Suicide Compared to Other Causes of Mortality in Physicians

ERIC Educational Resources Information Center

Torre, Dario M.; Wang, Nae-Yuh; Meoni, Lucy A.; Young, J. Hunter; Klag, Michael J.; Ford, Daniel E.

2005-01-01

Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results…

Establishing pulmonary and critical care medicine as a subspecialty in China: joint statement of the Chinese thoracic society and the American college of chest physicians.

PubMed

Qiao, Renli; Rosen, Mark J; Chen, Rongchang; Wu, Sinan; Marciniuk, Darcy; Wang, Chen

2014-01-01

This commentary heralds the recognition in China of a new subspecialty, Pulmonary and Critical Care Medicine, and the first national fellowship training pathway in any medical specialty. Because of striking environmental health-care similarities that existed in the United States, the Chinese medical community decided to model the specialty after that in the United States. Because of its expertise in educating pulmonary and critical care physicians in the United States, the American College of Chest Physicians was chosen by the Chinese Thoracic Society, with the approval of the Chinese government, to help with the transformation of this new specialty. A work group representing the two societies is collaborating to reorganize ICUs within a select group of large teaching hospitals in China and to introduce standardized and rigorous training in pulmonary and critical care medicine as a national program.

Euthanasia and physician-assisted suicide policy in The Netherlands and Oregon: a comparative analysis.

PubMed

Patel, Kant

2004-01-01

This article presents a comparative analysis of euthanasia and physician-assisted suicide policy in The Netherlands and the state of Oregon in the United States. The topics of euthanasia and physician-assisted suicide are discussed in the context of the historical setting of The Netherlands and the United States with special emphasis placed on public opinion, role of the courts and the legislative bodies, and opinions of physicians. Major similarities and differences in the laws of The Netherlands and Oregon are discussed. The article examines whether the passage of the law has led to a slide down the slippery slope in The Netherlands and Oregon as had been suggested by the opponents of the law. The article concludes that the empirical evidence does not support the contention of the opponents. However, the author argues that the potential for this happening is much greater in The Netherlands than in Oregon.

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

ERIC Educational Resources Information Center

Hatton, Jerald D.

2012-01-01

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

Women's participation in the medical profession: insights from experiences in Japan, Scandinavia, Russia, and Eastern Europe.

PubMed

Ramakrishnan, Aditi; Sambuco, Dana; Jagsi, Reshma

2014-11-01

Although much literature has focused on the status of female physicians in the United States, limited English-language studies have examined the role of women in the medical profession elsewhere in the world. This article synthesizes evidence regarding the status of female physicians in three purposively selected regions outside the United States: Japan, Scandinavia, and Russia and Eastern Europe. These three regions markedly differ in the proportion of female physicians in the workforce, overall status of the medical profession, cultural views of gender roles, and workforce policies. Through a review of studies and articles published between 1992 and 2012 examining women's representation, status measures such as salary and leadership positions, and experiences of female physicians, the authors discuss potential relationships between the representation of female physicians, their status in medicine, and the overall status of the profession. The findings suggest that even when women constitute a high proportion of the physician workforce, they may continue to be underrepresented in positions of leadership and prestige. Evolving workforce policies, environments, and cultural views of gender roles appear to play a critical role in mediating the relationship between women's participation in the medical profession and their ability to rise to positions of influence within it. These insights are informative for the ongoing debates over the impact of the demographic shifts in the composition of the medical workforce in the United States.

Women's Participation in the Medical Profession: Insights from Experiences in Japan, Scandinavia, Russia, and Eastern Europe

PubMed Central

Ramakrishnan, Aditi; Sambuco, Dana

2014-01-01

Abstract Although much literature has focused on the status of female physicians in the United States, limited English-language studies have examined the role of women in the medical profession elsewhere in the world. This article synthesizes evidence regarding the status of female physicians in three purposively selected regions outside the United States: Japan, Scandinavia, and Russia and Eastern Europe. These three regions markedly differ in the proportion of female physicians in the workforce, overall status of the medical profession, cultural views of gender roles, and workforce policies. Through a review of studies and articles published between 1992 and 2012 examining women's representation, status measures such as salary and leadership positions, and experiences of female physicians, the authors discuss potential relationships between the representation of female physicians, their status in medicine, and the overall status of the profession. The findings suggest that even when women constitute a high proportion of the physician workforce, they may continue to be underrepresented in positions of leadership and prestige. Evolving workforce policies, environments, and cultural views of gender roles appear to play a critical role in mediating the relationship between women's participation in the medical profession and their ability to rise to positions of influence within it. These insights are informative for the ongoing debates over the impact of the demographic shifts in the composition of the medical workforce in the United States. PMID:25320867

The European influence on workers' compensation reform in the United States

PubMed Central

2011-01-01

Workers' compensation law in the United States is derived from European models of social insurance introduced in Germany and in England. These two concepts of workers' compensation are found today in the federal and state workers' compensation programs in the United States. All reform proposals in the United States are influenced by the European experience with workers' compensation. In 2006, a reform proposal termed the Public Health Model was made that would abolish the workers' compensation system, and in its place adopt a national disability insurance system for all injuries and illnesses. In the public health model, health and safety professionals would work primarily in public health agencies. The public health model eliminates the physician from any role other than that of privately consulting with the patient and offering advice solely to the patient. The Public Health Model is strongly influenced by the European success with physician consultation with industry and labor. PMID:22151643

The migration of physicians and the local supply of practitioners: a five-year comparison.

PubMed

Ricketts, Thomas C

2013-12-01

The overall distribution of physicians in the United States is uneven, with concentrations in urban areas while some rural places have proportionately very few. This report examines the movement of physicians who have completed their training and choose to move from one location to another. The analysis linked the locations of practice of physicians practicing in the 50 U.S. states in 2006 and 2011 using data from the American Medical Association Physician Masterfile. Age, gender, location practice, activity status, and specialty were included in the data. Physicians who changed address in the five-year period were identified and were compared with nonmovers using descriptive statistics. A summary logistic regression of movers compared with nonmovers was performed to assess the most important correlates of migration. The overall rate of county-to-county relocation for physicians was 19.8% for the five-year period 2006-2011. Analyses indicated that older, male, and urban physicians were less likely to move; that physicians with osteopathic training were more likely to move; and that surgeons and primary care physicians were less likely to move compared with other specialists. The physician workforce in the United States migrates from place to place, and this movement determines the local supply of practitioners at any given time. Programs that intend to influence the local supply of doctors should account for this background tendency to relocate practice in order to achieve goals of more equal geographic distribution.

The Ethics of Organ Tourism: Role Morality and Organ Transplantation.

PubMed

Adams, Marcus P

2017-11-15

Organ tourism occurs when individuals in countries with existing organ transplant procedures, such as the United States, are unable to procure an organ by using those transplant procedures in enough time to save their life. In this paper, I am concerned with the following question: When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list? I argue that transplant physicians have a duty not to relist organ tourists. Specifically, I contend that we should locate physicians' duties in these cases within the new role of "transplant physician." This role results from transplant physicians' participation in a system that depends on organ donors' voluntary act of donation. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

78 FR 4439 - United States

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-22

... DEPARTMENT OF JUSTICE Antitrust Division United States v. Oklahoma State Chiropractic Independent... Chiropractic Independent Physicians Association and Larry M. Bridges, Civil Case No. 13-CV-21- TCK-TLW. On... prices or terms for chiropractic services. Copies of the Complaint, proposed Final Judgment, and...

Synergy between publication and promotion: comparing adoption of new evidence in Canada and the United States.

PubMed

Majumdar, Sumit R; McAlister, Finlay A; Soumerai, Stephen B

2003-10-15

Few studies have examined the effect of new evidence from clinical trials on physician practice. We took advantage of differences in promotional activity in Canada and the United States for the Heart Outcomes Prevention and Evaluation (HOPE) study and the Randomized Aldactone Evaluation Study (RALES) to determine if publication of new evidence changes practice, and the extent to which promotion influences adoption of new evidence. We used longitudinal dispensing data, collected from 1998 to 2001, to examine changes in prescribing patterns for ramipril and other angiotensin-converting enzyme (ACE) inhibitors before and after the HOPE study. We also obtained estimates for promotional expenditures. We stratified analyses by country, to isolate the effect of promotion, and used interrupted time series methods to adjust for pre-existing prescribing trends. Similar analyses were conducted for spironolactone use before and after RALES. Publication of the HOPE study results was associated with rapid increases in the use of ramipril. After adjusting for pre-existing prescribing trends, ramipril prescribing increased by 12% per month (P = 0.001) in Canada versus 5% per month (P = 0.001) in the United States after the study results were presented and published. One year later, ramipril accounted for 30% of the ACE inhibitor market in Canada versus 6% in the United States. The year before publication of these results, expenditures for detailing increased by 20% in Canada (to 18 US dollars per physician) but decreased by 7% in the United States (to 13 US dollars per physician); the year after publication, spending increased to 27 US dollars per physician in Canada versus 23 US dollars per physician in the United States. In the absence of promotional activity for RALES in either country, publication of results was associated with more modest but similar increases of 2% per month (P = 0.001) in spironolactone use in both countries. Publication of new evidence is associated with modest changes in practice. Promotional activity appears to increase the adoption of evidence. Rather than relying on the publication of articles and creation of guidelines, those wishing to accelerate the adoption of new evidence may need to undertake more active promotion.

75 FR 62451 - National Physician Assistants Week, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-12

... National Physician Assistants Week, 2010 By the President of the United States of America A Proclamation In... clinics, and other settings with provider shortages. During National Physician Assistants Week, we honor... heart-wrenching circumstances. As we recognize their countless contributions this week, we also pay...

Mechanisms of Prescription Drug Diversion Among Impaired Physicians

PubMed Central

Cummings, Simone Marie; Merlo, Lisa; Cottler, Linda B.

2014-01-01

The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision-makers as they seek to develop preventive. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician health program (PHP) were conducted. The content analysis revealed that physicians divert medications by stealing from the office or hospital, by defrauding patients and insurers, by using medication samples, and by misusing valid prescriptions. The implementation of policy interventions targeting these mechanisms has the potential to mitigate the amount of physician diversion that occurs. PMID:21745042

Physician Migration: A Challenge for America, a Challenge for the World

ERIC Educational Resources Information Center

Cooper, Richard A.

2005-01-01

For five decades, medical education policy in the United States has been built around the expectation that, if too few physicians were produced, additional physicians would be available from other countries. That policy is examined in the context of the desire for an ever-increasing number of physicians who will provide an ever-expanding array of…

Self-employment, specialty choice, and geographical distribution of physicians in Japan: A comparison with the United States.

PubMed

Matsumoto, Masatoshi; Inoue, Kazuo; Bowman, Robert; Kajii, Eiji

2010-08-01

Geographic and specialty maldistributions of physicians are political concerns in Japan. This study examined the associations of physician employment status with the number and geographic distribution of the physicians in each specialty in Japan, in comparison with the US. The number of physicians per unit population, proportion of clinic (Japan) or office (US) based physicians, and Gini coefficient of physicians against population were calculated in each of 20 specialties in Japan, and 21 specialties in the US. The geographic unit of Gini coefficient was municipality in Japan, and county in the US. Correlations among these three variables were also examined. The lower the proportion of clinic-based physicians was, the lower the number of physicians and the higher the Gini coefficient were in Japanese specialties, while there was no association between office-based rate and Gini coefficient in the US specialties. In radiology, anaesthesiology, emergency medicine, and pathology, Japanese clinic-based rates were less than one-tenth, and the numbers of physicians per unit population were less than half of the US values, and the Gini coefficients were substantially higher than the US values. Difficulty in being self-employed created low numbers in some specialties, and highly urban-biased distributions of these specialists in Japan. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

The other Founding Physicks: the lives and times of the physician signers of the Articles of Confederation and Perpetual Union.

PubMed

Bengtsson, Bengt-Ola S

2013-08-01

The Articles of Confederation and Perpetual Union was the interim constitution of the United States of America between 1777 and 1789. The name the United States of America is encountered here for the first time. Three physicians were among the 48 signers - Josiah Bartlett, Samuel Holten and Nathaniel Scudder. All three men started out studying and practising medicine but their lives took very different turns as the new nation emerged.

Contraceptive use by female physicians in the United States.

PubMed

Frank, E

1999-11-01

Little is known about female physicians' personal contraceptive use, and such usage could influence their prescribing patterns. We used data from the Women Physicians' Health Study, a large (n = 4501) national study, administered in 1993-1994, on characteristics of female physicians in the United States. These female physicians (ages 30-44 years) were more likely to use contraception than women in the general population (ages 15-44 years); this was true even when the physicians were compared with only other women of high socioeconomic status and when stratified by ethnicity, age, and number of children. Physicians were also more likely to use intrauterine devices, diaphragms, or condoms, and less likely to use female or male sterilization than were other women. Younger female physicians were especially unlikely to use permanent methods, particularly when compared with their age-matched counterparts in the general population. One fifth of contracepting physicians used more than one type of contraceptive; the most frequently used combination was spermicide with a barrier method. Female physicians contracept differently than do women in the general population, in ways consistent with delaying and reducing total fertility. Physicians' personal characteristics have been shown to influence their patient counseling practices, including their contraception-related attitudes and practices. Although female physicians' clinical advice might differ from their personal practices, as women physicians become more prevalent, their contraceptive choices could influence those of their patients.

The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis.

PubMed

Knudsen, Hannah K

2015-07-01

The U.S. Food and Drug Administration's approval of buprenorphine in 2002 expanded options for treating opioid use disorder (OUD). Physicians who intend to treat OUD patients with buprenorphine must seek a waiver to prescribe it, which may contribute to state-by-state variation in the supply of waivered physicians. This study integrates data extracted from the U.S. Drug Enforcement Agency's database of waivered physicians with state-level indicators of the macro environment, health-related resources, and treatment demand. In December 2013, the average state had 8.0 waivered physicians per 100,000 residents (SD = 5.2). Large regional differences between states in the Northeast relative to states in the Midwest, South, and West were observed. The percentage of residents covered by Medicaid as well as the population-adjusted availability of opioid treatment programs and substance use disorder treatment facilities were positively associated with buprenorphine physician supply. Buprenorphine physician supply was positively correlated with states' rates of overdose deaths, suggesting that physicians may seek the waiver in response to the magnitude of the opioid problem in their state. States with greater health-related resources, particularly in terms of the supply of opioid treatment programs and substance use disorder treatment programs, had more waivered physicians in 2013. The finding regarding Medicaid coverage suggests that states implementing Medicaid expansion under health reform may experience additional growth in buprenorphine physician supply. However, large regional disparities in the supply of waivered physicians may impede access to care for many Americans with OUD.

Comparison of Opioid Prescribing Patterns in the United States and Japan: Primary Care Physicians' Attitudes and Perceptions.

PubMed

Onishi, Eriko; Kobayashi, Tadashi; Dexter, Eve; Marino, Miguel; Maeno, Tetsuhiro; Deyo, Richard A

2017-01-01

Far fewer opioids are prescribed in Japan than in the United States. We conducted an online physician survey assessing attitudes and perceptions that might influence prescribing. A Japanese version was distributed to members of the Japan Primary Care Association and an English version to members of the American Academy of Family Physicians practicing in Oregon. We received 461 Japanese responses and 198 from the United States, though overall response rates were low (Japan: 10.1%, United States: 18.5%). Japanese respondents reported far less opioid prescribing than US respondents, especially for acute pain (acute pain: 49.4% vs 97.0%; chronic pain: 63.7% vs 90.9%; P < .001 for both). Almost half of respondents from both countries indicated that patient expectations and satisfaction were important factors that influence prescribing. US respondents were significantly more likely to identify medical indication and legal expectation as reasons to prescribe opioids for acute pain. Most US respondents (95.4%) thought opioids were used too often, versus 6.6% of Japanese respondents. Lower opioid use was reported in Japan, especially for acute pain, which may help minimize long-term use. Patient expectations and satisfaction seem to influence opioid prescribing in both countries. The United States could learn from Japanese regulatory and cultural perspectives. © Copyright 2017 by the American Board of Family Medicine.

THE EVOLUTION OF WATER QUALITY IN THE UNITED STATES - 1922-2003

EPA Science Inventory

The microbiological quality of recreational waters was first discussed in the United States as early as 1922 by the American Public Health Association's Committee on Bathing Beaches (APHA,1922) . The Committee surveyed 2000 physicians and state health officials inquiring about th...

Attitudes toward Suicide: Italian and United States Physicians.

ERIC Educational Resources Information Center

Domino, George; Perrone, Luisa

1993-01-01

Administered Suicide Opinion Questionnaire to 100 Italian and 100 U.S. physicians, comparable in age, gender, and medical field. Found significant difference on seven of eight scales, with Italian physicians showing greater agreement on mental illness, right to die, religion, impulsivity, normality, aggression, and moral evil scales. Found gender…

Medicare: Documenting Teaching Physician Services Still a Problem. Report to Congressional Committees by the United State General Accounting Office.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

Amounts billed for teaching physician services and paid by Medicare carriers were reviewed by the General Accounting Office (GAO) to determine whether such payments had been made only where the physicians had satisfied the requirements of the Social Security Act. Attention was focused on the requirement that teaching physicians must provide a…

Acupuncture: In Depth

MedlinePlus

... College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low- ... a conditioning-expectation effect. Forschende Komplementärmedizin ... health approaches for pain management in the United States. Mayo ...

Cost and workforce implications of subjecting all physicians to aviation industry work-hour restrictions.

PubMed

Payette, Michael; Chatterjee, Abhishek; Weeks, William B

2009-06-01

Efforts to improve patient safety have attempted to incorporate aviation industry safety standards. We sought to evaluate the cost and workforce implications of applying aviation duty-hour restrictions to the entire practicing physician workforce. The work hours and personnel deficit for United States residents and practicing physicians that would be created by the adoption of aviation standards were calculated. Application of aviation standards to the resident workforce creates an estimated annual cost of $6.5 billion, requiring a 174% increase in the number of residents to meet the deficit. Its application to practicing physicians creates an additional annual cost of $80.4 billion, requiring a 71% increase in the physician workforce. Adding in the aviation industry's mandatory retirement age (65 years) increases annual costs by $10.5 billion. The cost per life-year saved would be $1,035,227. Application of aviation duty-hour restrictions to the United States health care system would be prohibitively costly. Alternate approaches for improving patient safety are warranted.

Moral and Legal Issues Surrounding Terminal Sedation and Physician Assisted Suicide

DTIC Science & Technology

2002-09-23

1 MORAL AND LEGAL ISSUES SURROUNDING TERMINAL SEDATION AND PHYSICIAN ASSISTED SUICIDE by CONSTANCE ReJENNA BRADLEY B.S., United States Air Force...Title and Subtitle Moral and Legal Issues Surrounding Terminal Sedation and Physician-Assisted Suicide Contract Number Grant Number Program...Constance ReJenna (M.A., Philosophy) Moral and Legal Issues Surrounding Terminal Sedation and Physician Assisted Suicide Thesis directed by Instructor

Genital Herpes - Initial Visits to Physicians' Offices, United States, 1966-2012

MedlinePlus

... Archive Data & Statistics Sexually Transmitted Diseases Figure 48. Genital Herpes — Initial Visits to Physicians’ Offices, United States, 1966 – ... Statistics page . NOTE : The relative standard errors for genital herpes estimates of more than 100,000 range from ...

Genital Warts -- Initial Visits to Physicians' Offices, United States, 1966 - 2012

MedlinePlus

... 46. Genital Warts — Initial Visits to Physicians’ Offices, United States, 1966 – 2012 Recommend on Facebook Tweet Share Compartir ... OIG 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO (800-232-4636) , TTY: 888- ...

Licensed physicians who work in prisons: a profile.

PubMed Central

Lichtenstein, R L; Rykwalder, A

1983-01-01

A profile of the personal and professional characteristics of the physicians who work in America's prisons was obtained by analyzing data from a larger study of all licensed physicians in the United States who worked in a prison at least 12 hours a month during the fall of 1979. Psychiatrists were not included, nor were physicians working in jails. The population of 382 prison physicians comprised two major groups--those who worked in prisons full time and those who worked in them part time. Part-time physicians, who represented the majority of physicians involved in prison work (58 percent), were found to resemble closely the typical physician in the United States; they were predominantly trained in America, specialized, and board certified. In contrast, full-time prison physicians, who accounted for 73 percent of the total hours physicians spent working in prisons, differed significantly from the typical U.S. physician. They were older, less specialized, less likely to be board certified, and more likely to be graduates of non-U.S. medical schools. The professional characteristics of the full-time prison physicians raise serious questions about the quality of medical care they are likely to provide. It would seem, based on their professional attributes, that the part-time physicians are able to provide better quality care than their full-time colleagues. Prison health system could thus assure higher quality care to inmates by relying primarily on part-time rather than full-time practitioners. PMID:6419274

Predicting risk for disciplinary action by a state medical board.

PubMed

Cardarelli, Roberto; Licciardone, John C; Ramirez, Gilbert

2004-01-01

Disciplinary actions taken against physicians in the United States have been increasing over the last decade, yet the factors that place physicians at risk have not been well identified. The objective of this study is to identify predictors of physician disciplinary action. This case-control study used data from the Texas State Board of Medical Examiners from January 1989 through December 1998. Characteristics of disciplined physicians and predictors of disciplinary action for all violations and by type of violation were the main outcome descriptors. Years in practice, black physicians, and osteopathic graduates were positive predictors for disciplinary action. In contrast, female physicians, international medical graduates, and Hispanic and Asian physicians were less likely to receive disciplinary action compared with male, US allopathic, and white physicians, respectively. Most specialists, except psychiatrists and obstetrician-gynecologists, were less likely to be disciplined than were family practitioners, whereas general practitioners were more likely to be disciplined. More studies are needed to corroborate these findings.

Physician Preparedness for Big Genomic Data: A Review of Genomic Medicine Education Initiatives in the United States.

PubMed

Rubanovich, Caryn Kseniya; Cheung, Cynthia; Mandel, Jess; Bloss, Cinnamon S

2018-05-10

In the last decade, genomic medicine education initiatives have surfaced across the spectrum of physician training in order to help address a gap in genomic medicine preparedness among physicians. The approaches are diverse and stem from the belief that 21st century physicians must be proficient in genomic medicine applications as they will be leaders in the precision medicine movement. We conducted a review of literature in genomic medicine education and training for medical students, graduate medical education, and practicing physicians with articles published between June 2015 and January 2018 to gain a picture of the current state of genomic medicine education with a focus on the United States. We found evidence of progress in the development of new and innovative educational programs and other resources aimed at increasing physician knowledge and readiness. Three overarching educational approach themes emerged, including immersive and experiential learning; interdisciplinary and interprofessional education; and electronic- and web-based approaches. This review is not exhaustive, nevertheless, it may inform future directions and improvements for genomic medicine education. Important next-steps include: 1) identifying and studying ways to best implement low-cost dissemination of genomic information; 2) emphasizing genomic medicine education program evaluation; and 3) incorporating interprofessional and interdisciplinary initiatives. Genomic medicine education and training will become more and more relevant in the years to come as physicians increasingly interact with genomic and other precision medicine technologies.

Professional profile of pediatric intensivists in Rio de Janeiro, southeastern Brazil.

PubMed

Lacerda, Jandra Corrêa de; Barbosa, Arnaldo Prata; Cunha, Antonio José Ledo Alves da

2011-12-01

This study described the sociodemographic profile and professional qualifications of pediatric intensive care physicians in the State of Rio de Janeiro (RJ), southeastern Brazil. This investigation was an observational, cross-sectional and descriptive study that was conducted in neonatal, pediatric and mixed intensive care units in the State of Rio de Janeiro. Physicians working in the participating intensive care units voluntarily completed a semistructured and anonymous questionnaire. Questionnaires that were not returned within 30 days were considered lost, and questionnaires with less than 75% questions completed were excluded. The differences in neonatal and pediatric intensive care physicians' medical training were compared using the Chi-squared test with a 5% significance level. A total of 410 physicians were included in this study: 84% female, 48% between 30 and 39 years old and 45% with monthly incomes between US $1,700 to 2,700. Forty percent of these physicians worked exclusively in this specialty, and 72% worked in more than one intensive care unit. Only 50% of the participants had received specific training (either medical residency or specialization) in neonatology, and only 33% were board-certified specialists in this area. Only 27% of the physicians had received specific training in pediatric intensive care medicine, and only 17% were board-certified specialists (p < 0.0005 for both comparisons). Most (87%) physicians had participated in scientific events within the past 5 years, and 55% used the internet for continued medical education. However, only 25% had participated in any research. Most (63%) physicians were dissatisfied with their professional activity; 49% were dissatisfied due to working conditions, 23% due to low incomes and 18% due to training-related issues. These results suggested that the medical qualifications of neonatal and pediatric intensive care physicians in the State of Rio de Janeiro, Brazil are inadequate, especially in pediatric intensive care medicine. A high level of dissatisfaction was reported, which may jeopardize the quality of medical assistance that is provided by these professionals.

Effective implementation of work-hour limits and systemic improvements.

PubMed

Landrigan, Christopher P; Czeisler, Charles A; Barger, Laura K; Ayas, Najib T; Rothschild, Jeffrey M; Lockley, Steven W

2007-11-01

Sleep deprivation, ubiquitous among nurses and physicians, recently has been shown to greatly increase rates of serious medical errors and occupational injuries among health care workers in the United States. The Accreditation Council for Graduate Medical Education's current work-hour limits for physicians-in-training allow work hours well in excess of those proven safe. No regulations limit the work hours of other groups of health care providers in the United States. Consequently, nursing work shifts exceeding 12 hours remain common. Physician-in-training shifts of 30 consecutive hours continue to be endorsed officially, and data demonstrate that even the 30-hour limit is exceeded routinely. By contrast, European health care workers are limited by law to 13 consecutive hours of work and to 48-56 hours of work per week. Except for a few institutions that have eliminated 24-hour shifts, as a whole, the United States lags far behind other industrialized nations in ensuring safe work hours. Preventing health care provider sleep deprivation could be an extremely powerful means of addressing the epidemic of medical errors in the United States. Implementation of evidence-based work-hour limits, scientifically designed work schedules, and infrastructural changes, such as the development of standardized handoff systems, are urgently needed.

Mental Health Care: Licensing and Certification Requirements for Staff in State Hospitals. Fact Sheet for the Honorable Daniel K. Inouye, United States Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Div. of Human Resources.

The Office of United States Senator Daniel Inouye requested information on state minimum licensing and certification requirements for physicians, psychiatrists, psychologists, social workers, and nurses who work directly with patients in state mental hospitals. To obtain this information, the General Accounting Office called the offices of the…

What Makes Me Screen for HIV? Perceived Barriers and Facilitators to Conducting Recommended Routine HIV Testing among Primary care Physicians in the Southeastern United States

PubMed Central

White, Becky L.; Walsh, Joan; Rayasam, Swati; Pathman, Donald E.; Adimora, Adaora A.; Golin, Carol E.

2015-01-01

The Centers for Disease Control and Prevention have recommended routinely testing patients (aged 13–64) for HIV since 2006. However, many physicians do not routinely test. From January 2011- March 2012, we conducted 18 in-depth individual interviews and explored primary care physicians’ perceptions of barriers and facilitators to implementing routine HIV testing in North Carolina. Physicians’ comments were categorized thematically and fell into five groups: policy, community, practice, physician and patient. Lack of universal reimbursement was identified as the major policy barrier. Participants believed endorsement from the United States Preventive Services Tasks Force would facilitate adoption of routine HIV testing policies. Physicians reported HIV/AIDS stigma, socially conservative communities, lack of confidentiality, and rural geography as community barriers. Physicians believed public HIV testing campaigns would legitimize testing and decrease stigma in communities. Physicians cited time constraints and competing clinical priorities as physician barriers that could be overcome by delegating testing to nursing staff. HIV test refusal, low HIV risk perception, and stigma emerged as patient barriers. Physicians recommended adoption of routine HIV testing for all patients to facilitate and destigmatize testing. Physicians continue to experience a variety of barriers when implementing routine HIV testing in primary care settings. Our findings support multilevel approaches to enhance physician routine HIV testing in primary care settings. PMID:24643412

Internal migration of physicians who graduated in Brazil between 1980 and 2014.

PubMed

Scheffer, Mario Cesar; Cassenote, Alex Jones Flores; Guilloux, Aline Gil Alves; Dal Poz, Mario Roberto

2018-05-02

The internal migration of physicians from one place to another in the same country can unbalance the supply and distribution of these professionals in national health systems. In addition to economic, social and demographic issues, there are individual and professional factors associated with a physician's decision to migrate. In Brazil, there is an ongoing debate as to whether opening medicine programmes in the interior of the country can induce physicians to stay in these locations. This article examines the migration of physicians in Brazil based on the location of the medical schools from which they graduated. A cross-sectional design based on secondary data of 275,801 physicians registered in the Regional Councils of Medicine (Conselhos Regionais de Medicina-CRMs) who graduated between 1980 and 2014. The evaluated outcome was migration, which was defined as moving away from the state where they completed the medicine programme to another state where they currently work or live. 57.3% of the physicians in the study migrated. The probability of migration ratio was greater in small grouped municipalities and lower in state capitals. 93.4% of the physicians who trained in schools located in cities with less than 100,000 inhabitants migrated. Fewer women (54.2%) migrated than men (60.0%). More than half of the physicians who graduated between 1980 and 2014 are in federative units different from the unit in which they graduated. Individual factors, such as age, gender, time of graduation and specialty, vary between the physicians who did or did not migrate. The probability of migration ratio was greater in small municipalities of the Southeast region and strong in the states of Tocantins, Acre and Santa Catarina. New studies are recommended to deepen understanding of the factors related to the internal migration and non-migration of physicians to improve human resource for health policies.

The risk of disciplinary action by state medical boards against physicians prescribing opioids.

PubMed

Richard, Jack; Reidenberg, Marcus M

2005-02-01

Concern of physicians about being disciplined for prescribing opioids for patients in pain is one cause for undertreatment of pain. This study was done to assess the actual risk of being disciplined by state medical boards. A review of records of actions by the New York State Board for Professional Medical Misconduct for 3 years and of all medical boards in the United States for 9 months was done to determine this risk. New York State, with 7.8% of U.S. physicians, had 10 physicians disciplined annually related to overprescribing opioids, while the total for the entire U.S. was 120 physicians annually. Most physicians disciplined had multiple violations in addition to overprescribing controlled substances. In the national sample, 43% were prescribing for themselves or for nonpatients, 12% prescribed for addicts without addressing the patients' problems of addiction, 42% had inadequate records, 19% prescribed without indication for opioids, 13% were incompetent in additional ways, and 8% were having sexual activity with patients. Not a single physician, for whom information was available, was disciplined solely for overprescribing opioids. The actual risk of an American physician being disciplined by a state medical board for treating a real patient with opioids for a painful medical condition is virtually nonexistent.

Recruitment of Physicians to Rural America: A View through the Lens of Transaction Cost Theory

ERIC Educational Resources Information Center

Fannin, J. Matthew; Barnes, James N.

2007-01-01

Context: Many rural hospitals in the United States continue to have difficulties recruiting physicians. While several studies have examined some of the factors affecting the nature of this problem, we know far less about the role of economic incentives between rural providers and physicians. Purpose: This conceptual article describes an economic…

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.

Pharmaceutical residues in the drinking water supply: modeling residue concentrations in surface waters of drugs prescribed in the United States.

PubMed

Guerrero-Preston, Rafael; Brandt-Rauf, Paul

2008-09-01

Pharmaceutical residues and other organic wastewater contaminants (OWC) have been shown to survive conventional water-treatment processes and persist in potable water supplies. To estimate the geographical distribution of the Predicted Environmental Concentration (PEC) of selected drugs prescribed by office based physicians in the United States (US), after non-metabolized residues have been excreted and processed in wastewater treatment plants. The geographical distribution of the PEC in surface waters of pharmaceutical residues was calculated, in four regions of the US. Prescription drug data was obtained from the National Ambulatory Medical Care Survey (NAMCS). The PEC of three drugs prescribed by office based physicians in the US between 1998 and 2000 was compared to the concentrations of these pharmaceuticals found in a surface water characterization project conducted by the United States Geological Survey between 1999 and 2000. There were 803,185,420 medications prescribed by office-based physicians in the US between 1998 and 2000. Relief of pain, hormonal, cardiovascular and antimicrobial medications followed very similar prescription patterns, both in terms of quantity and geographical distribution. Together these four types of medications account for more than half of the medications prescribed between 1998 and 2000. The concentration of pharmaceutical residues found in the drinking water supply was not significantly correlated to the PEC of pharmaceuticals prescribed by office-based physicians. The geographical distribution of medications prescribed by office based physicians in the US underlines the need to implement effective public health strategies.

Views of United States physicians and members of the American Medical Association House of Delegates on physician-assisted suicide.

PubMed

Whitney, S N; Brown, B W; Brody, H; Alcser, K H; Bachman, J G; Greely, H T

2001-05-01

To ascertain the views of physicians and physician leaders toward the legalization of physician-assisted suicide. Confidential mail questionnaire. A nationwide random sample of physicians of all ages and specialties, and all members of the American Medical Association (AMA) House of Delegates as of April 1996. Demographic and practice characteristics and attitude toward legalization of physician-assisted suicide. Usable questionnaires were returned by 658 of 930 eligible physicians in the nationwide random sample (71%) and 315 of 390 eligible physicians in the House of Delegates (81%). In the nationwide random sample, 44.5% favored legalization (16.4% definitely and 28.1% probably), 33.9% opposed legalization (20.4% definitely and 13.5% probably), and 22% were unsure. Opposition to legalization was strongly associated with self-defined politically conservative beliefs, religious affiliation, and the importance of religion to the respondent (P <.001). Among members of the AMA House of Delegates, 23.5% favored legalization (7.3% definitely and 16.2% probably), 61.6% opposed legalization (43.5% definitely and 18.1% probably), and 15% were unsure; their views differed significantly from those of the nationwide random sample (P <.001). Given the choice, a majority of both groups would prefer no law at all, with physician-assisted suicide being neither legal nor illegal. Members of the AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is sometimes adversarial, most physicians in the United States are uncertain or endorse moderate views on assisted suicide.

Physician-industry cooperation in the medical device industry.

PubMed

Chatterji, Aaron K; Fabrizio, Kira R; Mitchell, Will; Schulman, Kevin A

2008-01-01

Anecdotal evidence suggests that innovative medical devices often arise from physicians' inventive activity, but no studies have documented the extent of such physician-engaged innovation. This paper uses patent data and the American Medical Association Physician Masterfile to provide evidence that physicians contribute to medical device innovation, accounting for almost 20 percent of approximately 26,000 medical device patents filed in the United States during 1990-1996. Moreover, two measures indicate that physician patents had more influence on subsequent inventive activity than nonphysician patents. This finding supports the maintenance of an open environment for physician-industry collaboration in the medical device discovery process.

The geographic distribution of the otolaryngology workforce in the United States.

PubMed

Lango, Miriam N; Handorf, Elizabeth; Arjmand, Ellis

2017-01-01

To describe the deployment of otolaryngologists and evaluate factors associated with the geographic distribution of otolaryngologists in the United States. Cross-sectional study. The otolaryngology physician supply was defined as the number of otolaryngologists per 100,000 in the hospital referral region (HRR). The otolaryngology physician supply was derived from the American Medical Association Masterfile or from the Medicare Enrollment and Provider Utilization Files. Multiple linear regression tested the association of population, physician, and hospital factors on the supply of Medicare-enrolled otolaryngologists/HRR. Two methods of measuring the otolaryngology workforce were moderately correlated across hospital referral regions (Pearson coefficient 0.513, P = .0001); regardless, the supply of otolaryngology providers varies greatly over different geographic regions. Otolaryngologists concentrate in regions with many other physicians, particularly specialist physicians. The otolaryngology supply also increases with regional population income and education levels. Using AMA-derived data, there was no association between the supply of otolaryngologists and staffed acute-care hospital beds and the presence of an otolaryngology residency-training program. In contrast, the supply of otolaryngology providers enrolled in Medicare independently increases for each HRR by 0.8 per 100,000 for each unit increase in supply of hospital beds (P < .0001) and by 0.49 per 100,000 in regions with an otolaryngology residency-training program (P = .006), accounting for all other factors. Irrespective of methodology, the supply of otolaryngologists varies widely across geographic regions in the United States. For Medicare beneficiaries, regional hospital factors-including the presence of an otolaryngology residency program-may improve access to otolaryngology services. NA Laryngoscope, 127:95-101, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

A population-based study of the association of medical manpower with county trauma death rates in the United States.

PubMed Central

Rutledge, R; Fakhry, S M; Baker, C C; Weaver, N; Ramenofsky, M; Sheldon, G F; Meyer, A A

1994-01-01

OBJECTIVE: To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates. SUMMARY BACKGROUND DATA: When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated. METHODS: Data on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used. RESULTS: Bivariate and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians. CONCLUSIONS: This study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. It also found that counties with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (ATLS) in trauma care have lower per-capita trauma death rates.(ABSTRACT TRUNCATED AT 400 WORDS) Images Figure 1. PMID:8185404

Folk healing: a description and synthesis.

PubMed

Ness, R C; Wintrob, R M

1981-11-01

All societies have developed ways of dealing with physical and mental illness, defined as folk healing systems. The authors review the systems of folk healing that have evolved in different cultural groups in the United States. They describe the faith healing practices of fundamentalist Christian groups, the belief in rootwork among white and black people in the southeastern United States, curanderismo among Mexican-Americans, and espiritismo among Americans from Puerto Rico. Most believers in folk healing also go to physicians for medical care. The authors argue that physicians should familiarize themselves with patients' folk healing beliefs in order to serve them more effectively.

Primary care: current problems and proposed solutions.

PubMed

Bodenheimer, Thomas; Pham, Hoangmai H

2010-05-01

In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining prompt access to primary care. A variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce.

Emergency Department Coverage by Primary Care Physicians in a Rural Practice-Based Research Network: Incentives, Confidence, and Training

ERIC Educational Resources Information Center

Lew, Edward; Fagnan, Lyle J.; Mattek, Nora; Mahler, Jo; Lowe, Robert A.

2009-01-01

Context: In rural areas of the United States, emergency departments (EDs) are often staffed by primary care physicians, as contrasted to urban and suburban hospitals where ED coverage is usually provided by physicians who are residency-trained in emergency medicine. Purpose: This study examines the reasons and incentives for rural Oregon primary…

Need for Physician Education on the Benefits and Risks of Male Circumcision in the United States

ERIC Educational Resources Information Center

Carbery, Baevin; Zhu, Julia; Gust, Deborah A.; Chen, Robert T.; Kretsinger, Katrina; Kilmarx, Peter H.

2012-01-01

Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult…

Characterizing critical care physician staffing in rural America: a description of Iowa intensive care unit staffing.

PubMed

Mohr, Nicholas M; Collier, John; Hassebroek, Elizabeth; Groth, Heather

2014-04-01

This study aimed to characterize intensive care unit (ICU) physician staffing patterns in a predominantly rural state. A prospective telephone survey of ICU nurse managers in all Iowa hospitals with an ICU was conducted. Of 122 Iowa hospitals, 64 ICUs in 58 (48%) hospitals were identified, and 46 (72%) responded to the survey. Most ICUs (96%) used an open admission model and cared for undifferentiated medical and surgical patients (88%), and only 27% of open ICUs required critical care or pulmonary consultation for admitted patients. Most (59%) Iowa ICUs had a critical care physician or pulmonologist available, and high-intensity staffing was practiced in 30% of ICUs. Most physicians identified as practicing critical care (63%) were not board certified in critical care. Critical care physicians were available in a minority of hospitals routinely for inpatient intubation and cardiac arrest management (29% and 10%, respectively), and emergency physicians and other practitioners commonly responded to emergencies throughout the hospital. Many Iowa hospitals have ICUs, and staffing patterns in Iowa ICUs mirror closely national staffing practices. Most ICUs are multispecialty, open ICUs in community hospitals. These factors should inform training and resource allocation for intensivists in rural states. © 2014.

United States National Healthcare Policies 2015: An Analysis with Implications for the Future of Medicine

PubMed Central

2016-01-01

There is little doubt that the tenure of President Barack Obama and implementation of the Affordable Care Act has had a profound effect on the United States healthcare delivery system in terms of the organization, finances, and clinical aspects of medical practice. As we enter the 2016 presidential election, looming issues of health affairs include 1) Is affordability achievable and can it be achieved without sacrificing the physician-patient relationship? and 2) Does practice consolidation and control by insurance providers cast physicians in a role as technicians? In countries such as the United Kingdom, policies seeking to increase healthcare affordability without sacrificing the quality of care have been implemented, as manifested through not only socialized medicine but also a general goal of cost cutting without sacrificing patient care. In addition, although done more as a tactical move with little impact on the overall budget, the healthcare benefits of political leaders in the United Kingdom are being trimmed in order to increase citizen buy-in in the healthcare model. This article compares recent healthcare policy changes in the United States to those of some constitutional democracies. The attitudes of healthcare stakeholders, including patients, physicians, and political leaders, are also analyzed. It is argued that the evolution of health affairs internationally is driven largely by efficacious political and economic factors, and that it behooves United States healthcare policy makers to note the impact of these international changes and to integrate the necessary changes in order to enhance patient care. PMID:26918219

United States National Healthcare Policies 2015: An Analysis with Implications for the Future of Medicine.

PubMed

Birk, Harjus S

2016-01-07

There is little doubt that the tenure of President Barack Obama and implementation of the Affordable Care Act has had a profound effect on the United States healthcare delivery system in terms of the organization, finances, and clinical aspects of medical practice. As we enter the 2016 presidential election, looming issues of health affairs include 1) Is affordability achievable and can it be achieved without sacrificing the physician-patient relationship? and 2) Does practice consolidation and control by insurance providers cast physicians in a role as technicians? In countries such as the United Kingdom, policies seeking to increase healthcare affordability without sacrificing the quality of care have been implemented, as manifested through not only socialized medicine but also a general goal of cost cutting without sacrificing patient care. In addition, although done more as a tactical move with little impact on the overall budget, the healthcare benefits of political leaders in the United Kingdom are being trimmed in order to increase citizen buy-in in the healthcare model. This article compares recent healthcare policy changes in the United States to those of some constitutional democracies. The attitudes of healthcare stakeholders, including patients, physicians, and political leaders, are also analyzed. It is argued that the evolution of health affairs internationally is driven largely by efficacious political and economic factors, and that it behooves United States healthcare policy makers to note the impact of these international changes and to integrate the necessary changes in order to enhance patient care.

Reporting by Physicians of Impaired Drivers and Potentially Impaired Drivers

PubMed Central

Berger, Jeffrey T; Rosner, Fred; Kark, Pieter; Bennett, Allen J

2000-01-01

Physicians routinely care for patients whose ability to operate a motor vehicle is compromised by a physical or cognitive condition. Physician management of this health information has ethical and legal implications. These concerns have been insufficiently addressed by professional organizations and public agencies. The legal status in the United States and Canada of reporting of impaired drivers is reviewed. The American Medical Association's position is detailed. Finally, the Bioethics Committee of the Medical Society of the State of New York proposes elements for an ethically defensible public response to this problem. PMID:11029682

Specialized Training on Addictions for Physicians in the United States

ERIC Educational Resources Information Center

Tontchev, Gramen V.; Housel, Timothy R.; Callahan, James F.; Kunz, Kevin B.; Miller, Michael M.; Blondell, Richard D.

2011-01-01

In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry (ADP); nonpsychiatrists seeking training in addiction medicine (ADM) can train in nonaccredited "fellowships," or can receive training in some ADP programs, only to not be granted a certificate of completion of…

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data

PubMed Central

Ly, Dan P; Seabury, Seth A

2015-01-01

Objectives To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians. Design Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13. Setting United States. Participants 48 881 physicians, 10 086 dentists, 13 883 pharmacists, 159 044 nurses, 18 920 healthcare executives, 59 284 lawyers, and 6 339 310 other non-healthcare professionals. Main outcome measures Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence). Results After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians. Conclusions Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce. PMID:25694110

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data.

PubMed

Ly, Dan P; Seabury, Seth A; Jena, Anupam B

2015-02-18

To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians. Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13. United States. 48,881 physicians, 10,086 dentists, 13,883 pharmacists, 159,044 nurses, 18,920 healthcare executives, 59,284 lawyers, and 6,339,310 other non-healthcare professionals. Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence). After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians. Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce. © Ly et al 2015.

Yellow pages advertising by physicians. Are doctors providing the information consumers want most?

PubMed

Butler, D D; Abernethy, A M

1996-01-01

Yellow pages listing are the most widely used form of physician advertising. Every month, approximately 21.6 million adults in the United States refer to the yellow pages before obtaining medical care. Mobile consumers--approximately 17% of the U.S. population who move each year--are heavy users of yellow pages. Consumers desire information on a physician's experience, but it is included in less than 1% of all physician display ads.

Culture, demographics, and critical care issues: an overview.

PubMed

Núñez, Germán R

2003-10-01

The population dynamic and the immigration trends in the United States continue to challenge health care professionals who each day must serve an increasingly diverse population. Today's physicians must not only have a solid background in medical sciences but they must also have knowledge of how culture, race, and ethnicity impact how patients view and accept traditional Western practices. Whether doctors and patients are close in the "context spectrum" will often determine their ability to communicate beyond the spoken language. According to a report of the American Medical Association, by the year 2000, out of a total 812,770 physicians, only 2.5% were Black, 3.5% Hispanic, and 8.9% Asian. Only a fraction of a percent was American Native/Alaskan Native. Therefore, the majority of the physicians are Caucasian, and it could be assumed that they would likely be accustomed to high-context communication styles. The gross of the demographic changes and population increases in the United States during the past 10 years can be attributed to immigration from regions of the world where low-context communication styles are prevalent. Such differences between physicians and patients can create difficult, tense situations in an already charged atmosphere as can be that of a critical care unit.

The "general recognition and acceptance" standard of objectivity for good faith in prescribing: legal and medical implications.

PubMed

Brushwood, David B

2007-01-01

The United States Court of Appeals for the 4th Circuit has ruled that a jury considering charges of drug trafficking against a pain management physician should be instructed that the defendant's good faith is a defense to the charges. The court rejected a subjective standard of good faith, and instead ruled that the good faith of the defendant must be evaluated from an objective perspective. This objective standard requires that the jury determine whether the defendant was practicing in accordance with the standard generally recognized and accepted in the United States. General recognition and acceptance are determined on a case-by-case basis, within the context of a defendant's practice. Simply because a physician's practice is out of the norm for many physicians does not mean it can't be generally recognized and accepted within the standard of medical practice. Expert witness testimony of pain management physicians will assist juries in the application of this standard for good faith in prescribing.

