2017-01-01

Patients' health literacy (HL) has emerged as a critical determinant of health outcomes and becoming one of the core competencies of health-care providers. Therefore, this study aimed to assess among Malaysian physicians, pharmacists, and nurses, their HL-related knowledge, attitude, and perceived barriers, and also to determine the associated factors. A cross-sectional study design was used to enroll 600 eligible respondents using stratified sampling from 6 public hospitals in Penang, Malaysia. A validated self-administered questionnaire was used for data collection. Descriptive and inferential analysis was performed with statistical significance defined as p  < 0.05. The response rate was 87.6% with 526 questionnaires completed. Of these, 34.2% had poor knowledge, and more than half had negative attitude (51.9%) toward HL with no significant differences among physicians, pharmacists, and nurses. The majority of the respondents perceived time constraints and lack of human resources as major HL barriers. Respondents who had heard the term or concept of HL had significantly higher level of knowledge ( p  < 0.001) and more positive attitude ( p  < 0.001). While longer service years (≥11 years) significantly contribute to the higher level of HL knowledge among health-care providers ( p  = 0.028). The study findings supported the concern on inadequate knowledge and substantially negative attitude toward HL among study health-care providers with highest cited barriers were time constraint and human resources. Thus, efforts to improve their perspective about HL to be effective patient educators are highly advocated.

Taking health care back: the physician's role in quality improvement.

PubMed

Becher, Elise C; Chassin, Mark R

2002-10-01

Physicians now enjoy a moment of tactical advantage in the evolution of the struggle for control over health care in the United States. The most effective way to capitalize on this-perhaps fleeting-position and to more permanently alter the balance of power in their favor is for physicians to establish strong and visionary leadership in health care quality improvement. Such an undertaking, if successful, could place the very essence of health care-defining, measuring, and improving its quality-in the hands of physicians. To succeed requires understanding the relationships between the different kinds of quality problems that plague our health care system, the various kinds of errors that lead to them, and how amenable these different kinds of errors may be to different interventions. The authors delineate a conceptual framework that describes these relationships, as well as their implications for conducting effective and durable quality improvement. The authors then illustrate how physicians could engage in this activity in three different settings: a four-or-five-physician primary care practice, a 50-physician multispecialty group, and a 450-bed community hospital. Finally, the authors submit that now is an opportune time for physicians and the organizations they direct or guide to take the leadership role in conducting health care quality improvement. Realizing the opportunity will require dedicating significant resources and changing traditional approaches to quality, but in so doing, physicians can regain much of the autonomy over the practice of medicine previously lost to government and managed care.

The effect of hospital-physician integration on health information technology adoption.

PubMed

Lammers, Eric

2013-10-01

The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co-invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology. Copyright © 2012 John Wiley & Sons, Ltd.

Refugees' advice to physicians: how to ask about mental health.

PubMed

Shannon, Patricia J

2014-08-01

About 45.2 million people were displaced from their homes in 2012 due to persecution, political conflict, generalized violence and human rights violations. Refugees who endure violence are at increased risk of developing chronic psychiatric disorders such as posttraumatic stress disorder and major depression. The primary care visit may be the first opportunity to detect the devastating psychological effects of trauma. Physicians and refugees have identified communication barriers that inhibit discussions about mental health. In this study, refugees offer advice to physicians about how to assess the mental health effects of trauma. Ethnocultural methodology informed 13 focus groups with 111 refugees from Burma, Bhutan, Somali and Ethiopia. Refugees responded to questions concerning how physicians should ask about mental health in acceptable ways. Focus groups were recorded, transcribed and analyzed using thematic categorization informed by Spradley's Developmental Research Sequence. Refugees recommended that physicians should take the time to make refugees comfortable, initiate direct conversations about mental health, inquire about the historical context of symptoms and provide psychoeducation about mental health and healing. Physicians may require specialized training to learn how to initiate conversations about mental health and provide direct education and appropriate mental health referrals in a brief medical appointment. To assist with making appropriate referrals, physicians may also benefit from education about evidence-based practices for treating symptoms of refugee trauma. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014.

PubMed

Cherry, Donald; Albert, Michael; McCaig, Linda F

2018-06-01

In 2016, mental illness affected about 45 million U.S. adults (1). Although mental health-related office visits are often made to psychiatrists (2), primary care physicians can serve as the main source of treatment for patients with mental health issues (3); however, availability of provider type may vary by geographic region (3,4). This report uses data from the 2012-2014 National Ambulatory Medical Care Survey (NAMCS) to examine adult mental healthrelated physician office visits by specialty and selected patient characteristics. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Motivational determinants among physicians in Lahore, Pakistan.

PubMed

Malik, Ahmad Azam; Yamamoto, Shelby Suzanne; Souares, Aurélia; Malik, Zeeshan; Sauerborn, Rainer

2010-07-09

Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries. A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural. Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians. Motivational determinants differed across different levels of care, sectors and genders. Nonetheless, the

Understanding a Nonlinear Causal Relationship Between Rewards and Physicians' Contributions in Online Health Care Communities: Longitudinal Study.

PubMed

Wang, Jying-Nan; Chiu, Ya-Ling; Yu, Haiyan; Hsu, Yuan-Teng

2017-12-21

The online health care community is not just a place for the public to share physician reviews or medical knowledge, but also a physician-patient communication platform. The medical resources of developing countries are relatively inadequate, and the online health care community is a potential solution to alleviate the phenomenon of long hospital queues and the lack of medical resources in rural areas. However, the success of the online health care community depends on online contributions by physicians. The aim of this study is to examine the effect of incentive mechanisms on physician's online contribution behavior in the online health community. We addressed the following questions: (1) from which specialty area are physicians more likely to participate in online health care community activities, (2) what are the factors affecting physician online contributions, and (3) do incentive mechanisms, including psychological and material rewards, result in differences of physician online contributions? We designed a longitudinal study involving a data sample in three waves. All data were collected from the Good Doctor website, which is the largest online health care community in China. We first used descriptive statistics to investigate the physician online contribution behavior in its entirety. Then multiple linear and quadratic regression models were applied to verify the causal relationship between rewards and physician online contribution. Our sample included 40,300 physicians from 3607 different hospitals, 10 different major specialty areas, and 31 different provinces or municipalities. Based on the multiple quadratic regression model, we found that the coefficients of the control variables, past physician online contributions, doctor review rating, clinic title, hospital level, and city level, were .415, .189, -.099, -.106, and -.143, respectively. For the psychological (or material) rewards, the standardized coefficient of the main effect was 0.261 (or 0

Direct-to-consumer advertising: public perceptions of its effects on health behaviors, health care, and the doctor-patient relationship.

PubMed

Murray, Elizabeth; Lo, Bernard; Pollack, Lance; Donelan, Karen; Lee, Ken

2004-01-01

To determine public perceptions of the effect of direct-to-consumer advertising (DTCA) of prescription medications on health behaviors, health care utilization, the doctor-patient relationship, and the association between socioeconomic status and these effects. Cross-sectional survey of randomly selected, nationally representative sample of the US public using computer-assisted telephone interviewing. numbers and proportions of respondents in the past 12 months who, as a result of DTCA, requested preventive care or scheduled a physician visit; were diagnosed with condition mentioned in advertisement; disclosed health concerns to a doctor; felt enhanced confidence or sense of control; perceived an effect on the doctor-patient relationship; requested a test, medication change, or specialist referral; or manifested serious dissatisfaction after a visit to a doctor. As a result of DTCA, 14% of respondents disclosed health concerns to a physician, 6% requested preventive care, 5% felt more in control during a physician visit; 5% made requests for a test, medication change, or specialist referral, and 3% received the requested intervention. One percent of patients reported negative outcomes, including worsened treatment, serious dissatisfaction with the visit, or that the physician acted challenged. Effects of DTCA were greater for respondents with low socioeconomic status. DTCA has positive and negative effects on health behaviors, health service utilization, and the doctor-patient relationship that are greatest on people of low socioeconomic status. The benefits of DTCA in terms of encouraging hard-to-reach sections of the population to seek preventive care must be balanced against increased health care costs caused by clinically inappropriate requests generated by DTCA.

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area.

PubMed

Pappa, Evelina; Niakas, Dimitris

2006-11-02

Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

A clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico.

PubMed Central

Bojalil, R.; Guiscafré, H.; Espinosa, P.; Viniegra, L.; Martínez, H.; Palafox, M.; Gutiérrez, G.

1999-01-01

In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussions of cases under guidance. Each training course was limited to six physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhoea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counselling for mothers; that of ARI case management covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counselling for mothers. In general the performance of public physicians both before and after the intervention was better than that of private doctors. Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands

Critical factors in recruiting health maintenance organization physicians.

PubMed

Fisher, N B; Smith, H L; Pasternak, D P

1993-01-01

What factors facilitate successful physician recruiting by health care organizations? Answers surfaced in a study of physician recruiting by a large HMO in the Southwest. Professional networking and word-of-mouth advertising appear to be the prominent means by which physicians learn of attractive staff positions. Successful recruiting also depends on a practice setting that fosters quality care, emphasis on patient care delivery, and collegial interaction.

Patient experience with outpatient encounters at public hospitals in Shanghai: Examining different aspects of physician services and implications of overcrowding.

PubMed

Bao, Yuhua; Fan, Guanrong; Zou, Dongdong; Wang, Tong; Xue, Di

2017-01-01

Over 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care. To assess outpatient experience with different aspects of physician services at China's public hospitals and its association with overcrowding of the hospital outpatient departments. Retrospective analysis of a large survey of outpatient experience in Shanghai, China. We tested the hypotheses that patient experience was poorer with physician-patient communication, education, and shared decision-making and where and when there was greater overcrowding of the hospital outpatient departments. Ordered logistic models were estimated separately for general and specialty hospitals. 7,147 outpatients at 40 public hospitals in Shanghai, China, in 2014. Patient experience with physician services were self-reported based on 12 questions as part of a validated instrument. Indicators of overcrowding included time of visit (morning vs. afternoon, Monday vs. rest of the week) and hospital outpatient volume in the first half of 2014. Overall, patients reported very favorable experience with physician services. Two out of the 12 questions pertaining to both communication and shared decision-making consistently received lower ratings. Hospitals whose outpatient volumes were in the top two quartiles received lower patient ratings, but the relationship achieved statistical significance among specialty hospitals only. Inadequate physician-patient communication and shared decision-making and hospital overcrowding compromise outpatient experience with physician services at Chinese public hospitals. Effective diversion of patients with chronic and less complex conditions to community health centers will be critical to alleviate the extreme workloads at hospitals with high patient volumes and, in turn, improve patient experience.

A study of national physician organizations' efforts to reduce racial and ethnic health disparities in the United States.

PubMed

Peek, Monica E; Wilson, Shannon C; Bussey-Jones, Jada; Lypson, Monica; Cordasco, Kristina; Jacobs, Elizabeth A; Bright, Cedric; Brown, Arleen F

2012-06-01

To characterize national physician organizations' efforts to reduce health disparities and identify organizational characteristics associated with such efforts. This cross-sectional study was conducted between September 2009 and June 2010. The authors used two-sample t tests and chi-square tests to compare the proportion of organizations with disparity-reducing activities between different organizational types (e.g., primary care versus subspecialty organizations, small [<1,000 members] versus large [>5,000 members]). Inclusion criteria required physician organizations to be (1) focused on physicians, (2) national in scope, and (3) membership based. The number of activities per organization ranged from 0 to 22. Approximately half (53%) of organizations had 0 or 1 disparity-reducing activities. Organizational characteristics associated with having at least 1 disparity-reducing effort included membership size (88% of large groups versus 58% of small groups had at least 1 activity; P = .004) and the presence of a health disparities committee (95% versus 59%; P < .001). Primary care (versus subspecialty) organizations and racial/ethnic minority physician organizations were more likely to have disparity-reducing efforts, although findings were not statistically significant. Common themes addressed by activities were health care access, health care disparities, workforce diversity, and language barriers. Common strategies included education of physicians/trainees and patients/general public, position statements, and advocacy. Despite the national priority to eliminate health disparities, more than half of national physician organizations are doing little to address this problem. Primary care and minority physician organizations, and those with disparities committees, may provide leadership to extend the scope of disparity-reduction efforts.

42 CFR 415.130 - Conditions for payment: Physician pathology services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions for payment: Physician pathology... Physician Services to Beneficiaries in Providers § 415.130 Conditions for payment: Physician pathology... of physician pathology services to fee-for-service Medicare beneficiaries who were hospital...