Communication Between Physicians and Patients with Ulcerative Colitis: Reflections and Insights from a Qualitative Study of In-Office Patient–Physician Visits

PubMed Central

Dubinsky, Marla C.; Martino, Steve; Hewett, Kathleen A.; Panés, Julian

2017-01-01

Background: We analyzed in-office communication between patients with ulcerative colitis (UC) and their gastroenterologists. Methods: Participating gastroenterologists (United States N = 15; Europe N = 8) identified eligible patients with scheduled clinic visits. Patients (United States N = 40; Europe N = 28; ≥18 yr old; physician-defined moderately-to-severely active ulcerative colitis for approximately ≥1 yr; ≥1 flare in preceding year; prior or current therapy with 5-aminosalicylates and/or corticosteroids) consented to have their visit recorded. Follow-up interviews were conducted separately with gastroenterologists and patients. Transcripts were analyzed using sociolinguistic methods to explore quality of life (QoL) impacts, treatment goals, and attitudes to therapies. Results: In the European and U.S. research, the trend was for patients not to discuss ulcerative colitis QoL impacts during their visits. In the U.S. research, complete patient–physician alignment on QoL impacts (patient and physician stating the same impacts) was seen in 40% of cases. Variation in treatment goals was seen between gastroenterologists and patients: 3% of U.S. patients described absence of inflammation as a treatment goal versus 25% of gastroenterologists. This goal was not always conveyed to the patient during visits. Consistent with guidelines, physicians generally framed biologic therapy as suitable for patients refractory to conventional therapies. However, although putative efficacy offered by biologic therapy is generally aligned with patients' stated treatment goals, many considered biologic therapy as more appropriate for more severe disease than theirs. Conclusions: Alignment between patients and physicians on ulcerative colitis QoL impact, treatment goals, and requirement of advanced therapies is poor. New tools are needed to cover this gap. PMID:28296817

The distribution of physicians workforce in Louisiana: results from a cross-sectional study.

PubMed

Masri, Maysoun Dimachkie; Oetjen, Reid; Campbell, Claudia; Webber, Larry; Diana, Mark L

2011-01-01

For the past two decades, Louisiana's population health rankings as reported by the United Health Foundation have been among the lowest in the nation. In addition, the 2009 Commonwealth State Scorecards Report ranked the Louisiana health system performance, in terms of health outcomes, among the poorest in the nation. One reason for this disparity could be attributed to shortages of physicians and other healthcare resources in the state. These shortages were exacerbated by the damage from Hurricanes Katrina and Rita in 2005 to hospitals and physicians' practices in New Orleans and throughout the state. This descriptive cross-sectional study focused on the geographical dimension of access and on one of its critical determinants: the availability of physicians. The objective behind this study was to offer a better understanding of the determinants of geographical imbalances in the distribution of physicians in the state of Louisiana. This study is part one of a three-part series that examines the association between total physician supply, primary care, and specialty care supply on mortality amenable to healthcare (MAHC).

Nutrition in Medicine: Nutrition Education for Medical Students and Residents

PubMed Central

Adams, Kelly M.; Kohlmeier, Martin; Powell, Margo; Zeisel, Steven H.

2015-01-01

Proper nutrition plays a key role in disease prevention and treatment. Many patients understand this link and look to physicians for guidance diet and physical activity. Actual physician practice, however, is often inadequate in addressing the nutrition aspects of diseases such as cancer, obesity, and diabetes. Physicians do not feel comfortable, confident, or adequately prepared to provide nutrition counseling, which may be related to suboptimal knowledge of basic nutrition science facts and understanding of potential nutrition interventions. Historically, nutrition education has been underrepresented at many medical schools and residency programs. Our surveys over a decade show that most medical schools in the United States are still not ensuring adequate nutrition education, and they are not producing graduates with the nutrition competencies required in medical practice. Physicians, residents, and medical students clearly need more training in nutrition assessment and intervention. The Nutrition in Medicine (NIM) project, established to develop and distribute a core nutrition curriculum for medical students, offers a comprehensive online set of courses free of charge to medical schools. The NIM medical school curriculum is widely used in the United States and abroad. A new initiative, Nutrition Education for Practicing Physicians, offers an innovative online medical nutrition education program for residents and other physicians-in-training, but with targeted, practice-based educational units designed to be completed in 15 minutes or less. The NIM project is strengthening medical nutrition practice by providing a free, comprehensive, online nutrition curriculum with clinically relevant, evidence-based medical education for undergraduate and postgraduate learners. PMID:20962306

Physician-executives past, present, and future.

PubMed

Smallwood, K G; Wilson, C N

1992-08-01

The dramatic changes in the United States' health care system during the last decade have sparked increasing interest in physician-executives. These executives, skilled in both clinical medicine and health care management, can be found in hospitals, managed care organizations, group practices, and government institutions. This paper outlines the physician-executive's roles and the development process. The remarkable growth in the number of physician-executives is expected to continue as they demonstrate their abilities to help health care providers expand ambulatory services, facilitate provider-physician relationships and physician recruitment, and lend expertise in quality improvement and risk management issues.

Pathology in the Medical Profession?: Taking the Pulse of Physician Wellness and Burnout.

PubMed

Schrijver, Iris

2016-09-01

-In the past decades, physician wellness has diminished in every aspect of professional life. Burnout symptoms in the United States affect 30% to 68% of physicians overall-exceeding the levels of any other professional group. The ramifications of burnout present an underrecognized crisis in the health care system that carries the consequences of personal, professional, institutional, and societal costs. -To bring to light the elements of current medical practice that contribute to physician professional fulfillment and burnout. Intervention measures, steps toward burnout prevention, and the present limitations thereof are also addressed. -This narrative literature review was performed by using studies in PubMed (National Center for Biotechnology Information) and large online physician surveys, published through December 2015. Because of geographic differences, the review is primarily concentrated on physicians across specialties in the United States. Small studies and those of single disciplines were excluded. -Many physicians learn to tolerate burnout symptoms despite negative personal consequences. Long-term work-related stress, however, may lead to the potential for negative effects on the quality of patient care, and to attrition. Interestingly, the factors that enhance physician fulfillment and those that may precipitate burnout symptoms are distinct. Optimization of physician well-being, therefore, requires tailored approaches in each of these 2 dimensions and is most likely to succeed if it includes approaches that are customized to career phase, physician specialty, and practice setting. Importantly, organization leaders must prioritize this issue and provide sustained support for wellness initiatives, to foster a culture that is conducive to physician well-being.

The Physician's Role in Assessing and Counseling Aging Drivers: A Training Session for Undergraduate Medical Students

ERIC Educational Resources Information Center

Rull, Gary; Rosher, Richard B.; Robinson, Sherry; McCann-Stone, Nancy

2008-01-01

The critical need for physicians to become entrenched in the issues of older drivers and public safety is the focus of a training initiative developed as a component of an innovative geriatrics curriculum, Aging (Couple) Across the Curriculum. As the number of aging drivers in the United States rises, physicians can play an important role in…

Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide

PubMed Central

Whitney, Simon N; Brown, Byron W; Brody, Howard; Alcser, Kirsten H; Bachman, Jerald G; Greely, Henry T

2001-01-01

OBJECTIVE To ascertain the views of physicians and physician leaders toward the legalization of physician-assisted suicide. DESIGN Confidential mail questionnaire. PARTICIPANTS A nationwide random sample of physicians of all ages and specialties, and all members of the American Medical Association (AMA) House of Delegates as of April 1996. MEASUREMENTS Demographic and practice characteristics and attitude toward legalization of physician-assisted suicide. MAIN RESULTS Usable questionnaires were returned by 658 of 930 eligible physicians in the nationwide random sample (71%) and 315 of 390 eligible physicians in the House of Delegates (81%). In the nationwide random sample, 44.5% favored legalization (16.4% definitely and 28.1% probably), 33.9% opposed legalization (20.4% definitely and 13.5% probably), and 22% were unsure. Opposition to legalization was strongly associated with self-defined politically conservative beliefs, religious affiliation, and the importance of religion to the respondent (P < .001). Among members of the AMA House of Delegates, 23.5% favored legalization (7.3% definitely and 16.2% probably), 61.6% opposed legalization (43.5% definitely and 18.1% probably), and 15% were unsure; their views differed significantly from those of the nationwide random sample (P < .001). Given the choice, a majority of both groups would prefer no law at all, with physician-assisted suicide being neither legal nor illegal. CONCLUSIONS Members of the AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is sometimes adversarial, most physicians in the United States are uncertain or endorse moderate views on assisted suicide. PMID:11359546

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

PubMed

Ly, Dan P; Seabury, Seth A; Jena, Anupam B

2016-06-07

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

The absence of cruelty is not the presence of humanness: physicians and the death penalty in the United States.

PubMed

Zivot, Joel B

2012-12-03

The death penalty by lethal injection is a legal punishment in the United States. Sodium Thiopental, once used in the death penalty cocktail, is no longer available for use in the United States as a consequence of this association. Anesthesiologists possess knowledge of Sodium Thiopental and possible chemical alternatives. Further, lethal injection has the look and feel of a medical act thereby encouraging physician participation and comment. Concern has been raised that the death penalty by lethal injection, is cruel. Physicians are ethically directed to prevent cruelty within the doctor-patient relationship and ethically prohibited from participation in any component of the death penalty. The US Supreme Court ruled that the death penalty is not cruel per se and is not in conflict with the 8th amendment of the US constitution. If the death penalty is not cruel, it requires no further refinement. If, on the other hand, the death penalty is in fact cruel, physicians have no mandate outside of the doctor patient relationship to reduce cruelty. Any intervention in the name of cruelty reduction, in the setting of lethal injection, does not lead to a more humane form of punishment. If physicians contend that the death penalty can be botched, they wrongly direct that it can be improved. The death penalty cocktail, as a method to reduce suffering during execution, is an unverifiable claim. At best, anesthetics produce an outward appearance of calmness only and do not address suffering as a consequence of the anticipation of death on the part of the condemned.

The absence of cruelty is not the presence of humanness: physicians and the death penalty in the United States

PubMed Central

2012-01-01

The death penalty by lethal injection is a legal punishment in the United States. Sodium Thiopental, once used in the death penalty cocktail, is no longer available for use in the United States as a consequence of this association. Anesthesiologists possess knowledge of Sodium Thiopental and possible chemical alternatives. Further, lethal injection has the look and feel of a medical act thereby encouraging physician participation and comment. Concern has been raised that the death penalty by lethal injection, is cruel. Physicians are ethically directed to prevent cruelty within the doctor-patient relationship and ethically prohibited from participation in any component of the death penalty. The US Supreme Court ruled that the death penalty is not cruel per se and is not in conflict with the 8th amendment of the US constitution. If the death penalty is not cruel, it requires no further refinement. If, on the other hand, the death penalty is in fact cruel, physicians have no mandate outside of the doctor patient relationship to reduce cruelty. Any intervention in the name of cruelty reduction, in the setting of lethal injection, does not lead to a more humane form of punishment. If physicians contend that the death penalty can be botched, they wrongly direct that it can be improved. The death penalty cocktail, as a method to reduce suffering during execution, is an unverifiable claim. At best, anesthetics produce an outward appearance of calmness only and do not address suffering as a consequence of the anticipation of death on the part of the condemned. PMID:23199336

Physician Attitudes Regarding School-Located Vaccination Clinics

ERIC Educational Resources Information Center

Fiala, Steven C.; Cieslak, Paul R.; DeBess, Emilio E.; Young, Collette M.; Winthrop, Kevin L.; Stevenson, Ellen B.

2013-01-01

Background: School-located vaccination clinics offer an opportunity to target children for vaccination programs during communicable disease outbreaks. However, children in the United States are primarily vaccinated in the pediatrician's or family physician's office, and the concept of school-located vaccinations may be unfamiliar to some parents…

Active-Duty Physicians' Perceptions and Satisfaction with Humanitarian Assistance and Disaster Relief Missions: Implications for the Field

PubMed Central

Oravec, Geoffrey J.; Artino, Anthony R.; Hickey, Patrick W.

2013-01-01

Background The United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals. Methods and Findings An Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean  = 5.74). Perceived benefit was greatest for the United States (mean  = 5.56) and self (mean  = 5.39) compared to the target population (mean  = 4.82). These perceptions were related to participants' intentions to extend their military medical service (total model R 2  = .37), with the strongest predictors being perceived benefit to self (β = .21, p<.01), the U.S. (β = .19, p<.01), and satisfaction (β = .18, p<.05). In addition, Air Force physicians reported higher levels of satisfaction (mean  = 6.10) than either Army (mean  = 5.27, Cohen's d = 0.75, p<.001) or Navy (mean  = 5.60, Cohen's d  = 0.46, p<.01) physicians. Conclusions Military physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals. PMID:23555564

Is there a (volunteer) doctor in the house? Free clinics and volunteer physician referral networks in the United States.

PubMed

Isaacs, Stephen L; Jellinek, Paul

2007-01-01

Although community health centers and public hospitals are the most visible safety-net providers, physicians in private practice are the main source of care for the uninsured and Medicaid enrollees. Yet the number of these physicians providing free care is declining, even as the need for their services increases. One promising strategy for halting the decline is to strengthen and increase volunteer health care programs: free clinics and physician-referral networks. This report reviews the state of these programs and suggests ways to improve them. Given the limits of volunteerism, the authors conclude that only national health insurance will solve the problem of the uninsured.

Applied Biomechanics Research for the United States Ski Team.

ERIC Educational Resources Information Center

Dillman, Charles J.

1982-01-01

Assisted by a team of physicians and sports scientists, the United States Ski Team has developed its own sports medicine program, the purpose of which is to assist coaches and athletes in controlling and optimizing factors which influence skiing performance. A number of biomechanical research projects which have been undertaken as part of this…

Latin American Medical Graduates: I. Determinants of the Decision to Remain in the United States.

ERIC Educational Resources Information Center

Gaviria, Moises; Wintrob, Ronald

1982-01-01

Fifty Peruvian physicians who decided to remain in the United States after postgraduate training disclose professional, economic and familial reasons for their decision. Fears of being unable to obtain a position that is professionally stimulating and that pays enough to support the family dominate the decision. (LC)

Details on suicide among US physicians: data from the National Violent Death Reporting System.

PubMed

Gold, Katherine J; Sen, Ananda; Schwenk, Thomas L

2013-01-01

Physician suicide is an important public health problem as the rate of suicide is higher among physicians than the general population. Unfortunately, few studies have evaluated information about mental health comorbidities and psychosocial stressors which may contribute to physician suicide. We sought to evaluate these factors among physicians versus non-physician suicide victims. We used data from the United States National Violent Death Reporting System to evaluate demographics, mental health variables, recent stressors and suicide methods among physician versus non-physician suicide victims in 17 states. The data set included 31,636 suicide victims of whom 203 were identified as physicians. Multivariable logistic regression found that having a known mental health disorder or a job problem which contributed to the suicide significantly predicted being a physician. Physicians were significantly more likely than non-physicians to have antipsychotics, benzodiazepines and barbiturates present on toxicology testing but not antidepressants. Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians. Copyright © 2013 Elsevier Inc. All rights reserved.

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

Hawai‘i Physician Workforce Assessment 2010

PubMed Central

Dall, Tim; Sakamoto, David

2012-01-01

Background National policy experts have estimated that the United States will be 15–20% short of physicians by the year 2020. In 2008, the Big Island of Hawai‘i was found to be 15% short of physicians. The current article describes research to determine the physician supply and demand across the State of Hawai‘i. Methods The researchers utilized licensure lists, all available sources of physician practice location information, and contacted provider offices to develop a database of practicing physicians in Hawai‘i. A statistical model based on national utilization of physician services by age, ethnicity, gender, insurance, and obesity rates was used to estimate demand for services. Using number of new state licenses per year, the researchers estimated the number of physicians who enter the Hawai‘i workforce annually. Physician age data were used to estimate retirements. Results Researchers found 2,860 full time equivalents of practicing, non-military, patient-care physicians in Hawai‘i (excluding those still in residency or fellowship programs). The calculated demand for physician services by specialty indicates a current shortage of physicians of over 600. This shortage may grow by 50 to 100 physicians per year if steps are not taken to reverse this trend. Physician retirement is the single largest element in the loss of physicians, with population growth and aging playing a significant role in increasing demand. Discussion Study findings indicate that Hawai‘i is 20% short of physicians and the situation is likely to worsen if mitigating steps are not taken immediately. PMID:22737636

Legal risks and responsibilities of physicians in the AIDS epidemic.

PubMed

Annas, George J

1988-01-01

Existing law in the United States applicable to physicians' obligations to treat AIDS and HIV-infected patients is summarized and ways are identified to strengthen current law so that these obligations are more sharply defined. Courts have affirmed an obligation to treat both in limited emergency situations and within the consensual physician patient relationship. Also, physicians may assume contractual obligations to entire groups of patients under employment contracts with hospitals and prepaid health plans and by agreements for Medicare and Medicaid reimbursement. Annas describes antidiscimination statutes as limited in scope and suggests ways to strengthen them. He maintains that physicians have special legal obligations because society has granted them special privileges, and he supports delineation and enforcement of ethical obligations by organized medicine, state licensing boards, hospitals, and medical schools.

Exploring the Relationships Between USMLE Performance and Disciplinary Action in Practice: A Validity Study of Score Inferences From a Licensure Examination.

PubMed

Cuddy, Monica M; Young, Aaron; Gelman, Andrew; Swanson, David B; Johnson, David A; Dillon, Gerard F; Clauser, Brian E

2017-12-01

Physicians must pass the United States Medical Licensing Examination (USMLE) to obtain an unrestricted license to practice allopathic medicine in the United States. Little is known, however, about how well USMLE performance relates to physician behavior in practice, particularly conduct inconsistent with safe, effective patient care. The authors examined the extent to which USMLE scores relate to the odds of receiving a disciplinary action from a U.S. state medical board. Controlling for multiple factors, the authors used non-nested multilevel logistic regression analyses to estimate the relationships between scores and receiving an action. The sample included 164,725 physicians who graduated from U.S. MD-granting medical schools between 1994 and 2006. Physicians had a mean Step 1 score of 214 (standard deviation [SD] = 21) and a mean Step 2 Clinical Knowledge (CK) score of 213 (SD = 23). Of the physicians, 2,205 (1.3%) received at least one action. Physicians with higher Step 2 CK scores had lower odds of receiving an action. A 1-SD increase in Step 2 CK scores corresponded to a decrease in the chance of disciplinary action by roughly 25% (odds ratio = 0.75; 95% CI = 0.70-0.80). After accounting for Step 2 CK scores, Step 1 scores were unrelated to the odds of receiving an action. USMLE Step 2 CK scores provide useful information about the odds a physician will receive an official sanction for problematic practice behavior. These results provide validity evidence supporting current interpretation and use of Step 2 CK scores.

Woodrow Wilson's hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy.

PubMed

Menger, Richard P; Storey, Christopher M; Guthikonda, Bharat; Missios, Symeon; Nanda, Anil; Cooper, John M

2015-07-01

World War I catapulted the United States from traditional isolationism to international involvement in a major European conflict. Woodrow Wilson envisaged a permanent American imprint on democracy in world affairs through participation in the League of Nations. Amid these defining events, Wilson suffered a major ischemic stroke on October 2, 1919, which left him incapacitated. What was probably his fourth and most devastating stroke was diagnosed and treated by his friend and personal physician, Admiral Cary Grayson. Grayson, who had tremendous personal and professional loyalty to Wilson, kept the severity of the stroke hidden from Congress, the American people, and even the president himself. During a cabinet briefing, Grayson formally refused to sign a document of disability and was reluctant to address the subject of presidential succession. Wilson was essentially incapacitated and hemiplegic, yet he remained an active president and all messages were relayed directly through his wife, Edith. Patient-physician confidentiality superseded national security amid the backdrop of friendship and political power on the eve of a pivotal juncture in the history of American foreign policy. It was in part because of the absence of Woodrow Wilson's vocal and unwavering support that the United States did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless without American support and was unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the United States assume its global leadership role and realize Wilson's visionary, yet contentious, groundwork for a Pax Americana. The authors describe Woodrow Wilson's stroke, the historical implications of his health decline, and its impact on United States foreign policy.

Impact of Physician Asthma Care Education on Patient Outcomes

ERIC Educational Resources Information Center

Cabana, Michael D.; Slish, Kathryn K.; Evans, David; Mellins, Robert B.; Brown, Randall W.; Lin, Xihong; Kaciroti, Niko; Clark, Noreen M.

2014-01-01

Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers were…

78 FR 47322 - Privacy Act of 1974; Report of an Altered System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

... reports for all health care practitioners (e.g., physicians, dentists, nurses, optometrists, pharmacists... appropriate decisions in the delivery of health care. 6. To state Medicaid Fraud Control Units that request... Information on Physicians and other Health Care Practitioners (NPDB), 09-15-0054, to include information...

On the brink of extinction: the future of translational physician-scientists in the United States.

PubMed

Furuya, Hideki; Brenner, Dean; Rosser, Charles J

2017-05-01

Over the past decade, we have seen an unparalleled growth in our knowledge of cancer biology and the translation of this biology into a new generation of therapeutic tools that are changing cancer treatment outcomes. With the continued explosion of new biologic discoveries, we find ourselves with a limited number of trained and engaged translational physician-scientists capable of bridging the chasm between basic science and clinical science. Here, we discuss the current state translational physician-scientists find themselves in and offer solutions to navigate during this difficult time.

A cost and policy analysis comparing immediate sequential cataract surgery and delayed sequential cataract surgery from the physician perspective in the United States.

PubMed

Neel, Sean T

2014-11-01

A cost analysis was performed to evaluate the effect on physicians in the United States of a transition from delayed sequential cataract surgery to immediate sequential cataract surgery. Financial and efficiency impacts of this change were evaluated to determine whether efficiency gains could offset potential reduced revenue. A cost analysis using Medicare cataract surgery volume estimates, Medicare 2012 physician cataract surgery reimbursement schedules, and estimates of potential additional office visit revenue comparing immediate sequential cataract surgery with delayed sequential cataract surgery for a single specialty ophthalmology practice in West Tennessee. This model should give an indication of the effect on physicians on a national basis. A single specialty ophthalmology practice in West Tennessee was found to have a cataract surgery revenue loss of $126,000, increased revenue from office visits of $34,449 to $106,271 (minimum and maximum offset methods), and a net loss of $19,900 to $91,700 (base case) with the conversion to immediate sequential cataract surgery. Physicians likely stand to lose financially, and this loss cannot be offset by increased patient visits under the current reimbursement system. This may result in physician resistance to converting to immediate sequential cataract surgery, gaming, and supplier-induced demand.

Health Care Market Concentration Trends In The United States: Evidence And Policy Responses.

PubMed

Fulton, Brent D

2017-09-01

Policy makers and analysts have been voicing concerns about the increasing concentration of health care providers and health insurers in markets nationwide, including the potential adverse effect on the cost and quality of health care. The Council of Economic Advisers recently expressed its concern about the lack of estimates of market concentration in many sectors of the US economy. To address this gap in health care, this study analyzed market concentration trends in the United States from 2010 to 2016 for hospitals, physician organizations, and health insurers. Hospital and physician organization markets became increasingly concentrated over this time period. Concentration among primary care physicians increased the most, partially because hospitals and health care systems acquired primary care physician organizations. In 2016, 90 percent of Metropolitan Statistical Areas (MSAs) were highly concentrated for hospitals, 65 percent for specialist physicians, 39 percent for primary care physicians, and 57 percent for insurers. Ninety-one percent of the 346 MSAs analyzed may have warranted concern and scrutiny because of their concentration levels in 2016 and changes in their concentrations since 2010. Public policies that enhance competition are needed, such as stricter enforcement of antitrust laws, reducing barriers to entry, and restricting anticompetitive behaviors. Project HOPE—The People-to-People Health Foundation, Inc.

Associations of physician-diagnosed asthma with country of residence in the first year of life and other immigration-related factors: Chicago asthma school study.

PubMed

Eldeirawi, Kamal M; Persky, Victoria W

2007-09-01

Among Mexican Americans in the United States, US-born children have higher rates of asthma than their Mexico-born peers. To evaluate the associations of immigration-related variables with physician-diagnosed asthma in a sample of Mexican American children. We analyzed data from the ongoing Chicago Asthma School Study, a population-based cross-sectional study, for 10,106 Mexican American schoolchildren in Chicago, Illinois. Mexican American children who lived in the United States in the first year of life were more likely to have physician-diagnosed asthma than their peers who lived in Mexico in the first year of life, independent of age, sex, income, language, and country of birth (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.09-2.94). The risk of asthma in US-born children was higher (but not significantly) than that observed in Mexico-born children after accounting for covariates, including country of residence in the first year of life (OR, 1.37; 95% CI, 0.86-2.18). Long-term immigrants (lived in the United States for 10 years) had an increased risk of asthma compared with short-term immigrants (lived in the United States for <10 years), independent of country of residence in the first year of life (OR, 1.93; 95% CI, 1.00-3.73). These findings confirm the importance of early childhood exposures and environmental factors that are modified with migration and acculturation in asthma development.

Is there a doctor in the house? . . . Or the Senate? Physicians in US Congress, 1960-2004.

PubMed

Kraus, Chadd K; Suarez, Thomas A

2004-11-03

The legislative and fiscal influences of Congress, as well as the continuing overall growth in health care spending as a portion of the gross domestic product, make congressional representation by physicians important because physicians have unique expertise in the impact of legislation on patient care and medical practice. To describe physician representation in the US Congress between 1960 and 2004 and relate the results to past representation of physicians in Congress. A retrospective observational study of members of the US Congress from all 50 states and all represented territories, who served from January 1960 to April 2004 (including 108th Congress), using data available in public access databases and congressional biographical records. Physician representation in Congress, including occupation before taking office, state/territory of representation, sex, party affiliation, and time served. During the past 44 years, 25 (1.1%) of 2196 members of Congress were physicians. Physicians in Congress were more likely to be members of the Republican Party (60% vs 45.1% of all members, P = .007) and were similar to other members of Congress in mean years of service (9.2 years for physicians vs 12.3 years for all members, P = .09) and in sex distribution (4.0% female physicians vs 6.8% all female members, P = .57). Physicians in Congress represented 17 states, the Virgin Islands, and Puerto Rico. Physician representation in Congress is low and is in stark contrast with physician roles during the first century of the United States. However, the 8 physicians currently serving in Congress may be indicative of a shift toward more direct influence of physicians in national politics.

Are Physicians Likely to Adopt Emerging Mobile Technologies? Attitudes and Innovation Factors Affecting Smartphone Use in the Southeastern United States

PubMed Central

Putzer, Gavin J; Park, Yangil

2012-01-01

The smartphone has emerged as an important technological device to assist physicians with medical decision making, clinical tasks, and other computing functions. A smartphone is a device that combines mobile telecommunication with Internet accessibility as well as word processing. Moreover, smartphones have additional features such as applications pertinent to clinical medicine and practice management. The purpose of this study was to investigate the innovation factors that affect a physician's decision to adopt an emerging mobile technological device such as a smartphone. The study sample consisted of 103 physicians from community hospitals and academic medical centers in the southeastern United States. Innovation factors are elements that affect an individual's attitude toward using and adopting an emerging technology. In our model, the innovation characteristics of compatibility, job relevance, the internal environment, observability, personal experience, and the external environment were all significant predictors of attitude toward using a smartphone. These influential innovation factors presumably are salient predictors of a physician's attitude toward using a smartphone to assist with clinical tasks. Health information technology devices such as smartphones offer promise as a means to improve clinical efficiency, medical quality, and care coordination and possibly reduce healthcare costs. PMID:22737094

A Survey Comparing Delegation of Cosmetic Procedures Between Dermatologists and Nondermatologists.

PubMed

Austin, Molly B; Srivastava, Divya; Bernstein, Ira H; Dover, Jeffrey S

2015-07-01

How delegation of procedures varies among cosmetic specialties in the United States is not well described. To better describe current practices in delegation of procedures to nonphysicians among physicians of different cosmetic specialties in the United States. An Internet-based survey was administered to physician members of the American Society for Dermatologic Surgery (ASDS), the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society for Laser Medicine and Surgery (ASLMS). A total of 823 responses were collected. Two hundred ninety-one of the 521 dermatologists (55.9%) reported delegating cosmetic procedures compared with 223 of the 302 nondermatologists (73.8%) (p < .05). When delegation occurred, dermatologists were more likely than nondermatologists to delegate the following procedures to higher level non-physician providers (NPP): chemical peels, neuromodulator and filler injections, laser hair removal, pulsed dye laser, tattoo removal, intense pulsed light, nonablative fractional laser, and sclerotherapy. No difference in delegation rate was noted between dermatologists and non-dermatologist physicians with respect to microdermabrasion, ablative fractional laser, cryolipolysis, radiofrequency skin tightening, focused ultrasound skin tightening, and focused ultrasound fat reduction. Dermatologists delegate procedures to NPP less frequently than non-dermatologist physicians, and when they do, it is typically to higher level NPP.

Plow, town, and gown: the politics of family practice in 1960s America.

PubMed

Tobbell, Dominique

2013-01-01

In the 1960s, general practitioners organized themselves into a state-based nationwide political movement that lobbied state legislators and state-funded medical schools to create departments of family practice. They framed their calls in the context of the national shortages of primary care physicians by arguing that those medical schools that received state funding had an obligation to the state to train sufficient numbers of primary care physicians to ensure the health care needs of the state's residents would be met. As this article reveals, two defining features of this activism were rural politics and the politics of town and gown. The history of family practice thus introduces a new dimension to the familiar dyad of town and gown relations: the plow-rural physicians who brought to the medical politics of the post-World War II United States a distinctive and powerful set of political, social, and economic interests.

Medical Tourism and Telemedicine: A New Frontier of an Old Business.

PubMed

Hong, Yan Alicia

2016-05-23

In October 2015, the "Chinese American Physicians E-Hospital" celebrated its "grand opening" online. All physicians affiliated with this E-Hospital are bilingual Chinese American physicians, who provide services ranging from initial teleconsulting to international transfer and treatment in the United States. Such telemedicine platform for medical tourism not only saves the patients from the hassles of identifying and connecting with an appropriate health service provider but also minimizes the language and cultural barriers. As a growing number of patients from middle- and low-income countries travel to the United States (US) for medical care, we face promising opportunities as well as mounting challenges. The Centers for Disease Control (CDC) in the US has guidance for Americans seeking care overseas, but is not available for international patients seeking care in US. This article opens a dialogue on the challenges associated with flourishing medical tourism and telemedicine, including quality assessment, risk communication, ethical guidelines, and legal concerns.

Religion and United States physicians' opinions and self-predicted practices concerning artificial nutrition and hydration.

PubMed

Wolenberg, Kelly M; Yoon, John D; Rasinski, Kenneth A; Curlin, Farr A

2013-12-01

This study surveyed 1,156 practicing US physicians to examine the relationship between physicians' religious characteristics and their approaches to artificial nutrition and hydration (ANH). Forty percent of physicians believed that unless a patient is imminently dying, the patient should always receive nutrition and fluids; 75 % believed that it is ethically permissible for doctors to withdraw ANH. The least religious physicians were less likely to oppose withholding or withdrawing ANH. Compared to non-evangelical Protestant physicians, Jews and Muslims were significantly more likely to oppose withholding ANH, and Muslims were significantly more likely to oppose withdrawing ANH.

The changing geography of Americans graduating from foreign medical schools.

PubMed

Johnson, Karin; Hagopian, Amy; Veninga, Catherine; Hart, L Gary

2006-02-01

To study U.S.-born international medical graduates in order to analyze changes in their numbers and countries of training from the 1960s and before until the early 2000s. This study was conducted from 2003-2004 at the Center for Health Workforce Studies, University of Washington. The analysis was based on data from March 2002 from the American Medical Association (AMA) for active physicians. AMA data were supplemented with data from several other sources. Descriptive statistics were produced on country of birth, country of medical school training, and year of training for all foreign-trained, patient-care physicians whose birth country was known. At least 17,000 of the foreign-trained physicians practicing in the United States are known to have been born in the United States. American physicians have graduated from foreign medical schools in increasing numbers since the 1960s. The number of U.S.-born physicians who graduated from a foreign medical school peaked in the early 1980s, but the phenomenon endures today. However, the countries in which these physicians chose to attend medical schools have changed significantly from the 1950s to the early 2000s. Over time, U.S.-born physicians have become much less likely to train in Europe and much more likely to train in certain Caribbean countries. U.S.-born physicians who graduate from medical schools abroad tend to train in just a handful of countries and attend a limited number of medical schools.

Physicians' perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States.

PubMed

Tyssen, Reidar; Palmer, Karen S; Solberg, Ingunn B; Voltmer, Edgar; Frank, Erica

2013-12-15

We lack national and cross-national studies of physicians' perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy. Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians' perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.

Geographic and specialty distribution of US physicians trained to treat opioid use disorder.

PubMed

Rosenblatt, Roger A; Andrilla, C Holly A; Catlin, Mary; Larson, Eric H

2015-01-01

The United States is experiencing an epidemic of opioid-related deaths driven by excessive prescribing of opioids, misuse of prescription drugs, and increased use of heroin. Buprenorphine-naloxone is an effective treatment for opioid use disorder and can be provided in office-based settings, but this treatment is unavailable to many patients who could benefit. We sought to describe the geographic distribution and specialties of physicians obtaining waivers from the Drug Enforcement Administration (DEA) to prescribe buprenorphine-naloxone to treat opioid use disorder and to identify potential shortages of physicians. We linked physicians authorized to prescribe buprenorphine on the July 2012 DEA Drug Addiction Treatment Act (DATA) Waived Physician List to the American Medical Association Physician Masterfile to determine their age, specialty, rural-urban status, and location. We then mapped the location of these physicians and determined their supply for all US counties. Sixteen percent of psychiatrists had received a DEA DATA waiver (41.6% of all physicians with waivers) but practiced primarily in urban areas. Only 3.0% of primary care physicians, the largest group of physicians in rural America, had received waivers. Most US counties therefore had no physicians who had obtained waivers to prescribe buprenorphine-naloxone, resulting in more than 30 million persons who were living in counties without access to buprenorphine treatment. In the United States opioid use and related unintentional lethal overdoses continue to rise, particularly in rural areas. Increasing access to office-based treatment of opioid use disorder--particularly in rural America--is a promising strategy to address rising rates of opioid use disorder and unintentional lethal overdoses. © 2015 Annals of Family Medicine, Inc.

The Learned Report on Teacher Education: A Vision Delayed

ERIC Educational Resources Information Center

Imig, David; Imig, Scott

2005-01-01

Ninety-five years ago, the Carnegie Foundation for the Advancement of Teaching released Bulletin #4, otherwise known as The Flexner Report on Medical Education in the United States and Canada, a report on the education of physicians in the United States and Canada that lead to closure of half the medical schools in the country and determine the…

Utilization of information technology in eastern North Carolina physician practices: determining the existence of a digital divide.

PubMed

Rosenthal, David A; Layman, Elizabeth J

2008-02-13

The United States Department of Health and Human Services (DHHS) has emphasized the importance of utilizing health information technologies, thus making the availability of electronic resources critical for physicians across the country. However, few empirical assessments exist regarding the current status of computerization and utilization of electronic resources in physician offices and physicians' perceptions of the advantages and disadvantages of computerization. Through a survey of physicians' utilization and perceptions of health information technology, this study found that a "digital divide" existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet.

Physician assisted suicide and the Supreme Court: putting the constitutional claim to rest.

PubMed Central

Mariner, W K

1997-01-01

Like the debate about many controversial questions of ethics and medical care in America, public debate about physician assisted suicide became focused on questions of constitutional law. On June 26, 1997, the United States Supreme Court unanimously rejected any constitutional right of terminally ill patients to physician assisted suicide. An analysis of the Court's reasoning reveals that its decisions resolved only a narrow constitutional question that affects relatively few people--mentally competent, terminally ill patients who wish to hasten their imminent deaths by having a physician prescribe medication that they intend to use to commit suicide. Although suicide is not a crime, states remain free to prohibit assisted suicide. One consequence of the Court's decisions may be renewed debate on state laws. A more productive result would be to address the broader public health concerns that gave rise to support for physician assisted suicide--inadequate care for the terminally ill and prevention of suicide. PMID:9431307

International emergency medicine fellowships.

PubMed

Anderson, Philip D; Aschkenasy, Miriam; Lis, Julian

2005-02-01

The active interchange of intellectual ideas in the quest to improve healthcare globally will likely be best served by active interchange among physicians around the world. Subspecialty fellowship training programs for United States and foreign graduates will provide a focused path to development of a global network of physicians dedicated to the delivery of high-quality emergency health services.

U.S. responses to Japanese wartime inhuman experimentation after World War II.

PubMed

Brody, Howard; Leonard, Sarah E; Nie, Jing-Bao; Weindling, Paul

2014-04-01

In 1945-46, representatives of the U.S. government made similar discoveries in both Germany and Japan, unearthing evidence of unethical experiments on human beings that could be viewed as war crimes. The outcomes in the two defeated nations, however, were strikingly different. In Germany, the United States, influenced by the Canadian physician John Thompson, played a key role in bringing Nazi physicians to trial and publicizing their misdeeds. In Japan, the United States played an equally key role in concealing information about the biological warfare experiments and in securing immunity from prosecution for the perpetrators. The greater force of appeals to national security and wartime exigency help to explain these different outcomes.

Disability in two health care systems: access, quality, satisfaction, and physician contacts among working-age Canadians and Americans with disabilities.

PubMed

Gulley, Stephen P; Altman, Barbara M

2008-10-01

An overarching question in health policy concerns whether the current mix of public and private health coverage in the United States can be, in one way or another, expanded to include all persons as it does in Canada. As typically high-end consumers of health care services, people with disabilities are key stakeholders to consider in this debate. The risk is that ways to cover more persons may be found only by sacrificing the quantity or quality of care on which people with disabilities so frequently depend. Yet, despite the many comparisons made of Canadian and U.S. health care, few focus directly on the needs of people with disabilities or the uninsured among them in the United States. This research is intended to address these gaps. Given this background, we compare the health care experiences of working-age uninsured and insured Americans with Canadian individuals (all of whom, insured) with a special focus on disability. Two questions for research guide our inquiry: (1) On the basis of disability severity level and health insurance status, are there differences in self-reported measures of access, utilization, satisfaction with, or quality of health care services within or between the United States and Canada? (2) After controlling covariates, when examining each level of disability severity, are there any significant differences in these measures of access, utilization, satisfaction, or quality between U.S. insured and Canadian persons? Cross-sectional data from the Joint Canada/United States Survey of Health (JCUSH) are analyzed with particular attention to disability severity level (none, nonsevere, or severe) among three analytic groups of working age residents (insured Americans, uninsured Americans, and Canadians). Differences in three measures of access, one measure of satisfaction with care, one quality of care measure, and two varieties of physician contacts are compared. Multivariate methods are then used to compare the healthcare experiences of insured U.S. and Canadian persons on the basis of disability level while controlling covariates. In covariate-controlled comparisons of insured Americans and Canadians, we find that people with disabilities report higher levels of unmet need than do their counterparts without disabilities, with no difference in this result between the nations. Our findings on access to medications and satisfaction with care among people with disabilities are similar, suggesting worse outcomes for people with disabilities, but few differences between insured U.S. and Canadian individuals. Generally, we find higher percentages who report having a regular physician, and higher contact rates with physicians among people with disabilities than among people without them in both countries. We find no evidence that total physician contacts are restricted in Canada relative to insured Americans at any of the disability levels. Yet we do find that quality ratings are lower among Canadian respondents than among insured Americans. However, bivariate estimates on access, satisfaction, quality, and physician contacts reveal particularly poor outcomes for uninsured persons with severe disabilities in the United States. For example, almost 40% do not report having a regular physician, 65% report that they need at least one medication that they cannot afford, 45% are not satisfied with the way their care is provided, 40% rate the overall quality of their care as fair or poor, and significant reductions in contacts with two types of physicians are evident within this group as well. Based on these results, we find evidence of disparities in health care on the basis of disability in both Canada and the United States. However, despite the fact that Canada makes health insurance coverage available to all residents, we find few significant reductions in access, satisfaction or physician contacts among Canadians with disabilities relative to their insured American counterparts. These results place a spotlight on the experiences of uninsured persons with disabilities in America and suggest further avenues for research.

Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive, Comparative Analysis Over Time.

PubMed

Fruth, Stacie J; Wiley, Steve

2016-09-01

Emergency department (ED) use in the United States is expected to rapidly increase. Nearly half of all ED visits are classified as semiurgent or nonurgent, and many fall into the musculoskeletal category. Despite growing international evidence that patients are appropriately and safely managed by ED physical therapists in a time-efficient manner, physical therapist practice in EDs is not widely understood or utilized in the United States. To date, no studies have reported the impressions of ED physicians about this practice. The purposes of this study were: (1) to assess ED physicians' impressions of ED physical therapist practice 2 years after practice was initiated and (2) to determine whether physicians' impressions changed 7 years later. All ED staff physicians and medical residents at a level I trauma hospital were invited to complete a survey in 2004 and 2011. In both years, a majority of physicians reported favorable impressions of ED physical therapist practice. Physical therapists were valued for educating patients about safety and injury prevention, providing appropriate gait training, assisting with disposition planning, and providing interventions as alternatives to pain medication. Many physicians supported standing physical therapist orders for certain musculoskeletal conditions. The most common concern was the additional time that patients spend in the ED for a physical therapist consult. The results of this study may not reflect the impressions of physicians in all EDs that employ physical therapists. Emergency department physicians reported favorable impressions of ED physical therapist practice 2 years and 9 years following its implementation in this hospital. This study showed that ED physicians support standing physical therapist orders for certain musculoskeletal conditions, which suggests that direct triage to ED physical therapists for these conditions could be considered. © 2016 American Physical Therapy Association.

Primary Care Physicians' Collection, Comfort, and Use of Race and Ethnicity in Clinical Practice in the United States.

PubMed

Bonham, Vence L; Umeh, Nkeiruka I; Cunningham, Brooke A; Abdallah, Khadijah E; Sellers, Sherrill L; Cooper, Lisa A

2017-01-01

The clinical utility of race and ethnicity has been debated. It is important to understand if and how race and ethnicity are communicated and collected in clinical settings. We investigated physicians' self-reported methods of collecting a patient's race and ethnicity in the clinical encounter, their comfort with collecting race and ethnicity, and associations with use of race in clinical decision-making. A national cross-sectional study of 787 clinically active general internists in the United States. Physicians' self-reported comfort with collecting patient race and ethnicity, their collection practices, and use of race in clinical care were assessed. Bivariate and multivariable regression analyses were conducted to examine associations between comfort, collection practices, and use of race. Most physicians asked patients to self-report their race or ethnicity (26.5%) on an intake form or collected this information directly from patients (26.2%). Most physicians were comfortable collecting patient race and ethnicity (84.3%). Physicians who were more comfortable collecting patient race and ethnicity ( β = 1.65; [95% confidence interval; CI 0.03-3.28]) or who directly collected patients' race and ethnicity ( β = 1.24 [95% CI 0.07-2.41]) were more likely to use race in clinical decision-making than physicians who were uncomfortable. This study documents variation in physician comfort level and practice patterns regarding patient race and ethnicity data collection. As the U.S. population becomes more diverse, future work should examine how physicians speak about race and ethnicity with patients and their use of race and ethnicity data impact patient-physician relationships, clinical decision-making, and patient outcomes.

Malpractice Liability Risk and Use of Diagnostic Imaging Services: A Systematic Review of the Literature.

PubMed

Li, Suhui; Brantley, Erin

2015-12-01

A widespread concern among physicians is that fear of medical malpractice liability may affect their decisions for diagnostic imaging orders. The purpose of this article is to synthesize evidence regarding the defensive use of imaging services. A literature search was conducted using a number of databases. The review included peer-reviewed publications that studied the link between physician orders of imaging tests and malpractice liability pressure. We identified 13 peer-reviewed studies conducted in the United States. Five of the studies reported physician assessments of the role of defensive medicine in imaging-order decisions; five assessed the association between physicians' liability risk and imaging ordering, and three assessed the impact of liability risk on imaging ordering at the state level. Although the belief that medical liability risk could influence decisions is highly prevalent among physicians, findings are mixed regarding the impact of liability risk on imaging orders at both the state and physician level. Inconclusive evidence suggests that physician ordering of imaging tests is affected by malpractice liability risk. Further research is needed to disentangle defensive medicine from other reasons for inefficient use of imaging. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Reputation Management and Content Control: An Analysis of Radiation Oncologists' Digital Identities.

PubMed

Prabhu, Arpan V; Kim, Christopher; De Guzman, Eison; Zhao, Eric; Madill, Evan; Cohen, Jonathan; Hansberry, David R; Agarwal, Nitin; Heron, Dwight E; Beriwal, Sushil

2017-12-01

Google is the most popular search engine in the United States, and patients are increasingly relying on online webpages to seek information about individual physicians. This study aims to characterize what patients find when they search for radiation oncologists online. The Centers for Medicare and Medicaid Services (CMS) Physician Comparable Downloadable File was used to identify all Medicare-participating radiation oncologists in the United States and Puerto Rico. Each radiation oncologist was characterized by medical school education, year of graduation, city of practice, gender, and affiliation with an academic institution. Using a custom Google-based search engine, up to the top 10 search results for each physician were extracted and categorized as relating to: (1) physician, hospital, or health care system; (2) third-party; (3) social media; (4) academic journal articles; or (5) other. Among all health care providers in the United States within CMS, 4443 self-identified as being radiation oncologists and yielded 40,764 search results. Of those, 1161 (26.1%) and 3282 (73.9%) were classified as academic and nonacademic radiation oncologists, respectively. At least 1 search result was obtained for 4398 physicians (99.0%). Physician, hospital, and health care-controlled websites (16,006; 39.3%) and third-party websites (10,494; 25.7%) were the 2 most often observed domain types. Social media platforms accounted for 2729 (6.7%) hits, and peer-reviewed academic journal websites accounted for 1397 (3.4%) results. About 6.8% and 6.7% of the top 10 links were social media websites for academic and nonacademic radiation oncologists, respectively. Most radiation oncologists lack self-controlled online content when patients search within the first page of Google search results. With the strong presence of third-party websites and lack of social media, opportunities exist for radiation oncologists to increase their online presence to improve patient-provider communication and better the image of the overall field. We discuss strategies to improve online visibility. Copyright © 2017 Elsevier Inc. All rights reserved.

Is there a need for clinical guidelines in the United States for the diagnosis of hereditary angioedema and the screening of family members of affected patients?

PubMed

Lunn, Michael L; Santos, Carah B; Craig, Timothy J

2010-03-01

Hereditary angioedema (HAE) is an autosomal dominant disorder characterized by a deficiency of C1 esterase inhibitor (C1 INH) protein or function. Guidelines do not exist regarding diagnostic criteria or routine testing of family members of patients with HAE. Laboratory data for diagnosis include complement factor 4 level; C1 INH antigenic protein level, which is reduced in approximately 85% of patients with HAE; and C1 INH functional assay, which is considered an unreliable test in the United States secondary to inconsistent standardization of assays. To assess the shortcomings of diagnosing HAE and to determine whether family members of patients with HAE are being adequately screened. The top physician prescribers of danazol in the United States were screened via an Internet questionnaire focusing on the diagnosis and current management of HAE. To assess the patient perspective on HAE, affected individuals in the United States, the United Kingdom, France, Germany, and The Netherlands participated in the Web-based International Survey of Patient Experience of Hereditary Angioedema. All 80 physicians who completed the survey were allergist or immunologists with a mean of 7 patients with C1 INH deficiency in their practices. Almost 84% of physician respondents used C1 INH level and function for diagnosis, and 63.8% used complement factor 4 levels. A total of 313 patients with HAE completed the survey. Respondents noted that only 48% of immediate family members and 26% of extended family members had been tested. Guidelines could potentially alleviate delays in diagnosis and incorrect diagnoses and could lead to adequate screening of family members.

Reproductive Health Services v. Webster, 17 March 1987, amended on 30 April 1987.

PubMed

1987-01-01

The plaintiff physicians and organizations providing abortion-related services challenged the constitutionality of provisions of a Missouri statute that a) state that life begins at conception and that unborn children have a protectable interest in life, health, and well being; b) require a physician to inform a woman seeking an abortion of certain facts; c) require all post sixteen-week abortions to be performed in a hospital; d) require certain tests to be performed in order to determine gestational age and viability; and e) prohibit the use of public funds, public employees, and public facilities for performing or assisting an abortion or encouraging or counseling an abortion except to save a woman's life. The Court ruled that all of these provisions were unconstitutional and in conflict with its previous rulings on a woman's right to obtain an abortion. In a related case the United States District Court, E.D. Missouri, E.D., held that the plaintiff physicians could not attack a statement of intent of the same law, which provides that "It is the intention of the general assembly of the state of Missouri to grant the right to life to all humans, born and unborn, and to regulate abortion to the full extent permitted by the Constitution of the United States, decisions of the United States Supreme Court, and federal statutes." See Women's Health Ctr. of West Cty. v. Webster, 24 September 1987, 670 F.Supp. 845. full text

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.

The pattern of topical corticosteroid prescribing in the United States, 1989-1991.

PubMed

Stern, R S

1996-08-01

Topical corticosteroids are widely used in the treatment of skin diseases. These preparations vary greatly in potency. They are available in both brand name and generic formulations, as well as in combination products. Our purpose was to determine the pattern of topical corticosteroids prescribing in the United States and the relation of patient and prescriber attributes to the type of corticosteroid preparation prescribed. Data from the 1989 to 1991 National Ambulatory Medical Care Survey were used to estimate the number of visits with a topical corticosteroid preparation prescribed and to identify prescribers with specific characteristics. In the United States, topical corticosteroids are prescribed or recommended at an average of 14 million visits per year to office-based health practitioners. Forty percent of these visits were to dermatologists. Dermatologists were 3.9 times more likely to prescribe very high potency steroids than were other physicians. Physicians other than dermatologists were 8.4 times more likely than dermatologists to prescribe combination agents containing moderate- or high-potency topical corticosteroids and an antiinfective agent. The pattern of topical corticosteroid prescribing is substantially different for dermatologists and other physicians. These differences may reflect differences in severity or complexity of the disease or differences in prescribing habits. The importance of these differences to the outcome of treated patients is not established.

Social Status Ranking of Occupations in the People's Republic of China, Taiwan, and the United States.

ERIC Educational Resources Information Center

Fredrickson, Ronald H.; And Others

1992-01-01

College students (n=1,039) in the People's Republic of China, Taiwan, and the United States ranked 24 occupations according to social status. There was more agreement than disagreement in the rankings, although exceptions were noted and explained by local conditions. Two occupations consistently ranked in highest group were physician and lawyer,…

An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California

PubMed Central

Nunberg, Helen; Kilmer, Beau; Pacula, Rosalie Liccardo; Burgdorf, James

2011-01-01

For more than a decade, medical marijuana has been at the forefront of the marijuana policy debate in the United States. Fourteen states allow physicians to recommend marijuana or provide a legal defense for patients and physicians if prosecuted in state courts; however, little is known about those individuals using marijuana for medicinal purposes and the symptoms they use it for. This study provides descriptive information from 1,655 patients seeking a physician’s recommendation for medical marijuana, the conditions for which they seek treatment, and the diagnoses made by the physicians. It conducts a systematic analysis of physician records and patient questionnaires obtained from consecutive patients being seen during a three month period at nine medical marijuana evaluation clinics belonging to a select medical group operating throughout the State of California. While this study is not representative of all medical marijuana users in California, it provides novel insights about an important population being affected by this policy. PMID:23750291

Monitoring Sub-Saharan African Physician Migration and Recruitment Post-Adoption of the WHO Code of Practice: Temporal and Geographic Patterns in the United States

PubMed Central

Tankwanchi, Akhenaten Benjamin Siankam; Vermund, Sten H.; Perkins, Douglas D.

2015-01-01

Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians’ locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician “brain drain”, it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians. PMID:25875010

Educating medical students as competent users of health information technologies: the MSOP data.

PubMed

McGowan, Julie J; Passiment, Morgan; Hoffman, Helene M

2007-01-01

As more health information technologies become part of the health care environment, the need for physicians with medical informatics competencies is growing. In 2006, a survey was created to determine the degree to which the Association of American Medical College's Medical School Objectives Project (MSOP) medical informatics competencies had been incorporated into medical school curricula in the United States. a web-based tool was used to create the survey; medical education deans or their designees were requested to complete the survey. Analysis focused on the clinician, researcher, and manager roles of physicians. Seventy usable surveys were returned. Many of the objectives were stated in the schools' respective curricula and the competencies were being evaluated. However, only a few schools taught and assessed the medical informatics objectives that required interaction with health information. To insure that physicians have the knowledge, skills, and attitudes to effectively and efficiently interact with today's health information technologies, more medical informatics concepts need to be included and assessed in all undergraduate medical education curricula in the United States.

United States private-sector physicians and pharmaceutical contract research: a qualitative study.

PubMed

Fisher, Jill A; Kalbaugh, Corey A

2012-01-01

There have been dramatic increases over the past 20 years in the number of nonacademic, private-sector physicians who serve as principal investigators on US clinical trials sponsored by the pharmaceutical industry. However, there has been little research on the implications of these investigators' role in clinical investigation. Our objective was to study private-sector clinics involved in US pharmaceutical clinical trials to understand the contract research arrangements supporting drug development, and specifically how private-sector physicians engaged in contract research describe their professional identities. We conducted a qualitative study in 2003-2004 combining observation at 25 private-sector research organizations in the southwestern United States and 63 semi-structured interviews with physicians, research staff, and research participants at those clinics. We used grounded theory to analyze and interpret our data. The 11 private-sector physicians who participated in our study reported becoming principal investigators on industry clinical trials primarily because contract research provides an additional revenue stream. The physicians reported that they saw themselves as trial practitioners and as businesspeople rather than as scientists or researchers. Our findings suggest that in addition to having financial motivation to participate in contract research, these US private-sector physicians have a professional identity aligned with an industry-based approach to research ethics. The generalizability of these findings and whether they have changed in the intervening years should be addressed in future studies. Please see later in the article for the Editors' Summary.

United States Private-Sector Physicians and Pharmaceutical Contract Research: A Qualitative Study

PubMed Central

Fisher, Jill A.; Kalbaugh, Corey A.

2012-01-01

Background There have been dramatic increases over the past 20 years in the number of nonacademic, private-sector physicians who serve as principal investigators on US clinical trials sponsored by the pharmaceutical industry. However, there has been little research on the implications of these investigators' role in clinical investigation. Our objective was to study private-sector clinics involved in US pharmaceutical clinical trials to understand the contract research arrangements supporting drug development, and specifically how private-sector physicians engaged in contract research describe their professional identities. Methods and Findings We conducted a qualitative study in 2003–2004 combining observation at 25 private-sector research organizations in the southwestern United States and 63 semi-structured interviews with physicians, research staff, and research participants at those clinics. We used grounded theory to analyze and interpret our data. The 11 private-sector physicians who participated in our study reported becoming principal investigators on industry clinical trials primarily because contract research provides an additional revenue stream. The physicians reported that they saw themselves as trial practitioners and as businesspeople rather than as scientists or researchers. Conclusions Our findings suggest that in addition to having financial motivation to participate in contract research, these US private-sector physicians have a professional identity aligned with an industry-based approach to research ethics. The generalizability of these findings and whether they have changed in the intervening years should be addressed in future studies. Please see later in the article for the Editors' Summary. PMID:22911055

A Capabilities Based Assessment of the United States Air Force Critical Care Air Transport Team

DTIC Science & Technology

2013-09-01

usually consist of a critical care physician, critical care nurse , and respiratory therapist. A Front-end Analysis has found several problems within...critically ill and wounded. This life-saving mission is executed by CCAT teams, which usually consist of a critical care physician, critical care nurse ...ill and wounded. This life-saving mission is executed by CCAT teams, which usually consist of a critical care physician, critical care nurse , and

A travel clinic in your office: grow your practice and protect international travelers.

PubMed

Kirsch, Michael

2009-01-01

Medical practices today face economic challenges from declining reimbursements and rising overhead costs. Physicians need to develop new income sources to invigorate their practices and remain viable. Travel medicine-advising and immunizing international travelers-is a rapidly growing specialty in the United States that generates substantial cash reimbursements and professional satisfaction. Travel Clinics of America, a physician-operated company, specializes in helping physicians to incorporate travel medicine into their existing practices.

Non-Research-Related Physician-Industry Relationships of Radiologists in the United States.

PubMed

Harvey, H Benjamin; Alkasab, Tarik K; Pandharipande, Pari V; Halpern, Elkan F; Prabhakar, Anand M; Oklu, Rahmi; Rosenthal, Daniel I; Hirsch, Joshua A; Gazelle, G Scott; Brink, James A

2015-11-01

To evaluate non-research-related, physician-industry financial relationships in the United States, in 2013, as reported pursuant to the Physician Payments Sunshine Act (a provision of the Affordable Care Act). In September 2014, CMS released the first five months (August 2013 to December 2013) of data disclosing physician-industry financial relationships. The frequency and value of non-research-related transfers in radiology were calculated and compared with those for 19 other specialties. Subanalyses of the frequency and value of such transfers in radiology were performed, based on state of licensure, radiologic subspecialty, nature of payment, manufacturer identity, and drug or device involved. A total of 7.4% (2,654 of 35,768) of radiologists from the United States had reportable non-research-related financial relationship(s) with industry during the 5-month period, the second-lowest level among the medical specialties evaluated. The average value of non-research-related transfers of value to radiologists, excluding royalties and licenses, was low ($438.71; SD: $2,912.15; median: $43.85), with <4% of radiologists receiving >$10 per month. Of all categories, that of food and beverage had the most transfers of value (86.0%; 5,655 of 6,577); royalties and licensure were associated with the greatest average value ($27,072.34; SD: $67,524.92). Although high-value relationships were rare, 57.8% (26 of 45) of radiologists who received a value >$1,000 per month held leadership positions in imaging enterprises. Less than 4% of radiologists have non-research-related financial relationships with industry that are valued at >$10 per month, suggesting that meaningful, deleterious effects of such relationships on radiology practice, if present, are infrequent. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Perceptions of Active Surveillance and Treatment Recommendations for Low-risk Prostate Cancer: Results from a National Survey of Radiation Oncologists and Urologists.

PubMed

Kim, Simon P; Gross, Cary P; Nguyen, Paul L; Smaldone, Marc C; Shah, Nilay D; Karnes, R Jeffrey; Thompson, R Houston; Han, Leona C; Yu, James B; Trinh, Quoc D; Ziegenfuss, Jeanette Y; Sun, Maxine; Tilburt, Jon C

2014-07-01

With the growing concerns about overtreatment in prostate cancer, the extent to which radiation oncologists and urologists perceive active surveillance (AS) as effective and recommend it to patients are unknown. To assess opinions of radiation oncologists and urologists about their perceptions of AS and treatment recommendations for low-risk prostate cancer. National survey of specialists. Radiation oncologists and urologists practicing in the United States. A total of 1366 respondents were asked whether AS was effective and whether it was underused nationally, whether their patients were interested in AS, and treatment recommendations for low-risk prostate cancer. Pearson's χ test and multivariate logistic regression were used to test for differences in physician perceptions on AS and treatment recommendations. Overall, 717 (52.5%) of physicians completed the survey with minimal differences between specialties (P=0.92). Although most physicians reported that AS is effective (71.9%) and underused in the United States (80.0%), 71.0% stated that their patients were not interested in AS. For low-risk prostate cancer, more physicians recommended radical prostatectomy (44.9%) or brachytherapy (35.4%); fewer endorsed AS (22.1%). On multivariable analysis, urologists were more likely to recommend surgery [odds ratio (OR): 4.19; P<0.001] and AS (OR: 2.55; P<0.001), but less likely to recommend brachytherapy (OR: 0.13; P<0.001) and external beam radiation therapy (OR: 0.11; P<0.001) compared with radiation oncologists. Most prostate cancer specialists in the United States believe AS effective and underused for low-risk prostate cancer, yet continue to recommend the primary treatments their specialties deliver.

Key Attributes of a Successful Physician Order Entry System Implementation in a Multi-hospital Environment

PubMed Central

Ahmad, Asif; Teater, Phyllis; Bentley, Thomas D.; Kuehn, Lynn; Kumar, Rajee R.; Thomas, Andrew; Mekhjian, Hagop S.

2002-01-01

The benefits of computerized physician order entry have been widely recognized, although few institutions have successfully installed these systems. Obstacles to successful implementation are organizational as well as technical. In the spring of 2000, following a 4-year period of planning and customization, a 9-month pilot project, and a 14-month hiatus for year 2000, the Ohio State University Health System extensively implemented physician order entry across inpatient units. Implementation for specialty and community services is targeted for completion in 2002. On implemented units, all orders are processed through the system, with 80 percent being entered by physicians and the rest by nursing or other licensed care providers. The system is deployable across diverse clinical environments, focused on physicians as the primary users, and accepted by clinicians. These are the three criteria by which the authors measured the success of their implementation. They believe that the availability of specialty-specific order sets, the engagement of physician leadership, and a large-scale system implementation were key strategic factors that enabled physician-users to accept a physician order entry system despite significant changes in workflow. PMID:11751800

Evaluating Motivational Interviewing in the Physician Assistant Curriculum.

PubMed

Halbach, Patrick; Keller, Abiola O

2017-09-01

Motivational interviewing (MI) is an evidence-based technique that enables clinicians to help patients modify health behaviors. Although MI is an essential tool for physician assistants (PAs), the extent to which it is addressed in PA curricula in the United States is unknown. This study is a comprehensive description of MI education in PA programs in the United States. Data are from the 2014 Physician Assistant Education Association Annual Program Survey. Descriptive statistics were conducted on de-identified data from all 186 PA programs in the United States. Of the 186 PA programs surveyed, 72.58% (n = 135) reported at least one course providing MI training. Availability of courses providing training in skills essential to the MI process varied. Having a course with verbal communication training was most frequently endorsed, and having a course with training in developing discrepancy was least frequently endorsed. The most popular teaching modality was lecture (84.95%, n = 158), whereas only 41.40% (n = 77) and 58.60% (n = 109) reported role play with evaluation and standardized patient exercises with evaluation, respectively. More than 70% of programs included at least one course in their curriculum that provided training in MI, suggesting that PA programs recognize the importance of MI. Instruction in change talk was not provided in nearly half of the programs. Role-play and standardized patient exercises with evaluation were underused methods despite their proven efficacy in MI education. As the first comprehensive benchmark of MI education for PAs, this study shows that although most programs address MI, opportunities exist to improve MI training in PA programs in the United States.

Perceived barriers to the regionalization of adult critical care in the United States: a qualitative preliminary study

PubMed Central

Kahn, Jeremy M; Asch, Rebecca J; Iwashyna, Theodore J; Rubenfeld, Gordon D; Angus, Derek C; Asch, David A

2008-01-01

Background Regionalization of adult critical care services may improve outcomes for critically ill patients. We sought to develop a framework for understanding clinician attitudes toward regionalization and potential barriers to developing a tiered, regionalized system of care in the United States. Methods We performed a qualitative study using semi-structured interviews of critical care stakeholders in the United States, including physicians, nurses and hospital administrators. Stakeholders were identified from a stratified-random sample of United States general medical and surgical hospitals. Key barriers and potential solutions were identified by performing content analysis of the interview transcriptions. Results We interviewed 30 stakeholders from 24 different hospitals, representing a broad range of hospital locations and sizes. Key barriers to regionalization included personal and economic strain on families, loss of autonomy on the part of referring physicians and hospitals, loss of revenue on the part of referring physicians and hospitals, the potential to worsen outcomes at small hospitals by limiting services, and the potential to overwhelm large hospitals. Improving communication between destination and source hospitals, provider education, instituting voluntary objective criteria to become a designated referral center, and mechanisms to feed back patients and revenue to source hospitals were identified as potential solutions to some of these barriers. Conclusion Regionalization efforts will be met with significant conceptual and structural barriers. These data provide a foundation for future research and can be used to inform policy decisions regarding the design and implementation of a regionalized system of critical care. PMID:19014704

Internal medicine in the United States and Germany: mutual influences from 1870 to today.

PubMed

Schulte-Bockolt, Arnd; Soergel, Konrad H; Stein, Juergen

2016-11-01

Over the past 140 years, the close academic and clinical interactions in Internal Medicine between German-speaking countries and the United States have been through three distinct stages. From 1870 until the First World War, German medical research, teaching, and university organization served as a model for U.S. medical schools and practice. However, after World War I, medical education reforms were implemented in the U.S., and due also to radical economic and political changes at home, German medicine lost its pioneering role. Furthermore, many scientists and clinicians were forced to emigrate in the face of racial and political persecution in Germany and Austria. Since the Second World War, American medicine has grown further to become the world leader in research, training, and clinical practice. The earlier trend of American physicians studying abroad was thus reversed, with many of today's foremost German physicians completing clinical and research training in the United States.

Pediatric Neglected Tropical Diseases in a Major Metropolitan Children's Hospital in the United States, 2004-2013.

PubMed

Sweet, Leigh R; Palazzi, Debra L

2016-12-01

We conducted a retrospective study of neglected tropical diseases (NTDs) diagnosed at Texas Children's Hospital between 2004 and 2013. Forty-three patients with an NTD were identified; 47% had never traveled outside of the United States. The results of this study highlight the importance of physician awareness of NTDs in children in the United States. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

PubMed

Meyers, C; Woods, R D

1996-04-01

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

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

PubMed Central

Meyers, C; Woods, R D

1996-01-01

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

Computerized physician order entry from a chief information officer perspective.

PubMed

Cotter, Carole M

2004-12-01

Designing and implementing a computerized physician order entry system in the critical care units of a large urban hospital system is an enormous undertaking. With their significant potential to improve health care and significantly reduce errors, the time for computerized physician order entry or physician order management systems is past due. Careful integrated planning is the key to success, requiring multidisciplinary teams at all levels of clinical and administrative management to work together. Articulated from the viewpoint of the Chief Information Officer of Lifespan, a not-for-profit hospital system in Rhode Island, the vision and strategy preceding the information technology plan, understanding the system's current state, the gap analysis between current and future state, and finally, building and implementing the information technology plan are described.

An Assessment of the Content of Medical Practice in the United States: Profiles of Physicians in Five Specialties.

ERIC Educational Resources Information Center

Girard, Roger A.; And Others

1982-01-01

The unique research methodology of a series of 24 specialty surveys of the professional activities of over 10,000 respondent physicians is described. Illustrative data are presented from five specialties (cardiology, family practice, general internal medicine, orthopedic surgery, and psychiatry), and the study's relevance and implications for…

Physicians, payers, and power. The United States is witnessing a struggle for control of healthcare.

PubMed

Friedman, E

1995-01-01

From its earliest days, healthcare in the United States has been controlled by providers, that is, by physicians and by hospitals (which, in turn, were also usually controlled by physicians). But this situation is changing. In the 1920s and 1930s, providers created health insurance companies like Blue Cross and Blue Shield to help patients pay for healthcare--to pay, in other words, for those services offered by providers. After World War II, the Hill-Burton program covered the nation with new hospitals. In the 1960s, Medicare and Medicaid eased the healthcare burden of older Americans--and also recapitalized hospitals. Thus providers called the shots in the creation of both the delivery and the payment systems. But in the 1970s, payers began to become more powerful. Now, in the 1990s, they have joined employers in acting to contain rapidly escalating healthcare costs. But even those long disturbed by the arrogance of some healthcare providers are now asking themselves: Is this really what we wanted? Payers are governed by the market; they may well seek, not the best, but the cheapest healthcare available. This is not in the interest of either patients or physicians. A middle ground--a new power alignment--will have to be worked out by patients, physicians, payers, and government.

Who Treats Adolescents and Young Adults with Cancer? A Report from the AYA HOPE Study.

PubMed

Parsons, Helen M; Harlan, Linda C; Schmidt, Susanne; Keegan, Theresa H M; Lynch, Charles F; Kent, Erin E; Wu, Xiao-Cheng; Schwartz, Stephen M; Chu, Roland L; Keel, Gretchen; Smith, Ashley Wilder

2015-09-01

Physicians play a critical role in delivering effective treatment and enabling successful transition to survivorship among adolescent and young adult (AYA) cancer patients. However, with no AYA cancer medical specialty, information on where and by whom AYAs with cancer are treated is limited. Using the National Cancer Institute's population-based AYA HOPE Study, 464 AYAs aged 15-39 at diagnosis treated by 903 physicians were identified. Differences in physician and hospital characteristics were examined by age at diagnosis and cancer type (germ cell cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphocytic leukemia [ALL], and sarcoma) using chi-square tests. Treating physicians were predominately 51-64 years old, male, United States-trained in non-pediatric specialties, and in group practices within large metropolitan areas. Older patients were less often treated by pediatric physicians (p < 0.01) and more likely to be treated by United States-trained physicians without research/teaching responsibilities and in hospitals without residency programs (p < 0.05). The majority of the few pediatricians (n = 44) treated ALL patients. Physicians with research/teaching responsibilities and those based in medical schools were more likely to treat patients with ALL and sarcoma compared with other cancer types (p < 0.01). Of HL patients, 73% were treated at a cancer center compared with 56% of patients with germ cell cancer (p < 0.01), while ALL (85%) and sarcoma (87%) patients were more likely to be treated in hospitals with residency programs (p < 0.01). Most AYAs with cancer were treated by non-pediatric physicians in community settings, although physician characteristics varied significantly by patient cancer type and age at diagnosis.

Physician Burnout and Well-Being: A Systematic Review and Framework for Action.

PubMed

Rothenberger, David A

2017-06-01

Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is far reaching and includes harm to the burned-out physician, as well as patients, coworkers, family members, close friends, and healthcare organizations. The purpose of this review is to provide an accurate, current summary of what is known about physician burnout and to develop a framework to reverse its current negative impact, decrease its prevalence, and implement effective organizational and personal interventions. I completed a comprehensive MEDLINE search of the medical literature from January 1, 2000, through December 28, 2016, related to medical student and physician burnout, stress, depression, suicide ideation, suicide, resiliency, wellness, and well-being. In addition, I selectively reviewed secondary articles, books addressing the relevant issues, and oral presentations at national professional meetings since 2013. Healthcare organizations within the United States were studied. The literature review is presented in 5 sections covering the basics of defining and measuring burnout; its impact, incidence, and causes; and interventions and remediation strategies. All US medical students, physicians in training, and practicing physicians are at significant risk of burnout. Its prevalence now exceeds 50%. Burnout is the unintended net result of multiple, highly disruptive changes in society at large, the medical profession, and the healthcare system. Both individual and organizational strategies have been only partially successful in mitigating burnout and in developing resiliency and well-being among physicians. Two highly effective strategies are aligning personal and organizational values and enabling physicians to devote 20% of their work activities to the part of their medical practice that is especially meaningful to them. More research is needed.

Perspectives: Using Results from HRSA's Health Workforce Simulation Model to Examine the Geography of Primary Care.

PubMed

Streeter, Robin A; Zangaro, George A; Chattopadhyay, Arpita

2017-02-01

Inform health planning and policy discussions by describing Health Resources and Services Administration's (HRSA's) Health Workforce Simulation Model (HWSM) and examining the HWSM's 2025 supply and demand projections for primary care physicians, nurse practitioners (NPs), and physician assistants (PAs). HRSA's recently published projections for primary care providers derive from an integrated microsimulation model that estimates health workforce supply and demand at national, regional, and state levels. Thirty-seven states are projected to have shortages of primary care physicians in 2025, and nine states are projected to have shortages of both primary care physicians and PAs. While no state is projected to have a 2025 shortage of primary care NPs, many states are expected to have only a small surplus. Primary care physician shortages are projected for all parts of the United States, while primary care PA shortages are generally confined to Midwestern and Southern states. No state is projected to have shortages of all three provider types. Projected shortages must be considered in the context of baseline assumptions regarding current supply, demand, provider-service ratios, and other factors. Still, these findings suggest geographies with possible primary care workforce shortages in 2025 and offer opportunities for targeting efforts to enhance workforce flexibility. © Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Peripatetic plague.

PubMed

Mann, J M; Schmid, G P; Stoesz, P A; Skinner, M D; Kaufmann, A F

1982-01-01

Cases of plague continue to occur in various parts of the world, including the western United States, where plague is endemic among the wild rodent population. In 1980, a case of plague acquired in New Mexico and hospitalized in Nebraska illustrated the problem of plague occurring in persons traveling from the state in which they become infected to another state. Nine cases of plague in travelers were identified among the 166 cases of plague reported in the United States from 1950 to 1980. Physicians should be aware of natural plague foci in the western United States and should obtain a travel history from patients with an illness clinically compatible with plague.

Physician emigration from sub-Saharan Africa to the United States: analysis of the 2011 AMA physician masterfile.

PubMed

Tankwanchi, Akhenaten Benjamin Siankam; Ozden, Cağlar; Vermund, Sten H

2013-01-01

The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States. We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤ 70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (-156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984-1999) of the structural adjustment programs. Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary.

Physician Emigration from Sub-Saharan Africa to the United States: Analysis of the 2011 AMA Physician Masterfile

PubMed Central

Tankwanchi, Akhenaten Benjamin Siankam; Özden, Çağlar; Vermund, Sten H.

2013-01-01

Background The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States. Methods and Findings We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (−156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984–1999) of the structural adjustment programs. Conclusion Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary PMID:24068894

Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians.

PubMed

Cardoso, Teresa; Fonseca, Teresa; Pereira, Sofia; Lencastre, Luís

2003-12-01

The objective of the present study was to evaluate the opinion of Portuguese intensive care physicians regarding 'do-not-resuscitate' (DNR) orders and decisions to withhold/withdraw treatment. A questionnaire was sent to all physicians working on a full-time basis in all intensive care units (ICUs) registered with the Portuguese Intensive Care Society. A total of 266 questionnaires were sent and 175 (66%) were returned. Physicians from 79% of the ICUs participated. All participants stated that DNR orders are applied in their units, and 98.3% stated that decisions to withhold treatment and 95.4% stated that decisions to withdraw treatment are also applied. About three quarters indicated that only the medical group makes these decisions. Fewer than 15% of the responders stated that they involve nurses, 9% involve patients and fewer than 11% involve patients' relatives in end-of-life decisions. Physicians with more than 10 years of clinical experience more frequently indicated that they involve nurses in these decisions (P < 0.05), and agnostic/atheist doctors more frequently involve patients' relatives in decisions to withhold/withdraw treatment (P < 0.05). When asked about who they thought should be involved, more than 26% indicated nurses, more than 35% indicated the patient and more than 25% indicated patients' relatives. More experienced doctors more frequently felt that nurses should be involved (P < 0.05), and male doctors more frequently stated that patients' relatives should be involved in DNR orders (P < 0.05). When a decision to withdraw treatment is made, 76.8% of 151 respondents indicated that they would initiate palliative care; no respondent indicated that they would administer drugs to accelerate the expected outcome. The probability of survival from the acute episode and patients' wishes were the most important criteria influencing end-of-life decisions. These decisions are made only by the medical group in most of the responding ICUs, with little input from nursing staff, patients, or patients' relatives, although many respondents expressed a wish to involve them more in this process. Sex, experience and religious beliefs of the respondents influences the way in which these decisions are made.

United States Responses to Japanese Wartime Inhuman Experimentation after World War II: National Security and Wartime Exigency

PubMed Central

Brody, Howard; Leonard, Sarah E.; Nie, Jing-Bao; Weindling, Paul

2015-01-01

In 1945-46, representatives of the United States government made similar discoveries in both Germany and Japan, unearthing evidence of unethical experiments on human beings that could be viewed as war crimes. The outcomes in the two defeated nations, however, were strikingly different. In Germany, the U.S., influenced by the Canadian physician John Thompson, played a key role in bringing Nazi physicians to trial and publicizing their misdeeds. In Japan, the U.S. played an equally key role in concealing information about the biological warfare experiments and securing immunity from prosecution for the perpetrators. The greater force of appeals to national security and wartime exigency help to explain these different outcomes. PMID:24534743

A comparison of physician emigration from Africa to the United States of America between 2005 and 2015.

PubMed

Duvivier, Robbert J; Burch, Vanessa C; Boulet, John R

2017-06-26

Migration of health professionals has been a cause for global concern, in particular migration from African countries with a high disease burden and already fragile health systems. An estimated one fifth of African-born physicians are working in high-income countries. Lack of good data makes it difficult to determine what constitutes "African" physicians, as most studies do not distinguish between their country of citizenship and country of training. Thus, the real extent of migration from African countries to the United States (US) remains unclear. This paper quantifies where African migrant physicians come from, where they were educated, and how these trends have changed over time. We combined data from the Educational Commission for Foreign Medical Graduates with the 2005 and 2015 American Medical Association Physician Masterfiles. Using a repeated cross-sectional study design, we reviewed the available data, including medical school attended, country of medical school, and citizenship when entering medical school. The outflow of African-educated physicians to the US has increased over the past 10 years, from 10 684 in 2005 to 13 584 in 2015 (27.1% increase). This represents 5.9% of all international medical graduates in the US workforce in 2015. The number of African-educated physicians who graduated from medical schools in sub-Saharan countries was 2014 in 2005 and 8150 in 2015 (304.6% increase). We found four distinct categorizations of African-trained physicians migrating to the US: (1) citizens from an African country who attended medical school in their own country (86.2%, n = 11,697); (2) citizens from an African country who attended medical school in another African country (2.3%, n = 317); (3) US citizens who attended medical school in an African country (4.0%, n = 537); (4) citizens from a country outside Africa, and other than the United States, who attended medical school in an African country (7.5%, n = 1013). Overall, six schools in Africa provided half of all African-educated physicians. The number of African-educated physicians in the US has increased over the past 10 years. We have distinguished four migration patterns, based on citizenship and country of medical school. The majority of African graduates come to the US from relatively few countries, and from a limited number of medical schools. A proportion are not citizens of the country where they attended medical school, highlighting the internationalization of medical education.

Nurse Workforce Challenges in the United States: Implications for Policy. OECD Health Working Papers, No. 35

ERIC Educational Resources Information Center

Aiken, Linda H.; Cheung, Robyn

2008-01-01

The United States has the largest professional nurse workforce in the world numbering close to 3 million but does not produce enough nurses to meet its growing demand. A shortage of close to a million professional nurses is projected to evolve by 2020. An emerging physician shortage will further exacerbate the nurse shortage as the boundaries in…

Bringing Health Care to the Under-Served: The Mid-Level Health Practitioner in Three Countries--China, the Soviet Union, and the United States.

ERIC Educational Resources Information Center

Kupferberg, Natalie

A comparison was made of the role of midlevel health practitioners and how they came into being and flourished in three countries: the "feldsher" of the Soviet Union, the barefoot doctor of China, and the physician assistant of the United States. Information was gathered from books, journals, periodicals, governments, and newspapers as…

Application of the resource-based relative value scale system to pediatrics.

PubMed

Gerstle, Robert S; Molteni, Richard A; Andreae, Margie C; Bradley, Joel F; Brewer, Eileen D; Calabrese, Jamie; Krug, Steven E; Liechty, Edward A; Linzer, Jeffrey F; Pillsbury, Julia M; Tuli, Sanjeev Y

2014-06-01

The majority of public and private payers in the United States currently use the Medicare Resource-Based Relative Value Scale as the basis for physician payment. Many large group and academic practices have adopted this objective system of physician work to benchmark physician productivity, including using it, wholly or in part, to determine compensation. The Resource-Based Relative Value Scale survey instrument, used to value physician services, was designed primarily for procedural services, leading to current concerns that American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) surveys may undervalue nonprocedural evaluation and management services. The American Academy of Pediatrics is represented on the RUC, the committee charged with maintaining accurate physician work values across specialties and age groups. The Academy, working closely with other primary care and subspecialty societies, actively pursues a balanced RUC membership and a survey instrument that will ensure appropriate work relative value unit assignments, thereby allowing pediatricians to receive appropriate payment for their services relative to other services.

Public opinion about doctors' pay.

PubMed Central

Ross, C E; Lauritsen, J

1985-01-01

Public opinion about doctors' incomes was examined in a national random sample of 843 respondents; 70.1 per cent of those questioned felt physicians are overpaid. There was a high degree of agreement among various groups that physicians are overpaid, but older people and Whites were more likely to think so than younger people and other ethnic groups. People who believe that the United States is characterized by unequal educational opportunity, unfair income distribution, and limited resources were also more likely to think physicians are overpaid. PMID:4003637

Comparing Smoking Cessation Outcomes in Nurse-Led and Physician-Led Primary Care Visits.

PubMed

Byers, Marcia A; Wright, Patricia; Tilford, John Mick; Nemeth, Lynne S; Matthews, Ellyn; Mitchell, Anita

Smoking is a significant public health concern in the United States, yet 50% of patients do not receive recommended tobacco use screening and counseling. This project compared smoking cessation rates in newly reimbursable nurse-led wellness visits with rates in physician-led visits. Although the findings were not statistically significant, they suggested that smoking cessation is at least equivalent in patients who attend nurse-led visits compared with physician-led visits and may be higher.

Public opinion about doctors' pay.

PubMed

Ross, C E; Lauritsen, J

1985-06-01

Public opinion about doctors' incomes was examined in a national random sample of 843 respondents; 70.1 per cent of those questioned felt physicians are overpaid. There was a high degree of agreement among various groups that physicians are overpaid, but older people and Whites were more likely to think so than younger people and other ethnic groups. People who believe that the United States is characterized by unequal educational opportunity, unfair income distribution, and limited resources were also more likely to think physicians are overpaid.

[The Internet and shared decision-making between patients and healthcare providers].

PubMed

Silber, Denise

2009-10-01

Insurance companies like Kaiser Permanente in the United States remunerate physicians for their email correspondence with patients, increasing the efficiency of office visits. A survey by the French National Board of Physicians regarding the computerization of medical practices in April 2009, confirms that both physicians and patients in France are very favorable to the development of these tools. When patients can manage and/or access their medical files and determine which providers can access them, they become a true partner.

The future of medical licensure in the United States.

PubMed

Thompson, James N

2006-12-01

Medical licensure in the United States is undergoing significant change. With calls for greater accountability and transparency, state medical boards and their membership association, the Federation of State Medical Boards (FSMB), are seeking ways to assure the public that physicians are maintaining their competence throughout the lifetime of their practice of medicine. At present, competence in cognitive, clinical, and communicative skills is regularly measured only at initial licensure. Yet, the public and policy-related organizations are demanding ongoing assessment of physicians' ability to safely and competently practice medicine. The author reports on activities that involve the FSMB and other national organizations, including the Educational Commission for Foreign Medical Graduates, in planning for a future of increased accountability and transparency of the licensing and regulatory communities that oversee the practice of medicine. He notes that topics of discussion include possible nationalization of what has been traditionally state-based licensure. He raises questions about a future that may include specialty-based licensure and greater national and even international license portability.

A Closer Look at the Junior Doctor Crisis in the United Kingdom's National Health Services: Is Emigration Justifiable?

PubMed

Teo, Wendy Zi Wei

2018-07-01

This article attempts to tackle the ethically and morally troubling issue of emigration of physicians from the United Kingdom, and whether it can be justified. Unlike most research that has already been undertaken in this field, which looks at migration from developing countries to developed countries, this article takes an in-depth look at the migration of physicians between developed countries, in particular from the United Kingdom (UK) to other developed countries such as Canada, Australia, New Zealand, and the United States (US). This examination was written in response to a current and critical crisis in the National Health Service (NHS), where impending contract changes may bring about a potential exodus of junior doctors.

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States.

PubMed

King, Marissa; Bearman, Peter S

2017-01-01

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing - providing gifts, information, samples, trips, honoraria and other inducements - to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone. Copyright © 2016 Elsevier Ltd. All rights reserved.

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

PubMed Central

King, Marissa; Bearman, Peter S.

2016-01-01

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing – providing gifts, information, samples, trips, honoraria and other inducements – to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone. PMID:27856120

Medical Tourism and Telemedicine: A New Frontier of an Old Business

PubMed Central

2016-01-01

In October 2015, the “Chinese American Physicians E-Hospital” celebrated its “grand opening” online. All physicians affiliated with this E-Hospital are bilingual Chinese American physicians, who provide services ranging from initial teleconsulting to international transfer and treatment in the United States. Such telemedicine platform for medical tourism not only saves the patients from the hassles of identifying and connecting with an appropriate health service provider but also minimizes the language and cultural barriers. As a growing number of patients from middle- and low-income countries travel to the United States (US) for medical care, we face promising opportunities as well as mounting challenges. The Centers for Disease Control (CDC) in the US has guidance for Americans seeking care overseas, but is not available for international patients seeking care in US. This article opens a dialogue on the challenges associated with flourishing medical tourism and telemedicine, including quality assessment, risk communication, ethical guidelines, and legal concerns. PMID:27215230

Radiation decontamination unit for the community hospital.

PubMed

Waldron, R L; Danielson, R A; Shultz, H E; Eckert, D E; Hendricks, K O

1981-05-01

"Freestanding" radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstruction. Because of the development of nuclear power plants in relatively remote areas and widespread transportation of radioactive materials it is important for hospitals and physicians to be prepared to handle radiation accident victims. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Ridge Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. It is important that the team leader be knowledgeable in radiation accident management and have personnel trained in radiation accident management as members of this team. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important. Periodic drills are necessary for this mobilization and the smooth operation of the unit.

A primer on medical education in the United States through the lens of a current resident physician.

PubMed

Mowery, Yvonne M

2015-10-01

Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor's degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship.

A primer on medical education in the United States through the lens of a current resident physician

PubMed Central

2015-01-01

Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor’s degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship. PMID:26623123

A primer on medical education in the United States through the lens of a current resident physician

PubMed Central

2015-01-01

Physician training and standards for medical licensure differ widely across the globe. The medical education process in the United States (US) typically involves a minimum of 11 years of formal training and multiple standardized examinations between graduating from secondary school and becoming an attending physician with full medical licensure. Students in the US traditionally enter a 4-year medical school after completing an undergraduate bachelor’s degree, in contrast to most other countries where medical training begins after graduation from high school. Medical school seniors planning to practice medicine in the US must complete postgraduate clinical training, referred to as residency, within the specialty of their choosing. The duration of residency varies depending on specialty, typically lasting between 3 and 7 years. For subspecialty fields, additional clinical training is often required in the form of a fellowship. Many experts have called for changes in the medical education system to shorten medical training in the US, and reforms are ongoing in some institutions. However, physician education in the US generally remains a progression from undergraduate premedical coursework to 4 years of medical school, followed by residency training with an optional subspecialty fellowship. PMID:26605316

Emerging and encouraging trends in e-prescribing adoption among providers and pharmacies.

PubMed

Gabriel, Meghan E; Furukawa, Michael F; Vaidya, Varun

2013-09-01

The objective of this study is to describe the growth in provider (physician, nurse practitioner, and physician assistant) adoption of e-prescribing and the growth in pharmacies actively accepting e-prescriptions using nationally representative data from December 2008 to December 2012. Additionally, this study explored e-prescribing adoption variation by urban and rural counties. Descriptive analysis of nationally representative, transactional e-prescribing data. Data for this analysis were from Surescripts. Surescripts is a leading e-prescription network utilized by a majority of all chain, franchise, or independently owned pharmacies in the United States routing prescriptions for more than 240 million patients through their network. The total number of prescribers, including physicians, nurse practitioners, and physician assistants e-prescribing via an electronic health record (EHR) on the Surescripts network has increased from 7% to 54%. Additionally, the number of pharmacies actively accepting e-prescriptions is 94%. These increases in pharmacies actively accepting e-prescriptions and the provider's eprescribing mirror the increase in the volume of e-prescriptions sent on the Surescripts network. This analysis shows that the vast majority of pharmacies in the United States are able to accept e-prescriptions and over half of providers are e-prescribing via an EHR.

Synergy, Salary, and Satisfaction: Benefits of Training in Critical Care Medicine and Infectious Diseases Gleaned From a National Pilot Survey of Dually Trained Physicians.

PubMed

Kadri, Sameer S; Rhee, Chanu; Magda, Gabriela; Strich, Jeffrey R; Cai, Rongman; Sun, Junfeng; Decker, Brooke K; O'Grady, Naomi P

2016-10-01

An increasing number of physicians are seeking dual training in critical care medicine (CCM) and infectious diseases (ID). Understanding experiences and perceptions of CCM-ID physicians could inform career choices and programmatic innovation. All physicians trained and/or certified in both CCM and ID to date in the United States were sent a Web-based questionnaire in 2015. Responses enabled a cross-sectional analysis of physician demographics and training and practice characteristics and satisfaction. Of 202 CCM-ID physicians, 196 were alive and reachable. The response rate was 79%. Forty-six percent trained and 34% practice in the northeastern United States. Only 40% received dual training at the same institution. Eighty-three percent identified as either an intensivist with ID expertise (44%) or as equally an intensivist and ID physician (38%). Median salary was $265 000 (interquartile range [IQR], $215 000-$350 000). Practice settings were split between academic (45%) and community settings (42%). Two-thirds are clinicians but 62% conduct some research and 26% practice outpatient ID. Top reasons to dually specialize included clinical synergy (70%), procedural activity (50%), and less interest in pulmonology (49%). Although 38% cited less proficiency with bronchoscopy as a disadvantage, 87% seldom need pulmonary consultation in the intensive care unit. Median career satisfaction was 4 (IQR, 4-5) out of 5, and 76% would dually train again. CCM-ID graduates prefer the acute care setting, predominantly CCM or a combination of CCM and ID. They find combination training and practice to be synergistic and satisfying, but most have had to seek CCM and ID training independently at separate institutions. Given these findings, avenues for combined training in CCM-ID should be considered. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards.

PubMed

Papadakis, Maxine A; Arnold, Gerald K; Blank, Linda L; Holmboe, Eric S; Lipner, Rebecca S

2008-06-03

Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support the Accreditation Council for Graduate Medical Education standards for professionalism and cognitive performance and the development of best practices to remediate these deficiencies.

Achieving Gender Equity in Physician Compensation and Career Advancement: A Position Paper of the American College of Physicians.

PubMed

Butkus, Renee; Serchen, Joshua; Moyer, Darilyn V; Bornstein, Sue S; Hingle, Susan Thompson

2018-05-15

Women comprise more than one third of the active physician workforce, an estimated 46% of all physicians-in-training, and more than half of all medical students in the United States. Although progress has been made toward gender diversity in the physician workforce, disparities in compensation exist and inequities have contributed to a disproportionately low number of female physicians achieving academic advancement and serving in leadership positions. Women in medicine face other challenges, including a lack of mentors, discrimination, gender bias, cultural environment of the workplace, imposter syndrome, and the need for better work-life integration. In this position paper, the American College of Physicians summarizes the unique challenges female physicians face over the course of their careers and provides recommendations to improve gender equity and ensure that the full potential of female physicians is realized.

Impact of the HITECH financial incentives on EHR adoption in small, physician-owned practices.

PubMed

Cohen, Martin F

2016-10-01

Physicians in small physician-owned practices in the United States have been slower to adopt EHRs than physicians in large practices or practices owned by large organizations. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 included provisions intended to address many of the potential barriers to EHR adoption cited in the literature, including a financial incentives program that has paid physicians and other professionals $13 billion through December 2015. Given the range of factors that may be influencing physicians' decisions on whether to adopt an EHR, and given the level of HITECH expenditures to date, there is significant policy value in assessing whether the HITECH incentives have actually had an impact on EHR adoption decisions among U.S. physicians in small, physician-owned practices. This study addresses this question by analyzing physicians' own views on the influence of the HITECH incentives as well as other potential considerations in their decision-making on whether to adopt an EHR. Using data from a national survey of physicians, five composite scales were created from groups of survey items to reflect physician views on different potential facilitators and barriers for EHR adoption as of 2011, after the launch of the HITECH incentives program. Multinomial and binary logistic regression models were specified to test which of these physician-reported considerations have a significant relationship with EHR adoption status among 1043 physicians working in physician-owned practices with no more than 10 physicians. Physicians' views on the importance of the HITECH financial incentives are strongly associated with EHR adoption during the first three years of the HITECH period (2010-2012). In the study's primary model, a one-point increase on a three-point scale for physician-reported influence of the HITECH financial incentives increases the relative risk of being in the process of adoption in 2011, compared to the risk of remaining a non-adopter, by a factor of 4.02 (p<0.001, 95% CI of 2.06-7.85). In a second model which excludes pre-HITECH adopters from the data, a one-point increase on the incentives scale increases the relative risk of having become a new EHR user in 2010 or 2011, compared to the risk of remaining a non-adopter, by a factor of 3.98 (p<0.01, 95% CI of 1.48-10.68) and also increases the relative risk of being in the process of adoption in 2011 by a factor of 5.73 (p<0.001, 95% CI of 2.57-12.76), compared to the risk of remaining a non-adopter in 2011. In contrast, a composite scale that reflects whether physicians viewed choosing a specific EHR vendor as challenging is not associated with adoption status. This study's principal finding is that the HITECH financial incentives were influential in accelerating EHR adoption among small, physician-owned practices in the United States. A second finding is that physician decision-making on EHR adoption in the United States has not matched what would be predicted by the literature on network effects. The market's failure to converge on a dominant design in the absence of interoperability means it will be difficult to achieve widespread exchange of patients' clinical information among different health care provider organizations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Food allergy knowledge, attitudes, and beliefs of primary care physicians.

PubMed

Gupta, Ruchi S; Springston, Elizabeth E; Kim, Jennifer S; Smith, Bridget; Pongracic, Jacqueline A; Wang, Xiaobin; Holl, Jane

2010-01-01

To provide insight into food allergy knowledge and perceptions among pediatricians and family physicians in the United States. A national sample of pediatricians and family physicians was recruited between April and July 2008 to complete the validated, Web-based Chicago Food Allergy Research Survey for Primary Care Physicians. Findings were analyzed to provide composite/itemized knowledge scores, describe attitudes and beliefs, and examine the effects of participant characteristics on response. The sample included 407 primary care physicians; 99% of the respondents reported providing care for food-allergic patients. Participants answered 61% of knowledge-based items correctly. Strengths and weaknesses were identified in each content domain evaluated by the survey. For example, 80% of physicians surveyed knew that the flu vaccine is unsafe for egg-allergic children, 90% recognized that the number of food-allergic children is increasing in the United States, and 80% were aware that there is no cure for food allergy. However, only 24% knew that oral food challenges may be used in the diagnosis of food allergy, 12% correctly rejected that chronic nasal problems are not symptom of food allergy, and 23% recognized that yogurts/cheeses from milk are unsafe for children with immunoglobulin E-mediated milk allergies. Fewer than 30% of the participants felt comfortable interpreting laboratory tests to diagnose food allergy or felt adequately prepared by their medical training to care for food-allergic children. Knowledge of food allergy among primary care physicians was fair. Opportunities for improvement exist, as acknowledged by participants' own perceptions of their clinical abilities in the management of food allergy.

Characteristics of medical professional liability claims in patients treated by family medicine physicians.