Occupational physicians and environmental medicine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ducatman, A.M.

1993-03-01

Physicians who practice environmental medicine seek to identify and to prevent patient and population exposures that cause adverse human health outcomes. Epidemiologic, toxicologic, clinical, and public health skills essential to this enterprise are indistinguishable from those of the occupational physician. Several important controversies illustrate the essential role of occupational physicians in environmental health science and policy, including environmental asbestos, dioxin, electromagnetic fields, and carcinogenicity testing. Our continuing involvement in environmental issues is predicted by three conditions, each unlikely to change. The human remains the animal of greatest interest; the natural experiment will have been performed (however unwittingly); and the workmore » site will continue to provide that first and clearest setting for measuring the outcome. Therefore, residency training must be expanded so that future occupational and environmental physicians will recognize their fundamental role in environmental health. The results of our industry cross factory walls with ease. So must our efforts.« less

Seniors’ Perceptions Of Health Care Not Closely Associated With Physician Supply

PubMed Central

Nyweide, David J.; Anthony, Denise L.; Chang, Chiang-Hua; Goodman, David

2011-01-01

We conducted a national random survey of Medicare beneficiaries to better understand the association between the supply of physicians and patients’ perceptions of their health care. We found that patients living in areas with more physicians per capita had perceptions of their health care that were similar to those of patients in regions with fewer physicians. In addition, there were no significant differences between the groups of patients in terms of numbers of visits to their personal physician in the previous year; amount of time spent with a physician; or access to tests or specialists. Our results suggest that simply training more physicians is unlikely to lead to improved access to care. Instead, focusing health policy on improving the quality and organization of care may be more beneficial. PMID:21289342

Welfare, wellness, and job satisfaction of Chinese physicians: A national survey of public tertiary hospitals in China.

PubMed

Sun, Jing; Ma, Jing; Hu, Guangyu; Zhao, Qi; Yuan, Changzheng; Si, Wen; Zhang, Xinqing; Liu, Yuanli

2017-07-01

Little national data are available on Chinese physicians' welfare, wellness, and job satisfaction. We conducted a self-administered smartphone-based national survey in early 2016 of 17 945 physicians from 136 tertiary hospitals across 31 provinces in China. In addition to collecting the physicians' basic information, we also measured 5 domains (the ethical and working environments, welfare, wellness, and job satisfaction). Half of the physicians reported a hospital-based annual income of less than RMB 72 000 ($10 300), and 60.31% of them did not think that the current medical pricing system reflects physicians' value. More than half (58.64%) of them did not have or did not know about medical malpractice insurance. These physicians worked long hours (an average of 10 h) and slept short hours (average 6 h). Only 35.78% of them thought that they were in good health, and 51.03% were in good mental health. Approximately, a quarter of them had helped to pay medical bills for patients who could not afford care, and 1 in 7 has been penalised for seeing patients who generated bad debts. Only 33.42% of them thought that their occupation receives social recognition and respect, and 70.98% would not encourage their children to pursue a medical career. The top 3 factors that may influence physician job satisfaction as chosen by the physicians were as follows: (1) the income distribution policy (45.92%), (2) working environment safety (25.86%), and (3) public trust and respect for their job (16.10%). In conclusion, we found that Chinese physicians bear heavy physical, mental, and financial stress, and many of them lack confidence that they receive trust and respect from society. Copyright © 2017 John Wiley & Sons, Ltd.

Adoption of health promotion practices in a cohort of U.S. physician organizations.

PubMed

Bellows, Nicole M; McMenamin, Sara B; Halpin, Helen A

2010-12-01

Physician organizations such as medical groups and independent practice associations can play a vital role in health promotion through the adoption of effective health promotion practices such as health risk assessments, patient reminder systems, and health promotion education programs. To examine organizational changes in a cohort of physician organizations and changing health promotion practices. Data for a cohort of 369 physician organizations in the U.S. with 20 or more physicians were collected between September 2000 and September 2001 and subsequently from March 2006 to March 2007. Paired-sample t tests were used to identify changes in physician organization characteristics and the use of nine health promotion practices between 2000-2001 and 2006-2007. Compared to 2000-2001, the cohort of physician organizations in 2006-2007 was larger, more likely to be owned by physicians; less likely to be owned by a hospital, health system, or HMO; more profitable; and more likely to use electronic information technology. Between 2000-2001 and 2006-2007, physician organizations increased the use of health risk appraisals to contact high-risk patients and increased the use of reminders for eye exams for diabetic patients. During the same time period, physician organizations decreased the use of nutrition and weight-loss health promotion programs. The adding and dropping of programs among physician organizations is due to many factors, including changing regulatory environments, market conditions, populations, and new health promotion technologies. In the coming years, incentives and regulatory policy should encourage the adoption of effective health promotion practices by physician organizations. Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Chances and risks of publication of quality data - the perspectives of Swiss physicians and nurses.

PubMed

Heller, Regula; Schwappach, David

2012-10-26

The release of quality data from acute care hospitals to the general public is based on the aim to inform the public, to provide transparency and to foster quality-based competition among providers. Due to the expected mechanisms of action and possibly the adverse consequences of public quality comparison, it is a controversial topic. The perspective of physicians and nurses is of particular importance in this context. They are mainly responsible for the collection of quality-control data, and are directly confronted with the results of public comparison. The research focus of this qualitative study was to discover what the views and opinions of the Swiss physicians and nurses were regarding these issues. It was investigated as to how the two professional groups appraised the opportunities as well as the risks of the release of quality data in Switzerland. A qualitative approach was chosen to answer the research question. For data collection, four focus groups were conducted with physicians and nurses who were employed in Swiss acute care hospitals. Qualitative content analysis was applied to the data. The results revealed that both occupational groups had a very critical and negative attitude regarding the recent developments. The perceived risks were dominating their view. In summary, their main concerns were: the reduction of complexity, the one-sided focus on measurable quality variables, risk selection, the threat of data manipulation and the abuse of published information by the media. An additional concern was that the impression is given that the complex construct of quality can be reduced to a few key figures, and it that it is constructed from a false message which then influences society and politics. This critical attitude is associated with the different value system and the professional self-concept that both physicians and nurses have, in comparison to the underlying principles of a market-based economy and the economic orientation of health care

Smoking and health: a physician's responsibility. A statement of the Joint Committee on Smoking and Health. American College of Chest Physicians, American Thoracic Society, Asia Pacific Society of Respirology, Canadian Thoracic Society, European Respiratory Society, International Union Against Tuberculosis and Lung Disease.

PubMed

1995-10-01

Tobacco use, particularly cigarette smoking, is a major cause of preventable disease and premature death worldwide. Both smokers and nonsmokers exposed to environmental tobacco smoke are at risk. Cessation of smoking reduces risks. Although the addicting properties of nicotine can make cessation difficult, both medical interventions aimed at helping smokers quit and social policies aimed at control of cigarette smoking can have significant benefits. Physicians should play an active role in control of smoking by ensuring that counselling and pharmacological therapy must be available for the individual smoker. Physicians should also participate in the public debate regarding smoking both individually and through medical organizations. As smoking represents a threat to the public health, physicians must take a strong and active role seeking its control.

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.

Non-physician-assisted suicide in The Netherlands: a cross-sectional survey among the general public.

PubMed

Schoonman, Merel Kristi; van Thiel, Ghislaine José Madeleine Wilhelmien; van Delden, Johannes Jozef Marten

2014-12-01

In The Netherlands, approximately 45% of patients' requests for euthanasia are granted by a physician. After a rejected request, some patients approach non-physicians and ask them for assistance in suicide. Recently, a non-physician who assisted his mother's suicide was declared guilty without punishment. The aim of the current study was to investigate the opinion of the Dutch general public on non-physician-assisted suicide. A cross-sectional survey among the Dutch general public was performed. A total of 1113 respondents were included (response rate 80%). The survey covered two case descriptions in which a patient asks a non-physician for assisted suicide after a non-granted request for physician-assisted dying. In both cases, a son, friend or professional facilitates the suicide by either the provision of information or the purchase of lethal medication. Respondents were invited to give their opinion on these cases and in addition on 10 propositions on non-physician-assisted suicide. When a son provides information on how to acquire lethal medication in case of a patient with a terminal illness, this involvement is accepted by 62% of the respondents. The actual purchase of lethal medication receives less support (38%). If the patient suffers without a serious disease, both forms of assistance are less accepted (46% and 24%, respectively). In addition, only 21% support the legalisation of non-physician-assisted suicide. The Dutch public prefer involvement of a physician in assisted suicide (69%). The Dutch general public consider non-physician-assisted suicide in some specific cases a tolerable alternative for patients with a rejected request for physician-assisted dying if the assistance is limited to the provision of information. However, the majority do not support the legalisation of non-physician-assisted suicide. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Democratic and Republican physicians provide different care on politicized health issues

PubMed Central

Hersh, Eitan D.; Goldenberg, Matthew N.

2016-01-01

Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians’ own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues—and only on such issues—Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician’s political attitudes might affect patient care is important to physicians and patients alike. PMID:27698126

Mental health practice and attitudes of family physicians can be changed!

PubMed

MacCarthy, Dan; Weinerman, Rivian; Kallstrom, Liza; Kadlec, Helena; Hollander, Marcus J; Patten, Scott

2013-01-01

An adult mental health module was developed in British Columbia to increase the use of evidence-based screening and cognitive behavioral self-management tools as well as medications that fit within busy family physician time constraints and payment systems. Aims were to enhance family physician skills, comfort, and confidence in diagnosing and treating mental health patients using the lens of depression; to improve patient experience and partnership; to increase use of action or care plans; and to increase mental health literacy and comfort of medical office assistants. The British Columbia Practice Support Program delivered the module using the Plan-Do-Study-Act cycle for learning improvement. Family physicians were trained in adult mental health, and medical office assistants were trained in mental health first aid. Following initial testing, the adult mental health module was implemented across the province. More than 1400 of the province's 3300 full-service family physicians have completed or started training. Family physicians reported high to very high success implementing self-management tools into their practices and the overall positive impact this approach had on patients. These measures were sustained or improved at 3 to 6 months after completion of the module. An Opening Minds Survey for health care professionals showed a decrease in stigmatizing attitudes of family physicians. The adult mental health module is changing the way participants practice. Office-based primary mental health care can be improved through reimbursed training and support for physicians to implement practical, time-efficient tools that conform to payment schemes. The module provided behavior-changing tools that seem to be changing stigmatizing attitudes towards this patient population. This unexpected discovery has piqued the interest of stigma experts at the Mental Health Commission of Canada.

Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study.

PubMed

Yang, Chiang-Hsing; Huang, Yu-Tung A; Hsueh, Ya-Seng A

2013-02-04

Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers' Gini coefficients also become close to one another. This study found that NHI's offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan.

Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study

PubMed Central

2013-01-01

Background Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Methods Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. Results The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers’ Gini coefficients also become close to one another. Conclusions This study found that NHI’s offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan. PMID:23374629

Rise of Health Consumerism in China and Its Effects on Physicians' Professional Identity and the Physician-Patient Relationship and Communication.

PubMed

Tang, Lu; Guan, Mengfei

2018-05-01

The physician-patient relationship in China is highly strained. This study examined the professional identity of physicians and their perceptions of the physician-patient relationship against the backdrop of the rise of health consumerism in China. Structured interviews with 29 physicians found that the marketization of medical care and the rise of health consumerism caused physicians to have a conflicted professional identity. The traditional bureaucratic relationship between physicians and patients based on implicit trust was gradually replaced by an arm's length relationship characterized by self-interest, opportunism, and mistrust. In addition, the transition from physician-centered communication to patient-centered communication in China was tenacious. Theoretical and practical implications of the current study are discussed.

Navigating Government Service as a Physician

ERIC Educational Resources Information Center

Koh, Howard K.

2016-01-01

Working in government can be a remarkable life experience for anyone but particularly for those who have trained in the worlds of medicine and public health. This article describes some lessons learned from a physician initially based in academic medicine and public health who has since spent more than a decade serving in leadership positions at…

[Availability of physicians and specialists in Chile].