PubMed

Flannery, Frank T; Parikh, Parul Divya; Oetgen, William J

2010-01-01

This study describes a large database of closed medical professional liability (MPL) claims involving family physicians in the United States. The purpose of this report is to provide information for practicing family physicians that will be useful in improving the quality of care, thereby reducing the incidence of patient injury and the consequent frequency of MPL claims. The Physician Insurers Association of America (PIAA) established a registry of closed MPL claims in 1985. This registry contains data describing 239,756 closed claims in the United States through 2008. The registry is maintained for educational programs that are designed to improve quality of care and reduce patient injury MPL claims. We summarized this closed claims database. Of 239,756 closed claims, 27,556 (11.5%) involved family physicians. Of these 27,556 closed claims, 8797 (31.9%) resulted in a payment, and the average payment was $164,107. In the entire registry, 29.5% of closed claims were paid, and the average payment was $209,156. The most common allegation among family medicine closed claims was diagnostic error, and the most prevalent diagnosis was acute myocardial infarction, which represented 24.1% of closed claims with diagnostic errors. Diagnostic errors related to patients with breast cancer represented the next most common condition, accounting for 21.3% of closed claims with diagnostic errors. MPL issues are common and are important to all practicing family physicians. Knowledge of the details of liability claims should assist practicing family physicians in improving quality of care, reducing patient injury, and reducing the incidence of MPL claims.

Physician Scientist Training in the United States: A Survey of the Current Literature.

PubMed

Kosik, R O; Tran, D T; Fan, Angela Pei-Chen; Mandell, G A; Tarng, D C; Hsu, H S; Chen, Y S; Su, T P; Wang, S J; Chiu, A W; Lee, C H; Hou, M C; Lee, F Y; Chen, W S; Chen, Q

2016-03-01

The declining number of physician scientists is an alarming issue. A systematic review of all existing programs described in the literature was performed, so as to highlight which programs may serve as the best models for the training of successful physician scientists. Multiple databases were searched, and 1,294 articles related to physician scientist training were identified. Preference was given to studies that looked at number of confirmed publications and/or research grants as primary outcomes. Thirteen programs were identified in nine studies. Eighty-three percent of Medical Scientist Training Program (MSTP) graduates, 77% of Clinician Investigator Training Program (CI) graduates, and only 16% of Medical Fellows Program graduates entered a career in academics. Seventy-eight percent of MSTP graduates succeeded in obtaining National Institute of Health (NIH) grants, while only 15% of Mayo Clinic National Research Service Award-T32 graduates obtained NIH grants. MSTP physician scientists who graduated in 1990 had 13.5 ± 12.5 publications, while MSTP physician scientists who graduated in 1975 had 51.2 ± 38.3 publications. Additionally, graduates from the Mayo Clinic's MD-PhD Program, the CI Program, and the NSRA Program had 18.2 ± 20.1, 26.5 ± 24.5, and 17.9 ± 26.3 publications, respectively. MSTP is a successful model for the training of physician scientists in the United States, but training at the postgraduate level also shows promising outcomes. An increase in the number of positions available for training at the postgraduate level should be considered. © The Author(s) 2014.

Progress for whose future? The impact of the Flexner Report on medical education for racial and ethnic minority physicians in the United States.

PubMed

Steinecke, Ann; Terrell, Charles

2010-02-01

The publication of the Flexner Report in 1910 had an immediate and enduring impact on the training of African American physicians in the United States. The Flexner Report's thesis, "that the country needs fewer and better doctors," was intended to normalize medical education for the majority of physicians, but its implementation just 48 years after the Emancipation Proclamation obstructed opportunities for African Americans pursuing medical education and restricted the production of physicians capable of addressing the health needs of a nation that would grow increasingly diverse across the century.This article provides a working definition of structural racism within academic medicine, reviews the significant physician workforce diversity initiatives of the past four decades, and suggests the most successful of these possess strategies common to addressing structural racism (community empowerment, collaboration, clear and measurable goals, leadership, and durable resources). Stymied by popular ballot initiatives, relentless legal challenges, and dwindling funds, current and future efforts to increase diversity in medicine must maintain a focus on addressing the active remnants of structural racism while they build on the broad benefits of diversity in education and medicine. Despite creative and tireless efforts, no significant progress in expanding diversity within the U.S. physician workforce can be made absent a national effort to address this enduring barrier in the collective social, economic, and political institutions. The centennial of the Flexner Report is an opportunity for the academic medicine community to renew its commitment to dismantling the barriers to diversity and improving medical education for all future physicians.

Drivers of healthcare expenditures associated with physician services.

PubMed

Koenig, Lane; Siegel, Jonathan M; Dobson, Allen; Hearle, Keith; Ho, Silver; Rudowitz, Robin

2003-06-01

To identify and rank the key contributors to increases in healthcare costs for physician services. We performed regression analysis using state-level physician cost data from the state health expenditure accounts maintained by the Centers for Medicare and Medicaid Services (CMS) and a national, private (commercial) health insurer. We estimated that during 1990 to 2000, nominal physician expenditures per capita grew 4.7% annually. Forty-two percent of this growth was attributable to general price inflation measured by the gross domestic product price deflator. The category of general economic variables and demographics was the next largest contributor to growth at 17%, followed by physician supply and provider structure (12%) and technology and treatment patterns (11%). Operating costs, health status, healthcare regulation, and health insurance benefit and product design comprised the remaining 18% of the growth. Because physicians are central to the healthcare system in the United States, efforts to contain physician spending reverberate through all healthcare services. The combined effect of an increase in the number and proportion of specialty care physicians, the continued development of clinical approaches for the control of chronic disease, and an aging population requiring intensive medical care imply that the current increase in healthcare expenditures could continue unabated, unless effective cost-control devices are deployed. To be effective, emerging strategies for influencing the affordability of healthcare services are likely to require a greater level of partnership between payers, providers, and other stakeholders.

Hospital employment of physicians and supply chain performance: An empirical investigation.

PubMed

Young, Gary J; Nyaga, Gilbert N; Zepeda, E David

2016-01-01

As hospital employment of physicians becomes increasingly common in the United States, much speculation exists as to whether this type of arrangement will promote hospital operating efficiency in such areas as supply chain management. Little empirical research has been conducted to address this question. The aim of this study was to provide an exploratory assessment of whether hospital employment of physicians is associated with better supply chain performance. Drawing from both agency and stewardship theories, we examined whether hospitals with a higher proportion of employed medical staff members have relatively better supply chain performance based on two performance measures, supply chain expenses and inventory costs. We conducted the study using a pooled, cross-sectional sample of hospitals located in California between 2007 and 2009. Key data sources were hospital annual financial reports from California's Office of Statewide Health Policy and Development and the American Hospital Association annual survey of hospitals. To examine the relationship between physician employment and supply chain performance, we specified physician employment as the proportion of total employed medical staff members as well as the proportion of employed medical staff members within key physician subgroups. We analyzed the data using generalized estimating equations. Study results generally supported our hypothesis that hospital employment of physicians is associated with better supply chain performance. Although the results of our study should be viewed as preliminary, the trend in the United States toward hospital employment of physicians may be a positive development for improved hospital operating efficiency. Hospital managers should also be attentive to training and educational resources that medical staff members may need to strengthen their role in supply chain activities.

Physicians’ perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States

PubMed Central

2013-01-01

Background We lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. Methods We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,083), the U.S. (n = 6,628), and Norway (n = 638), examining demographics, job satisfaction, and professional autonomy. Results Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians’ perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. Conclusions U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians. PMID:24330820

Cross-cultural comparisons of attitudes toward schizophrenia amongst the general population and physicians: a series of web-based surveys in Japan and the United States.

PubMed

Richards, Misty; Hori, Hiroaki; Sartorius, Norman; Kunugi, Hiroshi

2014-02-28

Cross-cultural differences in attitudes toward schizophrenia are suggested, while no studies have compared such attitudes between the United States and Japan. In our previous study in Japan (Hori et al., 2011), 197 subjects in the general population and 112 physicians (excluding psychiatrists) enrolled in a web-based survey using an Internet-based questionnaire format. Utilizing the identical web-based survey method in the United States, the present study enrolled 172 subjects in the general population and 45 physicians. Participants' attitudes toward schizophrenia were assessed with the English version of the 18-item questionnaire used in our previous Japanese survey. Using exploratory factor analysis, we identified four factors labeled "social distance," "belief of dangerousness," "underestimation of patients' abilities," and "skepticism regarding treatment." The two-way multivariate analysis of covariance on the four factors, with country and occupation as the between-subject factors and with potentially confounding demographic variables as the covariates, revealed that the general population in the US scored significantly lower than the Japanese counterparts on the factors "social distance" and "skepticism regarding treatment" and higher on "underestimation of patients' abilities." Our results suggest that culture may have an important role in shaping attitudes toward mental illness. Anti-stigma campaigns that target culture-specific biases are considered important. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Challenge of assessing symptoms in seriously ill intensive care unit patients: can proxy reporters help?

PubMed

Puntillo, Kathleen A; Neuhaus, John; Arai, Shoshana; Paul, Steven M; Gropper, Michael A; Cohen, Neal H; Miaskowski, Christine

2012-10-01

Determine levels of agreement among intensive care unit patients and their family members, nurses, and physicians (proxies) regarding patients' symptoms and compare levels of mean intensity (i.e., the magnitude of a symptom sensation) and distress (i.e., the degree of emotionality that a symptom engenders) of symptoms among patients and proxy reporters. Prospective study of proxy reporters of symptoms in seriously ill patients. Two intensive care units in a tertiary medical center in the Western United States. Two hundred and forty-five intensive care unit patients, 243 family members, 103 nurses, and 92 physicians. None. On the basis of the magnitude of intraclass correlation coefficients, where coefficients from .35 to .78 are considered to be appropriately robust, correlation coefficients between patients' and family members' ratings met this criterion (≥.35) for intensity in six of ten symptoms. No intensity ratings between patients and nurses had intraclass correlation coefficients >.32. Three symptoms had intensity correlation coefficients of ≥.36 between patients' and physicians' ratings. Correlation coefficients between patients and family members were >.40 for five symptom-distress ratings. No symptoms had distress correlation coefficients of ≥.28 between patients' and nurses' ratings. Two symptoms had symptom-distress correlation coefficients between patients' and physicians' ratings at >.39. Family members, nurses, and physicians reported higher symptom-intensity scores than patients did for 80%, 60%, and 60% of the symptoms, respectively. Family members, nurses, and physicians reported higher symptom-distress scores than patients did for 90%, 70%, and 80% of the symptoms, respectively. Patient-family intraclass correlation coefficients were sufficiently close for us to consider using family members to help assess intensive care unit patients' symptoms. Relatively low intraclass correlation coefficients between intensive care unit clinicians' and patients' symptom ratings indicate that some proxy raters overestimate whereas others underestimate patients' symptoms. Proxy overestimation of patients' symptom scores warrants further study because this may influence decisions about treating patients' symptoms.

The effect of medical malpractice liability on rate of referrals received by specialist physicians.

PubMed

Xu, Xiao; Spurr, Stephen J; Nan, Bin; Fendrick, A Mark

2013-10-01

Using nationally representative data from the United States, this paper analyzed the effect of a state’s medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state’s malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state’s medical malpractice environment on physicians’ referral behavior.

A national survey on the initial management of upper gastrointestinal bleeding.

PubMed

Liang, Peter S; Saltzman, John R

2014-01-01

To evaluate the initial management of upper gastrointestinal (GI) bleeding in the United States. Various guidelines have addressed the initial management of upper GI bleeding, but the extent to which these guidelines are followed in clinical practice is unknown. We conducted a national survey of emergency physicians, internists, and gastroenterologists practicing in hospitals affiliated with an ACGME-accredited gastroenterology fellowship. Participants rated their agreement and adherence to 9 preendoscopic quality indicators for the initial management of upper GI bleeding. Awareness, use, and barriers to the use of early prognostic risk scores were also assessed. A total of 1402 surveys were completed, with an estimated response rate of 11.3%. Gastroenterologists and trainees agreed with the quality indicators more than nongastroenterologists and attending physicians, respectively. There was no difference in the application of the quality indicators by specialty or clinical position. Among all physicians, 53% had ever heard of and 30% had ever used an upper GI bleeding risk score. More gastroenterologists than nongastroenterologists had heard of (82% vs. 44%, P<0.001) and used (51% vs. 23%, P<0.001) a risk score. There was no difference between attending physicians and trainees. Gastroenterologists and attending physicians more often cited lack of utility as a reason to not use risk scores, whereas nongastroenterologists and trainees more often cited lack of knowledge. Among emergency physicians, internists, and gastroenterologists in the United States, agreement with upper GI bleeding initial management guidelines was high but adherence--especially pertaining to the use of risk scores--was low.

The epidemiology of drug promotion.

PubMed

Silverman, M

1977-01-01

A survey was conducted on the promotion of 28 prescription drugs in the form of 40 different products marketed in the United States and Latin America by 23 multinational pharmaceutical companies. Striking differences were found in the manner in which the identical drug, marketed by the identical company or its foreign affiliate, was described to physicians in the United States and to physicians in Latin America. In the United States, the listed indications were usually few in number, while the contraindications, warnings, and potential adverse reactions were given in extensive detail. In Latin America, the listed indications were far more numerous, while the hazards were usually minimized, glossed over, or totally ignored. The differences were not simply between the United States on the one hand and all the Latin American countries on the other. There were substantial differences within Latin America, with the same global company telling one story in Mexico, another in Central America, a third in Ecuador and Colombia, and yet another in Brazil. The companies have sought to defend these practices by contending that they are not breaking any Latin American laws. In some countries, however, such promotion is in clear violation of the law. The corporate ethics and social responsibilities concerned here call for examination and action.

Interventional pain management at crossroads: the perfect storm brewing for a new decade of challenges.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Boswell, Mark V

2010-01-01

The health care industry in general and care of chronic pain in particular are described as recession-proof. However, a perfect storm with a confluence of many factors and events -none of which alone is particularly devastating - is brewing and may create a catastrophic force, even in a small specialty such as interventional pain management. Multiple challenges related to interventional pain management in the current decade will include individual and group physicians, office practices, ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPD). Rising health care costs are discussed on a daily basis in the United States. The critics have claimed that health outcomes are the same as or worse than those in other countries, but others have presented the evidence that the United States has the best health care system. All agree it is essential to reduce costs. Numerous factors contribute to increasing health care costs. They include administrative costs, waste, abuse, and fraud. It has been claimed the U.S. health care system wastes up to $800 billion a year. Of this, fraud accounts for approximately $200 billion a year, involving fraudulent Medicare claims, kickbacks for referrals for unnecessary services, and other scams. Administrative inefficiency and redundant paperwork accounts for 18% of health care waste, whereas medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11% of the total. Further, American physicians spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor, more than any other country. It has been illustrated that it takes $60,000 to $88,000 per physician per year, equal to one-third of a family practitioner's gross income, and $23 to $31 billion each year in total to interact with health insurance plans. The studies have illustrated that an average physician spends $68,274 per year communicating with insurance companies and performing other non-medical functions. For an office-based practice, the overall total in the United States is $38.7 billion, or $85,276 per physician. In the United States there are 2 types of physician payment systems: private health care and Medicare. Medicare has moved away from the Medicare Economic Index (MEI) and introduced the sustainable growth rate (SGR) formula which has led to cuts in physician payments on a yearly basis. In 2010 and beyond into the new decade, interventional pain management will see significant changes in how we practice medicine. There is focus on avoiding waste, abuse, fraud, and also cutting costs. Evidence-based medicine (EBM) and comparative effectiveness research (CER) have been introduced as cost-cutting and rationing measures, however, with biased approaches. This manuscript will analyze various issues related to interventional pain management with a critical analysis of physician payments, office facility payments, and ASC payments by various payor groups.

Is race medically relevant? A qualitative study of physicians' attitudes about the role of race in treatment decision-making

PubMed Central

2011-01-01

Background The role of patient race in medical decision-making is heavily debated. While some evidence suggests that patient race can be used by physicians to predict disease risk and determine drug therapy, other studies document bias and stereotyping by physicians based on patient race. It is critical, then, to explore physicians' attitudes regarding the medical relevance of patient race. Methods We conducted a qualitative study in the United States using ten focus groups of physicians stratified by self-identified race (black or white) and led by race-concordant moderators. Physicians were presented with a medical vignette about a patient (whose race was unknown) with Type 2 diabetes and untreated hypertension, who was also a current smoker. Participants were first asked to discuss what medical information they would need to treat the patient. Then physicians were asked to explicitly discuss the importance of race to the hypothetical patient's treatment. To identify common themes, codes, key words and physician demographics were compiled into a comprehensive table that allowed for examination of similarities and differences by physician race. Common themes were identified using the software package NVivo (QSR International, v7). Results Forty self-identified black and 50 self-identified white physicians participated in the study. All physicians - regardless of their own race - believed that medical history, family history, and weight were important for making treatment decisions for the patient. However, black and white physicians reported differences in their views about the relevance of race. Several black physicians indicated that patient race is a central factor for choosing treatment options such as aggressive therapies, patient medication and understanding disease risk. Moreover, many black physicians considered patient race important to understand the patient's views, such as alternative medicine preferences and cultural beliefs about illness. However, few white physicians explicitly indicated that the patient's race was important over-and-above medical history. Instead, white physicians reported that the patient should be treated aggressively regardless of race. Conclusions This investigation adds to our understanding about how physicians in the United States consider race when treating patients, and sheds light on issues physicians face when deciding the importance of race in medical decision-making. PMID:21819597

National Ambulatory Medical Care Survey: terrorism preparedness among office-based physicians, United States, 2003-2004.

PubMed

Niska, Richard W; Burt, Catharine W

2007-07-24

This investigation describes terrorism preparedness among U.S. office-based physicians and their staffs in identification and diagnosis of terrorism-related conditions, training methods and sources, and assistance with diagnosis and reporting. The National Ambulatory Medical Care Survey (NAMCS) is an annual national probability survey of approximately 3,000 U.S. nonfederal, office-based physicians. Terrorism preparedness items were added in 2003 and 2004. About 40 percent of physicians or their staffs received training for anthrax or smallpox, but less than one-third received training for any of the other exposures. About 42.2 percent of physicians, 13.5 percent of nurses, and 9.4 percent of physician assistants and nurse practitioners received training in at least one exposure. Approximately 56.2 percent of physicians indicated that they would contact state or local public health officials for diagnostic assistance more frequently than federal agencies and other sources. About 67.1 percent of physicians indicated that they would report a suspected terrorism-related condition to the state or local health department, 50.9 percent to the Centers for Disease Control and Prevention (CDC), 27.5 percent to the local hospital, and 1.8 percent to a local elected official's office. Approximately 78.8 percent of physicians had contact information for the local health department readily available. About 53.7 percent had reviewed the diseases reportable to health departments since September 2001, 11.3 percent had reviewed them before that month, and 35 percent had never reviewed them.

Trends in cardiac catheterization laboratories in the United States.

PubMed

Sheldon, W C

2001-05-01

The Society for Cardiac Angiography and Interventions has periodically published a Directory of Cardiac Catheterization Laboratories in the United States. All known catheterization laboratories are surveyed and certain operational characteristics are queried. These surveys, in 1983, 1987, 1993, 1995 and 1998, have demonstrated a 2.5 fold increase in cardiac catheterization laboratories since 1983, corresponding increases in numbers of physicians that perform procedures, and in the numbers of procedures performed, reflecting advances in cardiovascular medicine and technology. These surveys have also documented the evolution of interventional techniques, and a shift away from film based imaging, to digitally based methods. These data provide a substrate for consideration of national cardiovascular objectives and planning of future resource allocation by cardiovascular physicians and their colleagues. Copyright 2001 Wiley-Liss, Inc.

Home dialysis in the new USA bundled payment plan: implications and impact.

PubMed

Golper, Thomas A; Guest, Steven; Glickman, Joel D; Turk, Joe; Pulliam, Joseph P

2011-01-01

On 1 January 2011, a new payment system for Medicare patients will be implemented in the United States. This new system bundles services previously charged separately and under a "fee for service" environment. The authors discuss the implications of this approach. Over the next several pages is a response by American physicians and dialysis innovators to a federal initiative to change the way dialysis is paid for in the United States. Peter Blake, the Editor-in-Chief of Peritoneal Dialysis International, invited Thomas Golper to articulate physicians' concerns with this new payment scheme. After the government of the USA closed its comment period over the new payment methodology, called "bundling," Golper sought out colleagues from diverse backgrounds and compiled this collective view of the situation.

Climate change and skin disease.

PubMed

Lundgren, Ashley D

2018-04-01

Despite commanding essentially universal scientific consensus, climate change remains a divisive and poorly understood topic in the United States. Familiarity with this subject is not just for climate scientists. The impact of climate change on human morbidity and mortality may be considerable; thus, physicians also should be knowledgeable in this realm. Climate change science can seem opaque and inferential, creating fertile ground for political polemics and undoubtedly contributing to confusion among the general public. This puts physicians in a pivotal position to facilitate a practical understanding of climate change in the public sphere by discussing changes in disease patterns and their possible relationship to a changing climate. This article provides a background on climate change for dermatologists and highlights how climate change may impact the management of skin disease across the United States.

Untreated atrial fibrillation in the United States of America: Understanding the barriers and treatment options

PubMed Central

Verdino, Ralph J.

2014-01-01

Atrial fibrillation is the most commonly treated arrhythmia in the United States of America. Stroke is the most devastating consequence of atrial fibrillation. For decades, warfarin has been the most recommended treatment for patients with atrial fibrillation at risk for stroke and systemic emboli. However, many patients at risk are not treated with anticoagulants. Several reasons exist, including physician underestimation of patient stroke risk, physician overestimation of bleeding risk, and patients’ reluctance to take chronic warfarin due to the difficulties of this medication in relation to its pharmacokinetics and interactions with food and other medications. Risk scores have helped to better define patient risks and benefits from chronic anticoagulation. Novel anticoagulants (NOACs) have improved the ability for patients to be compliant with anticoagulation. PMID:25561824

Cancer Screening Practices among Physicians Serving Chinese Immigrants

PubMed Central

Aragones, Abraham; Trinh-Shevrin, Chau; Gany, Francesca

2012-01-01

Chinese immigrants in the United States are broadly affected by cancer health disparities. We examined the cancer screening attitudes and practices of physicians serving Chinese immigrants in the New York City (NYC) area by mailing a cancer screening survey, based on current guidelines, to a random sample of physicians serving this population. Fifty three physicians (44%) completed the survey. Seventy-two percent reported following the guidelines for breast cancer, 35% for cervical cancer screening, and 45% for all colorectal cancer screening tests. Sixty-eight percent of physicians were satisfied with their current rates of cancer screening with their Chinese immigrant patient population. Physicians serving the Chinese community in NYC follow cancer screening guidelines inadequately. Cancer screening rates in this population could likely be increased by interventions that target physicians and improve awareness of guidelines and recommended best practices. PMID:19202247

Reflective Practice and Readiness for Self-Directed Learning in Anesthesiology Residents Training in the United States

ERIC Educational Resources Information Center

Miller Juve, Amy Katrina

2012-01-01

The science and technology of medicine is evolving and changing at a fast pace. With these rapid advances, it is paramount that physicians maintain a level of medical knowledge that is current and relevant to their practice in order to address the challenges of patient care and safety. One way physicians can maintain a level of medical knowledge…

[Maimonides, a physician in the 12 century. Contribution to the history of medical ethics and deontology].

PubMed

Pavlović, B

2000-01-01

Maimonides, Moses ben Maimon (1135-1204), Jewish physician, philosopher and scholar was the first after Hippocrates to write a text of a "prayer" he spoke out at the beginning of his medical profession, e. i. when he took oath. The text of "Maimonides's prayer" is today obligatory in some schools of medicine in the United States of America.

The Convergence of Business and Medicine: A Study of MD/MBA Programs in the United States

ERIC Educational Resources Information Center

Keogh, Timothy J.; Martin, William Marty

2011-01-01

The purpose of this paper is to identify the convergence of business and medical education and describe the curricula of MD/MBA (Medical Doctor/Master of Business Administration) programs in the US. The focus of this study is to provide a guide to dual MD/MBA programs for physicians, aspiring physicians, policy makers and healthcare organizations.…

Electronic Health Record Use a Bitter Pill for Many Physicians.

PubMed

Meigs, Stephen L; Solomon, Michael

2016-01-01

Electronic health record (EHR) adoption among office-based physician practices in the United States has increased significantly in the past decade. However, the challenges of using EHRs have resulted in growing dissatisfaction with the systems among many of these physicians. The purpose of this qualitative multiple-case study was to increase understanding of physician perceptions regarding the value of using EHR technology. Important findings included the belief among physicians that EHR systems need to be more user-friendly and adaptable to individual clinic workflow preferences, physician beliefs that lack of interoperability among EHRs is a major barrier to meaningful use of the systems, and physician beliefs that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among office-based physician practices have produced positive results, additional support may be required in the future to maintain this momentum.

Electronic Health Record Use a Bitter Pill for Many Physicians

PubMed Central

Meigs, Stephen L.; Solomon, Michael

2016-01-01

Electronic health record (EHR) adoption among office-based physician practices in the United States has increased significantly in the past decade. However, the challenges of using EHRs have resulted in growing dissatisfaction with the systems among many of these physicians. The purpose of this qualitative multiple-case study was to increase understanding of physician perceptions regarding the value of using EHR technology. Important findings included the belief among physicians that EHR systems need to be more user-friendly and adaptable to individual clinic workflow preferences, physician beliefs that lack of interoperability among EHRs is a major barrier to meaningful use of the systems, and physician beliefs that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among office-based physician practices have produced positive results, additional support may be required in the future to maintain this momentum. PMID:26903782

An MBA: the utility and effect on physicians' careers.

PubMed

Parekh, Selene G; Singh, Bikramjit

2007-02-01

Higher economic, legislative, legal, and administrative constraints in health-care services in the United States have led to an increase in physician dissatisfaction and a decrease in physician morale. In this study, we attempted to understand the motivation for a physician to enroll in a business school, and to discover the utility of the Master of Business Administration degree and how it changed the career path for the practicing clinician. We conducted a retrospective study in which a twenty-seven-question survey was distributed by the United States Postal Service and by e-mail to 161 physician graduates of three East Coast business schools. The results were evaluated, and a statistical analysis was performed. Eighty-seven physicians (54%) responded. Eight surveys were discarded because of incomplete data or stray marks, leaving seventy-nine surveys. The average age of the respondents was 41.4 years. The major motivations for going back to school included learning the business aspects of the health-care system (fifty-three respondents; 67%) and obtaining a more interesting job (forty-one respondents; 52%). The time that the respondents allocated for health-care-related activities before and after obtaining the degree was 58.3% and 31.8%, respectively, for patient care (p < 0.001); 8.5% and 3.68% for teaching (p < 0.001); 4.57% and 1.46% for basic-science research (p = 0.11); 4.23% and 4.55% for clinical research (p = 0.90); and 11.8% and 33.5% for administrative responsibilities (p < 0.001). The physicians stated that the most pertinent skills they had acquired were those related to evaluating systems operations and implementing improvements (thirty-nine respondents; 49%), learning how to be an effective leader (thirty-five; 44%), comprehending financial principles (thirty-three; 42%), working within a team (twenty-seven; 34%), and negotiating effectively (twenty-five; 32%). Sixty-four physicians (81%) believed that their business degree had been very useful or essential in the advancement of their careers. Many physicians decide to acquire a Master of Business Administration degree to understand the business of medicine. After they complete the degree program, their practice patterns substantially change, which is reflected particularly by an increase in time spent on administrative responsibilities. In order for physicians to overcome the multifaceted challenges of the evolving health-care system, it is essential to continue educating a proportion of physicians in both medicine and business.

FRAMING EFFECTS ON PHYSICIANS' JUDGMENT AND DECISION MAKING.

PubMed

Bui, Thanh C; Krieger, Heather A; Blumenthal-Barby, Jennifer S

2015-10-01

This study aimed to assess physicians' susceptibility to framing effects in clinical judgment and decision making. A survey was administered online to 159 general internists in the United States. Participants were randomized into two groups, in which clinical scenarios varied in their framings: frequency vs percentage, with cost information vs without, female patient vs male patient, and mortality vs survival. Results showed that physicians' recommendations for patients in hypothetical scenarios were significantly different when the predicted probability of the outcomes was presented in frequency versus percentage form and when it was presented in mortality rate vs survival rate of the same magnitude. Physicians' recommendations were not different for other framing effects.

Thyroid hormone use: trends in the United States from 1960 through 1988.

PubMed

Kaufman, S C; Gross, T P; Kennedy, D L

1991-01-01

Thyroid hormone preparations comprised over 1% of all prescriptions filled by retail pharmacies during 1988 in the conterminous United States, i.e., the 48 contiguous states. Their large market share gives the patterns of their use substantial public health importance. This article describes prescription thyroid hormone use in the United States from 1960 through 1988, using pharmaceutical marketing research data collected from panels of retail pharmacies and office-based physicians. Although the use of natural products has declined by over 50% since 1960, about one fourth of all thyroid hormone prescriptions were for natural preparations as recently as 1988. Per capita thyroid mentions (i.e., patient-physician contacts during which a thyroid agent of any kind was recommended, prescribed, dispensed, administered, ordered to be given by a hospital, or given as a sample) doubled during this period among those over 59 years old. Per capita mentions for synthetic thyroid products increased fourfold and tenfold among men and women in this age group, respectively. Use for weight loss, despite the label's boxed warning indicating it to be ineffective and potentially dangerous, has diminished but persists. Obesity was second only to hypothyroidism among the diagnoses underlying thyroid product mentions.

A medical tourism primer for U.S. physicians.

PubMed

Carabello, Laura

2008-01-01

As healthcare in the United States has been changing rapidly over the past few decades, so has the manner in which healthcare has been provided, billed, and paid for. There is an increasing need for Americans to reach beyond domestic borders to the international community for certain medical procedures, treatment, and care at more affordable costs. This impacts not only consumers and their physicians, but also employers, benefit plan payors, administrators, and other industry stakeholders-including America's hospitals. This article provides a framework for discussion points for physician-patient communications regarding medical tourism.

Dancing around death: hospitalist-patient communication about serious illness.

PubMed

Anderson, Wendy G; Kools, Susan; Lyndon, Audrey

2013-01-01

Hospital physicians care for most seriously ill patients in the United States. We employed dimensional analysis to describe communication about death and dying in audio-recorded admission encounters between seriously ill patients and hospitalists. Acknowledging or not acknowledging the possibility of dying emerged as a key process. Acknowledgment was rare, and depended on synergistic communication behaviors between patient and physician. Facilitators included patients cuing for information and disclosing emotional distress, and physicians exploring the patient's understanding of his or her illness and emotional distress. When hospitalists focused on acute issues, stated that they were awaiting test results, and deferred to other physicians, discussion moved away from acknowledgment. Meaningful discussion of end-of-life issues, including goals and values, fears about death and dying, prognosis, and options for palliative care followed open acknowledgment. This acknowledgment process can serve as a guide for providers to sensitively and honestly discuss essential end-of-life issues.

Dancing Around Death: Hospitalist-Patient Communication About Serious Illness

PubMed Central

Anderson, Wendy G.; Kools, Susan; Lyndon, Audrey

2012-01-01

Hospital physicians care for most seriously ill patients in the United States. We employed dimensional analysis to describe communication about death and dying in audio-recorded admission encounters between seriously ill patients and hospitalists. Acknowledging or not acknowledging the possibility of dying emerged as a key process. Acknowledgment was rare, and depended on synergistic communication behaviors between patient and physician. Facilitators included patients cuing for information and disclosing emotional distress, and physicians exploring the patient’s understanding of his or her illness and emotional distress. When hospitalists focused on acute issues, stated that they were awaiting test results, and deferred to other physicians, discussion moved away from acknowledgment. Meaningful discussion of end-of-life issues, including goals and values, fears about death and dying, prognosis, and options for palliative care followed open acknowledgment. This acknowledgment process can serve as a guide for providers to sensitively and honestly discuss essential end-of-life issues. PMID:23034778

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

The role of health information technology in care coordination in the United States.

PubMed

Hsiao, Chun-Ju; King, Jennifer; Hing, Esther; Simon, Alan E

2015-02-01

Examine the extent to which office-based physicians in the United States receive patient health information necessary to coordinate care across settings and determine whether receipt of information needed to coordinate care is associated with use of health information technology (HIT) (defined by presence or absence of electronic health record system and electronic sharing of information). Cross-sectional study using the 2012 National Electronic Health Records Survey (65% weighted response rate). Office-based physicians. Use of HIT and 3 types of patient health information needed to coordinate care. In 2012, 64% of physicians routinely received the results of a patient's consultation with a provider outside of their practice, whereas 46% routinely received a patient's history and reason for a referred consultation from a provider outside of their practice. About 54% of physicians reported routinely receiving a patient's hospital discharge information. In adjusted analysis, significant differences in receiving necessary information were observed by use of HIT. Compared with those not using HIT, a lower percentage of physicians who used an electronic health record system and shared patient health information electronically failed to receive the results of outside consultations or patient's history and reason for a referred consultation. No significant differences were observed for the receipt of hospital discharge information by use of HIT. Among physicians routinely receiving information needed for care coordination, at least 54% of them did not receive the information electronically. Although a higher percentage of physicians using HIT received patient information necessary for care coordination than those who did not use HIT, more than one third did not routinely receive the needed patient information at all.

Getting physicians to open the survey: little evidence that an envelope teaser increases response rates.

PubMed

Ziegenfuss, Jeanette Y; Burmeister, Kelly; James, Katherine M; Haas, Lindsey; Tilburt, Jon C; Beebe, Timothy J

2012-03-31

Physician surveys are an important tool to assess attitudes, beliefs and self-reported behaviors of this policy relevant group. In order for a physician to respond to a mailed survey, they must first open the envelope. While there is some evidence that package elements can impact physician response rates, the impact of an envelope teaser is unknown. Here we assess this by testing the impact of adding a brightly colored "$25 incentive" sticker to the outside of an envelope on response rates and nonresponse bias in a survey of physicians. In the second mailing of a survey assessing physicians' moral beliefs and views on controversial health care topics, initial nonrespondents were randomly assigned to receive a survey in an envelope with a colored "$25 incentive" sticker (teaser group) or an envelope without a sticker (control group). Response rates were compared between the teaser and control groups overall and by age, gender, region of the United States, specialty and years in practice. Nonresponse bias was assessed by comparing the demographic composition of the respondents to the nonrespondents in the experimental and control condition. No significant differences in response rates were observed between the experimental and control conditions overall (p = 0.38) or after stratifying by age, gender, region, or practice type. Within the teaser condition, there was some variation in response rate by years since graduation. There was no independent effect of the teaser on response when simultaneously controlling for demographic characteristics (OR = 0.875, p = 0.4112). Neither response rates nor nonresponse bias were impacted by the use of an envelope teaser in a survey of physicians in the United States.

Healthcare technology: physician collaboration in reducing the surgical cost.

PubMed

Olson, Steven A; Obremskey, William T; Bozic, Kevin J

2013-06-01

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

Medical Spending Differences in the United States and Canada: The Role of Prices, Procedures, and Administrative Expenses

PubMed Central

Pozen, Alexis; Cutler, David M.

2011-01-01

The United States far outspends Canada on health care, but the sources of additional spending are unclear. We evaluated the importance of incomes, administration, and medical interventions in this difference. Pooling various sources, we calculated medical personnel incomes, administrative expenses, and procedure volume and intensity for the United States and Canada. We found that Canada spent $1,589 per capita less on physicians and hospitals in 2002. Administration accounted for the largest share of this difference (39%), followed by incomes (31%), and more intensive provision of medical services (14%). Whether this additional spending is wasteful or warranted is unknown. PMID:20812461

The history of euthanasia debates in the United States and Britain.

PubMed

Emanuel, E J

1994-11-15

Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pains of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life. Over the next 35 years, debates about the ethics of euthanasia raged in the United States and Britain, culminating in 1906 in an Ohio bill to legalize euthanasia, a bill that was ultimately defeated. The arguments propounded for and against euthanasia in the 19th century are identical to contemporary arguments. Such similarities suggest four conclusions: Public interest in euthanasia 1) is not linked with advances in biomedical technology; 2) it flourishes in times of economic recession, in which individualism and social Darwinism are invoked to justify public policy; 3) it arises when physician authority over medical decision making is challenged; and 4) it occurs when terminating life-sustaining medical interventions become standard medical practice and interest develops in extending such practices to include euthanasia.

The drugging of the Third World.

PubMed

Silverman, M; Lee, P R; Lydecker, M

1982-01-01

This article reports an investigation of the promotion of more than 500 products marketed by over 150 pharmaceutical companies in the United States, Great Britain, Latin America, Africa, and Asia. In contrast to the promotional material provided to physicians in the United States and Great Britain, material presented to physicians in Third World countries was found to be marked by gross exaggeration of product effectiveness and minimized or completely omitted potential hazards. No substantial differences could be found between multinational and domestic companies, brand-name and generic firms, or companies based in capitalist nations and those in socialist or communist-bloc countries in terms of the adequacy and accuracy of their promotion. Little evidence was found to support industry claims that the discrepancies in promotion reflect the different policies of various drug regulatory agencies. Much of the promotion concerned "luxury products," including costly tonics and appetite stimulants marketed in poor countries where the pressing need is for food. Bribery of influential physicians and key governmental officials may play an important role in irrational drug promotion and use in the Third World. Some of the proposed corrective approaches to this problem are examined.

Conflicts of interest between physicians and the pharmaceutical industry and special interest groups.

PubMed

Schetky, Diane H

2008-01-01

Health care in the United States is a tangled web of competing interest groups beneath which ethical conflicts of interest flourish. Physicians, professional organizations, and academic medical centers must continually evaluate their relationships with the pharmaceutical industry as they relate to personal, professional, and institutional ethical values. This article explores the relevant pressing ethical issues and proposals for changing course and managing these potentially troublesome relationships.

Ruxolitinib for the management of myelofibrosis: Results of an international physician survey.

PubMed

Ellis, Martin H; Koren-Michowitz, Maya; Lavi, Noa; Vannucchi, Alessandro M; Mesa, Ruben; Harrison, Claire N

2017-10-01

Ruxolitinib is established as treatment for symptomatic myeloproliferative neoplasm (MPN)-associated myelofibrosis. The strict inclusion and exclusion criteria and dose modification rules that applied to the COMFORTI and II studies that led to the licensing of ruxolitinib are not always applicable to routine clinical practice. Thus physicians now face decisions regarding ruxolitinib use that were not addressed in these pivotal trials. We performed an online survey of hematologists practicing in Europe, Israel, the United Kingdom and the United States. Demographic details regarding the physicians and their practice as relates to MPNs were collected. Management decisions pertaining to the use of ruxolitinib were obtained regarding 10 clinical scenarios relating to anemia, thrombocytopenia, frailty, infection and lack or loss of response to ruxolitnib in MF patients. 140 physicians responded to the survey. There were marked differences regarding their decisions for ruxolitinib administration in MF patients with or developing anemia or thrombocytopenia. Similarly there was little consensus regarding management of patients refractory or losing a response to ruxolitinib. There were differences between "MPN-focused" and "non-MPN-focused" physicians in certain areas. Physician practices regarding management of MF patients experiencing ruxolitinib-related toxicities or in whom response to the drug is lost was variable. This was true of "MPN-focused" and "non-MPN-focused" physicians in certain cases. Physician education and experience in using ruxolitinib may improve patient management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Diagnosis of Child Maltreatment: A Family Medicine Physician's Dilemma.

PubMed

Eniola, Kehinde; Evarts, Lori

2017-05-01

Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.

Mifepristone by prescription: a dream in the United States but reality in Australia.

PubMed

Grossman, Daniel; Goldstone, Philip

2015-09-01

The requirement that mifepristone be dispensed only by physicians in offices, clinics or hospitals - and not by prescription in pharmacies - has likely limited uptake by providers in the United States. However, in several other countries, provision by prescription in pharmacies is allowed, including in Australia. Mifepristone was first registered in Australia in 2012, and in 2015, a composite package including 200 mg mifepristone and four tablets of misoprostol 200 mcg was registered. Both were approved as Schedule 4 medications, which require prescribing by a physician and may be dispensed at pharmacies. As part of the registration for both products, a risk management plan was instituted that has several components. First, physicians must be certified to prescribe mifepristone. General practitioners wishing to become certified must complete online training that includes prescribing requirements and managing the medical abortion process; obstetrician-gynecologists are exempt from the online learning module. Pharmacists must also be certified in order to dispense the medication, although this does not require additional training. When a pharmacist receives a prescription for mifepristone, she or he must confirm through a secure website that the prescriber is certified. In every region of the country, there are more certified prescribers and dispensers of mifepristone than the number of facilities providing abortion care. The experience in Australia demonstrates the feasibility of mifepristone by prescription and should be a model for expanding access to early medical abortion in the United States. Copyright © 2015 Elsevier Inc. All rights reserved.

Pulmonary Hypertension Care Center Network: Improving Care and Outcomes in Pulmonary Hypertension.

PubMed

Sahay, Sandeep; Melendres-Groves, Lana; Pawar, Leena; Cajigas, Hector R

2017-04-01

Pulmonary hypertension (PH) is a chronic, progressive, life-threatening disease that requires expert multidisciplinary care. To facilitate this level of care, the Pulmonary Hypertension Association established across the United States a network of pulmonary hypertension care centers (PHCCs) with special expertise in PH, particularly pulmonary arterial hypertension, to raise the overall quality of care and outcomes for patients with this life-threatening disease. Since the inception of PHCCs in September 2014, to date 35 centers have been accredited in the United States. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. PHCCs also offer additional opportunities for improvements in PH care. The patient registry offered through the PHCCs is an organized system by which data are collected to evaluate the outcomes of patients with PH. This registry helps in detecting variations in outcomes across centers, thus identifying opportunities for improvement. Multiple tactics were undertaken to implement the strategic plan, training, and tools throughout the PHCC network. In addition, strategies to foster collaboration between care center staff and individuals with PH and their families are the cornerstone of the PHCCs. The Pulmonary Vascular Network of the American College of Chest Physicians believes this to be a positive step that will improve the quality of care delivered in the United States to patients with PH. Copyright © 2016 American College of Chest Physicians. Published by 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.

Current Perspective on the Use of Opioids in Perioperative Medicine: An Evidence-Based Literature Review, National Survey of 70,000 Physicians, and Multidisciplinary Clinical Appraisal.

PubMed

Jahr, Jonathan S; Bergese, Sergio D; Sheth, Ketan R; Bernthal, Nicholas M; Ho, Hung S; Stoicea, Nicoleta; Apfel, Christian C

2017-08-16

Opioids represent an important analgesic option for physicians managing acute pain in surgical patients. Opioid management is not without its drawbacks, however, and current trends suggest that opioids might be overused in the United States. An expert panel was convened to conduct a clinical appraisal regarding the use of opioids in the perioperative setting. The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the statement "Opioids are not overused in the United States, even though opioid adjunct therapy achieves greater pain control with less risk." The authors' evaluation of this statement was also compared with the results of a national survey of surgeons and anesthesiologists in the United States. We report the presented literature and proceedings of the panel discussion. The national survey revealed a wide range of opinions regarding opioid overuse in the United States. Current published evidence provides support for the efficacy of opioid therapy in surgical patients; however, it is not sufficient to conclude unequivocally that opioids are-or are not-overused in the management of acute surgical pain in the United States. Opioids remain a key component of multimodal perioperative analgesia, and strategic opioid use based on clinical considerations and patient-specific needs represents an opportunity to support improved postoperative outcomes and satisfaction. Future studies should focus on identifying optimal procedure-specific and patient-centered approaches to multimodal perioperative analgesia. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The Impact of Single-Payer Health Care on Physician Income in Canada, 1850–2005

PubMed Central

2011-01-01

This study traces the average net income of Canadian physicians over 150 years to determine the impact of medicare. It also compares medical income in Canada to that in the United States. Sources include academic studies, government reports, Census data, taxation statistics, and surveys. The results show that Canadian doctors enjoyed a windfall in earnings during the early years of medicare and that, after a period of adjustment, medicare enhanced physician income. Except during the windfall boom, Canadian physicians have earned less than their American counterparts. Until at least 2005, however, the medical profession was the top-earning trade in Canada relative to all other professions. PMID:21566029

Managing the negatives of experience in physician teams.

PubMed

Hoff, Timothy

2010-01-01

Experience is a key shaper of thought and action in the health care workplace and a fundamental component of management and professional policies dealing with improving quality of care. Physicians rely on experience to structure social interaction, to determine authority relations, and to resist organizational encroachments on their work and autonomy. However, an overreliance on experience within physician teams may paradoxically undermine learning, participation, and entrepreneurship, affecting organizational performance. Approximately 100 hours of direct observation of normal workdays for physician teams (n = 17 physicians) in two different work settings in a single academic medical center located in the Northeastern part of the United States. Qualitative data were collected from physician teams in the medical intensive care unit and trauma/general surgery settings. Data were transcribed and computer analyzed through an interactive process of open coding, theoretical sampling, and pattern recognition that proceeded longitudinally. Three particular experience-based schemas were identified that physician teams used to structure social relations and perform work. These schemas involved using experience as a commodity, trump card, and liberator. Each of these schemas consisted of strongly held norms, beliefs, and values that produced team dynamics with the potential for undermining learning, participation, and entrepreneurship in the group. Organizations may move to mitigate the negative impact of an overreliance on experience among physicians by promoting bureaucratic forms of control that enable physicians to engage learning, participation, and entrepreneurship in their work while not usurping existing and difficult-to-change cultural drivers of team behavior.

Impact of race on the professional lives of physicians of African descent.

PubMed

Nunez-Smith, Marcella; Curry, Leslie A; Bigby, JudyAnn; Berg, David; Krumholz, Harlan M; Bradley, Elizabeth H

2007-01-02

Increasing the racial and ethnic diversity of the physician workforce is a national priority. However, insight into the professional experiences of minority physicians is limited. This knowledge is fundamental to developing effective strategies to recruit, retain, and support a diverse physician workforce. To characterize how physicians of African descent experience race in the workplace. Qualitative study based on in-person and in-depth racially concordant interviews using a standard discussion guide. The 6 New England states in the United States. 25 practicing physicians of African descent representing a diverse range of primary practice settings, specialties, and ages. Professional experiences of physicians of African descent. 1) Awareness of race permeates the experience of physicians of African descent in the health care workplace; 2) race-related experiences shape interpersonal interactions and define the institutional climate; 3) responses to perceived racism at work vary along a spectrum from minimization to confrontation; 4) the health care workplace is often silent on issues of race; and 5) collective race-related experiences can result in "racial fatigue," with personal and professional consequences for physicians. The study was restricted to New England and may not reflect the experiences of physicians in other geographic regions. The findings are meant to be hypothesis-generating and require additional follow-up studies. The issue of race remains a pervasive influence in the work lives of physicians of African descent. Without sufficient attention to the specific ways in which race shapes physicians' work experiences, health care organizations are unlikely to create environments that successfully foster and sustain a diverse physician workforce.

Family Medicine Research in the United States From the late 1960s Into the Future.

PubMed

Bowman, Marjorie A; Lucan, Sean C; Rosenthal, Thomas C; Mainous, Arch G; James, Paul A

2017-04-01

When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field's inception, there have been notable research successes for which family medicine organizations, researchers, and leaders-assisted by federal and state governments and private foundations-can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been underrepresented in research funding. Clinical presentations in family medicine are often complex, poorly-differentiated, and exist as one of several patient complaints and diagnoses, and are not well-covered by the narrow basic-science and specialty research that defines most of the biomedical research enterprise. Overall health in the United States would benefit from a more robust research participation and greater support for family medicine research.