PubMed

Guillou, Michèle; Carabantes C, Jorge; Bustos F, Verónica

2011-05-01

The availability and planning of Human Resources are important issues in many countries, as it is a key factor to cope with the critical challenges of Health Care Systems. In Chile, the Ministry of Health has undertaken several studies in order to improve knowledge about the medical workforce both in public and private sectors. The aim of this paper is to update and systematize the existing data on physicians and specialists availability in Chile. Several information sources were crossed to obtain new and more precise figures about this topic. According to the Internal Revenue System, 29.996 physicians practice medicine in the country, 43% of them hired in public services, part or full time. There is a high concentration of professionals in the central regions of Chile. Being the overall density of physicians of one per 559 inhabitants, the figures in the central region is one per 471 and one per more than 800 in the South and North. Between 2004 and 2008, the public sector increased its physician workforce by more than 80% in primary health care and more than 20% in the secondary and tertiary levels. This paper presents a method for a more rigorous identification of the categories of general practitioner and specialist respectively, and the results obtained from the databases used.

Market effects on electronic health record adoption by physicians.

PubMed

Abdolrasulnia, Maziar; Menachemi, Nir; Shewchuk, Richard M; Ginter, Peter M; Duncan, W Jack; Brooks, Robert G

2008-01-01

Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied. The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians. Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians. A total of 2,926 physicians from practice sizes of 20 or less were included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption. Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.

Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults.

PubMed

Gerst-Emerson, Kerstin; Jayawardhana, Jayani

2015-05-01

We aimed to determine whether loneliness is associated with higher health care utilization among older adults in the United States. We used panel data from the Health and Retirement Study (2008 and 2012) to examine the long-term impact of loneliness on health care use. The sample was limited to community-dwelling persons in the United States aged 60 years and older. We used negative binomial regression models to determine the impact of loneliness on physician visits and hospitalizations. Under 2 definitions of loneliness, we found that a sizable proportion of those aged 60 years and older in the United States reported loneliness. Regression results showed that chronic loneliness (those lonely both in 2008 and 4 years later) was significantly and positively associated with physician visits (β = 0.075, SE = 0.034). Loneliness was not significantly associated with hospitalizations. Loneliness is a significant public health concern among elders. In addition to easing a potential source of suffering, the identification and targeting of interventions for lonely elders may significantly decrease physician visits and health care costs.

Public health research: lost in translation or speaking the wrong language?

PubMed

Kansagra, Susan M; Farley, Thomas A

2011-12-01

Public health leaders, like physicians, need to make decisions that impact health based on strong evidence. To generate useful evidence for public health leaders, research must focus on interventions that have potential to impact population-level health. Often policy and environmental changes are the interventions with the greatest potential impact on population health, but studying these is difficult because of limitations in the methods typically used and emphasized in health research. To create useful evidence for policy and environmental interventions, other research methods are needed, including observational studies, the use of surveillance data for evaluation, and predictive mathematical modeling. More emphasis is needed on these types of study designs by researchers, funding agencies, and scientific journals.

The need for professional doctors of public health.

PubMed Central

Roemer, M I

1986-01-01

Planning, organizing, and operating today's complex health care systems or heading Federal, State, and city public health agencies in the United States and other countries require professionals broadly prepared in the meaning, philosophy, and strategies of public health. It is and has been recognized that the best trained clinical physician could not be expected to know the policies and practices of official public health programs. The chief health official of a State or other jurisdiction, for example, deals with the epidemiology of many diseases; with all aspects of the environment; with hospitals, drugs, health manpower, and nutrition; with issues of health economics, finance, and politics; and with administration. For these tasks, most of medical education is irrelevant. To produce the needed specialists, candidates with a BA degree would be educated as doctors of public health. The proposed 5-year postgraduate curriculum is as demanding as the training for the MD degree, but completely different. The 38 subjects or courses in the curriculum are grouped into four categories: basic tools of social analysis, health and disease in populations, protection of health and prevention of disease, and health care systems and management. At present, MPH degree holders take only a handful of core and elective courses and emerge with little systematic knowledge about the majority of problems they face. The DrPH candidates at schools of public health spend most of their time on research and dissertation writing--adequate preparation for university teachers, but academia is not the goal of most candidates, nor the greatest need of society.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3080785

Vaccinations: A public health triumph and a public relations tragedy.

PubMed

Jacobson, Robert M

2012-08-01

Routine vaccination has been hailed as one of the top public health achievements of the last century. However, despite the reduced number of cases of and deaths from vaccine-preventable diseases such as pertussis and measles, outbreaks continue to occur as more parents fail to adequately vaccinate their children because of misinformation about immunizations. This article describes the challenges of making sure all children in the United States are fully immunized and what physicians need to know to effectively work with parents who may be hesitant to vaccinate their children.

Health promoting attitudes and behaviors of emergency physicians: exploring gender differences.

PubMed

Rondeau, Kent V; Francescutti, Louis H; Cummings, Garnet E

2006-01-01

The purpose of this paper is to report on gender differences in emergency physicians with respect to their attitudes, knowledge, and practices concerning health promotion and disease prevention. A mail survey of 325 male and 97 female Canadian emergency physicians. Results suggest female emergency physicians report having greater knowledge of health promotion topics, spend more time with each of their patients in the emergency setting, and engage in more health promotion counseling in the emergency setting than do their male counterparts. The paper argues that in the future, educating and socializing emergency physicians, both male and female, in the practice of health promotion will enhance the potential of the emergency department to be a more effective resource for their community.

A Study of National Physician Organizations’ Efforts to Reduce Racial and Ethnic Health Disparities in the United States

PubMed Central

Peek, Monica E.; Wilson, Shannon C.; Bussey-Jones, Jada; Lypson, Monica; Cordasco, Kristina; Jacobs, Elizabeth A.; Bright, Cedric; Brown, Arleen F.

2012-01-01

Purpose To characterize national physician organizations’ efforts to reduce health disparities and identify organizational characteristics associated with such efforts. Method This cross-sectional study was conducted between September 2009 and June 2010. The authors used two-sample t tests and chi-square tests to compare the proportion of organizations with disparity-reducing activities between different organizational types (e.g., primary care versus subspecialty organizations, small [<1,000 members] versus large [>5,000 members]). Inclusion criteria required physician organizations to be (1) focused on physicians, (2) national in scope, and (3) membership based. Results The number of activities per organization ranged from 0 to 22. Approximately half (53%) of organizations had 0 or 1 disparity-reducing activities. Organiza-tional characteristics associated with having at least 1 disparity-reducing effort included membership size (88% of large groups versus 58% of small groups had at least 1 activity; P = .004) and the presence of a health disparities committee (95% versus 59%; P < .001). Primary care (versus subspecialty) organizations and racial/ethnic minority physician organizations were more likely to have disparity-reducing efforts, although findings were not statistically significant. Common themes addressed by activities were health care access, health care disparities, workforce diversity, and language barriers. Common strategies included education of physicians/trainees and patients/general public, position statements, and advocacy. Conclusions Despite the national priority to eliminate health disparities, more than half of national physician organizations are doing little to address this problem. Primary care and minority physician organizations, and those with disparities committees, may provide leadership to extend the scope of disparity-reduction efforts. PMID:22534593

Physician leadership: a health-care system's investment in the future of quality care.

PubMed

Orlando, Rocco; Haytaian, Marcia

2012-08-01

The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

Health system reconstruction: Perspectives of Iraqi physicians

PubMed Central

Squires, A.; Sindi, A.; Fennie, K.

2010-01-01

In conflict or post-conflict situations, health system reconstruction becomes a critical component of ensuring stability. The purpose of this study was to determine the priorities for health system reconstruction among Iraqi physicians residing in the northern region of the country. A convenience sample of practicing male and female physicians residing in the Kurdish region completed a 13-item survey about health system reconstruction. A total of 1001 practitioners completed the survey with gender breakdown of 29% female and 71% male, all working in different specialty areas. Significant differences between the providers based on gender (p = 0.001), specialty (p = 0.001) and geographic location (p = 0.004) were found to affect the responses of the participants. This study demonstrates that input from healthcare professionals is important for health system reconstruction, but that gender, geography and medical specialty make the process complex. PMID:20155543

Retention of Physician Assistants in Rural Health Clinics

ERIC Educational Resources Information Center

Henry, Lisa R.; Hooker, Roderick S.

2007-01-01

Context: Improvement of rural health care access has been a guiding principle of federal and state policy regarding physician assistants (PAs). Purpose: To determine the factors that influence autonomous rural PAs (who work less than 8 hours per week with their supervising physician) to remain in remote locations. Methods: A qualitative…

The effect of a public health card program on the supply of health care.

PubMed

Johar, Meliyanni

2010-05-01

The supply-side responsiveness to public programs targeted to consumers is not widely studied. However, it is unlikely that supply variables remain constant, particularly when their link to the demand initiative is weak. The aim of this study is to provide such analysis, using the experience of the Indonesian health card program, which is a demand-sided program. Without an increase in staff or an appropriate salary revision, the salary payment system of the public sector may not adequately reward the existing health workers, lowering their incentives to maintain their public position. Using data from the Indonesian Family Life Surveys on public health centres, the leading providers of outpatient services in the public sector, this study found some evidence that the health card program resulted in a reduction in the number of full-time GPs working in these facilities. Other conditions not related to workers' compensation, such as infrastructure conditions and registration fees, were not adversely affected. Identification of this program's effect is achieved by variations in time and the intensity of health card distribution across communities. The findings highlight the importance of public policy management in general, and sheds light on physicians' behaviour in developing countries, about which we know very little. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Physician retention in community and migrant health centers: who stays and for how long?

PubMed

Singer, J D; Davidson, S M; Graham, S; Davidson, H S

1998-08-01

This study used discrete-time survival analysis to estimate the tenure of primary care physicians in Community Health Centers (CHCs), to identify the changing risk of leaving Community Health Center employment as time passes, and to identify factors associated with a physician's likelihood of remaining in a Community Health Center. Because of dramatic differences in physician career trajectories, much of the focus was on differences between physicians with and without National Health Service Corps obligations. Beginning with an administrative dataset at the Bureau of Primary Health Care that listed primary care physicians for each Community Health Center, the completeness and accuracy of the information provided were verified and an analytic database of all physicians working in those centers during a 21-month measurement window from January 1, 1990 through September 30, 1992 was constructed. The data included start and end dates, percent full-time equivalent status, and certain demographic characteristics. In addition, several data elements describing the Community Health Center were merged onto each physician record. These included urban or rural location, expenditure level, productivity, and federal grade. Through the use of discrete-time survival analysis, it was possible to include in the analytic sample all 2,654 physicians who worked during the period, even those who started working before January 1, 1990 and those who were still working on September 30, 1992. Survivor functions were estimated showing the proportion of physicians remaining after each quarter of their tenure (ie, after the fourth quarter of work, after the 12th quarter of work, etc). In addition, hazard functions were estimated showing the risk that a physician who had worked through the end of one quarter would leave during the following quarter. Finally, multivariate analysis demonstrated the relation of certain physician and center characteristics to the likelihood of the physician

42 CFR § 414.1465 - Physician-focused payment models.

Code of Federal Regulations, 2010 CFR

2017-10-01

... 42 Public Health 3 2017-10-01 2017-10-01 false Physician-focused payment models. § 414.1465... Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1465 Physician-focused payment models. (a) Definition. A physician-focused payment model (PFPM) is an Alternative Payment...

Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review

PubMed Central

2017-01-01

Background With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients’ Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship. Objective Our objective was to systematically review existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship. Methods We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients’ discussion of online findings during consultations and implications for the patient-physician relationship. Results We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients’ disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients’ relationship with their physicians. Conclusions Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be

Establishing a framework for a physician assistant/bioethics dual degree program.

PubMed

Carr, Mark F; Bergman, Brett A

2014-01-01

: Numerous medical schools currently offer a master of arts (MA) in bioethics dual degree for physicians. A degree in bioethics enhances the care physicians provide to patients and prepares physicians to serve on ethics committees and consult services. Additionally, they may work on institutional and public policy issues related to ethics. Several physician assistant (PA) programs currently offer a master of public health (MPH) dual degree for PAs. A degree in public health prepares PAs for leadership roles in meeting community health needs. With the success of PA/MPH dual degree programs, we argue here that a PA/bioethics dual degree would be another opportunity to advance the PA profession and consider how such a program might be implemented. The article includes the individual perspectives of the authors, one of whom completed a graduate-level certificate in bioethics concurrently with his 2-year PA program, while the other served as a bioethics program director.

Guns, schools, and mental illness: potential concerns for physicians and mental health professionals.

PubMed

Hall, Ryan Chaloner Winton; Friedman, Susan Hatters

2013-11-01

Since the recent shootings in Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut, there has been an ever-increasing state and national debate regarding gun control. All 3 shootings involved an alleged shooter who attended college, and in hindsight, evidence of a mental illness was potentially present in these individuals while in school. What appears to be different about the current round of debate is that both pro-gun control and anti-gun control advocates are focusing on mentally ill individuals, early detection of mental illness during school years, and the interactions of such individuals with physicians and the mental health system as a way to solve gun violence. This raises multiple questions for our profession about the apparent increase in these types of events, dangerousness in mentally ill individuals, when to intervene (voluntary vs involuntary), and what role physicians should play in the debate and ongoing prevention. As is evident from the historic Tarasoff court case, physicians and mental health professionals often have new regulations/duties, changes in the physician-patient relationship, and increased liability resulting from high-profile events such as these. Given that in many ways the prediction of who will actually commit a violent act is difficult to determine with accuracy, physicians need to be cautious with how the current gun debate evolves not only for ourselves (eg, increased liability, becoming de facto agents of the state) but for our patients as well (eg, increased stigma, erosion of civil liberties, and changes in the physician-patient relationship). We provide examples of potential troublesome legislation and suggestions on what can be done to improve safety for our patients and for the public. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Physician collective bargaining in a U.S. public hospital.

PubMed

Thompson, Stephen L; Salmon, J Warren

2003-01-01

In a study to investigate the factors that would drive attending physicians employed in a public hospital to seek collective bargaining with their employer, the authors developed an instrument to determine which variables and which hypotheses were predictive of union proneness. The findings reveal that a desire for voice was the number one reason for physicians' wanting to join a union. Union-prone physicians had a lower salary on average, were more dissatisfied with their income, were more likely to feel the effects of work "speed up" (too many patients and too little time), were less likely to have administrative functions (thus a larger patient care role), had a strong sense of entitlement to collective bargaining, believed that unions improve participation in decisions affecting their jobs (reinforcing their desire for voice), and had a sense that a union would improve their treatment by supervisors (reinforcing their desire for due process and equity).

Physician's emerging roles relating to trends in health information technology.

PubMed

David Johnson, J

2014-08-12

Objective: To determine the new roles that physicians will adopt in the near future to adjust to accelerating trends from managed care to outcome-based practice to health care reform to health information technology to the evolving role of health consumers. Methods: Trends and related developments concerning the changing roles of physicians based on prior literature reviews. Results: Six possible roles, traditional, gatekeeper, coach, navigator, informatician and one voice among many, are discussed in terms of physician's centrality, patient autonomy, decision-making and uncertainty, information seeking, satisfaction and outcomes, particularly those related to compliance. Conclusion: A greater understanding of these emerging roles could lead to more efficacious outcomes in our ever changing, increasingly complex medical system. Patients often have little understanding of emerging trends that lead to the development of specialized roles such as hospitalist and navigators and, relatedly, the evolving roles of physicians.

Comparative Analysis: Potential Barriers to Career Participation by North American Physicians in Global Health

PubMed Central

Rhee, Daniel S.; Heckman, Jennifer E.

2014-01-01

Physician interest in global health, particularly among family physicians, is reflected by an increasing proliferation of field training and service experiences. However, translating initial training involvement into a defined and sustainable global health career remains difficult and beset by numerous barriers. Existing global health literature has largely examined training experiences and related ethical considerations while neglecting the role of career development in global health. To explore this, this paper extrapolates potential barriers to global health career involvement from existing literature and compares these to salary and skills requirements for archetypal physician positions in global health, presenting a framework of possible barriers to sustained physician participation in global health work. Notable barriers identified include financial limitations, scheduling conflicts, security/family concerns, skills limitations, limited awareness of opportunities, and specialty choice, with family practice often closely aligned with global health experience. Proposed solutions include financial support, protected time, family relocation support, and additional training. This framework delineates barriers to career involvement in global health by physicians. Further research regarding these barriers as well as potential solutions may help direct policy and initiatives to better utilize physicians, particularly family physicians, as a valuable global health human resource. PMID:25405030

Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review.

PubMed

Tan, Sharon Swee-Lin; Goonawardene, Nadee

2017-01-19

With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients' Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship. Our objective was to systematically review existing research on patients' Internet health information seeking and its influence on the patient-physician relationship. We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients' discussion of online findings during consultations and implications for the patient-physician relationship. We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients' disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients' relationship with their physicians. Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be revisited to adapt to this changing demographic. �

42 CFR 414.108 - IOLs inserted in a physician's office.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false IOLs inserted in a physician's office. 414.108 Section 414.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee...

Extended use of electronic health records by primary care physicians: Does the electronic health record artefact matter?

PubMed

Raymond, Louis; Paré, Guy; Marchand, Marie

2017-04-01

The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes. Significant differences were observed among the three products with regard to their functional capability. The extent to which each of the electronic health record functionalities are used by physicians also varied significantly. Our results confirm that the electronic health record artefact 'does matter', its clinical functionalities explaining why certain physicians make more extended use of their system than others.

External collaboration and performance: North Carolina local public health departments, 1996.

PubMed

Lovelace, K

2000-01-01

This study examined the extent to which local public health departments in North Carolina collaborated with other groups and organizations, the health problems on which they worked together, and the effect of external collaboration on health departments' performance on core public health functions. The author mailed a questionnaire asking about interactions with city and county government agencies, boards of health, schools, nonprofits, physicians/private clinics, community health centers/migrant clinics, community members, citizens' groups, state and federal agencies, and universities to all of the directors of local public health departments in North Carolina. Sixty-four directors returned the questionnaire, for a response rate of 74.4%. Local public health departments most frequently interacted with boards of health, state agencies, community members, schools, city and county government agencies, and nonprofit agencies. Large majorities reported productive relationships with boards of health, state agencies, city and county government agencies, schools, nonprofit agencies, and hospitals. Greater frequency of interaction with several types of partners was associated with better performance. While questions exist about whether performance on core functions improves the community's health status, the results suggest that it is important for local public health departments to continue to build relationships with other organizations in the community.

Loneliness as a Public Health Issue: The Impact of Loneliness on Health Care Utilization Among Older Adults

PubMed Central

Jayawardhana, Jayani

2015-01-01

Objectives. We aimed to determine whether loneliness is associated with higher health care utilization among older adults in the United States. Methods. We used panel data from the Health and Retirement Study (2008 and 2012) to examine the long-term impact of loneliness on health care use. The sample was limited to community-dwelling persons in the United States aged 60 years and older. We used negative binomial regression models to determine the impact of loneliness on physician visits and hospitalizations. Results. Under 2 definitions of loneliness, we found that a sizable proportion of those aged 60 years and older in the United States reported loneliness. Regression results showed that chronic loneliness (those lonely both in 2008 and 4 years later) was significantly and positively associated with physician visits (β = 0.075, SE = 0.034). Loneliness was not significantly associated with hospitalizations. Conclusions. Loneliness is a significant public health concern among elders. In addition to easing a potential source of suffering, the identification and targeting of interventions for lonely elders may significantly decrease physician visits and health care costs. PMID:25790413

Knowledge and practice of travel medicine among primary health care physicians in Qatar.

PubMed

Al-Hajri, Mohammed; Bener, Abdulbari; Balbaid, Omar; Eljack, Ezaeldin

2011-11-01

This prospective descriptive survey was conducted among primary health care (PHC) physicians in Qatar from January to May 2007 in order to determine whether travelers obtained correct travel health information. Of 130 physicians approached, 98 agreed to participate in the study and 76 attended the symposium and complete the questionnaire. The questionnaire included sociodemographic characteristics, knowledge and practices about travel medicine before and after the symposium. Forty-four point seven percent of the subjects provided health advice to travelers. Female physicians (59.2%) outnumbered male physicians (40.8%). Qatari physicians (60.5%) outnumbered non-Qataris (39.5%). Most physicians spent at least 15 minutes with each traveler (44.1%). The symposium increased the knowledge of physicians about travel medicine. A significant increase in knowledge was seen in the post-symposium questionnaire for most questions. The main source of knowledge for most physicians was the internet (78.9%). Nearly half the subjects provided pre-travel health advice. All the subjects had improved knowledge of travel medicine following the symposium.

Physician survey on knowledge and reporting practices of transfusion-transmitted infections in Canada.

PubMed

Farzad, Ezzat; Cator, Magalie; Giulivi, Antonio; Zhang, Jun

2004-01-01

To assess physicians' knowledge and reporting practices of transfusion-transmitted infections (TTI). Cross-sectional postal survey. Family physicians and specialists. A survey questionnaire was sent by mail to 1,359 randomly selected physicians across Canada, and was followed up by a reminder telephone call. A total of 546 (40%) physicians completed and returned the questionnaire. The data from 512 eligible practitioners across Canada were analyzed. Almost all physicians were knowledgeable on the transmission of HIV, HBV and HCV through blood and plasma derivatives. However, physicians' knowledge, particularly the family physicians', was generally lower for less well-known TTIs. For example, only 7.2% of family physicians recognized Babesiosis as a TTI. Of the total 318 physicians who have encountered patients with possible TTI, 50% of them reported such cases to public health or other authorities and many reported to more than one organization. Of the total 159 non-reporting physicians, 91.1% explained that the cases were already reported by laboratories or other physicians. More than 90% of respondents think that it is important or very important that physicians report the cases of TTI to public health authorities for the purpose of surveillance, and more than 80% of them think that it is important or very important to include TTI as a separate entity in the communicable diseases surveillance systems. The majority of physicians recognize the more common TTIs and only 50% of them reported such cases. The majority of physicians support the reporting of TTI to public health authorities for surveillance. Recommendations are made to increase physicians' knowledge and reporting of TTI.

Effects of supplementary private health insurance on physician visits in Korea.

PubMed

Kang, Sungwook; You, Chang Hoon; Kwon, Young Dae; Oh, Eun-Hwan

2009-12-01

The coverage of social health insurance has remained limited, despite it being compulsory in Korea. Accordingly, Koreans have come to rely upon supplementary private health insurance (PHI) to cover their medical costs. We examined the effects of supplementary PHI on physician visits in Korea. This study used individual data from 11,043 respondents who participated in the Korean Labor and Income Panel Survey in 2001. We conducted a single probit model to identify the relationship between PHI and physician visits, with adjustment for the following covariates: demographic characteristics, socioeconomic status, health status, and health-related behavior. Finally, we performed a bivariate probit model to examine the true effect of PHI on physician visits, with adjustment for the above covariates plus unobservable covariates that might affect not only physician visit, but also the purchase of PHI. We found that about 38% of all respondents had one or more private health plans. Forty-five percent of all respondents visited one or more physicians, and 49% of those who were privately insured had physician visits compared with 42% of the uninsured. The single probit model showed that those with PHI were about 14 percentage points more likely to visit physicians than those who do not have PHI. However, this distinction disappears in the bivariate probit model. This result might have been a consequence of the nature of private health plans in Korea. Private insurance companies pay a fixed amount directly to their enrollees in case of illness/injury, and the individuals are responsible subsequently for purchasing their own healthcare services. This study demonstrated the potential of Korean PHI to address the problem of moral hazard. These results serve as a reference for policy makers when considering how to finance healthcare services, as well as to contain healthcare expenditure.

Forecasting the need for physicians in the United States: the Health Resources and Services Administration's physician requirements model.

PubMed Central

Greenberg, L; Cultice, J M

1997-01-01

OBJECTIVE: The Health Resources and Services Administration's Bureau of Health Professions developed a demographic utilization-based model of physician specialty requirements to explore the consequences of a broad range of scenarios pertaining to the nation's health care delivery system on need for physicians. DATA SOURCE/STUDY SETTING: The model uses selected data primarily from the National Center for Health Statistics, the American Medical Association, and the U.S. Bureau of Census. Forecasts are national estimates. STUDY DESIGN: Current (1989) utilization rates for ambulatory and inpatient medical specialty services were obtained for the population according to age, gender, race/ethnicity, and insurance status. These rates are used to estimate specialty-specific total service utilization expressed in patient care minutes for future populations and converted to physician requirements by applying per-physician productivity estimates. DATA COLLECTION/EXTRACTION METHODS: Secondary data were analyzed and put into matrixes for use in the mainframe computer-based model. Several missing data points, e.g., for HMO-enrolled populations, were extrapolated from available data by the project's contractor. PRINCIPAL FINDINGS: The authors contend that the Bureau's demographic utilization model represents improvements over other data-driven methodologies that rely on staffing ratios and similar supply-determined bases for estimating requirements. The model's distinct utility rests in offering national-level physician specialty requirements forecasts. Images Figure 1 PMID:9018213

Obligation for transparency regarding treating physician credentials at academic health centres.