FAMILY MEDICINE RESEARCH IN THE UNITED STATES: FROM THE LATE 1960’S INTO THE FUTURE

PubMed Central

Bowman, Marjorie A.; Lucan, Sean C.; Rosenthal, Thomas; Mainous, Arch; James, Paul

2017-01-01

When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field’s inception, there have been notable research successes for which family medicine organizations, researchers, and leaders – assisted by federal and state governments and private foundations - can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been underrepresented in research funding. Clinical presentations in family medicine are often complex, poorly-differentiated, and often exist as one of several patient complaints and diagnoses, and are not well-covered by the narrow basic-science and specialty research that defines most of the biomedical research enterprise. Overall health in the United States would benefit from a more robust research participation and greater support for family medicine research. PMID:28414408

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine

NASA Technical Reports Server (NTRS)

Rodenberg, H.; Myers, K. J.

1995-01-01

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine.

PubMed

Rodenberg, H; Myers, K J

1995-01-01

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

Women in Medicine

ERIC Educational Resources Information Center

Mandelbaum, Dorothy Rosenthal

1978-01-01

Literature written since 1973 about the individual woman physician and the situation of United States women in medicine is examined and reviewed. Discrimination problems, identity conflicts, and a "typical" personality profile are some of the issues addressed. (Author/ KR)

International Medical Graduates. Immigration Law and Policy and the U.S. Physician Workforce. Council on Graduate Medical Education Resource Paper. A COGME Panel Discussion (Washington, DC, March 12, 1996).

ERIC Educational Resources Information Center

Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Health Professions.

This report includes presentations and discussions by the Council on Graduate Medical Education (COGME) addressing issues related to the current supply of physicians in the United States and the role of international medical graduates (IMGs). The presentations focused on the following areas: the exchange visitor program and the use of waivers, the…

The State of Sexual Health Education in U.S. Medicine

ERIC Educational Resources Information Center

Criniti, S.; Andelloux, M.; Woodland, M. B.; Montgomery, O. C.; Hartmann, S. Urdaneta

2014-01-01

Although studies have shown that patients want to receive sexual health services from their physicians, doctors often lack the knowledge and skills to discuss sexual health with their patients. There is little consistency among medical schools and residency programs in the United States regarding comprehensiveness of education on sexual health.…

Real-world disparities between patient- and clinician-reported outcomes: results from a disease-specific program in depression and anxiety.

PubMed

Lubaczewski, Shannon; Shepherd, Jason; Fayyad, Rana; Guico-Pabia, Christine J

2014-01-01

The purpose of this study was to identify potential discordance between physician and patient rated measures of depression used by primary care physicians and psychiatrists. This study collected data from primary care physicians and psychiatrists in the United States between October and December 2009. A real-world, cross-sectional study was conducted using the Neuroses Disease-Specific Programme (Adelphi Real World, Macclesfield, United Kingdom). Treatment practice data were collected by 180 physicians (100 primary care and 80 psychiatrists) who were asked to provide information for the next 15 outpatients presenting prospectively with symptoms of anxiety and/or depression (n = 2,704 patients). The primary outcome measures were the Clinical Global Impressions-and Patient Global Impressions-Improvement scales, completed by both physicians and their matched patients, respectively. Cohen's kappa coefficient (κ) was calculated to assess the level of agreement between the Clinical Global Impressions-and Patient Global Impressions-Improvement scale responses. Physician- and patient-rated overall improvement in illness was 82% and 89%, respectively. Results of the kappa analysis demonstrated fair agreement between patients and physicians regarding overall improvement in illness (44% agreement; κ= 0.23). Physician ratings of patient improvement progressively decreased with increased severity of illness. These real-world data suggest that the degree of reduction in symptoms of anxiety and/or depression may be estimated differently by physicians when compared with their patients. Understanding the potential for disparities between physician- and patient-rated measures in reviewing patient care, particularly in patients with more severe depressive symptoms, can help ensure that treatment plans are aligned with patient needs.

The Relative Value Unit: History, Current Use, and Controversies.

PubMed

Baadh, Amanjit; Peterkin, Yuri; Wegener, Melanie; Flug, Jonathan; Katz, Douglas; Hoffmann, Jason C

2016-01-01

The relative value unit (RVU) is an important measuring tool for the work performed by physicians, and is currently used in the United States to calculate physician reimbursement. An understanding of radiology RVUs and current procedural terminology codes is important for radiologists, trainees, radiology managers, and administrators, as this knowledge would help them to understand better their current productivity and reimbursement, as well as controversies regarding reimbursement, and permit them to adapt to reimbursement changes that may occur in the future. This article reviews the components of the RVU and how radiology payment is calculated, highlights trends in RVUs and resultant payment for diagnostic and therapeutic imaging and examinations, and discusses current issues involving RVU and current procedural terminology codes. Copyright © 2015 Mosby, Inc. All rights reserved.

Physician Practice Consolidation Driven By Small Acquisitions, So Antitrust Agencies Have Few Tools To Intervene.

PubMed

Capps, Cory; Dranove, David; Ody, Christopher

2017-09-01

The growing concentration of physician markets throughout the United States has been raising antitrust concerns, yet the Department of Justice and the Federal Trade Commission have challenged only a small number of mergers and acquisitions in this field. Using proprietary claims data from states collectively containing more than 12 percent of the US population, we found that 22 percent of physician markets were highly concentrated in 2013, according to federal merger guidelines. Most of the increases in physician practice size and market concentration resulted from numerous small transactions, rather than a few large transactions. Among highly concentrated markets that had increases large enough to raise antitrust concerns, only 28 percent experienced any individual acquisition that would have been presumed to be anticompetitive under federal merger guidelines. Furthermore, most acquisitions were below the dollar thresholds that would have required the parties to report the transaction to antitrust authorities. Under present mechanisms, federal authorities have only limited ability to counteract consolidation in most US physician markets. Project HOPE—The People-to-People Health Foundation, Inc.

Peer review and psychiatric physician fitness for duty evaluations: analyzing the past and forecasting the future.

PubMed

Meyer, Donald J; Price, Marilyn

2012-01-01

In the United States, oversight of health care practitioners is delegated to a matrix of health care entities including but not limited to the state medical board which licenses physicians in the relevant jurisdiction. Typically, these organizations have their own codes of professional conduct. When a physician joins one of these health care organizations, legally the physician has entered into a contract with the organization and agreed to be bound by its regulations and procedures. The organization's peer review of a member physician for reasons of investigating questions of health care quality may require a psychiatric fitness for duty evaluation. That assessment is a forensic psychiatric examination to assist the peer review body much as an expert witness would assist the trier of fact in a criminal or civil law adjudication. Experts can better perform these functions if they are familiar with the legal differences that define these agencies' service under administrative as compared to civil or criminal law and procedures. Copyright © 2012 Elsevier Ltd. All rights reserved.

Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons.

PubMed

Silverman, Michael; Povitz, Marcus; Sontrop, Jessica M; Li, Lihua; Richard, Lucie; Cejic, Sonny; Shariff, Salimah Z

2017-06-06

Reducing inappropriate antibiotic prescribing for acute upper respiratory tract infections (AURIs) requires a better understanding of the factors associated with this practice. To determine the prevalence of antibiotic prescribing for nonbacterial AURIs and whether prescribing rates varied by physician characteristics. Retrospective analysis of linked administrative health care data. Primary care physician practices in Ontario, Canada (January-December 2012). Patients aged 66 years or older with nonbacterial AURIs. Patients with cancer or immunosuppressive conditions and residents of long-term care homes were excluded. Antibiotic prescriptions for physician-diagnosed AURIs. A multivariable logistic regression model with generalized estimating equations was used to examine whether prescribing rates varied by physician characteristics, accounting for clustering of patients among physicians and adjusting for patient-level covariates. The cohort included 8990 primary care physicians and 185 014 patients who presented with a nonbacterial AURI, including the common cold (53.4%), acute bronchitis (31.3%), acute sinusitis (13.6%), or acute laryngitis (1.6%). Forty-six percent of patients received an antibiotic prescription; most prescriptions were for broad-spectrum agents (69.9% [95% CI, 69.6% to 70.2%]). Patients were more likely to receive prescriptions from mid- and late-career physicians than early-career physicians (rate difference, 5.1 percentage points [CI, 3.9 to 6.4 percentage points] and 4.6 percentage points [CI, 3.3 to 5.8 percentage points], respectively), from physicians trained outside of Canada or the United States (3.6 percentage points [CI, 2.5 to 4.6 percentage points]), and from physicians who saw 25 to 44 patients per day or 45 or more patients per day than those who saw fewer than 25 patients per day (3.1 percentage points [CI, 2.1 to 4.0 percentage points] and 4.1 percentage points [CI, 2.7 to 5.5 percentage points], respectively). Physician rationale for prescribing was unknown. In this low-risk elderly cohort, 46% of patients with a nonbacterial AURI were prescribed antibiotics. Patients were more likely to receive prescriptions from mid- or late-career physicians with high patient volumes and from physicians who were trained outside of Canada or the United States. Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute.

Resolution of Low Back and Radicular Pain in a 40-year-old Male United States Navy Petty Officer after Collaborative Medical and Chiropractic Care

DTIC Science & Technology

2009-12-08

www.journalchiromed.com Journal of Chiropractic Medicine (2010) 9, 17–21Resolution of low back and radicular pain in a 40-year-old male United States...Navy Petty Officer after collaborative medical and chiropractic care☆ Gregory R. Lillie DC, MS⁎ Chiropractic Physician, Naval Branch Health Clinic...Military personnel; ChiropracticObjective: The aim of this study is to describe the interdisciplinary care, including chiropractic services, in a military

An Evaluation of Physician-to-Patient Communication Training in Medical Schools across the United States: A Status Report on the Nation's Efforts to Promote Health Literacy by Adding Health Literacy Courses to Medical School Curriculum

ERIC Educational Resources Information Center

Frazier, Andrea P.

2012-01-01

This research study employed a mixed method sequential approach and investigated the number of Schools of Medicine within the United States that offer health literacy as a component of their curriculum and a course of study within the academic setting. Data were gathered from medical school surveys and personal interviews. Curriculum content,…

The affect of vision and compassion upon role factors in physician leadership.

PubMed

Quinn, Joann F

2015-01-01

The career path for many professionals is often into a leadership role, yet many professionals do not have the competencies or inclination to lead. This study explores physician leaders as a representative group of professionals. While there have been many efforts at understanding the characteristics of effective physician leaders, a greater understanding is needed on the nature of physician leadership. The largest healthcare organization for physician leaders in the United States was surveyed to gain a greater understanding of the nature of leadership. Partial Lease Squares (PLS) was used to analyze results from 677 online surveys to understand the causal relationship of role conflict and role endorsement to participation. The findings reveal the mediating influence that positivity exerts upon participation, and offers health care leaders an opportunity to increase understanding of the social identification process that leads a higher level of professional participation, which may increase effectiveness for physicians in leadership.

Removing the "Silencer": Coverage and Protection of Physician Speech Under the First Amendment.

PubMed

Weiss, Ryan T

2016-01-01

The physician-patient relationship rests on a bedrock of trust. Without trust, patients--and for that matter, physicians--are less willing to divulge information critical to providing accurate medical diagnoses and treatments. The state of Florida seemingly ignored this when its legislature, with support from the National Rifle Association and other pro-gun advocates, enacted the Firearm Owners Privacy Act (FOPA), a statute that restricts physicians from questioning their patients about firearm ownership. In Wollschlaeger v. Governor of Florida, the United States Court of Appeals for the Eleventh Circuit held that FOPA did not regulate physician speech but, instead, regulated physician conduct. As such, the law was exempted from First Amendment scrutiny. But almost one year to the day after publishing its first Wollschlaeger opinion, the Eleventh Circuit sua sponte vacated its original opinion and substituted in its place a brand new opinion--one holding that FOPA was subject to First Amendment scrutiny, but nonetheless passed constitutional muster. This Note uses the diverging Wollschlaeger opinions as a vehicle to analyze the First Amendment's coverage and protection of physician speech. Specifically, it argues that an uninhibited line of communication is required to protect the trust necessary for an effective physician-patient relationship. This logical underpinning leads to the conclusion that the First Amendment presumptively covers physician speech and, furthermore, that physician speech should be subject to intermediate scrutiny--a level of scrutiny that FOPA cannot meet.

Use and Characteristics of Electronic Health Record Systems among Office-Based Physician Practices: United States, ...

MedlinePlus

... on Vital and Health Statistics Annual Reports Health Survey Research Methods Conference Reports from the National Medical Care Utilization and Expenditure Survey Clearinghouse on Health Indexes Statistical Notes for Health ...

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2017.

PubMed

Kim, David K; Riley, Laura E; Harriman, Kathleen H; Hunter, Paul; Bridges, Carolyn B

2017-02-10

In October 2016, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Adults Aged 19 Years or Older-United States, 2017. The 2017 adult immunization schedule summarizes ACIP recommendations in two figures, footnotes for the figures, and a table of contraindications and precautions for vaccines recommended for adults. These documents are available at https://www.cdc.gov/vaccines/schedules. The full ACIP recommendations for each vaccine can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2017 adult immunization schedule was also reviewed and approved by the American College of Physicians (https://www.acponline.org), the American Academy of Family Physicians (https://www.aafp.org), the American College of Obstetricians and Gynecologists (http://www.acog.org), and the American College of Nurse-Midwives (http://www.midwife.org).

A qualitative study on physicians' perceptions of specialty characteristics.

PubMed

Park, Kwi Hwa; Jun, Soo-Koung; Park, Ie Byung

2016-09-01

There has been limited research on physicians' perceptions of the specialty characteristics that are needed to sustain a successful career in medical specialties in Korea. Medical Specialty Preference Inventory in the United States or SCI59 (specialty choice inventory) in the United Kingdom are implemented to help medical students plan their careers. The purpose of this study was to explore the characteristics of the major specialties in Korea. Twelve physicians from different specialties participated in an exploratory study consisting of qualitative interviews about the personal ability and emotional characteristics and job attributes of each specialty. The collected data were analysed with content analysis methods. Twelve codes were extracted for ability & skill attributes, 23 codes for emotion & attitude attributes, and 12 codes for job attributes. Each specialty shows a different profile in terms of its characteristic attributes. The findings have implications for the design of career planning programs for medical students.

How much do cancer specialists earn? A comparison of physician fees and remuneration in oncology and radiology in high-income countries.

PubMed

Boyle, Seán; Petch, Jeremy; Batt, Kathy; Durand-Zaleski, Isabelle; Thomson, Sarah

2018-02-01

The main driver of higher spending on health care in the US is believed to be substantially higher fees paid to US physicians in comparison with other countries. We aim to compare physician incomes in radiology and oncology considering differences in relation to fees paid, physician capacity and volume of services provided in five countries: the United States, Canada, Australia, France and the United Kingdom. The fee for a consultation with a specialist in oncology varies threefold across countries, and more than fourfold for chemotherapy. There is also a three to fourfold variation in fees for ultrasound and CT scans. Physician earnings in the US are greater than in other countries in both oncology and radiology, more than three times higher than in the UK; Canadian oncologists and radiologists earn considerably more than their European counterparts. Although challenging, benchmarking earnings and fees for similar health care activities across countries, and understanding the factors that explain any differences, can provide valuable insights for policy makers trying to enhance efficiency and quality in service delivery, especially in the face of rising care costs. Copyright © 2017 Elsevier B.V. All rights reserved.

The historical decline of tobacco smoking among United States physicians: 1949–1984

PubMed Central

Smith, Derek R

2008-01-01

Background Tobacco use became an ingrained habit in the United States (US) following the First World War and a large proportion of physicians, similar to the general population, were smokers. The period from 1949 to 1984 was a pivotal era of change however, as the medical profession, like the society it served, became increasingly aware of the dangers that tobacco incurred for health. Methods An extensive review targeted all manuscripts published in academic journals between 1949 and 1984 that related to tobacco smoking among US physicians. The study was undertaken in 2007–08 with an internet search of relevant medical databases, after which time the reference lists of manuscripts were also examined to find additional articles. Results A total of 57 manuscripts met the inclusion criteria. From a research perspective, the methodology and coverage of smoking surveys ranged from detailed national investigations, to local medical association surveys, and journal readership questionnaires. From a historical perspective, it can be seen that by the 1950s many US physicians had begun questioning the safety of tobacco products, and by the 1960s and 1970s, this had resulted in a continuous decline in tobacco use. By the 1980s, few US physicians were still smoking, and many of their younger demographic had probably never smoked at all. Conclusion Although the quality and coverage of historical surveys varied over time, a review of their main results indicates a clear and consistent decline in tobacco use among US physicians between 1949 and 1984. Much can be learned from this pivotal era of public health, where the importance of scientific knowledge, professional leadership and social responsibility helped set positive examples in the fight against tobacco. PMID:18822167

Physician Variability in Management of Emergency Department Patients with Chest Pain.

PubMed

Smulowitz, Peter B; Barrett, Orit; Hall, Matthew M; Grossman, Shamai A; Ullman, Edward A; Novack, Victor

2017-06-01

Chest pain is a common emergency department (ED) presentation accounting for 8-10 million visits per year in the United States. Physician-level factors such as risk tolerance are predictive of admission rates. The recent advent of accelerated diagnostic pathways and ED observation units may have an impact in reducing variation in admission rates on the individual physician level. We conducted a single-institution retrospective observational study of ED patients with a diagnosis of chest pain as determined by diagnostic code from our hospital administrative database. We included ED visits from 2012 and 2013. Patients with an elevated troponin or an electrocardiogram (ECG) demonstrating an ST elevation myocardial infarction were excluded. Patients were divided into two groups: "admission" (this included observation and inpatients) and "discharged." We stratified physicians by age, gender, residency location, and years since medical school. We controlled for patient- and hospital-related factors including age, gender, race, insurance status, daily ED volume, and lab values. Of 4,577 patients with documented dispositions, 3,252 (70.9%) were either admitted to the hospital or into observation (in an ED observation unit or in the hospital), while 1,333 (29.1%) were discharged. Median number of patients per physician was 132 (interquartile range 89-172). Average admission rate was 73.7±9.5% ranging from 54% to 96%. Of the 3,252 admissions, 2,638 (81.1%) were to observation. There was significant variation in the admission rate at the individual physician level with adjusted odds ratio ranging from 0.42 to 5.8 as compared to the average admission. Among physicians' characteristics, years elapsed since finishing medical school demonstrated a trend towards association with a higher admission probability. There is substantial variation among physicians in the management of patients presenting with chest pain, with physician experience playing a role.

[Scientific publication output of Spanish emergency physicians from 2005 to 2014: a comparative study].

PubMed

Fernández-Guerrero, Inés María; Martín-Sánchez, Francisco Javier; Burillo-Putze, Guillermo; Miró, Òscar

2017-10-01

To analyze the research output of Spanish emergency physicians between 2005 and 2014 and to compare it to their output in the previous 10-year period (1995-2004) as well as to that of emergency physicians in other countries and Spanish physicians in other specialties. Original articles indexed in the Science Citation Index Expanded of the Web of Science were included. Documents from Spanish emergency physicians were identified by combining the word Spain and any other search term identifying an emergency service or unit in Spain. To identify articles from 7 other Spanish specialties (hematology, endocrinology, cardiology, pneumology, digestive medicine, pediatrics, surgery and orthopedic medicine or traumatology) and emergency physicians in 8 other countries (United States, United Kingdom, Ireland, Italy, France, Germany, Netherlands, Belgium) we used similar strategies. Information about production between 1995 and 2004 was extracted from a prior publication. Spanish emergency physicians signed 1254 articles (mean [SD], 125 [44] articles/y) between 2005 and 2014. That level of productivity was greater than in the 1995-2004 period (mean, 26 [14] articles/y), although the annual growth rate fell from 12.5% in the previous 10-year period to 5.2% in the most recent one. Emergency medicine was among the least productive Spanish specialties we studied, but our discipline's annual growth rate of 5.2% was the highest. Spanish emergency medicine occupies an intermediate position (ranking fifth) among the 9 countries studied, although the population-adjusted rank was higher (fourth). When output was adjusted for gross domestic product, Spain climbed higher in rank, to second position. The annual growth rate was the fourth highest among countries, after Germany (9.9%), the Netherlands (7.3%), and Italy (6.0%). The research output of Spanish emergency physicians continues to be quantitatively lower than that of other Spanish specialties and of emergency physicians in other countries. The annual rate of growth in publications, although good, fell below the growth rate of the previous period.

The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians.

PubMed

Emanuel, E J; Daniels, E R; Fairclough, D L; Clarridge, B R

1998-08-12

Despite intense debates about legalization, there are few data examining the details of actual euthanasia and physician-assisted suicide (PAS) cases in the United States. To determine whether the practices of euthanasia and PAS are consistent with proposed safeguards and the effect on physicians of having performed euthanasia or PAS. Structured in-depth telephone interviews. Randomly selected oncologists in the United States. Adherence to primary and secondary safeguards for the practice of euthanasia and PAS; regret, comfort, and fear of prosecution from performing euthanasia or PAS. A total of 355 oncologists (72.6% response rate) were interviewed on euthanasia and PAS. On 2 screening questions, 56 oncologists (15.8%) reported participating in euthanasia or PAS; 53 oncologists (94.6% response rate) participated in in-depth interviews. Thirty-eight of 53 oncologists described clearly defined cases of euthanasia or PAS. Twenty-three patients (60.5%) both initiated and repeated their request for euthanasia or PAS, but 6 patients (15.8%) did not participate in the decision for euthanasia or PAS. Thirty-seven patients (97.4%) were experiencing unremitting pain or such poor physical functioning they could not perform self-care. Physicians sought consultation in 15 cases (39.5%). Overall, oncologists adhered to all 3 main safeguards in 13 cases (34.2%): (1) having the patient initiate and repeat the request for euthanasia or PAS, (2) ensuring the patient was experiencing extreme physical pain or suffering, and (3) consulting with a colleague. Those who adhered to the safeguards had known their patients longer and tended to be more religious. In 28 cases (73.7%), the family supported the decision. In all cases of pain, patients were receiving narcotic analgesia. Fifteen patients (39.5%) were enrolled in a hospice. While 19 oncologists (52.6%) received comfort from having helped a patient with euthanasia or PAS, 9 (23.7%) regretted having performed euthanasia or PAS, and 15 (39.5%) feared prosecution. Intractable pain or poor physical functioning seem to be nearly absolute requirements for physicians to perform euthanasia or PAS. Only one third of cases are performed consistently with proposed safeguards. For some patients, end-of-life care that includes opioid analgesia and hospice care does not obviate their desire for euthanasia or PAS. While the majority of physicians seem comforted by their actions, some experience adverse consequences from having performed euthanasia or PAS.

[Department of training of physicians (for Missile Forces and Army) of Military-medical academy n. a. S.M.Kirov celebrates the 70th anniversary].

PubMed

Shvets, V A; Tsvetkov, S A; Ovchinnikov, D V; Deev, R V

2012-10-01

The article is dedicated to the history of the one of educational units of the Kirov Medical Academy. Department of training of physicians (for Missile Forces and Army) traces its origins to 1942 published in the resolution of the State Committee of Defense of the USSR, but in fact is the successor to hospital schools in the land and the Admiralty hospitals.

Improving business IQ in medicine through mentorship and education.

PubMed

Hill, Austin D

2014-09-01

Business intelligence in the field of medicine, particularly with physicians, has been an abstract concept at best with no objective metric. Furthermore, in many arenas, it was taboo for medical students, residents, and physicians to discuss the business and finances of their work for fear that it would interfere with their sacred duties as health care providers. There has been a substantial shift in this philosophy over the last few decades with the growth and evolution of the health care industry in the United States. In 2012, health care expenditures accounted for 17.2% of the United States Gross Domestic Product, averaging $8915 per person. The passage of the Affordable Care Act in March of 2010 sent a clear message to all that change is coming, and it is more important now than ever to have physician leaders whose skills and knowledge in business, management, and health care law rival their acumen within their medical practice. Students, residents, and fellows all express a desire to gain more business knowledge throughout their education and training, but many do not know where to begin or have access to programs that can further their knowledge. Whether you are an employed or private practice physician, academic or community based, improving your business intelligence will help you get a seat at the table where decisions are made and give you the skills to influence those decisions.

Does a full-time, 24-hour intensivist improve care and efficiency?

PubMed

Carlson, R W; Weiland, D E; Srivathsan, K

1996-07-01

This article reviews the hypothesis that staffing with full-time intensive care physicians leads to improvements in the management of ICUs and in the outcome for ICU patients. Variations in the professional organization of critical care units in the United States are discussed. The advantages and disadvantages of open, closed, and transitional (comanagement) ICU organizational structures are presented.

The Bell Commission: ethical implications for the training of physicians.

PubMed

Holzman, I R; Barnett, S H

2000-03-01

In 1989, the New York State Legislature enacted New York State Code 405 in response to the death of a patient in a New York City hospital. Code 405 was the culmination of a report (the Bell Commission Report) that implicated the training of residents as part of the problem leading to that tragic death. This paper explores the consequences of the regulatory changes in physician training. The sleep deprivation of house officers was considered a major issue requiring correction. There is little evidence to support the claim that sleep deprivation is a serious cause of medical misadventures. Nevertheless, the changes in house officers' working hours and responsibilities have profound implications. Changes in the time allotted to teaching, the ability to learn from patients admitted after a shift is over, and the increasing loss of continuity, all may have a negative impact on physician training. It is not clear that trainees are being realistically prepared for the actual practice of medicine - physicians often work extended hours. The most serious concern that has been raised is the loss of professionalism by physicians. Residents are now viewing themselves as hourly workers, and the State has intervened in an area of training formerly left to the profession to manage. We are now training doctors in New York State who will be comfortable working in an hourly wage setting, but not in the traditional practice of medicine as it has been in the United States during this century. We are concerned that this may sever the bond between doctor and patient - a bond that has been the bedrock of our conception of a physician.

The practice and earnings of preventive medicine physicians.

PubMed

Salive, M E

1992-01-01

A shortage of preventive medicine (PM) physicians exists in the United States. Researchers know little about these physicians' earnings and practice characteristics. The American College of Preventive Medicine (ACPM) mailed a survey to all self-identified PM physicians on the American Medical Association (AMA) Physician Masterfile. A total of 3,771 (54%) responded; respondents' sex and region of residence were typical for PM physicians in general, with a slight excess of older physicians and those reporting board certification. A total of 2,664 (71%) were working full time, with median earnings of $85,000 (mean $90,000). Among full-time physicians, relatively higher earnings were associated with the following characteristics: male sex; age 45 to 64 years; major source of income from clinical, business, or industrial sources, rather than governmental or academic; and PM board certification. Full-time PM physicians earned much less than office-based private practitioners in several primary care specialties in 1989. The gap in earnings between PM specialists in government positions and those in the private sector is also substantial. Both disparities may require creative solutions.

Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States.

PubMed

Tenner, C T; Herzog, K; Chaudhari, S; Bini, E J; Weinshel, E H

2012-10-01

Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. Since training for family medicine (FM) and internal medicine (IM) physicians differ, we hypothesised that there are differences in knowledge, attitudes and barriers regarding vaccination against HAV and HBV in patients with chronic HCV between these two groups. A two-page questionnaire was mailed to 3000 primary care (FM and IM) physicians randomly selected from the AMA Physician Masterfile in 2005. The survey included questions about physician demographics, knowledge and attitudes regarding vaccination. Among the 3000 physicians surveyed, 1209 (42.2%) returned completed surveys. There were no differences between respondents and non-respondents with regard to age, gender, geographic location or specialty. More FM than IM physicians stated that HCV+ patients should not be vaccinated against HAV (23.7% vs. 11.8%, p < 0.001) or HBV (21.9% vs. 10.6%, p < 0.001). FM physicians were also less likely than IM physicians to usually/always test HCV+ patients for immunity against HAV (33.9% vs. 48.6%, p < 0.001) or against HBV (50.8% vs. 68.0%, p < 0.001). There were numerous barriers to HAV and HBV vaccination identified. The median number of barriers was 3 for FM physicians and 2 for IM physicians (p < 0.001). Despite recommendations to vaccinate against HAV and HBV in patients with chronic HCV infection, physicians often do not test or vaccinate susceptible individuals. Interventions are needed to overcome the barriers identified and improve vaccination rates. © 2012 Blackwell Publishing Ltd.

Surplus or shortage? Unraveling the physician supply conundrum.

PubMed Central

Rosenblatt, R. A.; Lishner, D. M.

1991-01-01

Although the supply of physicians in the United States has doubled during the past 20 years, there is still disagreement as to whether we currently have or should expect a significant surplus of physicians. The evidence suggests that despite the rapid expansion in the pool of available physicians, serious physician shortages persist for certain rural populations, ethnic and occupational groups, and other medically disadvantaged segments of the population. Medical students' declining interest in rural practice and primary care specialties suggests that problems of geographic and specialty maldistribution may worsen despite a rising population of physicians. It is unlikely that a significant physician surplus will develop unless there is a conscious attempt to limit the proportion of national wealth expended on medical care. Pockets of shortage can be reduced by broadening the availability of health insurance, lessening large income disparities between different specialties, changing the way teaching institutions are reimbursed for their training costs, and supporting direct governmental service programs such as the National Health Service Corps. PMID:2024510

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States.

PubMed

Parks, Melissa A; Barnhart, Kurt T; Howard, David L

2018-06-06

When managing a nonviable pregnancy of unknown location (PUL), a debate has emerged in the literature whether to perform uterine curettage for definitive diagnosis of pregnancy location or administer methotrexate for a presumed ectopic pregnancy. The purpose of this study is to describe the treatment patterns when managing a PUL. A prospective, anonymous Internet based-electronic survey of PUL case scenarios was administered to a random sample of physicians across the United States. A total of 214 physicians responded. When presented with a PUL by ultrasound and a βhCG measurement of 3,270 mIU/mL, which is above the discriminatory level, 88.3% (188) would choose an additional βhCG measurement before recommending any intervention. When presented with a PUL by ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable gestation, 36.5% would offer uterine curettage and 31.3% would offer methotrexate. Resident and private clinicians had a fourfold lower adjusted odds of choosing uterine curettage compared to academic physicians. Based on our findings, there does not appear to be a consensus regarding the management of a PUL. © 2018 S. Karger AG, Basel.

Rationale for cost-effective laboratory medicine.

PubMed Central

Robinson, A

1994-01-01

There is virtually universal consensus that the health care system in the United States is too expensive and that costs need to be limited. Similar to health care costs in general, clinical laboratory expenditures have increased rapidly as a result of increased utilization and inflationary trends within the national economy. Economic constraints require that a compromise be reached between individual welfare and limited societal resources. Public pressure and changing health care needs have precipitated both subtle and radical laboratory changes to more effectively use allocated resources. Responsibility for excessive laboratory use can be assigned primarily to the following four groups: practicing physicians, physicians in training, patients, and the clinical laboratory. The strategies to contain escalating health care costs have ranged from individualized physician education programs to government intervention. Laboratories have responded to the fiscal restraints imposed by prospective payment systems by attempting to reduce operational costs without adversely impacting quality. Although cost containment directed at misutilization and overutilization of existing services has conserved resources, to date, an effective cost control mechanism has yet to be identified and successfully implemented on a grand enough scale to significantly impact health care expenditures in the United States. PMID:8055467

The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the United States

PubMed Central

Ulrich, Connie M.; Zhou, Qiuping (Pearl); Hanlon, Alexandra; Danis, Marion; Grady, Christine

2016-01-01

Purpose Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. Methods This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. Results Ethics preparedness and confidence were significantly associated with perceived quality of care (p < 0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p < 0.01). Forty-four percent of the variance in quality of care was explained by these factors. Conclusions Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care. PMID:24613597

The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the United States.

PubMed

Ulrich, Connie M; Zhou, Qiuping Pearl; Hanlon, Alexandra; Danis, Marion; Grady, Christine

2014-08-01

Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. Ethics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors. Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care. Copyright © 2014 Elsevier Inc. All rights reserved.

Sexual activity and counseling in the first month after acute myocardial infarction among younger adults in the United States and Spain: a prospective, observational study.

PubMed

Lindau, Stacy Tessler; Abramsohn, Emily M; Bueno, Héctor; D'Onofrio, Gail; Lichtman, Judith H; Lorenze, Nancy P; Mehta Sanghani, Rupa; Spatz, Erica S; Spertus, John A; Strait, Kelly; Wroblewski, Kristen; Zhou, Shengfan; Krumholz, Harlan M

2014-12-23

United States and European cardiovascular society guidelines recommend physicians counsel patients about resuming sexual activity after acute myocardial infarction (AMI), but little is known about patients' experience with counseling about sexual activity after AMI. The prospective, longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, conducted at 127 hospitals in the United States and Spain, was designed, in part, to evaluate gender differences in baseline sexual activity, function, and patient experience with physician counseling about sexual activity after an AMI. This study used baseline and 1-month data collected from the 2:1 sample of women (N=2349) and men (N=1152) ages 18 to 55 years with AMI. Median age was 48 years. Among those who reported discussing sexual activity with a physician in the month after AMI (12% of women, 19% of men), 68% were given restrictions: limit sex (35%), take a more passive role (26%), and/or keep the heart rate down (23%). In risk-adjusted analyses, factors associated with not discussing sexual activity with a physician included female gender (relative risk, 1.07; 95% confidence interval, 1.03-1.11), age (relative risk, 1.05 per 10 years; 95% confidence interval, 1.02-1.08), and sexual inactivity at baseline (relative risk, 1.11; 95% confidence interval, 1.08-1.15). Among patients who received counseling, women in Spain were significantly more likely to be given restrictions than U.S. women (relative risk; 1.36, 95% confidence interval, 1.11-1.66). Very few patients reported counseling for sexual activity after AMI. Those who did were commonly given restrictions not supported by evidence or guidelines. http://www.clinicaltrials.gov. Unique identifier: NCT00597922. © 2014 American Heart Association, Inc.

[Cost at the first level of care].

PubMed

Villarreal-Ríos, E; Montalvo-Almaguer, G; Salinas-Martínez, M; Guzmán-Padilla, J E; Tovar-Castillo, N H; Garza-Elizondo, M E

1996-01-01

To estimate the unit cost of 15 causes of demand for primary care per health clinic in an institutional (social security) health care system, and to determine the average cost at the state level. The cost of 80% of clinic visits was estimated in 35 of 40 clinics in the social security health care system in the state of Nuevo Leon, Mexico. The methodology for fixed costs consisted of: departmentalization, inputs, cost, weights and construction of matrices. Variable costs were estimated for standard patients by type of health care sought and with the consensus of experts; the sum of fixed and variable costs gave the unit cost. A computerized model was employed for data processing. A large variation in unit cost was observed between health clinics studied for all causes of demand, in both metropolitan and non-metropolitan areas. Prenatal care ($92.26) and diarrhea ($93.76) were the least expensive while diabetes ($240.42) and hypertension ($312.54) were the most expensive. Non-metropolitan costs were higher than metropolitan costs (p < 0.05); controlling for number of physician's offices showed that this was determined by medical units with only one physician's office. Knowledge of unit costs is a tool that, when used by medical administrators, allows adequate health care planning and efficient allocation of health resources.

Perspective: private schools of the Caribbean: outsourcing medical education.

PubMed

Eckhert, N Lynn

2010-04-01

Twenty-five percent of the U.S. physician workforce is made up of international medical graduates (IMGs), a growing proportion of whom (27% in 2005) are U.S. citizens. Most IMGs graduate from "offshore medical schools" (OMSs), for-profit institutions primarily located in the Caribbean region and established to train U.S. students who will return home to practice medicine. Following the recent call for a larger physician workforce, OMSs rapidly increased in number. Unlike U.S. schools, which must be accredited by the Liaison Committee on Medical Education, OMSs are recognized by their home countries and may not be subject to a rigorous accreditation process. Although gaps in specific data exist, a closer look at OMSs reveals that most enroll three groups of students per year, and many educate students initially at "offshore campuses" and later at clinical sites in the United States. Students from some OMSs are eligible for the U.S. Federal Family Education Loan Program. The lack of uniform data on OMSs is problematic for state medical boards, which struggle to assess the quality of the medical education offered at any one school and which, in some cases, disapprove a school. With the United States' continued reliance on IMGs to meet its health needs, the public and the profession will be best served by knowing more about medical education outside of the United States. Review of medical education in OMSs whose graduates will become part of U.S. health care delivery is timely as the United States reforms its health-care-delivery system.

Using Vignettes to Compare the Quality of Clinical Care Variation in Economically Divergent Countries

PubMed Central

Peabody, John W; Tozija, Fimka; Muñoz, Jorge A; Nordyke, Robert J; Luck, Jeff

2004-01-01

Objective To determine whether clinical vignettes can measure variations in the quality of clinical care in two economically divergent countries. Data Source/Study Setting Primary data collected between February 1997 and February 1998 at two Veterans Affairs facilities in the United States and four government-run outpatient facilities in Macedonia. Study Design Randomly selected, eligible Macedonian and U.S. physicians (>97 percent participation rate) completed vignettes for four common outpatient conditions. Responses were judged against a master list of explicit quality criteria and scored as percent correct. Data Collection/ Extraction An ANOVA model and two-tailed t-tests were used to compare overall scores by case, study site, and country. Principal Findings The mean score for U.S. physicians was 67 percent (+/−11 percent) compared to 48 percent (+/−11 percent) for Macedonian physicians. The quality of clinical practice, which emphasizes basic skills, varied greatly in both sites, but more so in Macedonia. However, the top Macedonian physicians in all sites approached or—in one case—exceeded the median score in the U.S. sites. Conclusions Vignettes are a useful method for making cross-national comparisons of the quality of care provided in very different settings. The vignette measurements revealed that some physicians in Macedonia performed at a standard comparable to that of their counterparts in the United States, despite the disparity of the two health systems. We infer that in poorer countries, policy that promotes improvements in the quality of clinical practice—not just structural inputs—could lead to rapid improvements in health. PMID:15544639

Hands in medicine: understanding the impact of competency-based education on the formation of medical students' identities in the United States.

PubMed

Gonsalves, Catherine; Zaidi, Zareen

2016-01-01

There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on 'doing the work of a physician' rather than identity formation and 'being a physician.' This study aims to understand how competency-based education impacts the development of a medical student's identity. Three ceramic models representing three core competencies 'medical knowledge,' 'patient care,' and 'professionalism' were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. Students across all four years of medical school related to the 'professionalism' competency domain (50%). They reflected that 'being an empathetic physician' was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized 'professionalism' as a competency. Students perceive 'professionalism' as a competency that impacts their identity formation in the social role of 'being a doctor,' albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

The birth of a house call practice.

PubMed

De Leon, Fidias E

2009-01-01

Increasingly, physicians of all specialties are frustrated with the complex, unrewarding system of third-party billing in the United States. It has led many physicians to wonder how best to change their practice to ameliorate these challenges or leave their practice altogether. It is possible that family physicians suffer most because they are trained to provide comprehensive care to all comers, regardless of reimbursement status. What they may not know is that leaving the practice might be the best thing for everyone, and it doesn't necessarily mean leaving medicine! As I realized during my experiences working in South Florida, transitioning to a house call practice can be emotionally and financially rewarding.

[Active euthanasia in Colombia and assisted suicide in California].

PubMed

Julesz, Máté

2016-01-31

The institution of active euthanasia has been legal in Colombia since 2015. In California, the regulation on physician-assisted suicide will come into effect on January 1, 2016. The legal institution of active euthanasia is not accepted under the law of the United States of America, however, physician-assisted suicide is accepted in an increasing number of member states. The related regulation in Oregon is imitated in other member states. In South America, Colombia is not the first country to legalize active euthanasia: active euthanasia has been legal in Uruguay since 1932. The North American legal tradition markedly differs from the South American one and both are incompatible with the Central European rule of law. In Hungary and in most European Union countries, solely the passive form of euthanasia is legal. In the Benelux countries, the active form of euthanasia is legal because the supranational law of the European Union does not prohibit it. Notwithstanding, European Union law does not prescribe legalization of either the active form of euthanasia, or the physician-assisted suicide.

An Introduction to Medical Malpractice in the United States

PubMed Central

2008-01-01

Medical malpractice law in the United States is derived from English common law, and was developed by rulings in various state courts. Medical malpractice lawsuits are a relatively common occurrence in the United States. The legal system is designed to encourage extensive discovery and negotiations between adversarial parties with the goal of resolving the dispute without going to jury trial. The injured patient must show that the physician acted negligently in rendering care, and that such negligence resulted in injury. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Money damages, if awarded, typically take into account both actual economic loss and noneconomic loss, such as pain and suffering. PMID:19034593

An introduction to medical malpractice in the United States.

PubMed

Bal, B Sonny

2009-02-01

Medical malpractice law in the United States is derived from English common law, and was developed by rulings in various state courts. Medical malpractice lawsuits are a relatively common occurrence in the United States. The legal system is designed to encourage extensive discovery and negotiations between adversarial parties with the goal of resolving the dispute without going to jury trial. The injured patient must show that the physician acted negligently in rendering care, and that such negligence resulted in injury. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Money damages, if awarded, typically take into account both actual economic loss and noneconomic loss, such as pain and suffering.

Increased flight surgeon role in military aeromedical evacuation.

PubMed

Lyons, T J; Connor, S B

1995-10-01

Physicians were involved in the development of aeromedical evacuation (medevac) and flight surgeons flew as crewmembers on the first U.S. military medevac flights. However, since World War II flight surgeons have not been routinely assigned to operational medevac units. The aeromedical literature addressing the role of physicians in medevac is controversial. Recent contingencies involving the U.S. Air Force (USAF) have required the augmentation of medevac units with flight surgeons. Beginning in 1992, the United States Air Forces Europe (USAFE) assigned three flight surgeons to the medevac squadron. Between 2 February 1993 and 24 March 1994 USAFE moved 241 patients on 29 missions out of the former Yugoslavia--most of these missions had a flight surgeon on the crew. Because advance medical information on the status of these patients is often nonexistent, the presence of a physician on the crew proved life-saving in some instances. In peacetime operations, there has been a recent trend in the European theater for the USAF to move more unstable patients. Dedicated medevac flight surgeons have proven to have the specific experience and training to perform effectively in the role of in-flight medical attendant. In addition, they are effective in negotiating with referring physicians about the urgency of movement, required equipment, the need for medical attendants, etc. These flight surgeons also provide medical coverage of transiting patients in the Aeromedical Staging Flight (ASF), thus providing needed continuity in the medevac system. Dedicated medevac flight surgeons fill a unique and valuable role in medevac systems. Agencies with medevac units should consider assigning flight surgeons to these units.

Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals.

PubMed

Sriraman, Natasha K; Kellams, Ann

2016-07-01

Despite recognized health benefits for both mothers and infants, significant disparities still exist in the rates of breastfeeding in the United States. Major organizations representing the health of women and children (including the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics [AAP], American Congress of Obstetrics and Gynecology [ACOG], American Academy of Family Physicians [AAFP], United Nations International Children's Emergency Fund (UNICEF), the World Health Organization [WHO], and the United States Public Health Service [PHS]) recommend exclusive breastfeeding, but statistics show that although many women initiate breastfeeding, few meet the recommended goals for duration and exclusivity. This article reviews the evidence related to barriers (prenatal, medical, societal, hospital, and sociocultural) that many mothers face, and explore the known barriers and the impact they have on a woman's ability to breastfeed her infant. Strategies will be discussed to address (and potentially overcome) some of the most common barriers women face along with a list of resources that can be useful in this effort. Gaps in care and areas that need further research will be noted. This article is targeted toward physicians and other healthcare providers who work with women and who can assist with and advocate for the removal of barriers and thereby improve the health of women and children by increasing the rates of breastfeeding initiation, duration, and exclusivity in the United States.

The effect of in-office waiting time on physician visit frequency among working-age adults.

PubMed

Tak, Hyo Jung; Hougham, Gavin W; Ruhnke, Atsuko; Ruhnke, Gregory W

2014-10-01

Disparities in unmet health care demand resulting from socioeconomic, racial, and financial factors have received a great deal of attention in the United States. However, out-of-pocket costs alone do not fully reflect the total opportunity cost that patients must consider as they seek medical attention. While there is an extensive literature on the price elasticity of demand for health care, empirical evidence regarding the effect of waiting time on utilization is sparse. Using the nationally representative 2003 Community Tracking Study Household Survey, the most recent iteration containing respondents' physician office visit frequency and estimated in-office waiting time in the United States (N = 23,484), we investigated the association between waiting time and calculated time cost with the number of physician visits among a sample of working-age adults. To avoid the bias that literature suggests would result from excluding respondents with zero physician visits, we imputed waiting time for the essential inclusion of such individuals. On average, respondents visited physician offices 3.55 times, during which time they waited 28.7 min. The estimates from a negative binomial model indicated that a doubling of waiting time was associated with a 7.7 percent decrease (p-value < 0.001) in physician visit frequency. For women and unemployed respondents, who visited physicians more frequently, the decrease was even larger, suggesting a stronger response to greater waiting times. We believe this finding reflects the discretionary nature of incremental visits in these groups, and a consequent lower perceived marginal benefit of additional visits. The results suggest that in-office waiting time may have a substantial influence on patients' propensity to seek medical attention. Although there is a belief that expansions in health insurance coverage increase health care utilization by reducing financial barriers to access, our results suggest that unintended consequences may arise if in-office waiting time increases. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comments on the AAMC policy statement recommending strategies for increasing the production of generalist physicians.

PubMed

Greer, D S; Bhak, K N; Zenker, B M

1994-04-01

The United States has a physician specialty imbalance, primarily a shortage of generalists (defined as family physicians, general internists, and general pediatricians) relative to other specialists. In recent years, the rising costs of health care, the expansion of managed care, and problems of access to care have accentuated the critical role that generalists must play in a cost-effective, accessible health care system. Despite numerous public and private initiatives designed to address the supply of generalist physicians, the ratio of generalists to specialists has been decreasing. Although the factors contributing to the shrinking proportion of generalists are many and are often outside the control of educators, there is evidence that medical schools can play a major role in influencing specialty choice. Recognizing the need to address the specialty imbalance in this country, the Association of American Medical Colleges (AAMC) appointed the Generalist Physician Task Force to develop a statement suggesting actions that the AAMC and its constituents could take to foster a greater representation of generalist physicians in the United States. The task force produced an Executive Summary, published as an AAMC policy statement in early 1993, that contained recommended strategies for medical schools, graduate medical education, and the practice environment. The authors of the present article critique these recommendations, provide a background and rationale for each of them, and give suggestions about how some of the recommendations might be implemented. While they are in general agreement with the AAMC policy statement, they feel the recommended strategies fall short of the need. They maintain that the AAMC statement represents an admirable but cautious approach to a daunting problem, and that the time is past when cautious approaches will suffice. The authors conclude with the hope that bolder initiatives will emerge from the new AAMC Office of Generalist Physician Programs.

Management of hypertension in light of the new national guidelines.

PubMed

Moser, Marvin

2003-08-01

The JNC-7 treatment recommendations, if followed by a majority of physicians, should help to reduce the number of resistant hypertensive patients in the United States and should result in an improved proportion of patients with controlled blood pressure.

Alternative methods of ophthalmic treatment in Russia.

PubMed

Vader, L

1994-04-01

Russian ophthalmic nurses and physicians are using alternative methods of treatment to supplement traditional eye care. As acupuncture and iridology become more popular in the United States, ophthalmic nurses need to be more knowledgeable about these treatments and the implications for patients.

Survey of United States Army Physician Opinion: The Issue of Written ’Do Not Resuscitate’ Orders

DTIC Science & Technology

1984-08-01

Westminister Press, 1975), p. 176-7. 71Cushing, p. 29. 72Alexander, p. 26. 73Kevin M. McIntyre, "Mediolegal Aspects of Decision Making in Resuscitation and Life...34Physicians Opinions Toward Legislation Defining Death and Withholding Life Support," Southern Medical Journal 74 (February 1981): 215-18. 82Norman K...Louis S. Let the Patient Decide. Philadelphia: The Westminister Press, 1978. Browning, Mary H. and Lewis, Edith P. comps. The Dying Patient: A Nursing

Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.

PubMed

DeKeyser Ganz, Freda; Engelberg, Ruth; Torres, Nicole; Curtis, Jared Randall

2016-04-01

To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation. Ethnographic (observations and interviews) and survey designs. Three ICUs (two in Israel and one in the United States). A convenience sample of nurses and physicians. None. Observations and interviews were analyzed using ethnographic and grounded theory methodologies. Questionnaires included a demographic information sheet and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. From observations and interviews, we developed a conceptual model of the process of shared clinical decision making that involves four stepped levels, proceeding from the lowest to the highest levels of collaboration: individual decision, information exchange, deliberation, and shared decision. This process is influenced by individual, dyadic, and system factors. Most decisions were made at the lower two levels. Levels of perceived collaboration were moderate with no statistically significant differences between physicians and nurses or between units. Both qualitative and quantitative data corroborated that physicians and nurses from all units were similarly and moderately satisfied with their level of collaboration and shared decision making. However, most ICU clinical decision making continues to take place independently, where there is some sharing of information but rarely are decisions made collectively. System factors, such as interdisciplinary rounds and unit culture, seem to have a strong impact on this process. This study provides a model for further study and improvement of interprofessional shared decision making.

Things Are Not as Bad as They Seem: Physicians' Ability to Predict Their Clinical Practice When a New Vaccine Becomes Available

PubMed Central

Hurley, Laura; Crane, Lori A.; Dong, Fran; Stokley, Shannon; Daley, Matthew F.; Barrow, Jennifer; Babbel, Christine; Dickinson, L. Miriam; Kempe, Allison

2013-01-01

Survey results regarding primary care physicians' likelihood of recommending a new vaccine were compared before and after the vaccine was licensed by the Food and Drug Administration for three new vaccines: herpes zoster (HZ), human papillomavirus (HPV) and rotavirus (RV), using physician networks representative of United States physicians. The main purpose of this study was to determine (a) how accurately physicians predict their eventual vaccine recommendations and the barriers they will experience in delivering the new vaccine and (b) whether physicians shift towards more or less strongly recommending a new vaccine from pre- to post-licensure. Responses from 284, 152 and 184 physicians were analyzed for the three vaccines, respectively. For all vaccines, there was a significant association between physicians' pre- and post-licensure recommendations (p<0.05). When responses changed from pre- to post-licensure, physicians tended to recommend a given vaccine more strongly than they had anticipated pre-licensure. Before vaccine availability, physicians tended to predict greater barriers to vaccine delivery than they eventually experienced. Surveys are useful for predicting physician practices, but may provide a slightly pessimistic view of physician adoption of new vaccines. Such data can be helpful in devising strategies to encourage vaccine delivery by physicians. PMID:23968639

What do physicians gain (and lose) with experience? Qualitative results from a cross-national study of diabetes

PubMed Central

Lutfey, Karen E; Marceau, Lisa D; Campbell, Stephen M; von dem Knesebeck, Olaf; McKinlay, John B

2010-01-01

An empirical puzzle has emerged over the last several decades of research on variation in clinical decision making involving mixed effects of physician experience. There is some evidence that physicians with greater experience may provide poorer quality care than their less experienced counterparts, as captured by various quality assurance measures. Physician experience is traditionally narrowly defined as years in practice or age, and there is a need for investigation into precisely what happens to physicians as they gain experience, including the reasoning and clinical skills acquired over time and the ways in which physicians consciously implement those skills into their work. In this study, we are concerned with 1) how physicians conceptualize and describe the meaning of their clinical experience, and 2) how they use their experience in clinical practice. To address these questions, we analyzed qualitative data drawn from in-depth interviews with physicians from the United States, United Kingdom, and Germany as a part of a larger factorial experiment of medical decision making for diabetes. Our results show that common measures of physician experience do not fully capture the skills physicians acquire over time or how they implement those skills in their clinical work. We found that what physicians actually gain over time is complex social, behavioral and intuitive wisdom as well as the ability to compare the present day patient against similar past patients. These active cognitive reasoning processes are essential components of a forward-looking research agenda in the area of physician experience and decision making. Guideline-based outcome measures, accompanied by underdeveloped age- and years-based definitions of experience, may prematurely conclude that more experienced physicians are providing deficient care while overlooking the ways in which they are providing more and better care than their less experienced counterparts. PMID:20356662

What do physicians gain (and lose) with experience? Qualitative results from a cross-national study of diabetes.

PubMed

Elstad, Emily A; Lutfey, Karen E; Marceau, Lisa D; Campbell, Stephen M; von dem Knesebeck, Olaf; McKinlay, John B

2010-06-01

An empirical puzzle has emerged over the last several decades of research on variation in clinical decision making involving mixed effects of physician experience. There is some evidence that physicians with greater experience may provide poorer quality care than their less experienced counterparts, as captured by various quality assurance measures. Physician experience is traditionally narrowly defined as years in practice or age, and there is a need for investigation into precisely what happens to physicians as they gain experience, including the reasoning and clinical skills acquired over time and the ways in which physicians consciously implement those skills into their work. In this study, we are concerned with 1) how physicians conceptualize and describe the meaning of their clinical experience, and 2) how they use their experience in clinical practice. To address these questions, we analyzed qualitative data drawn from in-depth interviews with physicians from the United States, United Kingdom, and Germany as a part of a larger factorial experiment of medical decision making for diabetes. Our results show that common measures of physician experience do not fully capture the skills physicians acquire over time or how they implement those skills in their clinical work. We found that what physicians actually gain over time is complex social, behavioral and intuitive wisdom as well as the ability to compare the present day patient against similar past patients. These active cognitive reasoning processes are essential components of a forward-looking research agenda in the area of physician experience and decision making. Guideline-based outcome measures, accompanied by underdeveloped age- and years-based definitions of experience, may prematurely conclude that more experienced physicians are providing deficient care while overlooking the ways in which they are providing more and better care than their less experienced counterparts. Copyright 2010 Elsevier Ltd. All rights reserved.

New wine in an old bottle: does alienation provide an explanation of the origins of physician discontent?

PubMed

McKinlay, John B; Marceau, Lisa

2011-01-01

We have witnessed transformational changes to the U.S. health care system over several decades. Alongside these changes is an increasing number of research reports and commentaries on physician workplace dissatisfaction and discontent. Primary care physicians, in particular, report dissatisfaction with conditions on the ground. Is there solid evidence concerning the magnitude of doctors' discontent, and how is it changing over time? Is it confined to the United States, or is it also occurring in other countries with different health care systems? Does physician discontent affect the processes, quality, and outcomes of medical care? This article addresses these questions. It considers the dimensions of physician dissatisfaction, whether there is a problem, and competing contributions to physician discontent. The authors suggest that the classic concept of alienation may build upon valuable earlier work and provide a new, coherent explanation of the workplace origins of physician discontent. Alienation theory combines both structural and psychological components associated with workplace discontent and has the potential to explain the changing position of knowledge workers (such as physicians) in the new economy.

Physician Participation In ACOs Is Lower In Places With Vulnerable Populations Compared To More Affluent Communities

PubMed Central

Yasaitis, Laura C.; Pajerowski, William; Polsky, Daniel; Werner, Rachel M.

2016-01-01

Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physician participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physician participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education—compared to other areas—had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations may not have as great access as other groups to physicians participating in ACOs, which could exacerbate existing disparities in health care quality. PMID:27503961

Recruitment of physicians to rural America: a view through the lens of Transaction Cost Theory.

PubMed

Fannin, J Matthew; Barnes, James N

2007-01-01

Many rural hospitals in the United States continue to have difficulties recruiting physicians. While several studies have examined some of the factors affecting the nature of this problem, we know far less about the role of economic incentives between rural providers and physicians. This conceptual article describes an economic theory of organization called Transaction Cost Theory (TCT) and applies it to rural hospital-physician relationships to highlight how transaction costs affect the type of contractual arrangement used by rural hospitals when recruiting physicians. The literature is reviewed to introduce TCT, describe current trends in hospital contracting with physicians, and develop a TCT contracting model for analysis of rural hospital-physician recruitment. The TCT model predicts that hospitals tend to favor contractual arrangements in which physicians are full-time employees if investments in physical or other assets made by hospitals cannot be easily redeployed for other services in the health care system. Transaction costs related to motivation and coordination of physician services are the key factors in understanding the unique contractual difficulties faced by rural providers. The TCT model can be used by rural hospital administrators to assess economic incentives for physician recruitment.

[Brazilian medical literature about the white plague: 1870-1940].

PubMed

Sheppard, D S

2001-01-01

The Darwinian theories compound the paradigm adopted by the physicians in Southern United States, when they turned to the subject of the differences in morbidity and mortality among the races after abolition. These physicians engaged in thoughts about the health crisis that assaulted the African-American population on that region. The Brazilian physicians, on the other hand, would not try to understand or explain the health crisis that overtook the population descended from Africans on their country. Actually, not a single Brazilian medical journal, since the end of abolition to the 1930s, published an article where a physician indicated the morbidity and mortality of his negro patients, or of negroes in general, as caused by any source related to the racial paradigm. The psychiatrists and eugenicist doctors were exceptions.

Socioeconomic and Physician Supply Determinants of Racial Disparities in Colorectal Cancer Screening

PubMed Central

Soneji, Samir; Armstrong, Katrina; Asch, David A.

2012-01-01

Purpose: Causes of racial disparities in colorectal cancer (CRC) screening may extend beyond individual-level characteristics. We examined how physician density, beyond socioeconomic factors, affected observed racial disadvantages in recent CRC screening for blacks and Hispanics. Methods: We obtained socioeconomic and CRC screening information on adults age ≥ 50 years from the Behavioral Risk Factor Surveillance System (1997 to 2008) and information on the number of primary care physicians and gastroenterologists from the American Medical Association Masterfile (1997 to 2008). We used fixed-effect multivariate logistic regression to model the probability of receiving a fecal occult blood test within the past year or endoscopic screening within the past 5 years as a function of individual-level socioeconomic factors and state-level physician supply. Results: In 2008, 60.6% of whites were current on CRC screening (95% CI, 60.6% to 61.0%) compared with 57.9% of blacks (95% CI, 56.7% to 59.2%) and 42.9% of Hispanics (95% CI, 41.0% to 44.8%). Inclusion of socioeconomic variables reversed black-white disparities (odds ratio [OR], 1.17; 95% CI, 1.15 to 1.19) but did not explain disadvantage for Hispanics (OR, 0.89; 95% CI, 0.87 to 0.92). Once interaction of race and physician supply was considered, likelihood of recent CRC screening became statistically indistinguishable for Hispanics and whites of similar socioeconomic status residing in states with high physician supplies. Conclusion: Socioeconomic factors and physician supply are key predictors of CRC screening. Adjustment for socioeconomic determinants explained black-white disparities; further adjustment for physician supply explained Hispanic-white disparities. Physician distribution is a potentially remediable contributor to ethnic/racial disparities in CRC screening. Whether the United States is able to equitably meet future demand for screening may depend on access, physician supply, and organization of the health care system. PMID:23277775

Socioeconomic and physician supply determinants of racial disparities in colorectal cancer screening.

PubMed

Soneji, Samir; Armstrong, Katrina; Asch, David A

2012-09-01

Causes of racial disparities in colorectal cancer (CRC) screening may extend beyond individual-level characteristics. We examined how physician density, beyond socioeconomic factors, affected observed racial disadvantages in recent CRC screening for blacks and Hispanics. We obtained socioeconomic and CRC screening information on adults age ≥ 50 years from the Behavioral Risk Factor Surveillance System (1997 to 2008) and information on the number of primary care physicians and gastroenterologists from the American Medical Association Masterfile (1997 to 2008). We used fixed-effect multivariate logistic regression to model the probability of receiving a fecal occult blood test within the past year or endoscopic screening within the past 5 years as a function of individual-level socioeconomic factors and state-level physician supply. In 2008, 60.6% of whites were current on CRC screening (95% CI, 60.6% to 61.0%) compared with 57.9% of blacks (95% CI, 56.7% to 59.2%) and 42.9% of Hispanics (95% CI, 41.0% to 44.8%). Inclusion of socioeconomic variables reversed black-white disparities (odds ratio [OR], 1.17; 95% CI, 1.15 to 1.19) but did not explain disadvantage for Hispanics (OR, 0.89; 95% CI, 0.87 to 0.92). Once interaction of race and physician supply was considered, likelihood of recent CRC screening became statistically indistinguishable for Hispanics and whites of similar socioeconomic status residing in states with high physician supplies. Socioeconomic factors and physician supply are key predictors of CRC screening. Adjustment for socioeconomic determinants explained black-white disparities; further adjustment for physician supply explained Hispanic-white disparities. Physician distribution is a potentially remediable contributor to ethnic/racial disparities in CRC screening. Whether the United States is able to equitably meet future demand for screening may depend on access, physician supply, and organization of the health care system.

Medical abortion reversal: science and politics meet.

PubMed

Bhatti, Khadijah Z; Nguyen, Antoinette T; Stuart, Gretchen S

2018-03-01

Medical abortion is a safe, effective, and acceptable option for patients seeking an early nonsurgical abortion. In 2014, medical abortion accounted for nearly one third (31%) of all abortions performed in the United States. State-level attempts to restrict reproductive and sexual health have recently included bills that require physicians to inform women that a medical abortion is reversible. In this commentary, we will review the history, current evidence-based regimen, and regulation of medical abortion. We will then examine current proposed and existing abortion reversal legislation. The objective of this commentary is to ensure physicians are armed with rigorous evidence to inform patients, communities, and policy makers about the safety of medical abortion. Furthermore, given the current paucity of evidence for medical abortion reversal, physicians and policy makers can dispel bad science and misinformation and advocate against medical abortion reversal legislation. Copyright © 2017 Elsevier Inc. All rights reserved.

Technology as friend or foe? Do electronic health records increase burnout?

PubMed

Ehrenfeld, Jesse M; Wanderer, Jonathan P

2018-06-01

To summarize recent relevant studies regarding the use of electronic health records and physician burnout. Recently acquired knowledge regarding the relationship between electronic health record use, professional satisfaction, burnout, and desire to leave clinical practice are discussed. Adoption of electronic health records has increased across the United States and worldwide. Although electronic health records have many benefits, there is growing concern about the adverse consequences of their use on physician satisfaction and burnout. Poor usability, incongruent workflows, and the addition of clerical tasks to physician documentation requirements have been previously highlighted as ongoing concerns with electronic health record adoption. In multiple recent studies, electronic health records have been shown to decrease professional satisfaction, increase burnout, and the likelihood that a physician will reduce or leave clinical practice. One interventional study demonstrated a positive effect of a dedicated electronic health record entry clerk on physicians working in an outpatient practice.

Consumerism in action: how patients and physicians negotiate payment in health care.

PubMed

Oh, Hyeyoung

2013-03-01

Drawing from the medical sociology literature on the patient-doctor relationship and microeconomic sociological scholarship about the role of money in personal relationships, I examined patient-physician interactions within a clinic that offered eye health and cosmetic facial services in the United States. Relying on ethnographic observations conducted in 2008, I evaluated how financial pressures shape the patient-physician relationship during the clinical encounter. To gain a financial advantage, patients attempted to reshape the relationship toward a socially intimate one, where favor and gift exchanges are more common. To ensure the rendering of services, the physician in turn allied herself with the patient, demonstrating how external parties are the barriers to affordable care. This allied relationship was tested when conflicts emerged, primarily because of the role of financial intermediaries in the clinical encounter. These conflicts resulted in the disintegration of the personal relationship, with patient and physician pitted against one another.

The ethical "elephant" in the death penalty "room".

PubMed

Keane, Michael

2008-10-01

The United States Supreme Court recently ruled that execution by a commonly used protocol of drug administration does not represent cruel or unusual punishment. Various medical journals have editorialized on this drug protocol, the death penalty in general and the role that physicians play. Many physicians, and societies of physicians, express the opinion that it is unethical for doctors to participate in executions. This Target Article explores the harm that occurs to murder victims' relatives when an execution is delayed or indefinitely postponed. By using established principles in psychiatry and the science of the brain, it is shown that victims' relatives can suffer brain damage when justice is not done. Conversely, adequate justice can reverse some of those changes in the brain. Thus, physician opposition to capital punishment may be contributing to significant harm. In this context, the ethics of physician involvement in lethal injection is complex.

The history of the nurse anesthesia profession.

PubMed

Ray, William T; Desai, Sukumar P

2016-05-01

Despite the fact that anesthesia was discovered in the United States, we believe that both physicians and nurses are largely unaware of many aspects of the development of the nurse anesthetist profession. A shortage of suitable anesthetists and the reluctance of physicians to provide anesthetics in the second half of the 19th century encouraged nurses to take on this role. We trace the origins of the nurse anesthetist profession and provide biographical information about its pioneers, including Catherine Lawrence, Sister Mary Bernard Sheridan, Alice Magaw, Agatha Cobourg Hodgins, and Helen Lamb. We comment on the role of the nuns and the effect of the support and encouragement of senior surgeons on the development of the specialty. We note the major effect of World Wars I and II on the training and recruitment of nurse anesthetists. We provide information on difficulties faced by nurse anesthetists and how these were overcome. Next, we examine how members of the profession organized, developed training programs, and formalized credentialing and licensing procedures. We conclude by examining the current state of nurse anesthesia practice in the United States. Copyright © 2016 Elsevier Inc. All rights reserved.

Blood component recalls in the United States.

PubMed

Ramsey, G; Sherman, L A

1999-05-01

United States blood suppliers are required to recall marketed blood components later found to be in violation of Food and Drug Administration (FDA) regulations for safety, purity, and potency. Many recalled units have already been transfused. Analysis of the frequency and nature of blood component recalls would be useful for blood suppliers, transfusion services, and physicians. Each blood component recall in the weekly FDA Enforcement Report from 1990 through 1997 was examined for the number of units, recall reason, and hazard class. Units for manufacturing were excluded. In 8 years, an estimated 241,800 blood components were recalled, or approximately 1 in 700 units available to US hospitals. Eighty-eight percent of recalled units were in 22 large recalls of over 1000 units each. The most common reasons were incorrect testing for syphilis (57% of units) or viral markers (19%), reactive or previously reactive donor viral markers (6-11%), and inadequate donor-history screening (4%). Twelve units were in the FDA's highest hazard Class I, 24 percent were in Class II, and 76 percent were in Class III. Over 43,900 units had HIV-related problems, but only 3 units involved HIV transmission. Large recalls have declined since peaking in 1995, but units in small recalls increased 116 percent in 1997 over the previous 7-year average. Although high-risk recalls are rare, many blood component recalls pose medical concerns for physicians and patients. The recent decline in large recalls may be due to increased FDA oversight, stricter accreditation standards for quality improvement, and more centralized donor testing in large specialized laboratories. However, smaller recalls, which involve nearly all blood suppliers, were sharply higher in 1997.

Cross-Cultural Obstetric and Gynecologic Care of Muslim Patients.

PubMed

Shahawy, Sarrah; Deshpande, Neha A; Nour, Nawal M

2015-11-01

With the growing number of Muslim patients in the United States, there is a greater need for obstetrician-gynecologists (ob-gyns) to understand the health care needs and values of this population to optimize patient rapport, provide high-quality reproductive care, and minimize health care disparities. The few studies that have explored Muslim women's health needs in the United States show that among the barriers Muslim women face in accessing health care services is the failure of health care providers to understand and accommodate their beliefs and customs. This article outlines health care practices and cultural competency tools relevant to modern obstetric and gynecologic care of Muslim patients, incorporating emerging data. There is an exploration of the diversity of opinion, practice, and cultural traditions among Muslims, which can be challenging for the ob-gyn who seeks to provide culturally competent care while attempting to avoid relying on cultural or religious stereotypes. This commentary also focuses on issues that might arise in the obstetric and gynecologic care of Muslim women, including the patient-physician relationship, modesty and interactions with male health care providers, sexual health, contraception, abortion, infertility, and intrapartum and postpartum care. Understanding the health care needs and values of Muslims in the United States may give physicians the tools necessary to better deliver high-quality care to this minority population.

The impact of financial incentives on physician productivity in medical groups.

PubMed

Conrad, Douglas A; Sales, Anne; Liang, Su-Ying; Chaudhuri, Anoshua; Maynard, Charles; Pieper, Lisa; Weinstein, Laurel; Gans, David; Piland, Neill

2002-08-01

To estimate the effect of financial incentives in medical groups--both at the level of individual physician and collectively--on individual physician productivity. Secondary data from 1997 on individual physician and group characteristics from two surveys: Medical Group Management Association (MGMA) Physician Compensation and Production Survey and the Cost Survey Area Resource File data on market characteristics, and various sources of state regulatory data. Cross-sectional estimation of individual physician production function models, using ordinary least squares and two-stage least squares regression. Data from respondents completing all items required for the two stages of production function estimation on both MGMA surveys (with RBRVS units as production measure: 102 groups, 2,237 physicians; and with charges as the production measure: 383 groups, 6,129 physicians). The 102 groups with complete data represent 1.8 percent of the 5,725 MGMA member groups. Individual production-based physician compensation leads to increased productivity, as expected (elasticity = .07, p < .05). The productivity effects of compensation methods based on equal shares of group net income and incentive bonuses are significantly positive (p < .05) and smaller in magnitude. The group-level financial incentive does not appear to be significantly related to physician productivity. Individual physician incentives based on own production do increase physician productivity.

14 CFR Special Federal Aviation... - Rules for use of portable oxygen concentrator systems on board aircraft

Code of Federal Regulations, 2010 CFR

2010-01-01

... must be capable of hearing the unit's alarms, seeing the alarm light indicators, and have the cognitive... licensed physician that: (i) States whether the user of the device has the physical and cognitive ability...

Physicians' perceptions of mobile technology for enhancing asthma care for youth.

PubMed

Schneider, Tali; Panzera, Anthony Dominic; Martinasek, Mary; McDermott, Robert; Couluris, Marisa; Lindenberger, James; Bryant, Carol

2016-06-01

This study assessed physicians' receptivity to using mobile technology as a strategy in patient care for adolescents with asthma. Understanding physicians' perceived barriers and benefits of integrating mobile technology in adolescents' asthma care and self-management is an initial step in enhancing overall patient and disease outcomes. We conducted in-depth interviews with second- and third-year pediatric residents and attending physicians who oversee pediatric residents in training (N = 27) at an academic medical center in the southeastern United States. We identified both benefits from and barriers to broader use of mobile technologies for improving asthma outcomes in adolescents. Resident physicians demonstrated greater readiness for integrating these technologies than did attending physicians. Prior to adoption of mobile technologies in the care of adolescent asthma patients, barriers to implementation should be understood. Prior to widespread adoption, such systems will need to be evaluated against traditional care for demonstration of patient outcomes that improve on the current situation. © The Author(s) 2014.

Future Research and Policy Directions in Physician Reimbursement

PubMed Central

McMenamin, Peter

1981-01-01

Payments to physicians absorb the second largest share of the health care dollar in the United States. In 1979, the share was 19 percent of the total, or $40.6 billion (Gibson, 1980). The Health Care Financing Administration (HCFA) alone spent $8.6 billion for physician services, representing approximately 16 percent of all public funds disbursed under HCFA programs. This paper presents an overview of various issues concerning physician reimbursement. Several major areas have been identified (access, cost, quality, and improving or refining the Office of Research, Demonstrations, and Statistics' [ORDS] research techniques for analyzing topics concerning physician reimbursement). Each area is introduced with a brief discussion of some of the problems associated with the physician reimbursement systems relating to that area. Selected results are then presented from the previous research in each area, along with descriptions of continuing studies currently underway. Each section concludes with a discussion of potential future directions for new research or data development. PMID:10309465

Review of survey articles regarding medication therapy management (MTM) services/programs in the United States.

PubMed

Oladapo, Abiola O; Rascati, Karen L

2012-08-01

To provide a summary of published survey articles regarding the provision of medication therapy management (MTM) services in the United States. A literature search was conducted to identify original articles on MTM-related surveys conducted in the United States, involving community and outpatient pharmacists, physicians, patients, or pharmacy students and published by the primary researchers who conducted the study. Search engines used included PubMed, Medline, and International Pharmaceutical Abstracts (IPA). If MTM was in the keyword list, mesh heading, title, or abstract, the article was reviewed. References from these articles were searched to determine whether other relevant articles were available. A total of 405 articles were initially reviewed; however, only 32 articles met the study requirements. Of the 32 articles, 17 surveyed community/outpatient pharmacists, 3 surveyed pharmacy students, 4 surveyed physicians, and 8 surveyed patients. The survey periods varied across the different studies, with the earliest survey conducted in 2004 and the most recent survey conducted in 2009. The surveys were conducted via the telephone, US mail, interoffice mail, e-mails, Internet/Web sites, hand-delivered questionnaires, and focus groups. Despite the identified barriers to the provision of MTM services, pharmacists reportedly found it professionally rewarding to provide these services. Pharmacists claimed to have adequate clinical knowledge, experience, and access to information required to provide MTM services. Pharmacy students were of the opinion that the provision of MTM services was important to the advancement of the pharmacy profession and in providing patients with a higher level of care. Physicians supported having pharmacists adjust patients’ drug therapy and educate patients on general drug information but not in selecting patients’ drug therapy. Finally, patients suggested that alternative ways need to be explored in describing and marketing MTM services for it to be appealing to them.

Tracking the Workforce: The American Society of Clinical Oncology Workforce Information System

PubMed Central

Kirkwood, M. Kelsey; Kosty, Michael P.; Bajorin, Dean F.; Bruinooge, Suanna S.; Goldstein, Michael A.

2013-01-01

Purpose: In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. Methods: The WIS report is composed of three sections: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. Results: The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Conclusion: Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages. PMID:23633965

Infectious Disease Physician Assessment of Hospital Preparedness for Ebola Virus Disease.

PubMed

Polgreen, Philip M; Santibanez, Scott; Koonin, Lisa M; Rupp, Mark E; Beekmann, Susan E; Del Rio, Carlos

2015-09-01

Background.  The first case of Ebola diagnosed in the United States and subsequent cases among 2 healthcare workers caring for that patient highlighted the importance of hospital preparedness in caring for Ebola patients. Methods.  From October 21, 2014 to November 11, 2014, infectious disease physicians who are part of the Emerging Infections Network (EIN) were surveyed about current Ebola preparedness at their institutions. Results.  Of 1566 EIN physician members, 869 (55.5%) responded to this survey. Almost all institutions represented in this survey showed a substantial degree of preparation for the management of patients with suspected and confirmed Ebola virus disease. Despite concerns regarding shortages of personal protective equipment, approximately two thirds of all respondents reported that their facilities had sufficient and ready availability of hoods, full body coveralls, and fluid-resistant or impermeable aprons. The majority of respondents indicated preference for transfer of Ebola patients to specialized treatment centers rather than caring for them locally. In general, we found that larger hospitals and teaching hospitals reported higher levels of preparedness. Conclusions.  Prior to the Centers for Disease Control and Prevention's plan for a tiered approach that identified specific roles for frontline, assessment, and designated treatment facilities, our query of infectious disease physicians suggested that healthcare facilities across the United States were making preparations for screening, diagnosis, and treatment of Ebola patients. Nevertheless, respondents from some hospitals indicated that they were relatively unprepared.

Crossing boundaries: a comprehensive survey of medical licensing laws and guidelines regulating the interstate practice of pathology.

PubMed

Hiemenz, Matthew C; Leung, Stanley T; Park, Jason Y

2014-03-01

In the United States, recent judicial interpretation of interstate licensure laws has found pathologists guilty of malpractice and, more importantly, the criminal practice of medicine without a license. These judgments against pathologists highlight the need for a timely and comprehensive survey of licensure requirements and laws regulating the interstate practice of pathology. For all 50 states, each state medical practice act and state medical board website was reviewed. In addition, each medical board was directly contacted by electronic mail, telephone, or US registered mail for information regarding specific legislation or guidelines related to the interstate practice of pathology. On the basis of this information, states were grouped according to similarities in legislation and medical board regulations. This comprehensive survey has determined that states define the practice of pathology on the basis of the geographic location of the patient at the time of surgery or phlebotomy. The majority of states (n=32) and the District of Columbia allow for a physician with an out-of-state license to perform limited consultation to a physician with the specific state license. Several states (n=5) prohibit physicians from consultation without a license for the specific state. Overall, these results reveal the heterogeneity of licensure requirements between states. Pathologists who either practice in multiple states, send cases to out-of-state consultants, or serve as consultants themselves should familiarize themselves with the medical licensure laws of the states from which they receive or send cases.

Preventing recurrence of severe morning sickness.

PubMed

Koren, Gideon; Maltepe, Caroline

2006-12-01

A recent Motherisk article showed that initiating antinauseants even before symptoms start could prevent recurrence of severe morning sickness. In the study described, however, different physicians used different drugs. How can one be sure which drugs work? The study of 26 women who had had severe morning sickness during previous pregnancies showed that using antiemetics before symptoms of morning sickness started appeared to prevent recurrence of severe morning sickness in subsequent pregnancies. Physicians in the United States used various antinauseant drugs. Physicians in Canada administered only one drug, the combination of doxylamine-pyridoxine (Diclectin), to 12 women. Subanalysis of these 12 women revealed that pre-emptive use of doxylamine-pyridoxine significantly decreased the likelihood that severe morning sickness would recur.

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.

Underrepresentation of Women and Minorities in the United States IR Academic Physician Workforce.

PubMed

Higgins, Mikhail C S S; Hwang, Wei-Ting; Richard, Chase; Chapman, Christina H; Laporte, Angelique; Both, Stefan; Thomas, Charles R; Deville, Curtiland

2016-12-01

To assess the United States interventional radiology (IR) academic physician workforce diversity and comparative specialties. Public registries were used to assess demographic differences among 2012 IR faculty and fellows, diagnostic radiology (DR) faculty and residents, DR subspecialty fellows (pediatric, abdominal, neuroradiology, and musculoskeletal), vascular surgery and interventional cardiology trainees, and 2010 US medical school graduates and US Census using binomial tests with .001 significance level (Bonferroni adjustment for multiple comparisons). Significant trends in IR physician representation were evaluated from 1992 to 2012. Women (15.4%), blacks (2.0%), and Hispanics (6.2%) were significantly underrepresented as IR fellows compared with the US population. Women were underrepresented as IR (7.3%) versus DR (27.8%) faculty and IR fellows (15.4%) versus medical school graduates (48.3%), DR residents (27.8%), pediatric radiology fellows (49.4%), and vascular surgery trainees (27.7%) (all P < .001). IR ranked last in female representation among radiologic subspecialty fellows. Blacks (1.8%, 2.1%, respectively, for IR faculty and fellows); Hispanics (1.8%, 6.2%); and combined American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders (1.8%, 0) showed no significant differences in representation as IR fellows compared with IR faculty, DR residents, other DR fellows, or interventional cardiology or vascular surgery trainees. Over 20 years, there was no significant increase in female or black representation as IR fellows or faculty. Women, blacks, and Hispanics are underrepresented in the IR academic physician workforce relative to the US population. Given prevalent health care disparities and an increasingly diverse society, research and training efforts should address IR physician workforce diversity. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

The role of nurse practitioners in health sector reform in Iran (2011).

PubMed

Vatankhah, Soudabe; Khalesi, Nader; Ebadifardazar, Farbod; Ferdousi, Masoud; Naji, Homayon; Farahabadi, Seyed Mohammad Ehsaan

2013-09-01

Most countries use educated nurses called "nurse practitioners" (NPs) besides the family physicians for diagnosis, treatment, and specifically health education of the family. The main goal of this study was to redefine the role of NPs for better use of their capabilities in the so-called "family physician reform" in Iran. This is a qualitative and comparative study carried out in three stages (triangulation method) in 2011. In the first stage, we conducted a literature review to design a conceptual framework. The second stage was a comparative study on four countries. In this study, we focused on the role of NPs, which in turn helped to redefine this role in the health sector reform of Iran. In the third stage, two expert panels were involved and the suggested roles were confirmed. In the United States, NPs are licensed by the state in which they practice and have a national board certification. In Canada, nurses involved in clinics should participate in specific training course of diagnosis and management of health care after registration. In Austria, nurses in Nursing homes and maternity do some of the medical procedures under the supervision of the physicians. In the United Kingdom, NPs increasingly substitute for GPs in the care of minor illness and routine management of chronic diseases. There is still debate in nursing and medical circles about what the focus of the NP roles should be. In Iran, whereas a noticeable reform toward "family physician" is ongoing, redefining the nurses' role is essential. They can perform more active roles in associating with GPs in the clinics of family physicians, both in urban and rural areas, even with higher degrees of autonomy.

Using the theory of reasoned action to determine physicians' intention to measure body mass index in children and adolescents.

PubMed

Khanna, Rahul; Kavookjian, Jan; Scott, Virginia Ginger; Kamal, Khalid M; Miller, Lesley-Ann N; Neal, William A

2009-06-01

Over the past few decades, childhood obesity has become a major public health issue in the United States. Numerous public and professional organizations recommend that physicians periodically screen for obesity in children and adolescents using the body mass index (BMI). However, studies have shown that physicians infrequently measure BMI in children and adolescents. The purpose of this study was to use the theory of reasoned action (TRA) to explain physicians' intentions to measure BMI in children and adolescents. The study objectives were to (1) determine if attitude and subjective norm predict physicians' intention to measure BMI in children and adolescents; (2) determine if family physicians and pediatricians differ in terms of theoretical factors; and (3) assess differences in behavioral beliefs, outcome evaluations, normative beliefs, and motivation to comply among physicians based on their level of intention to measure BMI. A cross-sectional mailed survey of 2590 physicians (family physicians and pediatricians) practicing in 4 states was conducted. A self-administered questionnaire was designed that included items related to the TRA constructs. The association between the theoretical constructs was examined using correlation and regression analyses. Student's t test was used to determine differences between family physicians and pediatricians on theoretical constructs and to compare the underlying beliefs of nonintenders with intenders. The usable response rate was 22.8%. Less than half (44%) of the physicians strongly intended to measure BMI in children and adolescents. Together, the TRA constructs attitude and subjective norm explained up to 49.9% of the variance in intention. Pediatricians had a significantly (P<.01) higher intention to measure BMI as compared to family physicians. There were significant (P<.01) behavioral and normative belief differences between physicians who intend and those who do not intend to measure BMI. The TRA is a useful model in identifying the factors that are associated with physicians' intentions to measure BMI.

The Development of Sports Medicine.

ERIC Educational Resources Information Center

Waddington, Ivan

1996-01-01

The development of sports medicine was influenced by medicalization and increasing competitiveness in modern sport, with sports physicians helping to develop performance enhancing drugs and techniques. This paper discusses sports medicine and drug use in Eastern European countries, early development of anabolic steroids in the United States, and…

The Long March to Health.

ERIC Educational Resources Information Center

Silver, George A.

1979-01-01

The comprehensive medical care system being utilized in China is described. Topics discussed include: the availability of medical care, training of physicians, medical care costs, and the political and social implications of the Chinese system. Lessons the United States can learn from the Chinese experience are presented. (BT)

Effects of Knowledge, Attitudes, and Practices of Primary Care Providers on Antibiotic Selection, United States

PubMed Central

Roberts, Rebecca M.; Albert, Alison P.; Johnson, Darcia D.; Hicks, Lauri A.

2014-01-01

Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections. Participants were generally familiar with guideline recommendations for antibiotic drug selection for common infections, but did not always comply with them. Reasons for nonadherence included the belief that nonrecommended agents are more likely to cure an infection, concern for patient or parent satisfaction, and fear of infectious complications. Providers inconsistently defined broad- and narrow-spectrum antibiotic agents. There was widespread concern for antibiotic resistance; however, it was not commonly considered when selecting therapy. Strategies to encourage use of first-line agents are needed in addition to limiting unnecessary prescribing of antibiotic drugs. PMID:25418868

Content, Quality, and Assessment Tools of Physician-Rating Websites in 12 Countries: Quantitative Analysis.

PubMed

Rothenfluh, Fabia; Schulz, Peter J

2018-06-14

Websites on which users can rate their physician are becoming increasingly popular, but little is known about the website quality, the information content, and the tools they offer users to assess physicians. This study assesses these aspects on physician-rating websites in German- and English-speaking countries. The objective of this study was to collect information on websites with a physician rating or review tool in 12 countries in terms of metadata, website quality (transparency, privacy and freedom of speech of physicians and patients, check mechanisms for appropriateness and accuracy of reviews, and ease of page navigation), professional information about the physician, rating scales and tools, as well as traffic rank. A systematic Web search based on a set of predefined keywords was conducted on Google, Bing, and Yahoo in August 2016. A final sample of 143 physician-rating websites was analyzed and coded for metadata, quality, information content, and the physician-rating tools. The majority of websites were registered in the United States (40/143) or Germany (25/143). The vast majority were commercially owned (120/143, 83.9%), and 69.9% (100/143) displayed some form of physician advertisement. Overall, information content (mean 9.95/25) as well as quality were low (mean 18.67/47). Websites registered in the United Kingdom obtained the highest quality scores (mean 26.50/47), followed by Australian websites (mean 21.50/47). In terms of rating tools, physician-rating websites were most frequently asking users to score overall performance, punctuality, or wait time in practice. This study evidences that websites that provide physician rating should improve and communicate their quality standards, especially in terms of physician and user protection, as well as transparency. In addition, given that quality standards on physician-rating websites are low overall, the development of transparent guidelines is required. Furthermore, attention should be paid to the financial goals that the majority of physician-rating websites, especially the ones that are commercially owned, pursue. ©Fabia Rothenfluh, Peter J Schulz. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.06.2018.

Expanding primary care capacity by reducing waste and improving the efficiency of care.

PubMed

Shipman, Scott A; Sinsky, Christine A

2013-11-01

Most solutions proposed for the looming shortage of primary care physicians entail strategies that fall into one of three categories: train more, lose fewer, or find someone else. A fourth strategy deserves more attention: waste less. This article examines the remarkable inefficiency and waste in primary care today and highlights practices that have addressed these problems. For example, delegating certain administrative tasks such as managing task lists in the electronic health record can give physicians more time to see additional patients. Flow managers who guide physicians from task to task throughout the clinical day have been shown to improve physicians' efficiency and capacity. Even something as simple as placing a printer in every exam room can save each physician twenty minutes per day. Modest but systemwide improvements could yield dramatic gains in physician capacity while potentially reducing physician burnout and its implications for the quality of care. If widely adopted, small efforts to empower nonphysicians, reengineer workflows, exploit technology, and update policies to eliminate wasted effort could yield the capacity for millions of additional patient visits per year in the United States.

Job satisfaction and motivation among physicians in academic medical centers: insights from a cross-national study.

PubMed

Janus, Katharina; Amelung, Volker E; Baker, Laurence C; Gaitanides, Michael; Schwartz, Friedrich W; Rundall, Thomas G

2008-12-01

Our study assesses how work-related monetary and nonmonetary factors affect physicians' job satisfaction at three academic medical centers in Germany and the United States, two countries whose differing health care systems experience similar problems in maintaining their physician workforce. We used descriptive statistics and factor and correlation analyses to evaluate physicians' responses to a self-administered questionnaire. Our study revealed that German physician respondents were less satisfied overall than their U.S. counterparts. In both countries, participation in decision making that may affect physicians' work was an important correlate of satisfaction. In Germany other important factors were opportunities for continuing education, job security, extent of administrative work, collegial relationships, and access to specialized technology. In the U.S. sample, job security, financial incentives, interaction with colleagues, and cooperative working relationships with colleagues and management were important predictors of overall job satisfaction. The implications of these findings for the development of policies and management tactics to increase physician job satisfaction in German and U.S. academic medical centers are discussed.

Attitudes towards collaboration and servant leadership among nurses, physicians and residents.

PubMed

Garber, Jeannie Scruggs; Madigan, Elizabeth A; Click, Elizabeth R; Fitzpatrick, Joyce J

2009-07-01

A descriptive, comparative study was conducted to examine the attitudes of nurses, physicians and residents towards collaboration and to assess their self-perception of servant leadership characteristics. The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration and the Barbuto-Wheeler Servant Leadership Questionnaire were utilized for data collection. Registered nurses (RNs) (n = 2,660), physicians (n = 447) and residents (n = 171) in a Southeastern United States health system were surveyed via the intranet; there were 497 responses for analysis. The response rate should be considered and generalizations made with caution regarding the study results. RN scores were higher for both total scores and subscales as compared to physician/resident groups for collaboration and servant leadership. There was a weak positive correlation between collaboration and servant leadership in the RN group and no significant correlation between the variables in the physician/resident group. Findings from this study have implications for nursing and physician education and practice and may serve as a framework for future studies. Representative samples are needed to gain further insight and to guide future research.

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

PubMed

Metz, Anneke M

2017-01-01

Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating from medical school, choosing primary care specialties, and working in medically underserved areas. MEDPREP may therefore serve as a model for increasing physician diversity and addressing the needs of medically underserved communities.

Postdoctoral Professional Fellowships in Laboratory Medicine.

PubMed

Straseski, Joely A

2013-04-01

Doctoral level scientists often pursue a traditional academic route, focusing their efforts on research and education. However, additional options exist for those that are interested in using their laboratory and research skills in a clinical setting. Clinical laboratory directors serve as the interface between the clinical laboratory and the users of laboratory test results. This article describes these career paths options for PhD scientists. Clinical laboratory directors are primarily trained via one of two routes: physicians that have been trained in clinical pathology or non-physician doctoral scientists that have completed professional fellowship training. This article will focus on the latter of these 2 routes. In the United States, completing a postdoctoral fellowship in laboratory-specific professional fields qualifies non-physician doctoral scientists as laboratory directors and consultants. Their expert consultation provides invaluable insight into testing procedures such as possible sources of interference or inaccurate test results, preferred testing for specific clinical situations, and confirmatory methods. They must also be knowledgeable about current instrumentation, assay limitations, and the newest available technologies. One of the older and more developed professional fellowships in the United States, clinical chemistry, encompasses many laboratory disciplines and will be highlighted in detail. Training information specific to clinical immunology, clinical microbiology, and clinical genetics is also discussed.

Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment

PubMed Central

Link, Carol L.; Stern, Theodore A.; Piccolo, Rebecca S.; Marceau, Lisa D.; Arber, Sara; Adams, Ann; Siegrist, Johannes; von dem Knesebeck, Olaf

2011-01-01

Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a “patient” with exactly the same symptoms indicative of depression in 3 different health care systems (Germany, the United Kingdom, and the United States). Method: A factorial experiment was conducted between 2001 and 2006 in which 384 randomly selected primary care physicians viewed a video vignette of a patient presenting with symptoms suggestive of depression. Under the supervision of experienced clinicians, professional actors were trained to realistically portray patients who presented with 7 symptoms of depression: sleep disturbance, decreased interest, guilt, diminished energy, impaired concentration, poor appetite, and psychomotor agitation or retardation. Results: Most physicians listed depression as one of their diagnoses (89.6%), but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (P = .0251). American physicians were almost twice as likely to prescribe an antidepressant as British physicians (P = .0241). German physicians were significantly more likely to refer the patient to a mental health professional than British or American physicians (P < .0001). German physicians wanted to see the patient in follow-up sooner than British or American physicians (P < .0001). Conclusions: Primary care physicians in different countries diagnose the exact same symptoms of depression differently depending on the patient's gender. There are also significant differences between countries in the management of a patient with symptoms suggestive of depression. International differences in prevalence rates for depression, and perhaps other diseases, may in part result from differences among health care systems in different countries. PMID:22295269

The Validity of Online Patient Ratings of Physicians: Analysis of Physician Peer Reviews and Patient Ratings.

PubMed

McGrath, Robert J; Priestley, Jennifer Lewis; Zhou, Yiyun; Culligan, Patrick J

2018-04-09

Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as "America's Top Doctors" through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed "Top Doctor" versus those who were not. The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization. ©Robert J McGrath, Jennifer Lewis Priestley, Yiyun Zhou, Patrick J Culligan. Originally published in the Interactive Journal of Medical Research (http://www.i-jmr.org/), 09.04.2018.

"An aristocracy of talent": the South Carolina physician-naturalists and their times.

PubMed

Bryan, Charles S; Whitehead, A Weaver

2014-01-01

During the natural history movement of the 18th and early 19th centuries, Charleston as a center was rivaled in the United States only by Philadelphia, New York, and Boston. Prominent physician-naturalists included Alexander Garden (for whom the gardenia is named), John Edwards Holbrook ("father of American herpetology"), and Francis Peyre Porcher (whose Resources of Southern Fields and Forests helped Confederates compensate for drug shortages). The Charleston physician-naturalists belonged to an "aristocracy of talent" as distinguished from the "aristocracy of wealth" of lowcountry planters, who probably did more than any other group to perpetuate slavery and propel the South toward a disastrous civil war. None of the physician-naturalists actively opposed slavery or secession, a reminder that we are all prisoners of the prevailing paradigms and prejudices of our times.

“An Aristocracy of Talent”: The South Carolina Physician-Naturalists and their Times

PubMed Central

Bryan, Charles S.; Whitehead, A. Weaver

2014-01-01

During the natural history movement of the 18th and early 19th centuries, Charleston as a center was rivaled in the United States only by Philadelphia, New York, and Boston. Prominent physician-naturalists included Alexander Garden (for whom the gardenia is named), John Edwards Holbrook (“father of American herpetology”), and Francis Peyre Porcher (whose Resources of Southern Fields and Forests helped Confederates compensate for drug shortages). The Charleston physician-naturalists belonged to an “aristocracy of talent” as distinguished from the “aristocracy of wealth” of lowcountry planters, who probably did more than any other group to perpetuate slavery and propel the South toward a disastrous civil war. None of the physician-naturalists actively opposed slavery or secession, a reminder that we are all prisoners of the prevailing paradigms and prejudices of our times. PMID:25125748

Ethics, Cultural Competence, and the Changing Face of America

PubMed Central

Chilton, Janice A.

2012-01-01

The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation’s examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine—Anne Fadiman’s The Spirit Catches You And You Fall Down. PMID:23794754

[Organizational forms of emergency medicine in international comparison].