PubMed

Martin, Paul J; Skill, N James; Koniaris, Leonidas G

2018-02-26

Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Physicians in training as quality managers: survival strategy for academic health centers.

PubMed

Wofford, J L; Moran, W P; Cohen, S J; Simon, R C

1997-12-01

Being responsible for medical education places academic health centers at a disadvantage in competing for managed care contracts. Although many suggestions have been made for changing medical education to produce physicians who are better prepared for the managed care environment, few studies have shown how physicians in training can actually contribute to the competitiveness of an academic health center. We present three examples of engaging trainees in projects with a population-based perspective that demonstrate how quality improvement for the academic health center can be operationalized and even led by physicians in training. In addition to gaining experience in a managed care skill that is increasingly important for future employment, physicians in training can simultaneously improve the quality of care delivered through the academic health center.

Views of US physicians about controlling health care costs.

PubMed

Tilburt, Jon C; Wynia, Matthew K; Sheeler, Robert D; Thorsteinsdottir, Bjorg; James, Katherine M; Egginton, Jason S; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr

2013-07-24

Physicians' views about health care costs are germane to pending policy reforms. To assess physicians' attitudes toward and perceived role in addressing health care costs. A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1

A history of PAs in the US Public Health Service.

PubMed

McKinnon, Mark F; Elizondo, Epifanio; Bonfiglio, Susan M; Hunter-Buskey, Robin N; Placide, Frances P; Bunnell, Rebecca A

2016-12-01

Since 1798, the men and women of the Commissioned Corps of the US Public Health Service (USPHS), one of the seven US uniformed services, have served on the front lines of public health. Two hundred years after the start of the USPHS, the first physician assistant (PA) entered the service to carry on the tradition of protecting, promoting, and advancing the health and safety of the nation. These dedicated clinicians are involved in healthcare delivery to underserved and vulnerable populations, disease control and prevention, biomedical research, food and drug regulation, and national and international response efforts for natural and man-made disasters. This article describes how PAs in the Commissioned Corps of the USPHS have impacted the health and safety of not only the United States but also the international community.

Navigating Government Service as a Physician.

PubMed

Koh, Howard K

2016-02-01

Working in government can be a remarkable life experience for anyone but particularly for those who have trained in the worlds of medicine and public health. This article describes some lessons learned from a physician initially based in academic medicine and public health who has since spent more than a decade serving in leadership positions at the state and federal levels. Many of the described themes about policy making can guide health professionals who wish to understand and ultimately contribute to the public sector. Certainly, the challenges and risks are noteworthy. However, for those willing and able to take the leap, government service can offer extraordinary opportunities not only for tremendous personal growth but also for making broader contributions to public health. © 2015 Society for Public Health Education.

Impact of the social networking applications for health information management for patients and physicians.

PubMed

Sahama, Tony; Liang, Jian; Iannella, Renato

2012-01-01

Most social network users hold more than one social network account and utilize them in different ways depending on the digital context. For example, friendly chat on Facebook, professional discussion on LinkedIn, and health information exchange on PatientsLikeMe. Thus many web users need to manage many disparate profiles across many distributed online sources. Maintaining these profiles is cumbersome, time consuming, inefficient, and leads to lost opportunity. In this paper we propose a framework for multiple profile management of online social networks and showcase a demonstrator utilising an open source platform. The result of the research enables a user to create and manage an integrated profile and share/synchronise their profiles with their social networks. A number of use cases were created to capture the functional requirements and describe the interactions between users and the online services. An innovative application of this project is in public health informatics. We utilize the prototype to examine how the framework can benefit patients and physicians. The framework can greatly enhance health information management for patients and more importantly offer a more comprehensive personal health overview of patients to physicians.

Information demands of occupational health physicians and their attitude towards evidence-based medicine.

PubMed

Schaafsma, Frederieke; Hulshof, Carel; van Dijk, Frank; Verbeek, Jos

2004-08-01

This study assessed the extent and nature of information demands among occupational health physicians and their attitude towards the application of evidence-based medicine in occupational health. A questionnaire survey was carried out among a random sample of 159 physicians practicing occupational medicine in The Netherlands. The questionnaire investigated the type and number of questions encountered in daily practice, the actions taken in response, the physicians' experience in using scientific databases on the Internet, and their attitude towards evidence-based medicine. The occupational health physicians' questions concerned medical, legal, and rehabilitation topics in particular. In pursuing answers to their questions, they generally chose to contact colleagues. Scientific databases were not consulted very often, although, in general, the attitude towards evidence-based medicine was positive. In addition to known barriers for practicing evidence-based medicine, occupational health physicians perceive a lack of scientific evidence in their field. The extensiveness of the field of knowledge in occupational health care was not regarded as an obstacle to their application of evidence-based medicine. Occupational health physicians have a demand for information on a broad range of topics, and, in most cases, their attitude towards evidence-based medicine is fairly positive. Besides education and training in evidence-based medicine, access to the Internet and the presence of a good knowledge infrastructure would help occupational health physicians use evidence-based medicine.

Workplace violence against physicians and nurses in Palestinian public hospitals: a cross-sectional study

PubMed Central

2012-01-01

Background Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model. Results The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of

Public health and terrorism preparedness: cross-border issues.

PubMed

Olson, Debra; Leitheiser, Aggie; Atchison, Christopher; Larson, Susan; Homzik, Cassandra

2005-01-01

On December 15, 2003, the Centers for Public Health Preparedness at the University of Minnesota and the University of Iowa convened the "Public Health and Terrorism Preparedness: Cross-Border Issues Roundtable." The purpose of the roundtable was to gather public health professionals and government agency representatives at the state, provincial, and local levels to identify unmet cross-border emergency preparedness and response needs and develop strategies for addressing these needs. Representatives from six state and local public health departments and three provincial governments were invited to identify cross-border needs and issues using a nominal group process. The result of the roundtable was identification of the needs considered most important and most doable across all the focus groups. The need to collaborate on and exchange plans and protocols among agencies was identified as most important and most doable across all groups. Development of contact protocols and creation and maintenance of a contact database was also considered important and doable for a majority of groups. Other needs ranked important across the majority of groups included specific isolation and quarantine protocols for multi-state responses; a system for rapid and secure exchange of information; specific protocols for sharing human resources across borders, including emergency credentials for physicians and health care workers; and a specific protocol to coordinate Strategic National Stockpile mechanisms across border communities.

Health Information-Seeking Patterns of the General Public and Indications for Disease Surveillance: Register-Based Study Using Lyme Disease.

PubMed

Pesälä, Samuli; Virtanen, Mikko J; Sane, Jussi; Mustonen, Pekka; Kaila, Minna; Helve, Otto

2017-11-06

People using the Internet to find information on health issues, such as specific diseases, usually start their search from a general search engine, for example, Google. Internet searches such as these may yield results and data of questionable quality and reliability. Health Library is a free-of-charge medical portal on the Internet providing medical information for the general public. Physician's Databases, an Internet evidence-based medicine source, provides medical information for health care professionals (HCPs) to support their clinical practice. Both databases are available throughout Finland, but the latter is used only by health professionals and pharmacies. Little is known about how the general public seeks medical information from medical sources on the Internet, how this behavior differs from HCPs' queries, and what causes possible differences in behavior. The aim of our study was to evaluate how the general public's and HCPs' information-seeking trends from Internet medical databases differ seasonally and temporally. In addition, we aimed to evaluate whether the general public's information-seeking trends could be utilized for disease surveillance and whether media coverage could affect these seeking trends. Lyme disease, serving as a well-defined disease model with distinct seasonal variation, was chosen as a case study. Two Internet medical databases, Health Library and Physician's Databases, were used. We compared the general public's article openings on Lyme disease from Health Library to HCPs' article openings on Lyme disease from Physician's Databases seasonally across Finland from 2011 to 2015. Additionally, media publications related to Lyme disease were searched from the largest and most popular media websites in Finland. Both databases, Health Library and Physician's Databases, show visually similar patterns in temporal variations of article openings on Lyme disease in Finland from 2011 to 2015. However, Health Library openings show not only

Assessing the Health of Future Physicians: An Opportunity for Preventive Education

ERIC Educational Resources Information Center

Clair, Jennifer H.; Wilson, Diane B.; Clore, John N.

2004-01-01

Introduction: Research shows that physicians who model prevention are more likely to encourage preventive behaviors in their patients. Therefore, understanding the health of medical students ought to provide insight into the development of health promotion programs that influence the way these future physicians practice medicine. A…

42 CFR 415.130 - Conditions for payment: Physician pathology services.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-inclusive care for the elderly (PACE) under 1894 of the Act; or (iv) A social health maintenance... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment: Physician pathology services. 415.130 Section 415.130 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

Brazilian physicians hold national strike against medical insurance companies.

PubMed

Falavigna, Asdrubal; da Silva, Pedro Guarise

2012-01-01

The Brazilian Health System has two different forms of access, public and private. The purpose of the public health system is to provide universal, complete access, free of charge, for the entire population. The private sector is composed by people who have private insurance. Nowadays, about 43 million Brazilians, or 26.3% of the population, have private health insurance. The main motivations of the physicians for the strike were the low payment for medical services and the constant interference of the private health insurance companies in medical autonomy. For this reason, Brazilian physicians held a 24-hour strike against the Medical Insurance Companies that did not accept to negotiate new fees in almost all Brazilian states. At least 120,000 physicians from all specialties stopped elective activities during that day, only providing urgent or emergency care. It is estimated that the strike affected 25 to 35 million Brazilians, about 76% of the total number of medical insurance users. Copyright © 2012 Elsevier Inc. All rights reserved.

Physicians' job satisfaction and motivation in a public academic hospital.

PubMed

de Oliveira Vasconcelos Filho, Paulo; de Souza, Miriam Regina; Elias, Paulo Eduardo Mangeon; D'Ávila Viana, Ana Luiza

2016-12-07

Physician shortage is a global issue that concerns Brazil's authorities. The organizational structure and the environment of a medical institution can hide a low-quality life of a physician. This study examines the relationship between the hospital work environment and physicians' job satisfaction and motivation when working in a large public academic hospital. The study was restricted to one large, multispecialty Brazil's hospital. Six hundred hospital physicians were invited to participate by e-mail. A short version of the Physician Worklife Survey (PWS) was used to measure working satisfaction. Physicians were also asked for socio-demographic information, medical specialty, and the intention to continue working in the hospital. Data from 141 questionnaires were included in the analyses. Forty-five physicians graduated from the hospital's university, and they did not intend to leave the hospital under any circumstance (affective bond). The motivating factor for beginning the career at the hospital and to continue working there were the connection to the medical school and the hospital status as a "prestigious academic hospital"; the physicians were more satisfied with the career than the specialty. Only 30% completely agreed with the statement "If I had to start my career over again, I would choose my current specialty," while 45% completely agreed with the statement "I am not well compensated given my training and experience." The greater point of satisfaction was the relationship with physician colleagues. They are annoyed about the amount of calls they are requested to take and about how work encroaches on their personal time. No significant differences between medical specialties were found in the analysis. The participants were satisfied with their profession. The fact that they remained at the hospital was related to the academic environment, the relationship with colleagues, and the high prestige in which society holds the institution. The points of

Acceptance of New Medicaid Patients by Primary Care Physicians and Experiences with Physician Availability among Children on Medicaid or the Children's Health Insurance Program

PubMed Central

Decker, Sandra L

2015-01-01

Objective To estimate the relationship between physicians' acceptance of new Medicaid patients and access to health care. Data Sources The National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey and the National Health Interview Survey (NHIS) 2011/2012. Study Design Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children's Health Insurance Program (CHIP) from the NHIS and state-level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS, controlling for other factors. Principal Findings Nearly 16 percent of children with a significant health condition or development delay had a doctor's office or clinic indicate that the child's health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar. Conclusions Measures of experiences with physician availability for children on Medicaid/CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients. PMID:25683869

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

PubMed Central

Wall, Melanie; Yu, Gary; Penido, Cláudia; Schmidt, Clecy

2012-01-01

Objectives. We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice. Methods. We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience. Results. Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated. Conclusions. Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries. PMID:22994254

[Physicians see both pros and cons of health care financial management. Questionnaire study provides more insights--with starting point in controversial DN-article series].