PubMed

Lipp, M

1993-09-01

The tasks of preclinical emergency medicine systems (PEMS) are to stabilize and maintain the vital functions and to guarantee qualified transport to the hospital. Worldwide, different structures exist as a result of historical developments. Legal regulations for PEMS have been introduced in most of the industrialized countries since 1960. More and more aspects have been subject to detailed regulations. PEMS are provided either by state-owned or by state-controlled (private) organisations. In most of the "underdeveloped" countries legal regulations do not exist and PEMS is often provided by social workers, by the army or by volunteers. In most countries, PEMS are financed by the state with a charge on the patient. In a few states PEMS are totally financed by the public health structure. Modern PEMS are controlled from dispatch centres which receive emergency calls (mostly by telephone) and send the appropriate rescue unit. In most states the staff of dispatch centres are paramedics; in some countries and in some urban areas physicians control the dispatch centre. In PEMS without physicians on the scene, an information exchange between the scene and the hospital can be observed frequently, in contrast to systems with physicians on the scene. Worldwide, ground-based PEMS are preferred, but in most countries an additional air rescue system has been established. The quality and quantity of the technical equipment of the ground-based PEMS differ widely: nationwide regulations exist, however, in the USA and Germany. Generally, there are two main concepts concerning the personnel structure: PEMS are either physician based or not. Requirements for emergency physicians differ greatly: in some countries no formal requirements exist, in others extensive practical and theoretical training is required.(ABSTRACT TRUNCATED AT 250 WORDS)

A framework for conducting follow-up meetings with parents after a child's death in the pediatric intensive care unit.

PubMed

Eggly, Susan; Meert, Kathleen L; Berger, John; Zimmerman, Jerry; Anand, Kanwaljeet J S; Newth, Christopher J L; Harrison, Rick; Carcillo, Joseph; Dean, J Michael; Willson, Douglas F; Nicholson, Carol

2011-03-01

To describe a framework to assist pediatric intensive care unit physicians in conducting follow-up meetings with parents after their child's death. Many childhood deaths occur in pediatric intensive care units. Parents of children who die in pediatric intensive care units often desire a follow-up meeting with the physician(s) who cared for their child. Prior research conducted by the Collaborative Pediatric Critical Care Research Network on the experiences and perspectives of bereaved parents and pediatric intensive care unit physicians regarding the desirability, content, and conditions of follow-up meetings. The framework includes suggestions for inviting families to follow-up meetings (i.e., developing an institutional system, invitation timing, and format); preparing for the meeting (i.e., assessing family preferences; determining location, attendees, and discussion topics; reviewing medical and psychosocial history); structure of the meeting (i.e., opening, closing, and developing a meeting agenda); communicating effectively during the meeting; and follow-up for both parents and physicians. This framework is based on the experience and perspectives of bereaved parents and pediatric intensive care unit physicians. Future research should be conducted to determine the extent to which physician-parent follow-up meetings provide a benefit to parents, families, physicians, and other healthcare providers participating in these encounters.

Domestic Sex Trafficking of Minors: Medical Student and Physician Awareness.

PubMed

Titchen, Kanani E; Loo, Dyani; Berdan, Elizabeth; Rysavy, Mary Becker; Ng, Jessica J; Sharif, Iman

2017-02-01

Our aim was to assess: (1) medical trainee and practicing physician awareness about domestic sex trafficking of minors; and (2) whether respondents believe that awareness of trafficking is important to their practice. We designed an anonymous electronic survey, and a convenience sample was collected from June through October 2013. Voluntary participants were 1648 medical students, residents, and practicing physicians throughout the United States. Data were analyzed for correlations between study cohort characteristics and: (1) agreement with the statement: "knowing about sex trafficking in my state is important to my profession"; (2) knowledge of national statistics regarding the sex trafficking of minors; and (3) knowledge of appropriate responses to encountering a trafficked victim. More practicing physicians than residents or medical students: (1) agreed or strongly agreed that knowledge about human trafficking was important to their practice (80.6%, 71.1%, and 69.2%, respectively; P = .0008); (2) correctly estimated the number of US trafficked youth according to the US Department of State data (16.1%, 11.7%, and 7.9%, respectively; P = .0011); and (3) were more likely to report an appropriate response to a trafficked victim (40.4%, 20.4%, and 8.9%, respectively; P = .0001). Although most medical trainees and physicians place importance on knowing about human trafficking, they lack knowledge about the scope of the problem, and most would not know where to turn if they encountered a trafficking victim. There exists a need for standardized trafficking education for physicians, residents, and medical students. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Corporate and Hospital Profiteering in Emergency Medicine: Problems of the Past, Present, and Future.

PubMed

Derlet, Robert W; McNamara, Robert M; Plantz, Scott H; Organ, Matthew K; Richards, John R

2016-06-01

Health care delivery in the United States has evolved in many ways over the past century, including the development of the specialty of Emergency Medicine (EM). With the creation of this specialty, many positive changes have occurred within hospital emergency departments (EDs) to improve access and quality of care of the nation's de facto "safety net." The specialty of EM has been further defined and held to high standards with regard to board certification, sub-specialization, maintenance of skills, and research. Despite these advances, problems remain. This review discusses the history and evolution of for-profit corporate influence on EM, emergency physicians, finance, and demise of democratic group practice. The review also explores federal and state health care financing issues pertinent to EM and discusses potential solutions. The monopolistic growth of large corporate contract management groups and hospital ownership of vertically integrated physician groups has resulted in the elimination of many local democratic emergency physician groups. Potential downsides of this trend include unfair or unlawful termination of emergency physicians, restrictive covenants, quotas for productivity, admissions, testing, patient satisfaction, and the rising cost of health care. Other problems impact the financial outlook for EM and include falling federal, state, and private insurance reimbursement for emergency care, balance-billing, up-coding, unnecessary testing, and admissions. Emergency physicians should be aware of the many changes happening to the specialty and practice of EM resulting from corporate control, influence, and changing federal and state health care financing issues. Copyright © 2016 Elsevier Inc. All rights reserved.

Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence.

PubMed

Twibell, Renee Samples; Siela, Debra; Neal, Alexis; Riwitis, Cheryl; Beane, Heather

Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events. This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation. By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale. Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001). These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.

Sex and values.

PubMed

Renshaw, D C

1978-09-01

Concerned professionals in the United States warn that sexuality is in danger of being dehumanized by a new frankness in the mass media as well as in sex therapy. However, with sensitivity and common sense responsible physicians realize that sexuality and moral values are inextricably interwoven for self as for patients, mandating that excellence of care take this fact into careful account. Sexual ignorance is neither innocence nor bliss. Physicians of all disciplines may make significant contributions by providing understanding leadership and sane sex education to patients as well as to communities in search of information and direction.

Medicare physician payment systems: impact of 2011 schedule on interventional pain management.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Caraway, David L; Benyamin, Ramsin M; Hirsch, Joshua A

2011-01-01

Physicians in the United States have been affected by significant changes in the patterns of medical practice evolving over the last several decades. The recently passed affordable health care law, termed the Patient Protection and Affordable Care Act of 2010 (the ACA, for short) affects physicians more than any other law. Physician services are an integral part of health care. Physicians are paid in the United States for their personal services. This payment also includes the overhead expenses for maintaining an office and providing services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula-based payment, mostly based on the Medicare payment system. Physician services are billed under Part B. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in the Medical Economic Index (MEI). Nevertheless, the policy failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician's charges, which also failed to live up to expectations for operational success. Then, in 1998, the sustainable growth rate (SGR) system was introduced. In 2009, multiple attempts were made by Congress to repeal the formula - rather unsuccessfully. Consequently, the SGR formula continues to hamper physician payments. The mechanism of the SGR includes 3 components that are incorporated into a statutory formula: expenditure targets, growth rate period, and annual adjustments of payment rates for physician services. Further, the relative value of a physician fee schedule is based on 3 components: physician work, practice expense (PE), and malpractice expense that are used to determine a value ranking for each service to which it is applied. On average, the work component represents 53.5% of a service's relative value, the fee component represents 43.6%, and the malpractice component represents 3.9%. The final schedule for physician payment was issued on November 24, 2010. This was based on a total cut of 30.8% with 24.9% of the cut attributed to SGR. However, as usual, with patchwork efficiency, Congress passed a one-year extension of the 0% update, effective through December 2011. Consequently, CMS issued an emergency update of the 2011 Medicare fee schedule, with multiple revisions, resulting in a reduction of the conversion factor of $36.8729 from December 2010 to $33.9764 for 2011.

Race/ethnicity and workplace discrimination: results of a national survey of physicians.

PubMed

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

2009-11-01

Promoting racial/ethnic diversity within the physician workforce is a national priority. However, the extent of racial/ethnic discrimination reported by physicians from diverse backgrounds in today's health-care workplace is unknown. To determine the prevalence of physician experiences of perceived racial/ethnic discrimination at work and to explore physician views about race and discussions regarding race/ethnicity in the workplace. Cross-sectional, national survey conducted in 2006-2007. Practicing physicians (total n = 529) from diverse racial/ethnic backgrounds in the United States. We examined physicians' experience of racial/ethnic discrimination over their career course, their experience of discrimination in their current work setting, and their views about race/ethnicity and discrimination at work. The proportion of physicians who reported that they had experienced racial/ethnic discrimination "sometimes, often, or very often" during their medical career was substantial among non-majority physicians (71% of black physicians, 45% of Asian physicians, 63% of "other" race physicians, and 27% of Hispanic/Latino(a) physicians, compared with 7% of white physicians, all p < 0.05). Similarly, the proportion of non-majority physicians who reported that they experienced discrimination in their current work setting was substantial (59% of black, 39% of Asian, 35% of "other" race, 24% of Hispanic/Latino(a) physicians, and 21% of white physicians). Physician views about the role of race/ethnicity at work varied significantly by respondent race/ethnicity. Many non-majority physicians report experiencing racial/ethnic discrimination in the workplace. Opportunities exist for health-care organizations and diverse physicians to work together to improve the climate of perceived discrimination where they work.

Religion and Spiritual Care in Pediatric Intensive Care Unit: Parental Attitudes Regarding Physician Spiritual and Religious Inquiry.

PubMed

Arutyunyan, Tsovinar; Odetola, Folafoluwa; Swieringa, Ryan; Niedner, Matthew

2018-01-01

Parents of seriously ill children require attention to their spiritual needs, especially during end-of-life care. The objective of this study was to characterize parental attitudes regarding physician inquiry into their belief system. Materials and Main Results: A total of 162 surveys from parents of children hospitalized for >48 hours in pediatric intensive care unit in a tertiary academic medical center were analyzed. Forty-nine percent of all respondents and 62% of those who identified themselves as moderate to very spiritual or religious stated that their beliefs influenced the decisions they made about their child's medical care. Although 34% of all respondents would like their physician to ask about their spiritual or religious beliefs, 48% would desire such enquiry if their child was seriously ill. Those who identified themselves as moderate to very spiritual or religious were most likely to welcome the discussion ( P < .001). Two-thirds of the respondents would feel comforted to know that their child's physician prayed for their child. One-third of all respondents would feel very comfortable discussing their beliefs with a physician, whereas 62% would feel very comfortable having such discussions with a chaplain. The study findings suggest parental ambivalence when it comes to discussing their spiritual or religious beliefs with their child's physicians. Given that improved understanding of parental spiritual and religious beliefs may be important in the decision-making process, incorporation of the expertise of professional spiritual care providers may provide the optimal context for enhanced parent-physician collaboration in the care of the critically ill child.

Bronchoscopy Simulation: A Brief Review

ERIC Educational Resources Information Center

Davoudi, Mohsen; Colt, Henri G.

2009-01-01

More than 500,000 flexible bronchoscopies are performed annually by chest physicians in the United States (Ernst et al., Chest 123:1693-1717, 2003). Indications include diagnosis of lung cancer and airway tumors, benign strictures, pulmonary infections, and treatment of central airway obstruction, emphysema, and intraepithelial lesions such as…

Nutrition in the Curriculum: Medical Experience.

ERIC Educational Resources Information Center

Shils, Maurice E.

1990-01-01

A review of current curricula in United States medical schools indicates a continued need for more adequate instruction of clinical nutrition to physicians in training and in practice. A major problem is failure to provide patient-oriented, case-related teaching in clinical years to all clinical clerks. (Author/MSE)

ADD and Physicians.

ERIC Educational Resources Information Center

Hewick, Walter; And Others

In the United States today Attention Deficit Disorder (ADD) is recognized by professionals as a distinct disorder, a neurobiological disability marked by inattentiveness, impulsivity, and hyperactivity. About 2-10% of school-age children suffer from ADD, making it an issue of rising concern to families and school leaders. It is necessary that…

Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

PubMed

Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

2017-06-01

Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

Physicians' Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.

PubMed

Yasaitis, Laura C; Pajerowski, William; Polsky, Daniel; Werner, Rachel M

2016-08-01

Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physicians' participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physicians' participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education-compared to other areas-had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations' access to physicians participating in ACOs may not be as great as access for other groups, which could exacerbate existing disparities in health care quality. Project HOPE—The People-to-People Health Foundation, Inc.

Risk management in obstetric care for family physicians: results of a 10-year project.

PubMed

Nesbitt, Thomas S; Hixon, Allen; Tanji, Jeffrey L; Scherger, Joseph E; Abbott, Dana

2003-01-01

Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.

Clinical Criteria for Physician Aid in Dying.

PubMed

Orentlicher, David; Pope, Thaddeus Mason; Rich, Ben A

2016-03-01

More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID. Their proposal was carefully considered and temperate, but there were little data on the practice of AID at the time. (With AID, a physician writes a prescription for life-ending medication for a terminally ill, mentally capacitated adult.) With the passage of time, a substantial body of data on AID has developed from the states of Oregon and Washington. For more than 17 years, physicians in Oregon have been authorized to provide a prescription for AID. Accordingly, we have updated the clinical criteria of Quill, et al., based on the many years of experience with AID. With more jurisdictions authorizing AID, it is critical that physicians can turn to reliable clinical criteria. As with any medical practice, AID must be provided in a safe and effective manner. Physicians need to know (1) how to respond to a patient's inquiry about AID, (2) how to assess patient decision making capacity, and (3) how to address a range of other issues that may arise. To ensure that physicians have the guidance they need, Compassion & Choices convened the Physician Aid-in-Dying Clinical Criteria Committee, in July 2012, to create clinical criteria for physicians who are willing to provide AID to patients who request it. The committee includes experts in medicine, law, bioethics, hospice, nursing, social work, and pharmacy. Using an iterative consensus process, the Committee drafted the criteria over a one-year period.

Medical Device Regulation: A Comparison of the United States and the European Union.

PubMed

Maak, Travis G; Wylie, James D

2016-08-01

Medical device regulation is a controversial topic in both the United States and the European Union. Many physicians and innovators in the United States cite a restrictive US FDA regulatory process as the reason for earlier and more rapid clinical advances in Europe. The FDA approval process mandates that a device be proved efficacious compared with a control or be substantially equivalent to a predicate device, whereas the European Union approval process mandates that the device perform its intended function. Stringent, peer-reviewed safety data have not been reported. However, after recent high-profile device failures, political pressure in both the United States and the European Union has favored more restrictive approval processes. Substantial reforms of the European Union process within the next 5 to 10 years will result in a more stringent approach to device regulation, similar to that of the FDA. Changes in the FDA regulatory process have been suggested but are not imminent.

The Impact of Financial Incentives on Physician Productivity in Medical Groups

PubMed Central

Conrad, Douglas A; Sales, Anne; Liang, Su-Ying; Chaudhuri, Anoshua; Maynard, Charles; Pieper, Lisa; Weinstein, Laurel; Gans, David; Piland, Neill

2002-01-01

Objective To estimate the effect of financial incentives in medical groups—both at the level of individual physician and collectively—on individual physician productivity. Data Sources/Study Setting Secondary data from 1997 on individual physician and group characteristics from two surveys: Medical Group Management Association (MGMA) Physician Compensation and Production Survey and the Cost Survey; Area Resource File data on market characteristics, and various sources of state regulatory data. Study Design Cross-sectional estimation of individual physician production function models, using ordinary least squares and two-stage least squares regression. Data Collection Data from respondents completing all items required for the two stages of production function estimation on both MGMA surveys (with RBRVS units as production measure: 102 groups, 2,237 physicians; and with charges as the production measure: 383 groups, 6,129 physicians). The 102 groups with complete data represent 1.8 percent of the 5,725 MGMA member groups. Principal Findings Individual production-based physician compensation leads to increased productivity, as expected (elasticity=.07, p<.05). The productivity effects of compensation methods based on equal shares of group net income and incentive bonuses are significantly positive (p<.05) and smaller in magnitude. The group-levelfinancial incentive does not appear to be significantly related to physician productivity. Conclusions Individual physician incentives based on own production do increase physician productivity. PMID:12236389

Prescription drug monitoring programs in the United States of America

PubMed Central

Félix, Sausan El Burai; Mack, Karin

2015-01-01

SYNOPSIS Since the late 1990s, the number of opioid analgesic overdose deaths has quadrupled in the United States of America (from 4 030 deaths in 1999 to 16 651 in 2010). The objectives of this article are to provide an overview of the problem of prescription drug overdose in the United States and to discuss actions that could help reduce the problem, with particular attention to the characteristics of prescription drug monitoring programs (PDMPs). These programs consist of state-level databases that monitor controlled substances. The information compiled in the databases is at the disposal of authorized persons (e.g., physicians, pharmacists, and other health-care providers) and may be used only for professional purposes. Suppliers can use such information to prevent interaction with other drugs or therapeutic duplication, or to identify drug-search behavior. Law enforcement agencies can use these programs to identify improper drug prescription or dispensing patterns, or drug diversion. PMID:25563153

Perceived effects of attending physician workload in academic medical intensive care units: a national survey of training program directors.

PubMed

Ward, Nicholas S; Read, Richard; Afessa, Bekele; Kahn, Jeremy M

2012-02-01

Increases in the size and number of American intensive care units have not been accompanied by a comparable increase in the critical care physician workforce, raising concerns that intensivists are becoming overburdened by workload. This is especially concerning in academic intensive care units where attending physicians must couple teaching duties with patient care. We performed an in-person and electronic survey of the membership of the Association of Pulmonary and Critical Care Medicine Program Directors, soliciting information about patient workload, other hospital and medical education duties, and perceptions of the workplace and teaching environment of their intensive care units. Eighty-four out of a total 121 possible responses were received from program directors or their delegates, resulting in a response rate of 69%. The average daily (SD) census (as perceived by the respondents) was 18.8 ± 8.9 patients, and average (SD) maximum service size recalled was 24.1 ± 9.9 patients. Twenty-seven percent reported no policy setting an upper limit for the daily census. Twenty-eight percent of respondents felt the average census was "too many" and 71% felt the maximum size was "too many." The median (interquartile range) patient-to-attending physician ratio was 13 (10-16). When categorized according to this median, respondents from intensive care units with high patient/physician ratios (n = 31) perceived significantly more time constraints, more stress, and difficulties with teaching trainees than respondents with low patient/physician ratios (n = 40). The total number of non-nursing healthcare workers per patient was similar in both groups, suggesting that having more nonattending physician staff does not alleviate perceptions of overwork and stress in the attending physician. Academic intensive care unit physicians that direct fellowship programs frequently perceived being overburdened in the intensive care unit. Understaffing intensive care units with attending physicians may have a negative impact on teaching, patient care, and workforce stability.

Should Physicians Have Facial Piercings?

PubMed Central

Newman, Alison W; Wright, Seth W; Wrenn, Keith D; Bernard, Aline

2005-01-01

OBJECTIVE The objective of this study was to assess attitudes of patrons and medical school faculty about physicians with nontraditional facial piercings. We also examined whether a piercing affected the perceived competency and trustworthiness of physicians. DESIGN Survey. SETTING Teaching hospital in the southeastern United States. PARTICIPANTS Emergency department patrons and medical school faculty physicians. INTERVENTIONS First, patrons were shown photographs of models with a nontraditional piercing and asked about the appropriateness for a physician or medical student. In the second phase, patrons blinded to the purpose of the study were shown identical photographs of physician models with or without piercings and asked about competency and trustworthiness. The third phase was an assessment of attitudes of faculty regarding piercings. MEASUREMENTS AND MAIN RESULTS Nose and lip piercings were felt to be appropriate for a physician by 24% and 22% of patrons, respectively. Perceived competency and trustworthiness of models with these types of piercings were also negatively affected. An earring in a male was felt to be appropriate by 35% of patrons, but an earring on male models did not negatively affect perceived competency or trustworthiness. Nose and eyebrow piercings were felt to be appropriate by only 7% and 5% of faculty physicians and working with a physician or student with a nose or eyebrow piercing would bother 58% and 59% of faculty, respectively. An ear piercing in a male was felt to be appropriate by 20% of faculty, and 25% stated it would bother them to work with a male physician or student with an ear piercing. CONCLUSIONS Many patrons and physicians feel that some types of nontraditional piercings are inappropriate attire for physicians, and some piercings negatively affect perceived competency and trustworthiness. Health care providers should understand that attire may affect a patient's opinion about their abilities and possibly erode confidence in them as a clinician. PMID:15836523

Career Counseling as Experienced by Practicing Black Ophthalmologists.

ERIC Educational Resources Information Center

Gaines, Victor Pryor

This study was an effort to understand the phenomenal dearth of black physicians in the United States, particularly in the specialty of ophthalmology, and to determine to what extent practicing ophthalmologists had had exposure to professional career counseling. A questionnaire was sent to a random sample of black ophthalmologists to acquire…

Goldenseal (Hydrastis canadensis): an annotated bibliography

Treesearch

Mary L. Predny; James L. Chamberlain

2005-01-01

Goldenseal (Hydrastis Canadensis), a member of the buttercup family (Ranunculaceae), is an herbaceous perennial found in rich hardwood forests throughout the Northeastern United States and Canada. Originally used by Native Americans as both a medicine and a dye, the herb was eventually adopted by the settlers and eclectic physicians in the 19th...

Eskimo Medicine Man.

ERIC Educational Resources Information Center

George, Otto

"Eskimo Medicine Man" is a record of primitive Alaskan life in the 1930's. It records the experiences in Alaska's remote areas of Dr. Otto George, the last "traveling physician" for the Department of Interior's Indian Service, when in all the territory (an area one-fifth that of the contiguous United States) there were fewer…

Meals Served in Public Schools.

ERIC Educational Resources Information Center

Vivigal, Lisa

The Physicians Committee for Responsible Medicine (PCRM) contacted public school districts around the United States to determine if they offered low-fat, healthful meals. The PCRM ranked the schools according to whether they served low-fat and vegetarian meals daily, whether these meals varied through the week, and whether children needed to…

Understanding Disadvantage among Medical School Applicants

ERIC Educational Resources Information Center

Espinoza-Shanahan, Crystal C.

2016-01-01

The United States is a nation of peoples with highly stratified degrees of healthcare access and coverage, including many individuals with none at all. Exacerbating the problem of widespread health disparities is a persistent shortage of physicians over recent decades. Of most urgency is the need for doctors within already underserved minority…

The education, role, distribution, and compensation of physician assistants in orthopedic surgery.

PubMed

Chalupa, Robyn L; Hooker, Roderick S

2016-05-01

Physician assistants (PAs) have worked alongside surgeons since the 1970s, yet little is known about their postgraduate education, roles, distribution, and compensation. In 2015, an estimated 8,900 PAs were employed in orthopedics (9.4% of all clinically active PAs in the United States). This study analyzed surveys undertaken by Physician Assistants in Orthopaedic Surgery (PAOS) from 2009 to 2015 and found that most PAs working in orthopedics (85%) reported regularly assisting in surgery. Demand for PAs in orthopedics is expected to grow because of population growth, increasing incidence of musculoskeletal conditions, shortages of surgeons, and changing technology. Improved data acquisition and more detailed analyses are needed to better understand the nature of this specialized workforce.

Pilot Survey of Physician Assistants Regarding Lesbian, Gay, Bisexual, and Transgender Providers Suggests Role for Workplace Nondiscrimination Policies.

PubMed

Ewton, Tiffany A; Lingas, Elena O

2015-12-01

Lesbian, gay, bisexual, and transgender (LGBT) medical providers in the United States have historically faced discrimination from their peers. To assess current workplace culture and attitudes, and to evaluate awareness of workplace and professional policies regarding LGBT discrimination, we sent a cross-sectional survey to 163 PAs (Physician Assistants). Respondents had an overall positive attitude towards LGBT providers, yet the majority was not aware of relevant policy statements (>60%). A significant association existed between policy awareness and LGBT inclusivity (P<.025) and confidence reporting anti-gay harassment (P=.017). Despite improved societal attitudes toward LGBT providers, non-discriminatory work environments for LGBT physician assistants may relate to greater awareness of specific workplace policy standards.

Liability issues in managed care.

PubMed

Ellis, M S

1997-05-01

The explosive growth in Managed Care Organizations as a mechanism for providing health care in the United States has generated an equal explosion in litigation and new legislation related to problems within this delivery system. Abuses have included the "gagging" of physicians from providing full disclosure of medical options for their patients, inappropriate denial of care, denial of specialty referral, false claims data, insurer insolvency, economic credentialling, deselection, financial disincentives to render care, and lack of appeal or grievance mechanisms. These issues and others have resulted in injuries to patients and damage to the patient/physician relationship. This article discusses some of the more dramatic litigated cases and endeavors to alert both physicians and patients to potential legal matters that should be considered before becoming involved within this structure.

Preventing recurrence of severe morning sickness

PubMed Central

Koren, Gideon; Maltepe, Caroline

2006-01-01

QUESTION A recent Motherisk article showed that initiating antinauseants even before symptoms start could prevent recurrence of severe morning sickness. In the study described, however, different physicians used different drugs. How can one be sure which drugs work? ANSWER The study of 26 women who had had severe morning sickness during previous pregnancies showed that using antiemetics before symptoms of morning sickness started appeared to prevent recurrence of severe morning sickness in subsequent pregnancies. Physicians in the United States used various antinauseant drugs. Physicians in Canada administered only one drug, the combination of doxylamine-pyridoxine (Diclectin®), to 12 women. Subanalysis of these 12 women revealed that pre-emptive use of doxylamine-pyridoxine significantly decreased the likelihood that severe morning sickness would recur. PMID:17279232

Perspectives of Somali Bantu refugee women living with circumcision in the United States: a focus group approach.

PubMed

Upvall, Michele J; Mohammed, Khadra; Dodge, Pamela D

2009-03-01

The purpose of this study was to explore healthcare perspectives of Somali Bantu refugees in relation to their status as women who have been circumcised and recently resettled in the United States. These women and their families were already uprooted from Somalia to Kenya for over 10 years, increasing their vulnerability and marginal status beyond that of women who have been circumcised. A purposive, inclusive sample of 23 resettled Somali women in southwestern Pennsylvania of the United States participated in focus group sessions for data collection. A supplemental interview with a physician who provided care to the women was also conducted. Verbatim audio taped transcripts from the focus groups and physician interview were coded into primary and secondary levels. Implications for development of culturally competent healthcare providers include attention to providing explanations for routine clinic procedures and accepting the Somali women regardless of anatomical difference, not focusing on the circumcision. Healthcare providers must also develop their skills in working with interpreters and facilitate trust to minimize suspicion of the health care system. Circumcision is considered a normal part of everyday life for the Somali Bantu refugee woman. Communication skills are fundamental to providing culturally competent care for these women. Finally, healthcare providers must take responsibility for acquiring knowledge of the Somali women's challenges as refugees living with circumcision and as immigrants in need of healthcare services.

Status of Adults With X-Linked Agammaglobulinemia

PubMed Central

Winkelstein, Jerry A.; Conley, Mary Ellen; James, Cynthia; Howard, Vanessa; Boyle, John

2010-01-01

Since many children with X-linked agammaglobulinemia (XLA) can now be expected to reach adulthood, knowledge of the status of adults with XLA would be of importance to the patients, their families, and the physicians caring for these patients. We performed the current study in adults with XLA to examine the impact of XLA on their daily lives and quality of life, their educational and socioeconomic status, their knowledge of the inheritance of their disorder, and their reproductive attitudes. Physicians who had entered adult patients with XLA in a national registry were asked to pass on a survey instrument to their patients. The patients then filled out the survey instrument and returned it directly to the investigators. Adults with XLA were hospitalized more frequently and missed more work and/or school than did the general United States population. However, their quality of life was comparable to that of the general United States population. They achieved a higher level of education and had a higher income than did the general United States population. Their knowledge of the inheritance of their disease was excellent. Sixty percent of them would not exercise any reproductive planning options as a result of their disease. The results of the current study suggest that although the disease impacts the daily lives of adults with XLA, they still become productive members of society and excel in many areas. PMID:18794707

Work stress of primary care physicians in the US, UK and German health care systems.

PubMed

Siegrist, Johannes; Shackelton, Rebecca; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-07-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. Copyright 2010 Elsevier Ltd. All rights reserved.

Work stress of primary care physicians in the US, UK and German health care systems

PubMed Central

Siegrist, Johannes; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-01-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005–2007. Results demonstrate country-specific differences in work stress- with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. PMID:20494505

Indian medical students' views on immigration for training and practice.

PubMed

Rao, Nyapati R; Rao, Uttam K; Cooper, Richard A

2006-02-01

To assess the attitudes of medical students in India about participating in graduate medical education in the United States and other countries and in subsequent clinical practice in those countries. A total of 240 students who were attending their final year at two medical schools in Bangalore, India, were surveyed during 2004. Surveys were completed by 166 (69%) of the students. Among the responding students, 98 (59%) thought of leaving India for further training abroad. Of those who wished to leave, 41 (42%) preferred the United States, 42 (43%) preferred the United Kingdom, and 9 (9%) preferred Canada, Australia or New Zealand. Only two students preferred the Middle East. Most who favored training in the United States indicated that they intended to remain after training, whereas fewer than 20% of those who favored training in the United Kingdom had such intentions. While more than 60% perceived greater professional opportunities in the United States than in India, approximately 75% were concerned that the United States had become less welcoming after the terrorist attacks of 9/11, and similar numbers were concerned about the examination administered by the Educational Commission on Foreign Medical Graduates. Conversely, the majority of respondents felt that opportunities for physicians in India were improving. While optimism about future medical careers in India is increasing, the interest of Indian medical students in training and subsequently practicing in the United States remains high.

The Alignment and Blending of Payment Incentives within Physician Organizations

PubMed Central

Robinson, James C; Shortell, Stephen M; Li, Rui; Casalino, Lawrence P; Rundall, Thomas

2004-01-01

Objective To analyze the blend of retrospective (fee-for-service, productivity-based salary) and prospective (capitation, nonproductivity-based salary) methods for compensating individual physicians within medical groups and independent practice associations (IPAs) and the influence of managed care on the compensation blend used by these physician organizations. Data Sources Of the 1,587 medical groups and IPAs with 20 or more physicians in the United States, 1,104 responded to a one-hour telephone survey, with 627 providing detailed information on physician payment methods. Study Design We calculated the distribution of compensation methods for primary care and specialty physicians, separately, in both medical groups and IPAs. Multivariate regression methods were used to analyze the influence of market and organizational factors on the payment method developed by physician organizations for individual physicians. Principal Findings Within physician organizations, approximately one-quarter of physicians are paid on a purely retrospective (fee-for-service) basis, approximately one-quarter are paid on a purely prospective (capitation, nonproductivity-based salary) basis, and approximately one-half on blends of retrospective and prospective methods. Medical groups and IPAs in heavily penetrated managed care markets are significantly less likely to pay their individual physicians based on fee-for-service than are organizations in less heavily penetrated markets. Conclusions Physician organizations rely on a wide range of prospective, retrospective, and blended payment methods and seek to align the incentives faced by individual physicians with the market incentives faced by the physician organization. PMID:15333124

A framework for conducting follow-up meetings with parents after a child's death in the pediatric intensive care unit*

PubMed Central

Eggly, Susan; Berger, John; Zimmerman, Jerry; Anand, Kanwaljeet J. S.; Newth, Christopher J. L.; Harrison, Rick; Carcillo, Joseph; Dean, J. Michael; Willson, Douglas F.; Nicholson, Carol

2012-01-01

Objective To describe a framework to assist pediatric intensive care unit physicians in conducting follow-up meetings with parents after their child's death. Many childhood deaths occur in pediatric intensive care units. Parents of children who die in pediatric intensive care units often desire a follow-up meeting with the physician(s) who cared for their child. Data Sources Prior research conducted by the Collaborative Pediatric Critical Care Research Network on the experiences and perspectives of bereaved parents and pediatric intensive care unit physicians regarding the desirability, content, and conditions of follow-up meetings. Results The framework includes suggestions for inviting families to follow-up meetings (i.e., developing an institutional system, invitation timing, and format); preparing for the meeting (i.e., assessing family preferences; determining location, attendees, and discussion topics; reviewing medical and psychosocial history); structure of the meeting (i.e., opening, closing, and developing a meeting agenda); communicating effectively during the meeting; and follow-up for both parents and physicians. Conclusion This framework is based on the experience and perspectives of bereaved parents and pediatric intensive care unit physicians. Future research should be conducted to determine the extent to which physician-parent follow-up meetings provide a benefit to parents, families, physicians, and other healthcare providers participating in these encounters. PMID:20625339

Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis.

PubMed

Freeman, Thomas R; Petterson, Stephen; Finnegan, Sean; Bazemore, Andrew

2016-12-01

The relative ease of movement of physicians across the Canada/US border has led to what is sometimes referred to as a 'brain drain' and previous analysis estimated that the equivalent of two graduating classes from Canadian medical schools were leaving to practice in the US each year. Both countries fill gaps in physician supply with international medical graduates (IMGs) so the movement of Canadian trained physicians to the US has international ramifications. Medical school enrolments have been increased on both sides of the border, yet there continues to be concerns about adequacy of physician human resources. This analysis was undertaken to re-examine the issue of Canadian physician migration to the US. We conducted a cross-sectional analysis of the 2015 American Medical Association (AMA) Masterfile to identify and locate any graduates of Canadian schools of medicine (CMGs) working in the United States in direct patient care. We reviewed annual reports of the Canadian Resident Matching Service (CaRMS); the Canadian Post-MD Education Registry (CAPER); and the Canadian Collaborative Centre for Physician Resources (C3PR). Beginning in the early 1990s the number of CMGs locating in the U.S. reached an all-time high and then abruptly dropped off in 1995. CMGs are going to the US for post-graduate training in smaller numbers and, are less likely to remain than at any time since the 1970's. This four decade retrospective found considerable variation in the migration pattern of CMGs to the US. CMGs' decision to emigrate to the U.S. may be influenced by both 'push' and 'pull' factors. The relative strength of these factors changed and by 2004, more CMGs were returning from abroad than were leaving and the current outflow is negligible. This study supports the need for medical human resource planning to assume a long-term view taking into account national and international trends to avoid the rapid changes that were observed. These results are of importance to medical resource planning.

Management of Helicobacter Pylori in the United States: Results from a national survey of gastroenterology physicians.

PubMed

Murakami, Traci T; Scranton, Rebecca A; Brown, Heidi E; Harris, Robin B; Chen, Zhao; Musuku, Sunitha; Oren, Eyal

2017-07-01

We sought to determine current knowledge and practices among gastroenterology physicians and assess adherence to current guidelines for H. pylori management. Online surveys were distributed in 2014 to practicing gastroenterology physicians for information related to the diagnosis and treatment of H. pylori infection. A total of 582 completed surveys were reviewed. The H. pylori screening test used "almost always" was gastric biopsy obtained during endoscopy (histology) (59%) followed by stool antigen test (20%). Standard triple therapy for 14days was commonly prescribed by 53% of respondents. The stool antigen test was most frequently chosen to confirm H. pylori eradication (51%), although only 58% of physicians checked for eradication in patients who underwent treatment. Adherence to current American College of Gastroenterology guidelines is low. Although more physicians treat patients with a positive H. pylori test, only half ensure eradication after treatment. Improving knowledge of the resistance patterns of H. pylori may be critical to ensure successful eradication. Copyright © 2017 Elsevier Inc. All rights reserved.

Commentary: improving the supply and distribution of primary care physicians.

PubMed

Dorsey, E Ray; Nicholson, Sean; Frist, William H

2011-05-01

The current medical education system and reimbursement policies in the United States have contributed to a maldistribution of physicians by specialty and geography. The causes of this maldistribution include financial barriers that prevent the individuals who would be the most likely to serve in primary care and underserved areas from entering the profession, large taxpayer subsidies to teaching hospitals that provide incentives to act in ways that are not in the best interest of society, and reimbursement policies that discourage physicians from providing primary care. The authors propose that the maldistribution of physicians can be addressed successfully by reducing the financial barriers to becoming a primary care physician, aligning subsidies with societal interests, and providing financial incentives that target primary care. They suggest that the Patient Protection and Affordable Care Act of 2010 takes steps in the right direction but that more financially prudent measures should be taken as politicians revisit health care reform with heightened financial scrutiny. Copyright © by the Association of American medical Colleges.

Economic Expansion Is a Major Determinant of Physician Supply and Utilization

PubMed Central

Cooper, Richard A; Getzen, Thomas E; Laud, Prakash

2003-01-01

Objective To assess the relationship between levels of economic development and the supply and utilization of physicians. Data Sources Data were obtained from the American Medical Association, American Osteopathic Association, Organization for Economic Cooperation and Development (OECD), Bureau of Health Professions, Bureau of Labor Statistics, Bureau of Economic Analysis, Census Bureau, Health Care Financing Administration, and historical sources. Study Design Economic development, expressed as real per capita gross domestic product (GDP) or personal income, was correlated with per capita health care labor and physician supply within countries and states over periods of time spanning 25–70 years and across countries, states, and metropolitan statistical areas (MSAs) at multiple points in time over periods of up to 30 years. Longitudinal data were analyzed in four complementary ways: (1) simple univariate regressions; (2) regressions in which temporal trends were partialled out; (3) time series comparing percentage differences across segments of time; and (4) a bivariate Granger causality test. Cross-sectional data were assessed at multiple time points by means of univariate regression analyses. Principal Findings Under each analytic scenario, physician supply correlated with differences in GDP or personal income. Longitudinal correlations were associated with temporal lags of approximately 5 years for health employment and 10 years for changes in physician supply. The magnitude of changes in per capita physician supply in the United States was equivalent to differences of approximately 0.75 percent for each 1.0 percent difference in GDP. The greatest effects of economic expansion were on the medical specialties, whereas the surgical and hospital-based specialties were affected to a lesser degree, and levels of economic expansion had little influence on family/general practice. Conclusions Economic expansion has a strong, lagged relationship with changes in physician supply. This suggests that economic projections could serve as a gauge for projecting the future utilization of physician services. PMID:12785567

Comparison of Plastic Surgery Residency Training in United States and China.

PubMed

Zheng, Jianmin; Zhang, Boheng; Yin, Yiqing; Fang, Taolin; Wei, Ning; Lineaweaver, William C; Zhang, Feng

2015-12-01

Residency training is internationally recognized as the only way for the physicians to be qualified to practice independently. China has instituted a new residency training program for the specialty of plastic surgery. Meanwhile, plastic surgery residency training programs in the United States are presently in a transition because of restricted work hours. The purpose of this study is to compare the current characteristics of plastic surgery residency training in 2 countries. Flow path, structure, curriculum, operative experience, research, and evaluation of training in 2 countries were measured. The number of required cases was compared quantitatively whereas other aspects were compared qualitatively. Plastic surgery residency training programs in 2 countries differ regarding specific characteristics. Requirements to become a plastic surgery resident in the United States are more rigorous. Ownership structure of the regulatory agency for residency training in 2 countries is diverse. Training duration in the United States is more flexible. Clinical and research training is more practical and the method of evaluation of residency training is more reasonable in the United States. The job opportunities after residency differ substantially between 2 countries. Not every resident has a chance to be an independent surgeon and would require much more training time in China than it does in the United States. Plastic surgery residency training programs in the United States and China have their unique characteristics. The training programs in the United States are more standardized. Both the United States and China may complement each other to create training programs that will ultimately provide high-quality care for all people.

Acculturation Needs of Pediatric International Medical Graduates: A Qualitative Study.

PubMed

Osta, Amanda D; Barnes, Michelle M; Pessagno, Regina; Schwartz, Alan; Hirshfield, Laura E

2017-01-01

Phenomenon: International medical graduates (IMGs) play a key role in host countries' health systems but face unique challenges, which makes effective, tailored support for IMGs essential. Prior literature describing the acculturation needs of IMGs focused primarily on communication content and style. We conducted a qualitative study to explore acculturation that might be specific to IMG residents who care for children. In a study conducted from November 2011 to April 2012, we performed four 90-minute semistructured focus groups with 26 pediatric IMG residents from 12 countries. The focus group transcripts were analyzed using open and focused coding methodology. The focus groups and subsequent analysis demonstrated that pediatric IMG residents' socialization to their home culture impacts their transition to practice in the United States; they must adjust not only to a U.S. culture, different from their own, but also to the culture of medicine in the United States. We identified the following new acculturation themes: understanding the education system and family structure, social determinants of health, communication with African American parents, contraception, physician handoffs, physicians' role in prevention, adolescent health, and physicians' role in child advocacy. We further highlight the acculturation challenges faced by pediatric IMG residents and offer brief recommendations for the creation of a deliberate acculturation curriculum for pediatric IMG residents. Insight: Residency training is a unique period in physicians' personal and professional development and can be particularly challenging for IMGs. There is a significant gap in the identified acculturation needs and the current curricula available to IMG residents who care for children.

Who do you prefer? A study of public preferences for health care provider type in performing cutaneous surgery and cosmetic procedures in the United States.

PubMed

Bangash, Haider K; Ibrahimi, Omar A; Green, Lawrence J; Alam, Murad; Eisen, Daniel B; Armstrong, April W

2014-06-01

The public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States. An internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures. Three hundred fifty-four respondents undertook the survey. Dermatologists were identified as the most preferable health care provider to evaluate and biopsy worrisome lesions on the face (69.8%), perform skin cancer surgery on the back (73.4%), perform skin cancer surgery on the face (62.7%), and perform laser procedures (56.3%) by most of the respondents. For filler injections, the responders similarly identified plastic surgeons and dermatologists (47.3% vs 44.6%, respectively) as the most preferred health care provider. For botulinum toxin injections, there was a slight preference for plastic surgeons followed by dermatologists (50.6% vs 38.4%). Plastic surgeons were the preferred health care provider for procedures such as liposuction (74.4%) and face-lift surgery (96.1%) by most of the respondents. Dermatologists are recognized as the preferred health care providers over plastic surgeons, primary care physicians, general surgeons, and nurse practitioners/physician's assistants to perform a variety of cutaneous cosmetic and surgical procedures including skin cancer surgery, on the face and body, and laser procedures. The general public expressed similar preferences for dermatologists and plastic surgeons regarding filler injections.

E-Cigarette Advice to Patients From Physicians and Dentists in the United States.

PubMed

Drouin, Olivier; McMillen, Robert C; Klein, Jonathan D; Winickoff, Jonathan P

2018-06-01

To report on adults' recall of discussion by physicians and dentists about e-cigarettes. A nationally representative cross-sectional survey (Internet and random digit dialing) in the United States. Adults who ever used e-cigarettes. Participant-reported discussion about the potential benefits and harms of e-cigarettes with their doctor, dentist, or child's doctor in the past 12 months. Fisher exact test for the analysis between benefits and harms for each type of provider and for rates of advice between provider types. Among the 3030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those who had seen their doctor, dentist, or child's doctor in the last year, 7.3%, 1.7%, and 10.1%, respectively, reported discussing potential harms of e-cigarettes. Conversely, 5.8%, 1.7%, and 9.3% of patients who had seen their doctor, dentist, or child's doctor in the last year reported that the clinician discussed the potential benefits of e-cigarettes. Each clinician type was as likely to discuss harms as benefits. Rates of advice were similar between doctors and child's doctors but lower for dentists. Rates were comparable when the analysis was limited to current e-cigarette users, participants with children, or those who reported using both e-cigarettes and combusted tobacco. Few physicians and dentists discuss either the harms or benefits of e-cigarettes with their patients. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.

Montana's courting of physician aid in dying. Could Des Moines follow suit?

PubMed

Svenson, Arthur G

2010-09-01

Montana recently joined Oregon and Washington as the only states in the nation to legalize the choice among terminally ill adults to hasten death by self-administering a lethal dose of drugs prescribed by a physician. Unlike Oregon and Washington, however, Montana's legalization of physician aid in dying (PAID) resulted not from public consideration of a statewide initiative, but from the judicial resolution of a lawsuit, Baxter v. Montana. As originally conceived, a trial judge reasoned that the unenumerated right to PAID is embraced by enumerated state constitutional rights to privacy and dignity. On appeal, Montana's supreme court jettisoned this construct, and, in its place, fashioned a legal home for PAID out of state homicide, consent defense, and end-of-life statutes. Central to this court's statutory rendering is the finding that state law, allowing terminally ill Montanans sustained by life support to withdraw such treatment and die, discriminates against terminally ill Montanans not sustained by life support who seek death; these classes are similar, the justices reckoned, entitling both to choose death. This analysis examines Montana's courting of PAID, offering textual examination of state trial and appellate court opinions, an accounting of legal strategies advanced in amici curiae briefs, and commentary about the problems and prospects with Baxter's holding. I argue, ultimately, that the equality principles statutorily conceived in Baxter (1) could be parroted in the vast majority of states that both criminalize assisted suicide and enumerate constitutional equal protection guarantees, and (2) could replace sub silentio the equal protection paradigm applied to "physician-assisted suicide" by the United States Supreme Court in its landmark Vacco v. Quill ruling.

An economic analysis of payment for health care services: the United States and Switzerland compared.

PubMed

Zweifel, Peter; Tai-Seale, Ming

2009-06-01

This article seeks to assess whether physician payment reforms in the United States and Switzerland were likely to attain their objectives. We first introduce basic contract theory, with the organizing principle being the degree of information asymmetry between the patient and the health care provider. Depending on the degree of information asymmetry, different forms of payment induce "appropriate" behavior. These theoretical results are then pitted against the RBRVS of the United States to find that a number of its aspects are not optimal. We then turn to Switzerland's Tarmed and find that it fails to conform with the prescriptions of economic contract theory as well. The article closes with a review of possible reforms that could do away with uniform fee schedules to improve the performance of the health care system.

Antioxidant and Associated Capacities of Camu Camu (Myrciaria dubia): A Systematic Review

PubMed Central

Langley, Paul C.; Pergolizzi, Joseph V.; Taylor, Robert

2015-01-01

Abstract An aging population in the United States presents important challenges for patients and physicians. The presence of inflammation can contribute to an accelerated aging process, the increasing presence of comorbidities, oxidative stress, and an increased prevalence of chronic pain. As patient-centered care is embracing a multimodal, integrative approach to the management of disease, patients and physicians are increasingly looking to the potential contribution of natural products. Camu camu, a well-researched and innovative natural product, has the potential to contribute, possibly substantially, to this management paradigm. The key issue is to raise camu camu's visibility through increased emphasis on its robust evidentiary base and its various formulations, as well as making consumers, patients, and physicians more aware of its potential. A program to increase the visibility of camu camu can contribute substantially not only to the management of inflammatory conditions and its positive contribution to overall good health but also to its potential role in many disease states. PMID:25275221

Antioxidant and associated capacities of Camu camu (Myrciaria dubia): a systematic review.