PubMed

Björk, Joar; Petersson, Christer

2015-05-12

In the spring of 2013, the Swedish journalist Maciej Zaremba wrote a series of articles criticizing the impact of NPM (New Public Management) on Swedish health care. The present study examines the views of experienced Swedish physicians (general practitioners and internal medicine speclialists) on the problems focused in Mr Zaremba's article series. The respondents (51 general practitioners and 61 internal medicine specialists) mention advantages as well as disadvantages with NPM in Swedish health care. The majority agrees that with NPM, physicians loose influence over health care governance to other professional groups. The majority disagree with the charge made by Mr Zaremba that NPM has had the effect of manipulating Swedish physicians away from the standards of good medical care.

[Managment system in safety and health at work organization. An Italian example in public sector: Inps].

PubMed

Di Loreto, G; Felicioli, G

2010-01-01

The Istituto Nazionale della Previdenza Sociale (Inps) is one of the biggest Public Sector organizations in Italy; about 30.000 people work in his structures. Fifteen years ago, Inps launched a long term project with the objective to create a complex and efficient safety and health at work organization. Italian law contemplates a specific kind of physician working on safety and health at work, called "Medico competente", and 85 Inps's physicians work also as "Medico competente". This work describes how IT improved coordination and efficiency in this occupational health's management system.

The effects of austerity measures on quality of healthcare services: a national survey of physicians in the public and private sectors in Portugal.

PubMed

Correia, Tiago; Carapinheiro, Graça; Carvalho, Helena; Silva, José Manuel; Dussault, Gilles

2017-12-12

The European Union member countries reacted differently to the 2008 economic and financial crisis. However, few countries have monitored the outcomes of their policy responses, and there is therefore little evidence as to whether or not savings undermined the performance of health systems. We discuss the situation in Portugal, where a financial adjustment program was implemented between 2011 and 2014, and explore the views of health workers on the effects of austerity measures on quality of care delivery. A nationwide survey of physicians' experiences was conducted in 2013-2014 (n = 3442). We used a two-step model to compare public and private services and look at the possible moderating effects of the physicians' specialty and years of practice. Our data analysis included descriptive statistics, the independent t test, analysis of variance (ANOVA), multivariate logistic regression, General Linear Model Univariate Analysis, non-parametric methods (bootstrap), and post hoc probing. Mainly in the public sector, the policy goal of maintaining quality of care was undermined by a lack of resources, the deterioration in medical residency conditions, and to a lesser extent, greater administrative interference in clinical decision-making. Differences in public and private services showed that the effects of the austerity measures were not the same throughout the health system. Our results also showed that physicians with similar years of practice and in the same medical specialty did not necessarily experience the same pressures. The debate on the effects of austerity measures should focus more closely on health workers' concrete experiences, as they demonstrate the non-linearity between policy setting and expected outcomes. We also suggest that it is necessary to explore the interplay between lower quality and the undermining of trust relationships in health.

Physicians' and consumers' conflicting attitudes toward health care advertising.

PubMed

Krohn, F B; Flynn, C

2001-01-01

The purpose of this paper is to explore the conflicting attitudes held by physicians and health care consumers toward health care advertising in an attempt to resolve the question. The paper introduces the differing positions held by the two groups. The rationale behind physicians' attitudes is then presented that advertising can be unethical, misleading, deceptive, and lead to unnecessary price increases. They believe that word-of-mouth does and should play the major role in attracting new patients. The opposite view of consumers is then presented which contends that health care advertising leads to higher consumer awareness of services, better services, promotes competitive pricing, and lowers rather than raises health care costs. The final section of the paper compares the arguments presented and concludes that health care advertising clearly has a place in the health care industry.

Quashing ownership: health reform law bans new physician-owned hospitals.

PubMed

Ortolon, Ken

2010-08-01

With nearly 70 Texas hospitals with some type of physician investment, the state is a national leader in the physician-owned hospital industry. And, members of that industry say it has been good for patients. But the health system reform law Congress passed earlier this year slams the door on new physician-owned hospitals by prohibiting them from obtaining a Medicare provider number.

Food allergy knowledge, attitudes and beliefs: Focus groups of parents, physicians and the general public

PubMed Central

Gupta, Ruchi S; Kim, Jennifer S; Barnathan, Julia A; Amsden, Laura B; Tummala, Lakshmi S; Holl, Jane L

2008-01-01

Background Food allergy prevalence is increasing in US children. Presently, the primary means of preventing potentially fatal reactions are avoidance of allergens, prompt recognition of food allergy reactions, and knowledge about food allergy reaction treatments. Focus groups were held as a preliminary step in the development of validated survey instruments to assess food allergy knowledge, attitudes, and beliefs of parents, physicians, and the general public. Methods Eight focus groups were conducted between January and July of 2006 in the Chicago area with parents of children with food allergy (3 groups), physicians (3 groups), and the general public (2 groups). A constant comparative method was used to identify the emerging themes which were then grouped into key domains of food allergy knowledge, attitudes, and beliefs. Results Parents of children with food allergy had solid fundamental knowledge but had concerns about primary care physicians' knowledge of food allergy, diagnostic approaches, and treatment practices. The considerable impact of children's food allergies on familial quality of life was articulated. Physicians had good basic knowledge of food allergy but differed in their approach to diagnosis and advice about starting solids and breastfeeding. The general public had wide variation in knowledge about food allergy with many misconceptions of key concepts related to prevalence, definition, and triggers of food allergy. Conclusion Appreciable food allergy knowledge gaps exist, especially among physicians and the general public. The quality of life for children with food allergy and their families is significantly affected. PMID:18803842

Role of pharmacogenetics in public health and clinical health care: a SWOT analysis

PubMed Central

Kapoor, Ritika; Tan-Koi, Wei Chuen; Teo, Yik-Ying

2016-01-01

Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively. PMID:27577547

Role of pharmacogenetics in public health and clinical health care: a SWOT analysis.

PubMed

Kapoor, Ritika; Tan-Koi, Wei Chuen; Teo, Yik-Ying

2016-12-01

Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively.

Public health ethics. Public justification and public trust.

PubMed

Childress, J F; Bernheim, R Gaare

2008-02-01

Viewing public health as a political and social undertaking as well as a goal of this activity, the authors develop some key elements in a framework for public health ethics, with particular attention to the formation of public health policies and to decisions by public health officials that are not fully determined by established public policies. They concentrate on ways to approach ethical conflicts about public health interventions. These conflicts arise because, in addition to the value of public health, societies have a wide range of other values that sometimes constrain the selection of means to achieve public health goals. The authors analyze three approaches for resolving these conflicts (absolutist, contextualist, and presumptivist), argue for the superiority of the presumptivist approach, and briefly explicate five conditions for rebutting presumptions in a process of public justification. In a liberal, pluralistic, democratic society, a presumptivist approach that engages the public in the context of a variety of relationships can provide a foundation for public trust, which is essential to public health as a political and social practice as well as to achieving public health goals.

Emergency physicians' perceptions of health information exchange.

PubMed

Shapiro, Jason S; Kannry, Joseph; Kushniruk, Andre W; Kuperman, Gilad

2007-01-01

Health information exchange (HIE) is a potentially powerful technology that can improve the quality of care delivered in emergency departments, but little is known about emergency physicians' current perceptions of HIE. This study sought to assess emergency physicians' perceived needs and knowledge of HIE. A questionnaire was developed based on heuristics from the literature and implemented in a Web-based tool. The survey was sent as a hyperlink via e-mail to 371 attending emergency physicians at 12 hospitals in New York City. The response rate was 58% (n = 216). Although 63% said more than one quarter of their patients would benefit from external health information, the barriers to obtain it without HIE are too high--85% said it was difficult or very difficult to obtain external data, taking an average of 66 minutes, 72% said that their attempts fail half of the time, and 56% currently attempt to obtain external data less than 10% of the time. When asked to create a rank-order list, electrocardiograms (ECGs) were ranked the highest, followed by discharge summaries. Respondents also chose images over written reports for ECGs and X-rays, but preferred written reports for advanced imaging and cardiac studies. There is a strong perceived need for HIE, most respondents were not aware of HIE prior to this study, and there are certain types of data and presentations of data that are preferred by emergency physicians in the New York City region.

[Health services research for the public health service (PHS) and the public health system].

PubMed

Hollederer, A; Wildner, M

2015-03-01

There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

The need to incorporate health information technology into physicians' education and professional development.

PubMed

Graham-Jones, Pierce; Jain, Sachin H; Friedman, Charles P; Marcotte, Leah; Blumenthal, David

2012-03-01

Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.

Views of US Physicians About Controlling Health Care Costs

PubMed Central

Tilburt, Jon C.; Wynia, Matthew K.; Sheeler, Robert D.; Thorsteinsdottir, Bjorg; James, Katherine M.; Egginton, Jason S.; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr

2017-01-01

Importance Physicians' views about health care costs are germane to pending policy reforms. Objective To assess physicians' attitudes toward and perceived role in addressing health care costs. Design, Setting, and Participants A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Main Outcomes and Measures Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. Results A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients' best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type

Health information technology and physicians' perceptions of healthcare quality.

PubMed

Fang, Hai; Peifer, Karen L; Chen, Jie; Rizzo, John A

2011-03-01

To investigate the relationship between the use of health information technology (HIT) and physician perceptions of providing high-quality care and to determine whether this relationship has changed over time. We used 2 waves of longitudinal data from the Community Tracking Study Physician Surveys, 2000-2001 and 2004-2005. Three measures of HIT were examined: a binary variable measuring the use of at least 1 type of HIT, a continuous variable measuring the total number of HIT types, and a binary variable measuring use of all 5 HIT types related to "meaningful use" of HIT as defined by Centers for Medicare and Medicaid Services. Three multivariate models were estimated to study the effect of each HIT measure on physicians' perception of providing high-quality care. Individual fixed-effects estimation also was used to control for individual time-invariant factors. Using at least 1 type of HIT significantly enhanced physicians' perception of providing high-quality care in 2000-2001, but not in 2004-2005. The marginal effect of adding 1 extra HIT type was positive and statistically significant in both periods. The association between using all 5 HIT types related to meaningful use and perceived quality was statistically significant in 2000-2001, but not in 2004-2005. Health information technology has become a multifunctional system and appears to have enhanced physicians' perception of providing high-quality care. Physicians' perceptions of medical care quality improved as the number of HIT types used increased. This study supports more extensive use of HIT in physician practices.

Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions.

PubMed

Dyrbye, Liselotte N; West, Colin P; Sinsky, Christine A; Goeders, Lindsey E; Satele, Daniel V; Shanafelt, Tait D

2017-10-01

To determine whether state medical licensure application questions (MLAQs) about mental health are related to physicians' reluctance to seek help for a mental health condition because of concerns about repercussions to their medical licensure. In 2016, we collected initial and renewal medical licensure application forms from 50 states and the District of Columbia. We coded MLAQs related to physicians' mental health as "consistent" if they inquired only about current impairment from a mental health condition or did not ask about mental health conditions. We obtained data on care-seeking attitudes for a mental health problem from a nationally representative convenience sample of 5829 physicians who completed a survey between August 28, 2014, and October 6, 2014. Analyses explored relationships between state of employment, MLAQs, and physicians' reluctance to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure. We obtained initial licensure applications from 51 of 51 (100%) and renewal applications from 48 of 51 (94.1%) medical licensing boards. Only one-third of states currently have MLAQs about mental health on their initial and renewal application forms that are considered consistent. Nearly 40% of physicians (2325 of 5829) reported that they would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure. Physicians working in a state in which neither the initial nor the renewal application was consistent were more likely to be reluctant to seek help (odds ratio, 1.21; 95% CI, 1.07-1.37; P=.002 vs both applications consistent). Our findings support that MLAQs regarding mental health conditions present a barrier to physicians seeking help. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 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 supervisory...

Does community health care require different competencies from physicians and nurses?

PubMed Central

2014-01-01

Background Recently competency approach in Health Professionals’ Education (HPE) has become quite popular and for an effective competency based HPE, it is important to design the curriculum around the health care needs of the population to be served and on the expected roles of the health care providers. Unfortunately, in community settings roles of health providers tend to be described less clearly, particularly at the Primary Health Care (PHC) level where a multidisciplinary and appropriately prepared health team is generally lacking. Moreover, to tailor the education on community needs there is no substantial evidence on what specific requirements the providers must be prepared for. Methods This study has explored specific tasks of physicians and nurses employed to work in primary or secondary health care units in a context where there is a structural scarcity of community health care providers. In-depth Interviews of 11 physicians and 06 nurses working in community settings of Pakistan were conducted along with review of their job descriptions. Results At all levels of health settings, physicians’ were mostly engaged with diagnosing and prescribing medical illness of patients coming to health center and nurses depending on their employer were either providing preventive health care activities, assisting physicians or occupied in day to day management of health center. Geographical location or level of health facility did not have major effect on the roles being expected or performed, however the factors that determined the roles performed by health providers were employer expectations, preparation of health providers for providing community based care, role clarity and availability of resources including health team at health facilities. Conclusions Exploration of specific tasks of physicians and nurses working in community settings provide a useful framework to map competencies, and can help educators revisit the curricula and instructional designs

[Mental health in physicians doing the rural and suburban health service in Peru: a baseline study].

PubMed

Galán-Rodas, Edén; Gálvez-Buccollini, Juan Antonio; Vega-Galdós, Favio; Osada, Jorge; Guerrero-Padilla, Daisy; Vega-Dienstmaier, Johann; Talledo, Lety; Catacora, Manuel; Fiestas, Fabián

2011-06-01

The disadvantageous conditions in which young physicians have to do their rural and sub-urban health service (SERUMS) may put them in a high risk for mental disorders. This study aims to establish the baseline levels of depression and alcohol use problems among those physicians scheduled to complete their SERUMS during the period 2011-2012. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Alcohol Use Disorders Identification Test (AUDIT) were administered as screening tests to 493 physicians. Depression scores were met by 26% females and 14.5% males, and alcohol use problem scores were met by 22% females and 26% males. Overall, 39% persons scored for either of both mental health entities. Mental health problems seem to be common among young physicians scheduled to migrate to their SERUMS. These problems must be addressed to avoid greater risks.

Do doctors have a moral duty to work in the public health sector? Ethical considerations regarding the social obligations of medicine.

PubMed

Aguilera Dreyse, Bernardo; López Gaete, Gonzalo

2017-12-22

This article discusses whether physicians have social obligations and whether these obligations imply a moral duty to work in the public sector. The article focuses on the context of the Chilean health system, which has an unequal distribution of physicians to the detriment of the public sector, thus making the issue a particularly pressing one. After addressing arguments from different ethical theories and some empirical evidence, the article concludes that the physician has some social obligations in relation to a fair distribution of health resources, and that professional excellence should incorporate cultivating virtues related to social justice. In addition, it is argued that the moral duty to work in the public sector can be placed in the context of prima facie obligations which admit exceptions and allow the possibility of conflict with other professional obligations.

Accessibility of general practitioners and selected specialist physicians by car and by public transport in a rural region of Germany.

PubMed

Stentzel, Ulrike; Piegsa, Jens; Fredrich, Daniel; Hoffmann, Wolfgang; van den Berg, Neeltje

2016-10-19

The accessibility of medical care facilities in sparsely populated rural regions is relevant especially for elderly people which often represent a large segment of the population in such regions. Elderly people have higher morbidity risks and a higher demand for medical care. Although travelling with private cars is the dominating traffic mode in rural regions, accessibility by public transport is increasingly important especially because of limited mobility of elderly people. The aim of this study was to determine accessibility both by car and public transport to general practitioners (GP) and selected specialist physicians for a whole region and to detect areas with poor to no access in the county Vorpommern-Greifswald, which is a rural and sparsely populated region in the very northeast of Germany. Accessibility of medical care facilities by car was calculated on the basis of a network analysis within a geographic information system (GIS) with routable street data. Accessibility by public transport was calculated using GIS and a network analysis based on the implementation of Dijkstra's algorithm. The travelling time to general practitioners (GP) by car in the study region ranges from 0.1 to 22.9 min. This is a significant difference compared to other physician groups. Traveling times to specialist physicians are 0.4 to 42.9 min. A minority of 80 % of the inhabitants reach the specialist physicians within 20 min. The accessibility of specialist physicians by public transport is poor. The travel time (round trip) to GPs averages 99.3 min, to internists 143.0, to ophthalmologists 129.3 and to urologists 159.9 min. These differences were significant. Assumed was a one hour appointment on a Tuesday at 11 am. 8,973 inhabitants (3.8 %) have no connection to a GP by public transport. 15,455 inhabitants (6.5 %) have no connection to specialist internists. Good accessibility by public transport is not a question of distance but of transport connections. GIS

Factors influencing physicians' choice of workplace: systematic review of drivers of attrition and policy interventions to address them.

PubMed

El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E

2016-12-01

The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians' choice of workplace, and policy interventions for retaining physicians in the public sector. Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Nineteen articles met the inclusion criteria. Six major themes that affected physicians' choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. While factors affecting physicians' choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross-country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector.

Determinants of physician utilization, emergency room use, and hospitalizations among populations with multiple health vulnerabilities.

PubMed

Small, La Fleur F

2011-09-01

Understanding the factors that influence differing types of health care utilization within vulnerable groups can serve as a basis for projecting future health care needs, forecasting future health care expenditures, and influencing social policy. In this article the Behavioral Model for Vulnerable Populations is used to evaluate discretionary (physician visits) and non-discretionary (emergency room visits, and hospitalizations) health utilization patterns of a sample of 1466 respondents with one or more vulnerable health classification. Reported vulnerabilities include: (1) persons with substance disorders; (2) homeless persons; (3) persons with mental health problems; (4) victims of violent crime; (5) persons diagnosed with HIV/AIDS; (6) and persons in receipt of public benefits. Hierarchical logistic regression is used on three nested models to model factors that influence physician visits, emergency room visits, and hospitalizations. Additionally, bivariate logistic regression analyses are completed using a vulnerability index to evaluate the impact of increased numbers of vulnerability on all three forms of health care utilization. Findings from this study suggest the Behavioral Model of Vulnerable Populations be employed in future research regarding health care utilization patterns among vulnerable populations. This article encourages further research investigating the cumulative effect of health vulnerabilities on the use of non-discretionary services so that this behavior could be better understood and appropriate social policies and behavioral interventions implemented.

Perceptions of electronic health record implementation: a statewide survey of physicians in Rhode Island.

PubMed

Wylie, Matthew C; Baier, Rosa R; Gardner, Rebekah L

2014-10-01

Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience. We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice. The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction. We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time. Copyright © 2014 Elsevier Inc. All rights reserved.

"The doctors' choice is America's choice": the physician in US cigarette advertisements, 1930-1953.

PubMed

Gardner, Martha N; Brandt, Allan M

2006-02-01

In the 1930s and 1940s, smoking became the norm for both men and women in the United States, and a majority of physicians smoked. At the same time, there was rising public anxiety about the health risks of cigarette smoking. One strategic response of tobacco companies was to devise advertising referring directly to physicians. As ad campaigns featuring physicians developed through the early 1950s, tobacco executives used the doctor image to assure the consumer that their respective brands were safe. These advertisements also suggested that the individual physicians' clinical judgment should continue to be the arbiter of the harms of cigarette smoking even as systematic health evidence accumulated. However, by 1954, industry strategists deemed physician images in advertisements no longer credible in the face of growing public concern about the health evidence implicating cigarettes.

Evaluation of a wildfire smoke forecasting system as a tool for public health protection.

PubMed

Yao, Jiayun; Brauer, Michael; Henderson, Sarah B

2013-10-01

Exposure to wildfire smoke has been associated with cardiopulmonary health impacts. Climate change will increase the severity and frequency of smoke events, suggesting a need for enhanced public health protection. Forecasts of smoke exposure can facilitate public health responses. We evaluated the utility of a wildfire smoke forecasting system (BlueSky) for public health protection by comparing its forecasts with observations and assessing their associations with population-level indicators of respiratory health in British Columbia, Canada. We compared BlueSky PM2.5 forecasts with PM2.5 measurements from air quality monitors, and BlueSky smoke plume forecasts with plume tracings from National Oceanic and Atmospheric Administration Hazard Mapping System remote sensing data. Daily counts of the asthma drug salbutamol sulfate dispensations and asthma-related physician visits were aggregated for each geographic local health area (LHA). Daily continuous measures of PM2.5 and binary measures of smoke plume presence, either forecasted or observed, were assigned to each LHA. Poisson regression was used to estimate the association between exposure measures and health indicators. We found modest agreement between forecasts and observations, which was improved during intense fire periods. A 30-μg/m3 increase in BlueSky PM2.5 was associated with an 8% increase in salbutamol dispensations and a 5% increase in asthma-related physician visits. BlueSky plume coverage was associated with 5% and 6% increases in the two health indicators, respectively. The effects were similar for observed smoke, and generally stronger in very smoky areas. BlueSky forecasts showed modest agreement with retrospective measures of smoke and were predictive of respiratory health indicators, suggesting they can provide useful information for public health protection.

Fielding a current idea: exploring the public health impact of electromagnetic radiation.

PubMed

Genuis, Stephen J

2008-02-01

Several publications in the scientific literature have raised concern about the individual and public health impact of adverse non-ionizing radiation (a-NIR) from electromagnetic field (EMF) exposure emanating from certain power, electrical and wireless devices commonly found in the home, workplace, school and community. Despite the many challenges in establishing irrefutable scientific proof of harm and the various gaps in elucidating the precise mechanisms of harm, epidemiological analyses continue to suggest considerable potential for injury and affliction as a result of a-NIR exposure. As environmental health has not been emphasized in medical education, some clinicians are not fully aware of possible EMF-related health problems and, as a result, manifestations of a-NIR may remain misdiagnosed and ineffectually managed. It is important for physicians and public health officials to be aware of the fundamental science and clinical implications of EMF exposure. A review of the scientific literature relating to the link between electromagnetic radiation and human health, several public health recommendations, and four case histories are presented for consideration.

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

Help-seeking preferences in the area of mild cognitive impairment: comparing family physicians and the lay public.

PubMed

Werner, Perla; Heinik, Jeremia; Giveon, Shmuel; Segel-Karpas, Dikla; Kitai, Eliezer

2014-01-01

Mild cognitive impairment (MCI) or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer's disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician) regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior. A better understanding of help-seeking preferences is required in order to promote early detection and management. To compare help-seeking preferences of family physicians and the lay public in the area of MCI. A structured questionnaire was used to collect data from 197 family physicians (self-administered) and 517 persons aged 45 and over from the lay public (face to face). Information regarding familiarity with MCI and help-seeking preferences was assessed. The vast majority in both samples reported that family physician, spouse, and children are the most highly recommended sources of help-seeking. In regard to professional sources of help-seeking, a higher percentage of the physicians than the lay public sample consistently recommended seeking help from nurses and social workers and psychiatrists, but a higher percentage of the lay public recommended turning to a neurologist for help. There were both similarities and differences between family physicians and the lay public in their preferences regarding help-seeking for a person with MCI. Most prominent is the physicians' greater tendency to recommend professional sources of help-seeking. Understanding of help-seeking preferences of both physicians and lay persons might help overcome barriers for establishing diagnosis, receiving care, and improving communication between doctors and patients.

Education and personalized genomics: deciphering the public's genetic health report

PubMed Central

Lamb, Neil E; Myers, Richard M; Gunter, Chris

2010-01-01

Where do members of the public turn to understand what genetic tests mean in terms of their own health? Now that genome-wide association studies and complete genome sequencing are widely available, the importance of education in personalized genomics cannot be overstated. Although some media have introduced the concept of genetic testing to better understand health and disease, the public's understanding of the scope and impact of genetic variation has not kept up with the pace of the science or technology. Unfortunately, the likely sources to which the public turn to for guidance – their physician and the media – are often no better prepared. We examine several venues for information, including print and online guides for both lay and health-oriented audiences, and summarize selected resources in multiple formats. We also note on the roadblocks to progress and discuss ways to remove them, as urgent action is needed to connect people with their genomes in a meaningful way. PMID:20161675

42 CFR 405.2413 - Services and supplies incident to a physician's services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Services and supplies incident to a physician's services. 405.2413 Section 405.2413 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Rural...

Relationship Between Time of First Publication and Subsequent Publication Success Among Non-PhD Physician-Scientists.

PubMed

Riggs, Kevin R; Reitman, Zachary J; Mielenz, Thelma J; Goodman, Philip C

2012-06-01

Studies have shown that publication of work during medical school and residency is associated with higher numbers of later publications and citations of published research. However, it is unknown whether this association exists for non-PhD physician-scientists and whether the association persists later into their careers. We extracted publication records from the curricula vitae (CVs) of 102 corresponding authors of articles published in 2008 in the New England Journal of Medicine and JAMA, and obtained those authors' citation records from Web of Science. We used regression models to examine the association between time of first publication and later publication and citation rates for the entire postgraduate career and a recent 2-year period. After adjusting for time since medical school graduation, sex, location of medical school (United States or not United States), and additional non-PhD degrees, we found that authors who first published before graduating from medical school had a greater mean number of publications after medical school and during the period from 2006 to 2007 (164 and 28, respectively) than those who first published during the 5 years afterward (111 and 19, respectively) and those who first published more than 5 years after graduation (59 and 13, respectively). Similarly, authors who first published before graduating from medical school had a greater mean number of citations of their published work since graduation and of publications from 2006 to 2007 (4634 and 333, respectively) than those who first published during the 5 years afterward (2936 and 183, respectively) and those who first published more than 5 years after graduation (1512 and 143, respectively). Early publication is associated with higher numbers of publications and more citations of published research among non-PhD physician-scientists. This association persists well into a researcher's career.

Public health emergencies and the public health/managed care challenge.

PubMed

Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

2002-01-01

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

School Nurse Communication Effectiveness with Physicians and Satisfaction with School Health Services

ERIC Educational Resources Information Center

Volkman, Julie E.; Hillemeier, Marianne M.

2008-01-01

This study examined school nurses' communication with community physicians and its relationship to school nurse satisfaction with school health services. A stratified random sample of school nurses in Pennsylvania (N = 615) were surveyed about communication effectiveness with community physicians, satisfaction with school health services for…

Training public health superheroes: five talents for public health leadership.

PubMed

Day, Matthew; Shickle, Darren; Smith, Kevin; Zakariasen, Ken; Moskol, Jacob; Oliver, Thomas

2014-12-01

Public health leaders have been criticized for their policy stances, relationships with governments and failure to train the next generation. New approaches to the identification and training of public health leaders may be required. To inform these, lessons can be drawn from public health 'superheroes'; public health leaders perceived to be the most admired and effective by their peers. Members and Fellows of the UK Faculty of Public Health were contacted via e-newsletter and magazine and asked to nominate their 'Public Health Superhero'. Twenty-six responses were received, nominating 40 different people. Twelve semi-structured interviews were conducted. Thematic analysis, based on 'grounded theory', was conducted. Five leadership 'talents' for public health were identified: mentoring-nurturing, shaping-organizing, networking-connecting, knowing-interpreting and advocating-impacting. Talent-based approaches have been effective for leadership development in other sectors. These talents are the first specific to the practice of public health and align with some aspects of existing frameworks. An increased focus on identifying and developing talents during public health training, as opposed to 'competency'-based approaches, may be effective in strengthening public health leadership. Further research to understand the combination and intensity of talents across a larger sample of public health leaders is required. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Surgery, public health, and Pakistan.

PubMed

Zafar, Syed Nabeel; McQueen, K A Kelly

2011-12-01

Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

Multiple variable motivators involved in the recruitment of physicians for the Indian Health Service.

PubMed

Hostetter, C L; Felsen, J D

1975-01-01

Attracting physicians to serve in isolated areas, often with marginal facilities, support staff, and remuneration, has long been a problem of the Indian Health Service (IHS). Until recently the physician draft was instrumental in motivating physicians to accept such assignments. Realizing that this "negative incentive" would no longer operate when the draft ended as of July 1, 1973, in the fall of 1972 the IHS staff launched some major "positive" efforts to recruit physicians. The mass media and other communication techniques were used to try to sell U.S. physicians and medical students on what the Service could offer them in terms of adventure, challenge, personal fulfillment, idealism, and the opportunity to be part of a progressive, comprehensive health system. Such efforts assisted in recruiting 69 physicians to begin service in July 1973. These 69 were in addition to approximately 100 who had already been recruited from among persons who had expressed interest in joining the Indian Health Service or who had applied to it before inception of this major recruitment effort. As of July 1, 1973, however, the Service was still approximately 30 physicians short of filling 200 vacancies. In June and July of 1973, an evaluation was done to determine what had motivated the 169 physicians to join the Indian Health Service. They were asked an open ended question: What prompted you to seek employment with the Indian Health Service? Whether physicians listed personal, subjective motivators or recruitment techniques was of as much interest as the specific answers they gave. More than 75 percent (100 of 129) mentioned recruitment techniques, such as magazine advertisements, rather than personal motivating factors, such as challenge. Personal contact with a present or former IHS physician seemed to be especially influential in attracting physicians. The present state of the recruitment art does not provide the means to adequately identify, qualify, quantify, and rank the

Guideline attribute and implementation preferences among physicians in multiple health systems.

PubMed

Stone, Tamara T; Schweikhart, Sharon B; Mantese, Annamarie; Sonnad, Seema S

2005-01-01

Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments. Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma. Paired sample t tests and Tukey's method of comparisons determined the relative ranking of physicians' guideline implementation preferences. Physicians preferred guidelines located on the front of the patient chart, in palm pilots, or in progress notes and presented as flow charts/flow diagrams, algorithms, or preprinted orders that contain strategies to minimize readmits/encourage self-management and immediate treatment flows. Discussions with colleagues and continuing medical education are the most effective strategies for encouraging guideline use, and randomized controlled trials remain the most persuasive medical evidence. Health care organizations must align guideline implementation efforts with physician preferences to encourage utilization. The results of this study reveal systematic physician preferences for guideline implementation that can be applied to clinical settings to encourage guideline use by physicians.

COGME 1995 Physician Workforce Funding Recommendations for Department of Health and Human Services' Programs. Council on Graduate Medical Education, 7th Report.

ERIC Educational Resources Information Center

Council on Graduate Medical Education.

This report presents specific recommendations to the Department of Health and Human Services and Congress from the Council on Graduate Medical Education that address Medicare's direct and indirect graduate medical education (GME) payments and the monies allocated by the Public Health Service that is targeted toward physician education and primary…

[Familial characteristics and self-perceived health among female and male primary care physicians in Andalusia (Spain)].

PubMed

Delgado, Ana; Saletti-Cuesta, Lorena; López-Fernández, Luis Andrés; Toro-Cárdenas, Silvia

2013-01-01

To determine the relationships between a group of professional and family characteristics and the components of physical and mental health in female and male primary care physicians working in health centers in Andalusia (Spain). A descriptive, cross-sectional, multicenter study was performed. The population consisted of urban health centers in Andalusia and their physicians. The sample comprised 88 health centers and 500 physicians. Measurements consisted of sex, age, professional characteristics (postgraduate training in family medicine, position of health center manager, accreditation as a residents' tutor, and workload based on patient quota and the mean number of patients/day); family responsibilities, defined by two dimensions of the family-work relationship (support overload-family support deficit and family-work conflict); and perceived physical and mental health. The data source was a self-administered questionnaire sent by surface mail. Multiple regression analyses were performed for physical and mental health for the whole sample and by gender. Responses were obtained from 368 physicians (73.6%). Mental health was worse in female physicians than in male physicians; no differences were found between genders in physical health. The family-work conflict was associated with physical and mental health in physicians of both genders. Physical health deteriorated with increasing age in both genders, improved in the female tutors of residents, and decreased with increasing family-work conflict in male physicians. Mental health decreased with increasing housework on the weekends and with family-work conflict in both genders. In male physicians, mental health deteriorated with postgraduate training in family medicine and improved if they were health center managers. Workload and professional characteristics have little relationship with the health of primary care physicians. Family characteristics play a greater role. Copyright © 2012 SESPAS. Published by Elsevier

Postal censorship of Bosnian public health institutions during the Second World War: The Independent State of Croatia versus Dr. Stanko Sielski.

PubMed

Papalas, John A; Tahirović, Husref

2016-11-01

This study aims to present evidence of censorship during World War II by the Independent State of Croatia of one of its public health officials, Dr. Stanko Sielski who was a physician trained in epidemiology and public health. During World War II, he directed the Institute for Combating Endemic Syphilis in the Bosnian town Banja Luka. The staff under his direction consisted solely of Jewish physicians. We analyzed two groups of envelopes either sent by or to Dr. Stanko Sielski during the War and found evidence of censorship only in communications with a Jewish physician dated towards the end of the War. Dr. Stanko Sielski would be posthumously recognized for his efforts to shield his Jewish colleagues. The newly available, but still limited data, which we present indicates efforts to censor Dr. Stanko Sielski's postal communications towards the War's end. The censors targeted specifically Dr. Stanko Sielski's correspondences with the Jewish physicians he was protecting. This material highlights the many challenges his public health service experienced during the time of armed conflict. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

[The provision of population of the Russian Federation with basic personnel resource of public health care system].

PubMed

Schepin, V O

2013-01-01

The article presents the results of complex scientific analysis of number and structure of physicians and paramedical personnel of public and municipal health care system of the Russian Federation. The provision of country population, its federal okrugs and federation subjects with physicians and paramedical personnel of various specialties are analyzed too, including ratio of physicians and paramedical personnel and territorial differentiation of provision of population with basic medical personnel. The study results demonstrate that in 2012 provision of population (per 10 000 of population) with physicians increased from 43.9 to 44.7. At the same time provision with paramedical personnel decreased from 92.3 to 90.8. in the Russian Federation are preserved significant territorial disproportions of provision of population with medical personnel resource. The provision of population with physicians and paramedical personnel is 4.3 times and 1.9 times higher in cities than in rural area. The differences between extreme indicators of provision of population of the Russian Federation with physicians and paramedical personnel are 2.9 and 2.4 times correspondingly. The differences between indicators of provision with physicians of clinical specialties are 2.6 times. The average ratio between physician and paramedical personnel is 1:2.03. The structure of medical manpower corresponds to the need of population in medical care in incomplete measure. The materials substantiate necessity to continue modernization, optimization and development of manpower support of public health care system in the Russian Federation.

Career satisfaction of US women physicians: results from the Women Physicians' Health Study. Society of General Internal Medicine Career Satisfaction Study Group.

PubMed

Frank, E; McMurray, J E; Linzer, M; Elon, L

1999-07-12

Despite major changes in health care, the prevalence and predictors of career satisfaction have not recently been comprehensively studied in either women or men physicians. The Women Physicians' Health Study surveyed a nationally representative random sample (n = 4501 respondents; response rate, 59%) of US women physicians. Using univariate and logistic regression analyses, we examined personal and professional characteristics that were correlated with 3 major outcomes: career satisfaction, desire to become a physician again, and desire to change one's specialty. Women physicians were generally satisfied with their careers (84% usually, almost always, or always satisfied). However, 31% would maybe, probably, or definitely not choose to be a physician again, and 38% would maybe, probably, or definitely prefer to change their specialty. Physician's age, control of the work environment, work stress, and a history of harassment were independent predictors of all 3 outcomes, with younger physicians and those having least work control, most work stress, or having experienced severe harassment reporting the most dissatisfaction. The strongest association (odds ratio, 11.3; 95% confidence interval, 7.3-17.5; P<.001) was between work control and career satisfaction. Other significant predictors (P<.01) of outcomes included birthplace, ethnicity, sexual orientation, having children, stress at home, religious fervor, mental health, specialty, practice type, and workload. Women physicians generally report career satisfaction, but many, if given the choice, would not become a physician again or would choose a different specialty. Correctable factors such as work stress, harassment, and poor control over work environment should be addressed to improve the recruitment and retention of women physicians.

42 CFR 456.604 - Physician team member inspecting care of recipients.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Physician team member inspecting care of recipients... Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of recipients. No physician member of a team may inspect the care of a recipient for whom he is...

42 CFR 456.604 - Physician team member inspecting care of recipients.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Physician team member inspecting care of recipients... Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of recipients. No physician member of a team may inspect the care of a recipient for whom he is...

[History of the public health policy in Chad 1900-1995].

PubMed

Massenet, D

1996-01-01

Public health policy in Chad began after colonization in 1899 and remained under the control of French Army Medical Corps for a long time. Military doctors shared their time between treating service personnel and indigenous people entitled Medical Assistance and making rounds in their sector. Since independence public health in the country has been based on a two-pronged association including fixed facilities (hospitals and dispensaries) and mobile services such as the Endemic Disease Unit whose most notable success was control of sleeping sickness in the southern part of the country. Over the years Chad has built up a national medical staff comprising 150 physicians. A medical school was opened in N'Djamena in 1990 and paramedical personnel are now trained at the National School for Public Health. War and lack of funds interrupted mobile services and there is presently a recrudescence of sleeping sickness. Since 1990 the World Health Organization has imposed its views and primary care is now available for all. However, it is now too early to judge the efficacity of this program in Chad.

Provider perceptions of reproductive health service quality in jordanian public community health centers.

PubMed

Al-Qutob, Raeda; Nasir, Laeth S

2008-05-01

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.