PubMed

Langley, Paul C; Pergolizzi, Joseph V; Taylor, Robert; Ridgway, Caroline

2015-01-01

An aging population in the United States presents important challenges for patients and physicians. The presence of inflammation can contribute to an accelerated aging process, the increasing presence of comorbidities, oxidative stress, and an increased prevalence of chronic pain. As patient-centered care is embracing a multimodal, integrative approach to the management of disease, patients and physicians are increasingly looking to the potential contribution of natural products. Camu camu, a well-researched and innovative natural product, has the potential to contribute, possibly substantially, to this management paradigm. The key issue is to raise camu camu's visibility through increased emphasis on its robust evidentiary base and its various formulations, as well as making consumers, patients, and physicians more aware of its potential. A program to increase the visibility of camu camu can contribute substantially not only to the management of inflammatory conditions and its positive contribution to overall good health but also to its potential role in many disease states.

National health insurance in America--can we practice with it? Can we continue to practice without it?

PubMed Central

Grumbach, K

1989-01-01

Health insurance in the United States is failing patients and physicians alike. In this country 37 million uninsured face economic barriers to care, and the health of many suffers as a result. The "corporatization" of medical care threatens professional values with an unprecedented administrative and commercial intrusion into the daily practice of medicine. Competitive strategies have also failed their most ostensible goal--cost control. In contrast, Canada offers a model of a national health insurance plan that provides universal and comprehensive coverage, succeeds at restraining health care inflation, and does little to abrogate the clinical autonomy of physicians in private practice. I propose that American physicians relent in their historical opposition to national health insurance and participate in the development of a universal, public insurance plan responsive to the needs of both patients and physicians. Images PMID:2672604

Senior academic physicians and retirement considerations.

PubMed

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

2013-01-01

An increasing number of academic senior physicians are approaching their potential retirement in good health with accumulated clinical and research experience that can be a valuable asset to an academic institution. Considering the need to let the next generation ascend to leadership roles, when and how should a medical career be brought to a close? We explore the roles for academic medical faculty as they move into their senior years and approach various retirement options. The individual and institutional considerations require a frank dialogue among the interested parties to optimize the benefits while minimizing the risks for both. In the United States there is no fixed age for retirement as there is in Europe, but European physicians are initiating changes. What is certain is that careful planning, innovative thinking, and the incorporation of new patterns of medical practice are all part of this complex transition and timing of senior academic physicians into retirement. Copyright © 2013 Elsevier Inc. All rights reserved.

Physician training in aerospace medicine--an historical review in the United States.

PubMed

Doarn, Charles R; Mohler, Stanley R

2013-02-01

The training of U.S. physicians in aviation medicine closely followed the development of reliable airplanes. This training has matured as aviation and space travel have become more routine over the past several decades. In the U.S., this training began in support of military pilots who were flying increasingly complex aircraft in the early part of the 20th century. As individuals reached into the stratosphere, low Earth orbit, and eventually to the Moon, physicians were trained not only through military efforts but in academic settings as well. This paper provides an historical summary of how physician training in aerospace medicine developed in the U.S., citing both the development of the military activities and, more importantly, the perspectives of the academic programs. This history is important as we move forward in the development of commercial space travel and the needs that such a business model will be required to meet.

The "art" of medicine and the "smokescreen" of the randomized trial off-label use of vascular devices.

PubMed

Ansel, Gary M; Jaff, Michael R

2008-12-01

Once a device is approved for sale in the United States by the Food and Drug Administration (FDA), it can legally be used by doctors to treat any condition a physician determines is medically appropriate. Based on postmarket published data and physician procedural experience, this may even become the standard of care when an alternative device either does not exist or is inferior in performance, even before FDA approval. This right of physicians to practice medicine without FDA approval is Federal law. The off-label use of medical devices for the treatment of peripheral vascular disease has recently become the latest target by groups with interests that have little to do with patient care. This interference has begun to negatively impact the latitude necessary for physicians to best treat their patients. Copyright 2008 Wiley-Liss, Inc.

MACRA: A New Age for Physician Payments.

PubMed

Huston, Kent Kwasind

2017-04-01

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 introduced a new system of physician payments in the United States. This legislation and the complex rules written to enact the law intend to force a shift away from volume-based payments and into so called value-based payments. Physicians and other clinicians will be graded via quality and cost metrics and payments will be adjusted based on performance. Robust use of certified electronic health records is required under MACRA. Physicians will follow one of two payment reform tracks known as the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) pathways. Although there are rheumatology and other specialty specific quality measures in the MIPS program, there are no rheumatology specific APMs to date. A thorough understating of MACRA is required for medical practices to survive the new era of payment reform.

Animal rights and animal experimentation. Implications for physicians.

PubMed Central

Gelpi, A. P.

1991-01-01

Practicing physicians are just becoming aware of the animal rights movement, which during the 1980s spawned numerous acts of violence against research facilities throughout the United States. The animal rightists are challenging physicians to show moral justification for the human exploitation of nature and the world of subhuman species. They have aroused public interest in animal welfare, sparked protective legislation for experimental animals, and indirectly encouraged the creation of committees to oversee the conduct of animal experimentation and the conditions of animal confinement. This controversy has necessitated a closer look at the questions of animal experimentation and animal rights against the backdrop of human experimentation and human rights. Physicians and specialists in animal care seek to alleviate suffering and anxiety, and, as moderates, they may be able to bring both sides of the animal rights controversy together in a spirit of mutual tolerance and in the common cause of promoting both human and animal welfare. PMID:1949772

Funding of Graduate Medical Education in a Market-Based Healthcare System.

PubMed

Schuster, Barbara L

2017-02-01

The graduate medical education (GME) process in the United States is considered the most respected model for high-quality education of graduate physicians in the world. With substantial funding through government and private insurers and through structured educational accreditation standards, the American Board of Medical Specialists-certified physicians are recognized for their expertise in delivering high-quality medical care. However, under fiscal constraints and changing social expectations, questions are continually posed about the process of funding and whether the "physician outcomes" are sufficient to continue with the investment. This article reviews the history of postgraduate physician education, the multiple funding pathways, disruptions to a placid educational system and changing social expectations. The ultimate issues involve the core goals of GME and how much GME should shoulder responsibility for changing the healthcare system. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Media images of physicians and nurses in the United States.

PubMed

Krantzler, N J

1986-01-01

This paper analyzes images of physicians and nurses presented in advertisements in the medical and nursing journals JAMA (Journal of the American Medical Association) and AJN (American Journal of Nursing). Advertisements are viewed as hyper-ritualized displays of symbols and rituals associated with medical and nursing practice, both reflecting and reaffirming stereotypes and beliefs that are widely held in the society at large. Trends over the past few decades show that medical advertisements are dropping some traditional symbols (such as the white coat and stethoscope) in favor of depicting science-in-action and high technology. Nursing advertisements, however, are more frequently utilizing the symbols formerly reserved for physicians. Both physicians and nurses are depicted in their respective journals as existing largely independent of one another. While these advertisements clearly do not depict social reality, they present a fictionalized version which reflects and reproduces some of the expressed ideals in medical and nursing practice.

Physician/chemist/geologist: Charles Thomas Jackson's life of conflict and controversy

USGS Publications Warehouse

Landa, E.R.

1995-01-01

After a brief medical career, Charles Thomas Jackson (1805-1880) began work as a consulting chemist and geologist in Boston. He serves as State Geologist in Maine, Rhode Island, and New Hampshire from 1837 to 1884, and completed geological surveys of those States. In 1847, he was appointed United States Geologist to undertake a survey of the public lands of the Lake Superior region of Michigan. This survey was beset by strife, and Jackson was forced to resign in 1849. -from Author

Dehydration treatment practices among pediatrics-trained and non-pediatrics trained emergency physicians.

PubMed

Nunez, Jeranil; Liu, Deborah R; Nager, Alan L

2012-04-01

We sought to survey emergency physicians in the United States regarding the management of pediatric dehydration secondary to acute gastroenteritis. We hypothesized that responses from physicians with dedicated pediatric training (PT), that is, board certification in pediatrics or pediatric emergency medicine, would differ from responses of physicians with no dedicated pediatric training (non-PT). An anonymous survey was mailed to randomly selected members of the American College of Emergency Physicians and sent electronically to enrollees of Brown University pediatric emergency medicine listserv. The survey consisted of 17 multiple-choice questions based on a clinical scenario depicting a 2-year-old with acute gastroenteritis and moderate dehydration. Questions asked related to treatment preferences, practice setting, and training information. One thousand sixty-nine surveys were received: 997 surveys were used for data analysis, including 269 PT physicians and 721 non-PT physicians. Seventy-nine percent of PT physicians correctly classified the scenario patient as moderately dehydrated versus 71% of non-PT physicians (P = 0.063). Among those who correctly classified the patient, 121 PT physicians (58%) and 350 non-PT physicians (68%) would initially hydrate the patient with intravenous fluids. Pediatrics-trained physicians were more likely to initially choose oral or nasogastric hydration compared with non-PT physicians (P = 0.0127). Pediatrics-trained physicians were less likely to perform laboratory testing compared with the non-PT group (n = 92, 45%, vs n = 337, 66%; P < 0.0001). Contrary to established recommendations for the management of moderately dehydrated children, significantly more PT physicians, compared with non-PT physicians, follow established guidelines.

Physician survey examining the impact of an educational tool for responsible opioid prescribing.

PubMed

Young, Aaron; Alfred, Kelly C; Davignon, Philip P; Hughes, LaSharn M; Robin, Lisa A; Chaudhry, Humayun J

2012-01-01

In response to the need for physician education on proper opioid prescribing, the Federation of State Medical Boards (FSMB) and the FSMB Foundation, the philanthropic arm of the FSMB, commissioned and distributed Responsible Opioid Use: A Physician's Guide to more than 165, 000 licensed physicians in the United States. The book, written by pain management specialist Scott Fishman, MD, seeks tofurtherphysicians' continuing medical education by providing information on how to properly prescribe opioids to treat patients in pain. Although the book has been widely distributed, there have been no systematic studies of its impact. To address this knowledge gap, the authors surveyed licensed physicians in Georgia who received a copy of the book to determine whether it added to their knowledge about prescribing opioids, and if they planned to make changes in theirpractice based on reading the book. Six weeks after licensed physicians in Georgia received the book, a survey was sent to 12,666 of them via e-mail. A total of508 physicians completed the online survey. Of these, 82.1 percent rated the book either "very good" or "good" on providing pragmatic steps for improved care forpatients in pain, and more than 80 percent agreed that the book is a useful educational tool. Almost one-third (32.2percent) claimed that they intend to make changes to theirpractice after reading the book. The analysis also showed physicians in a solo practice were more likely to make changes (41.8percent) than their counterparts in office-based group practice (33.3 percent) and hospital-based (25.0 percent) settings. Primary care providers (41.6 percent) were also much more likely to make changes than physicians working in other specialty areas of medicine (22.8 percent). Well over half (57. 7percent) of the respondents indicated the book was better than other publications they had read on opioid prescribing and pain management. The results from this state-wide survey of licensed physicians demonstrate the value of educating physicians about how to appropriately prescribe, document, and treat patients who need opioid medications for pain management. The findings should be of value to organizations seeking to better educate physicians about appropriate opioid prescribing by providing insight into which physician population would be the most receptive to the type of information presented in Dr. Fishman's book. When faced with limited resources, an organizational strategy that first targets solo and primary care practitioners may improve physician educational efforts about prescribing opioids better than a strategy targeting medical and surgical specialists or those physicians participating in group practice settings.

Slow progressive acceptance of intravenous thrombolysis for patients with stroke by rural primary care physicians.

PubMed

Leira, Enrique C; Pary, Jennifer K; Davis, Patricia H; Grimsman, Karla J; Adams, Harold P

2007-04-01

In the rural United States, patients with stroke are usually first evaluated locally by a nonneurologist physician (NNP) before treatment is determined. To determine the evolution of NNPs' familiarity and attitudes about using recombinant tissue plasminogen activator (rtPA) since this therapy has been approved. Cross-sectional design using 2 similar surveys mailed in 1997 and 2003 to all primary care, family, internal, and emergency medicine physicians in the state of Iowa (1582 and 1679 physicians, respectively). All NNPs (primary care, internal, and emergency medicine) practicing in the state of Iowa. Comparison of 1997 and 2003 aggregate responses to questions about familiarity and willingness to use rtPA to treat patients who have had an acute ischemic stroke. The willingness of NNPs to use rtPA to treat acute ischemic stroke increased from 18% to 32% between 1997 and 2003. The number of NNPs who were very familiar with the National Institutes of Health Stroke Scale increased from 1% to 13%. Compared with physicians in 1997, more physicians in 2003 knew that prolonged international normalized ratios (42% vs 61%) or excessively high blood pressures (61% vs 78%) were contraindications for the use of rtPA. Still, half of the respondents perceived that they were inadequately exposed to educational material about rtPA during these years. Most expressed preference for personal methods of delivery for future educational efforts. The familiarity and comfort among NNPs with the administration of rtPA is still relatively low in rural settings. The improvement observed between the years 1997 and 2003 is encouraging. The responses suggest that NNPs' acceptance of rtPA can be further improved with educational campaigns involving personal methods of delivery.

Physician leadership development at Cleveland Clinic: a brief review.

PubMed

Christensen, Terri; Stoller, James K

2016-06-01

We aim to describe the rationale for and spectrum of leadership development programs, highlighting experience at a large healthcare institution (Cleveland Clinic, Cleveland, Ohio, USA). Developing leaders is a universal priority to sustain organizational success. In health care, significant challenges of ensuring quality and access and making care affordable are widely shared internationally and demand effective physician leadership. Yet, leadership competencies differ from clinical and scientific competencies and features of selecting and training physicians-who have been called "heroic lone healers" -often conspire against physicians being effective leaders or followers. Thus, developing leadership competencies in physicians is critical.Leadership development programs have been signature features of successful organizations and various Australian organizations offer such training (e.g. The Australian Leadership Foundation and the University of South Australia), but relatively few health care organizations have adopted the practice of offering such training, both in Australia and elsewhere. As a United States example of one such integrated program, the Cleveland Clinic, a large, closed-staff physician-led group practice in Cleveland, Ohio has offered physician leadership training for over 15 years. This paper describes the rationale, structure, and some of the observed impacts associated with this program. © The Royal Australian and New Zealand College of Psychiatrists 2016.

The Elusive Standard of Care.

PubMed

Cooke, Brian K; Worsham, Elizabeth; Reisfield, Gary M

2017-09-01

In medical negligence cases, the forensic expert must explain to a trier of fact what a defendant physician should have done, or not done, in a specific set of circumstances and whether the physician's conduct constitutes a breach of duty. The parameters of the duty are delineated by the standard of care. Many facets of the standard of care have been well explored in the literature, but gaps remain in a complete understanding of this concept. We examine the standard of care, its origins, and who determines the prevailing standard, beginning with an overview of the historical roots of the standard of care and, using case law, tracing its evolution from the 19th century through the early 21st century. We then analyze the locality rule and consider local, state, and national standards of care. The locality rule requires a defendant physician to provide the same degree of skill and care that is required of a physician practicing in the same or similar community. This rule remains alive in some jurisdictions in the United States. Last, we address the relationship between the standard of care and clinical practice guidelines. © 2017 American Academy of Psychiatry and the Law.

Towards Patient-Centered Conflicts of Interest Policy

PubMed Central

Young, Peter D.; Xie, Dawei; Schmidt, Harald

2018-01-01

Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians’ medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians’ reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. We set out to explore user awareness of the database and the ease of accessibility to disclosed information, however, as we show, both awareness and actual use are very low. Two practical policies can greatly enhance its intended function and help alleviate ethical tension. The first is to provide data for individual physicians not merely in absolute terms, but in meaningful context, that is, in relation to the zip code, city, and state averages. The second increases access to the OPP dataset by adding hyperlinks from physicians’ professional websites directly to their Open Payments disclosure pages. These changes considerably improve transparency and the utility of available data, and can furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices. PMID:29524935

EKG analysis skills of family practice residents in the United Arab Emirates: a comparison with US data.

PubMed

Margolis, S; Reed, R

2001-06-01

Concern has been raised about the electrocardiogram (EKG) analysis skills of family practice residents in the United States. This study examined EKG analysis skills of family practice residents, medical students, interns, and general practitioners (GPs) in the United Arab Emirates (UAE), a different environment. The measurement instrument was a set of 10 EKGs, used in a study of US family practice residents. Two of the EKGs were normal, and there were 14 clinical abnormalities in the remainder. There was no significant difference in the correct diagnosis of acute myocardial infarction between US family practice residents and UAE family practice residents, medical students, or GPs. Interns' diagnoses were significantly poorer. The mean score for correctly identifying acute myocardial infarction and both normal EKGs was not significantly different between groups: 2.50 medical students, 2.35 interns, 2.58 UAE family practice residents, 2.67 FD, and 2.55 US family practice residents. However, the US family practice resident mean score of 11.26 for all 16 clinical findings was significantly higher than any group in the UAE: 5.35 medical students, 5.87 interns, 6.08 UAE family practice residents, 5.69 family physicians. Difficulty in EKG interpretation transcends geographic boundaries, suggesting that new approaches to teaching these skills need to be explored. Improved EKG reading skills by family physicians are generally needed in both the United States and the UAE.

Knowledge and Attitude of ER and Intensive Care Unit Physicians toward Do-Not-Resuscitate in a Tertiary Care Center in Saudi Arabia: A Survey Study.

PubMed

Gouda, Alaa; Alrasheed, Norah; Ali, Alaa; Allaf, Ahmad; Almudaiheem, Najd; Ali, Youssuf; Alghabban, Ahmad; Alsalolami, Sami

2018-04-01

Only a few studies from Arab Muslim countries address do-not-resuscitate (DNR) practice. The knowledge of physicians about the existing policy and the attitude towards DNR were surveyed. The objective of this study is to identify the knowledge of the participants of the local DNR policy and barriers of addressing DNR including religious background. A questionnaire has been distributed to Emergency Room (ER) and Intensive Care Unit (ICU) physicians. A total of 112 physicians mostly Muslims (97.3%). About 108 (96.4%) were aware about the existence of DNR policy in our institute. 107 (95.5%) stated that DNR is not against Islamic. Only (13.4%) of the physicians have advance directives and (90.2%) answered they will request to be DNR if they have terminal illness. Lack of patients and families understanding (51.8%) and inadequate training (35.7%) were the two most important barriers for effective DNR discussion. Patients and families level of education (58.0%) and cultural factors (52.7%) were the main obstacles in initiating a DNR order. There is a lack of knowledge about DNR policy which makes the optimization of DNR process difficult. Most physicians wish DNR for themselves and their patients at the end of life, but only a few of them have advance directives. The most important barriers for initializing and discussing DNR were lack of patient understanding, level of education, and the culture of patients. Most of the Muslim physicians believe that DNR is not against Islamic rules. We suggest that the DNR concept should be a part of any training program.

Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention.

PubMed

Schneider, Suzanne; Kingsolver, Karen; Rosdahl, Jullia

2014-01-01

Physicians in the United States increasingly confront stress, burnout, and other serious symptoms at an alarming level. As a result, there is growing public interest in the development of interventions that improve physician resiliency. The aim of this study is to evaluate the perceived impact of Physician Well-being Coaching on physician stress and resiliency, as implemented in a major medical center. Semi-structured interviews were conducted with 11 physician-participants, and three coaches of a Physician Well-being Coaching pilot focused on three main areas: life context, impacts of coaching, and coaching process. Interviewees were physicians who completed between three and eight individual coaching sessions between October 2012 and May 2013 through the Physician Well-being Coaching pilot program. Qualitative content analysis of the 11 physician interviews and three coach interviews using Atlas.ti to generate patterns and themes. Physician Well-being Coaching helped participants increase resilience via skill and awareness development in the following three main areas: (1) boundary setting and prioritization, (2) self-compassion and self-care, and (3) self-awareness. These insights often led to behavior changes and were perceived by physicians to have indirect but positive impact on patient care. Devaluing self-care while prioritizing the care of others may be a significant, but unnecessary, source of burnout for physicians. This study suggests that coaching can potentially help physicians alter this pattern through skill development and increased self-awareness. It also suggests that by strengthening physician self-care, coaching can help to positively impact patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

Prescription data mining, medical privacy and the First Amendment: the U.S. Supreme Court in Sorrell v. IMS health Inc.

PubMed

Boumil, Marcia M; Dunn, Kaitlyn; Ryan, Nancy; Clearwater, Katrina

2012-01-01

In 2011, the United States Supreme Court in Sorrell v. IMS Health Inc. struck down a Vermont law that would restrict the ability of pharmaceutical companies to purchase certain physician-identifiable prescription data without the consent of the prescriber. The law's stated purpose was threefold: to protect the privacy of medical information, to protect the public health and to contain healthcare costs by promoting Vermont's preference in having physicians prescribe more generic drugs. The issue before the Supreme Court was whether the Vermont law represented a legitimate, common sense regulatory program or a bold attempt to suppress commercial speech when the "message" is disfavored by the state. Striking down the law, the Supreme Court applied a heightened level of First Amendment scrutiny to this commercial transaction and held that the Vermont law was not narrowly tailored to protect legitimate privacy interests.

Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States.

PubMed

Wegwarth, Odette; Schwartz, Lisa M; Woloshin, Steven; Gaissmaier, Wolfgang; Gigerenzer, Gerd

2012-03-06

Unlike reduced mortality rates, improved survival rates and increased early detection do not prove that cancer screening tests save lives. Nevertheless, these 2 statistics are often used to promote screening. To learn whether primary care physicians understand which statistics provide evidence about whether screening saves lives. Parallel-group, randomized trial (randomization controlled for order effect only), conducted by Internet survey. (ClinicalTrials.gov registration number: NCT00981019) National sample of U.S. primary care physicians from a research panel maintained by Harris Interactive (79% cooperation rate). 297 physicians who practiced both inpatient and outpatient medicine were surveyed in 2010, and 115 physicians who practiced exclusively outpatient medicine were surveyed in 2011. Physicians received scenarios about the effect of 2 hypothetical screening tests: The effect was described as improved 5-year survival and increased early detection in one scenario and as decreased cancer mortality and increased incidence in the other. Physicians' recommendation of screening and perception of its benefit in the scenarios and general knowledge of screening statistics. Primary care physicians were more enthusiastic about the screening test supported by irrelevant evidence (5-year survival increased from 68% to 99%) than about the test supported by relevant evidence (cancer mortality reduced from 2 to 1.6 in 1000 persons). When presented with irrelevant evidence, 69% of physicians recommended the test, compared with 23% when presented with relevant evidence (P < 0.001). When asked general knowledge questions about screening statistics, many physicians did not distinguish between irrelevant and relevant screening evidence; 76% versus 81%, respectively, stated that each of these statistics proves that screening saves lives (P = 0.39). About one half (47%) of the physicians incorrectly said that finding more cases of cancer in screened as opposed to unscreened populations "proves that screening saves lives." Physicians' recommendations for screening were based on hypothetical scenarios, not actual practice. Most primary care physicians mistakenly interpreted improved survival and increased detection with screening as evidence that screening saves lives. Few correctly recognized that only reduced mortality in a randomized trial constitutes evidence of the benefit of screening. Harding Center for Risk Literacy, Max Planck Institute for Human Development.

Oncologist Support for Consolidated Payments for Cancer Care Management in the United States.

PubMed

Narayanan, Siva; Hautamaki, Emily

2016-07-01

The cost of cancer care in the United States continues to rise, with pressure on oncologists to provide high-quality, cost-effective care while maintaining the financial stability of their practice. Existing payment models do not typically reward care coordination or quality of care. In May 2014, the American Society of Clinical Oncology (ASCO) released a payment reform proposal (revised in May 2015) that includes a new payment structure for quality-of-care performance metrics. To assess US oncologists' perspectives on and support for ASCO's payment reform proposal, and to determine use of quality-of-care metrics, factors influencing their perception of value of new cancer drugs, the influence of cost on treatment decisions, and the perceptions of the reimbursement climate in the country. Physicians and medical directors specializing in oncology in the United States practicing for at least 2 years and managing at least 20 patients with cancer were randomly invited, from an online physician panel, to participate in an anonymous, cross-sectional, 15-minute online survey conducted between July and November 2014. The survey assessed physicians' level of support for the payment reform, use of quality-of-care metrics, factors influencing their perception of the value of a new cancer drug, the impact of cost on treatment decision-making, and their perceptions of the overall reimbursement climate. Descriptive statistics (chi-square tests and t-tests for discrete and continuous variables, respectively) were used to analyze the data. Logistic regression models were constructed to evaluate the main payment models described in the payment reform proposal. Of the 231 physicians and medical directors who participated in this study, approximately 50% strongly or somewhat supported the proposed payment reform. Stronger support was seen among survey respondents who were male, who rated the overall reimbursement climate as excellent/good, who have a contract with a commercial payer that reimburses for dispensed oral cancer drugs, or who practice in a hospital setting. The use of at least 1 quality-of-care metric was more common among respondents participating in an accountable care organization (ACO) than among those not participating in an ACO (92.6% vs 83.2%, respectively; P = .0380). The most common metric used by the physicians in their practice setting was patient satisfaction scores (60.1%). Accountability for delivering high-quality care was supported by 74.9% of respondents; those who practice in a hospital setting were twice as likely as those in private practice to support accountability for quality of care (81.3% vs 67.6%; odds ratio, 2.1; P = .0176). Support for ASCO's payment reform proposal is mixed among oncology physicians and medical directors, underscoring the importance of continuous and broader engagement of practicing physicians around the country via outreach and dialogue on topics that impact their clinical practices, as well as providing education or awareness activities by ASCO to its membership.

Variation in Emergency Department vs Internal Medicine Excess Charges in the United States.

PubMed

Xu, Tim; Park, Angela; Bai, Ge; Joo, Sarah; Hutfless, Susan M; Mehta, Ambar; Anderson, Gerard F; Makary, Martin A

2017-08-01

Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen (median, 5.0; IQR, 3.5-6.7 for ≥20% uninsured), and location (median, 5.3; IQR, 3.8-6.8 for the southeastern United States). Across hospitals, there is wide variation in excess charges on ED services, which are often priced higher than internal medicine services. Our results inform policy efforts to protect uninsured and out-of-network patients from highly variable pricing.

Nurses' perspectives on the intersection of safety and informed decision making in maternity care.

PubMed

Jacobson, Carrie H; Zlatnik, Marya G; Kennedy, Holly Powell; Lyndon, Audrey

2013-01-01

To explore maternity nurses' perceptions of women's informed decision making during labor and birth to better understand how interdisciplinary communication challenges might affect patient safety. Constructivist grounded theory. Four hospitals in the western United States. Forty-six (46) nurses and physicians practicing in maternity units. Data collection strategies included individual interviews and participant observation. Data were analyzed using the constant comparative method, dimensional analysis, and situational analysis (Charmaz, 2006; Clarke, 2005; Schatzman, 1991). The nurses' central action of holding off harm encompassed three communication strategies: persuading agreement, managing information, and coaching of mothers and physicians. These strategies were executed in a complex, hierarchical context characterized by varied practice patterns and relationships. Nurses' priorities and patient safety goals were sometimes misaligned with those of physicians, resulting in potentially unsafe communication. The communication strategies nurses employed resulted in intended and unintended consequences with safety implications for mothers and providers and had the potential to trap women in the middle of interprofessional conflicts and differences of opinion. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

The Utility of Teleultrasound to Guide Acute Patient Management.

PubMed

Becker, Christian; Fusaro, Mario; Patel, Dhruv; Shalom, Isaac; Frishman, William H; Scurlock, Corey

Ultrasound has evolved into a core bedside tool for diagnostic and management purposes for all subsets of adult and pediatric critically-ill patients. Teleintensive care unit coverage has undergone a similar rapid expansion period throughout the United States. Round-the-clock access to ultrasound equipment is very common in today's intensive care unit, but 24/7 coverage with staff trained to acquire and interpret point-of-care ultrasound in real time is lagging behind equipment availability. Medical trainees and physician extenders require attending level supervision to ensure consistent image acquisition and accurate interpretation. Teleintensivists can extend the utility of ultrasound by supervising and guiding providers without or with only partial training in ultrasound, and also by extending direct trainee ultrasound supervision to time periods when no direct bedside attending supervisor is available, and when treatment decisions otherwise would have been made without supervision and feedback on image acquisition and interpretation. Nursing staff without ultrasound training can also be directed to perform basic ultrasound exams, which may have immediate diagnostic and/or treatment consequences, thereby overcoming access barriers in the absence of physicians or physician extenders. We discuss 4 real-life clinical scenarios in which teleintensivist supervision extended and standardized bedside ultrasound exams to guide management decisions which significantly impacted patient outcomes.

Life insurance, living benefits, and physician-assisted death.

PubMed

Parker, Frederick R; Rubin, Harvey W; Winslade, William J

2004-01-01

One of the most significant concerns about the legalization of physician-assisted death in the United States relates to the possibility that a chronically or terminally ill person would choose to end her or his life for financial reasons. Because we believe that the life insurance industry is uniquely poised to help minimize any such incentive, we submit that it has a moral obligation to do so. In particular, we propose that the industry encourage greater flexibility in the payout of policy benefits in the event an insured should be diagnosed with a terminal illness or suffer from intractable pain.

The History of Preconception Care: Evolving Guidelines and Standards

PubMed Central

Moos, Merry-K.; Curtis, Michele

2006-01-01

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail. PMID:16710764

The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

PubMed

Pines, Jesse M

2006-05-01

Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.

American physicians and dual loyalty obligations in the "war on terror"

PubMed Central

Singh, Jerome Amir

2003-01-01

Background Post-September 11, 2001, the U.S. government has labeled thousands of Afghan war detainees "unlawful combatants". This label effectively deprives these detainees of the protection they would receive as "prisoners of war" under international humanitarian law. Reports have emerged that indicate that thousands of detainees being held in secret military facilities outside the United States are being subjected to questionable "stress and duress" interrogation tactics by U.S. authorities. If true, American military physicians could be inadvertently becoming complicit in detainee abuse. Moreover, the American government's openly negative views towards such detainees could result in military physicians not wanting to provide reasonable care to detainees, despite it being their ethical duty to do so. Discussion This paper assesses the physician's obligations to treat war detainees in the light of relevant instruments of international humanitarian law and medical ethics. It briefly outlines how detainee abuse flourished in apartheid South Africa when state physicians became morally detached from the interests of their detainee patients. I caution U.S physicians not to let the same mindset befall them. I urge the U.S. medical community to advocate for detainee rights in the U.S, regardless of the political culture the detainee emerged from. I offer recommendations to U.S physicians facing dual loyalty conflicts of interest in the "war on terror". Summary If U.S. physicians are faced with a conflict of interest between following national policies or international principles of humanitarian law and medical ethics, they should opt to adhere to the latter when treating war detainees. It is important for the U.S. medical community to speak out against possible detainee abuse by the U.S. government. PMID:12892567

Oregon's Death With Dignity Act: 20 Years of Experience to Inform the Debate.

PubMed

Hedberg, Katrina; New, Craig

2017-10-17

Twenty years ago, Oregon voters approved the Death With Dignity Act, making Oregon the first state in the United States to allow physicians to prescribe medications to be self-administered by terminally ill patients to hasten their death. This report summarizes the experience in Oregon, including the numbers and types of participating patients and providers. These data should inform the ongoing policy debate as additional jurisdictions consider such legislation.

Dietary Management in Hyperlipidemia. Nutrition in Primary Care Series, Number 12.

ERIC Educational Resources Information Center

Gallagher-Allred, Charlette R.; Townley, Nancy A.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Dietary Management in Obesity. Nutrition in Primary Care Series, Number 9.

ERIC Educational Resources Information Center

Gallagher-Allred, Charlette R.; Townley, Nancy A.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

For the Health-Care Work Force, a Critical Prognosis

ERIC Educational Resources Information Center

Rahn, Daniel W.; Wartman, Steven A.

2007-01-01

The United States faces a looming shortage of many types of health-care professionals, including nurses, physicians, dentists, pharmacists, and allied-health and public-health workers. There may also be a shortage of faculty members in the health sciences. The results will be felt acutely within the next 10 years. Colleges and health-science…

A Web-Based Framework for Improving Geriatric Education

ERIC Educational Resources Information Center

Hirth, Victor A.; Hajjar, Ihab

2004-01-01

Despite the growth in the elderly population, physicians with special geriatric training and certification number only 9,000 out of 650,000 doctors in the United States. The flexibility and increasing availability of the Internet makes it an ideal avenue for addressing the educational needs of health care providers to improve the health and care…

Appraisal of Nutritional Status. Nutrition in Primary Care Series, Number 2.

ERIC Educational Resources Information Center

Latanick, Maureen Rogan; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

INFORMATION ABOUT NARCOTICS - RESOURCE MATERIAL FOR TEACHERS.

ERIC Educational Resources Information Center

ABRAMS, IRVING; HAWKINS, BARBARA A.

A SHORT HISTORY OF NARCOTICS AND THEIR LEGAL CONTROL IN THE UNITED STATES IS PRESENTED WITH AN EXPLANATION OF ADDICTION AND METHODS OF ITS PREVENTION. TEACHERS ARE INFORMED OF WAYS IN WHICH TO IDENTIFY ADDICTED STUDENTS. FOR EXAMPLE, THEY MAY BE CLOSELY OBSERVED IN PHYSICAL EDUCATION CLASSES, AND ABNORMALITIES INVESTIGATED BY A PHYSICIAN.…

Midwifery in American Institutes of Higher Education: Women's Work, Vocations and the 21st Century

ERIC Educational Resources Information Center

Brucker, Mary C.

2009-01-01

Midwifery is one of the universal professions. At the end of the nineteenth century, midwives in the United States were disenfranchised from the mainstream. A concerted effort was waged by male physicians to characterize midwifery practices as unscientific while simultaneously preventing midwives from obtaining formal education. Although midwifery…

A Hierarchy of Medicine: Health Strategies of Elder Khmer Refugees in the United States

ERIC Educational Resources Information Center

Lewis, Denise C.

2007-01-01

This study addresses ways Khmer refugee elders utilize traditional herbal medicine with Western biomedicine in the treatment and prevention of illnesses. Methods include semi-structured and informal interviews with elders and family members, semi-structured interviews with local health care providers and Khmer physicians, and participant…

Decoding Fad Diets. Nutrition in Health Promotion Series, Number 20.

ERIC Educational Resources Information Center

Crosser, Gail Hoddlebrink

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Vitamins and Trace Minerals. Nutrition in Health Promotion Series, Number 23.

ERIC Educational Resources Information Center

Molleson, Ann L.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Physicians in the Academic Marketplace.

ERIC Educational Resources Information Center

Burke, Dolores L.

This book explores the medical professoriate, in particular medical faculty mobility in and out of academic positions as it relates to the organization of academic medicine in United States universities. The work is based on interviews conducted with 300 faculty members in six major medical schools over a period of 6 months in late 1988 and early…

Mandatory Use of Electronic Health Records: Overcoming Physician Resistance

ERIC Educational Resources Information Center

Brown, Viseeta K.

2012-01-01

Literature supports the idea that electronic health records hold tremendous value for the healthcare system in that it increases patient safety, improves the quality of care and provides greater efficiency. The move toward mandatory implementation of electronic health records is a growing concern in the United States health care industry. The…

Protecting Bone and Teeth. Nutrition in Health Promotion Series, Number 21.

ERIC Educational Resources Information Center

Roehrig, Karla L.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Dietary Management in Hypertension. Nutrition in Primary Care Series, Number 11.

ERIC Educational Resources Information Center

Molleson, Ann L.; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Normal Diet: Geriatrics. Nutrition in Primary Care Series, Number 8.

ERIC Educational Resources Information Center

Molleson, Ann L.; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

A Qualitative Study of the "Doctor as Teacher" Principle in Naturopathic Medicine

ERIC Educational Resources Information Center

Adams, Matthew R.

2017-01-01

There is a field of complementary and alternative medicine known as naturopathic medicine. There are five naturopathic schools in the United States of America and two in Canada. Information regarding the practices and experiences of naturopathic physicians, especially relating to the principle of "doctor as teacher" is non-existent. The…

Metabolic Principles. Nutrition in Health Promotion Series, Number 18.

ERIC Educational Resources Information Center

Allred, John B.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Quality of Diabetes Mellitus Care by Rural Primary Care Physicians

ERIC Educational Resources Information Center

Tonks, Stephen A.; Makwana, Sohil; Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Allison, Jeroan J.; Curry, William; Estrada, Carlos A.

2012-01-01

Purpose: To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. Methods: Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients' residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas…

National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007

ERIC Educational Resources Information Center

Comer, Jonathan S.; Olfson, Mark; Mojtabai, Ramin

2010-01-01

Objective: To examine patterns and recent trends in multiclass psychotropic treatment among youth visits to office-based physicians in the United States. Method: Annual data from the 1996-2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multiclass psychotropic treatment within a nationally…

Foreign Medical Graduates in the 1980s: Trends in Specialization.

ERIC Educational Resources Information Center

Mick, Stephen S.; Worobey, Jacqueline Lowe

1984-01-01

Despite predictions of a physician surplus by 1990, graduates of foreign medical schools (both aliens and U.S. citizens) continue to flow into the United States. Secondary analysis of 1980 data suggests that graduates of foreign schools may secure their presence within the American medical system by selecting specialties where shortages exist. (KH)

Nutrient and Drug Interactions. Nutrition in Primary Care Series, Number 3.

ERIC Educational Resources Information Center

Molleson, Ann L.; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

19 CFR 201.27 - Special procedures: Medical records.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 3 2011-04-01 2011-04-01 false Special procedures: Medical records. 201.27 Section 201.27 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL... Act request to the Privacy Act Officer as called for in § 201.24(a) of this part, specify a physician...

19 CFR 201.27 - Special procedures: Medical records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 3 2010-04-01 2010-04-01 false Special procedures: Medical records. 201.27 Section 201.27 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL... Act request to the Privacy Act Officer as called for in § 201.24(a) of this part, specify a physician...

Questions about Common Ailments. Nutrition in Health Promotion Series, Number 26.

ERIC Educational Resources Information Center

Crosser, Gail Hoddlebrink; Molleson, Ann L.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Nutrition and Physical Activity. Nutrition in Health Promotion Series, Number 22.

ERIC Educational Resources Information Center

Latanick, Maureen Rogan; Allred, John B.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Arbutus menziesii Pursh. Pacific madrone

Treesearch

Philip M. McDonald

1990-01-01

Pacific madrone (Arbutus menziesii) is one of the most widely distributed tree species native to the Pacific coast. Named for its discoverer, Archibald Menzies, a 19th century Scottish physician and naturalist, the species is called arbutus in Canada, and madrone, madroña, or madroño in the United States. The latter name is...

Clinical peer review in the United States: history, legal development and subsequent abuse.

PubMed

Vyas, Dinesh; Hozain, Ahmed E

2014-06-07

The Joint Commission on Accreditation requires hospitals to conduct peer review to retain accreditation. Despite the intended purpose of improving quality medical care, the peer review process has suffered several setbacks throughout its tenure. In the 1980s, abuse of peer review for personal economic interest led to a highly publicized multimillion-dollar verdict by the United States Supreme Court against the perpetrating physicians and hospital. The verdict led to decreased physician participation for fear of possible litigation. Believing that peer review was critical to quality medical care, Congress subsequently enacted the Health Care Quality Improvement Act (HCQIA) granting comprehensive legal immunity for peer reviewers to increase participation. While serving its intended goal, HCQIA has also granted peer reviewers significant immunity likely emboldening abuses resulting in Sham Peer Reviews. While legal reform of HCQIA is necessary to reduce sham peer reviews, further measures including the need for standardization of the peer review process alongside external organizational monitoring are critical to improving peer review and reducing the prevalence of sham peer reviews.

Clinical peer review in the United States: History, legal development and subsequent abuse

PubMed Central

Vyas, Dinesh; Hozain, Ahmed E

2014-01-01

The Joint Commission on Accreditation requires hospitals to conduct peer review to retain accreditation. Despite the intended purpose of improving quality medical care, the peer review process has suffered several setbacks throughout its tenure. In the 1980s, abuse of peer review for personal economic interest led to a highly publicized multimillion-dollar verdict by the United States Supreme Court against the perpetrating physicians and hospital. The verdict led to decreased physician participation for fear of possible litigation. Believing that peer review was critical to quality medical care, Congress subsequently enacted the Health Care Quality Improvement Act (HCQIA) granting comprehensive legal immunity for peer reviewers to increase participation. While serving its intended goal, HCQIA has also granted peer reviewers significant immunity likely emboldening abuses resulting in Sham Peer Reviews. While legal reform of HCQIA is necessary to reduce sham peer reviews, further measures including the need for standardization of the peer review process alongside external organizational monitoring are critical to improving peer review and reducing the prevalence of sham peer reviews. PMID:24914357

Financial incentives, quality improvement programs, and the adoption of clinical information technology.

PubMed

Robinson, James C; Casalino, Lawrence P; Gillies, Robin R; Rittenhouse, Diane R; Shortell, Stephen S; Fernandes-Taylor, Sara

2009-04-01

Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices. National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT. Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P < 0.001). External incentives and participation in quality improvement initiatives are associated with greater use of CIT by large physician practices.

Promoting healthy lifestyles and decreasing childhood obesity: increasing physician effectiveness through advocacy.

PubMed

Saxe, Jessica Schorr

2011-01-01

Childhood obesity is a well-documented public health crisis. Even many children who are not overweight have inadequate physical activity, poor nutrition, excessive television and other screen time, or some combination thereof. The solution lies in the community. Environmental interventions are among the most effective for improving public health. In addition to addressing lifestyle issues in the office, physicians should advocate for environmental approaches. We can advocate at institutional, local, state, and federal levels through speaking, writing, and collaborating with others. In the United States, the timing is right to synergize with efforts such as the White House Task Force on Childhood Obesity and the Surgeon General's emphasis on changing the national conversation "from a negative one about obesity and illness" to a positive one about health and fitness.

Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study.

PubMed

Barnato, Amber E; Hsu, Heather E; Bryce, Cindy L; Lave, Judith R; Emlet, Lillian L; Angus, Derek C; Arnold, Robert M

2008-12-01

To determine the feasibility of high-fidelity simulation for studying variation in intensive care unit admission decision making for critically ill elders with end-stage cancer. Mixed qualitative and quantitative analysis of physician subjects participating in a simulation scenario using hospital set, actors, medical chart, and vital signs tracings. The simulation depicted a 78-yr-old man with metastatic gastric cancer, life-threatening hypoxia most likely attributable to cancer progression, and stable preferences to avoid intensive care unit admission and intubation. Two independent raters assessed the simulations and subjects completed a postsimulation web-based survey and debriefing interview. Peter M. Winter Institute for Simulation Education and Research at the University of Pittsburgh. Twenty-seven hospital-based attending physicians, including 6 emergency physicians, 13 hospitalists, and 8 intensivists. Outcomes included qualitative report of clinical verisimilitude during the debriefing interview, survey-reported diagnosis and prognosis, and observed treatment decisions. Independent variables included physician demographics, risk attitude, and reactions to uncertainty. All (100%) reported that the case and simulation were highly realistic, and their diagnostic and prognostic assessments were consistent with our intent. Eight physicians (29.6%) admitted the patient to the intensive care unit. Among the eight physicians who admitted the patient to the intensive care unit, three (37%) initiated palliation, two (25%) documented the patient's code status (do not intubate/do not resuscitate), and one intubated the patient. Among the 19 physicians who did not admit the patient to the intensive care unit, 13 (68%) initiated palliation and 5 (42%) documented code status. Intensivists and emergency physicians (p = 0.048) were more likely to admit the patient to the intensive care unit. Years since medical school graduation were inversely associated with the initiation of palliative care (p = 0.043). Simulation can reproduce the decision context of intensive care unit triage for a critically ill patient with terminal illness. When faced with an identical patient, hospital-based physicians from the same institution vary significantly in their treatment decisions.

Financial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data.

PubMed

Fleischman, William; Ross, Joseph S; Melnick, Edward R; Newman, David H; Venkatesh, Arjun K

2016-08-01

The Open Payments program requires reporting of payments by medical product companies to teaching hospitals and licensed physicians. We seek to describe nonresearch, nonroyalty payments made to emergency physicians in the United States. We performed a descriptive analysis of the most recent Open Payments data released to the public by the Centers for Medicare & Medicaid Services covering the 2014 calendar year. We calculated the median payment, the total pay per physician, the types of payments, and the drugs and devices associated with payments to emergency physicians. For context, we also calculated total pay per physician and the percentage of active physicians receiving payments for all specialties. There were 46,405 payments totaling $10,693,310 to 12,883 emergency physicians, representing 30% of active emergency physicians in 2013. The percentage of active physicians within a specialty who received a payment ranged from 14.6% in preventive medicine to 91% in orthopedic surgery. The median payment and median total pay to emergency physicians were $16 (interquartile range $12 to $68) and $44 (interquartile range $16 to $123), respectively. The majority of payments (83%) were less than $100. Food and beverage (86%) was the most frequent type of payment. The most common products associated with payments to emergency physicians were rivaroxaban, apixaban, ticagrelor, ceftaroline, canagliflozin, dabigatran, and alteplase. Nearly a third of emergency physicians received nonresearch, nonroyalty payments from industry in 2014. Most payments were of small monetary value and for activities related to the marketing of antithrombotic drugs. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The circle game: understanding physician migration patterns within Canada.

PubMed

Dauphinee, W Dale

2006-12-01

This report explores the movement of physicians to, from, and within Canada and identifies recurring patterns of migration. The primary position of the report is that physician movement is part of reality both internationally and within Canada, and that movement of Canadian-trained physicians creates a need for international medical graduates (IMGs) in "physician-losing" locations. The report's argument is based on data retrieved from public sources on aggregate physician practice patterns in Canada and analyzed for migration patterns. In addition, literature was reviewed on factors affecting the migration patterns being described.Canadian-educated physicians have tended to move from less prosperous to more prosperous provinces and from rural to urban areas; because of the resulting need, the physician-losing locales generally have the highest proportions of IMGs. Physicians traditionally have tended to emigrate from Canada to the United States, thus increasing Canadian demand for IMGs, but recently this movement has slowed and even reversed. In Canada, liberalized immigration policies for physicians combined with a shortage of postgraduate training positions to create a serious bottleneck early in the current decade. However, this problem is now being resolved. In summary, physician migration within Canada shows specific long-term patterns, and IMGs will be needed in underserved areas for years to come. Well-informed policies for workforce management are essential in Canada to ensure an adequate physician supply consisting mainly of Canadian-educated physicians but also including IMGs. A role for nonadvocacy groups such as the Educational Commission for Foreign Medical Graduates may be to help ensure that recruitment of physicians from developing countries follows accepted ethical principles.

The effect of the physician J-1 visa waiver on rural Wisconsin.

PubMed

Crouse, Byron J; Munson, Randy L

2006-10-01

One strategy to increase the number of physicians in rural and other underserved areas grants a waiver to foreign physicians in this country on a J-1 education visa allowing them to stay in the United States if they practice in designated underserved areas. The goal of this study is to evaluate the retention and acceptance of the J-1 Visa Waiver physicians in rural Wisconsin. Sites in Wisconsin at which physicians with a J-1 Visa Waiver practiced between 1996 and 2002 were identified. A 12-item survey that assessed the acceptance and retention of these physicians was sent to leaders of institutions that had participated in this program. Retention of J-1 Visa Waiver physicians was compared to other physicians recruited to rural Wisconsin practices by the Wisconsin Office of Rural Health during the same time period. While there was a general perception that the communities were well satisfied with the care provided and the physicians worked well with the medical community, there was a lower satisfaction with physician integration into the community-at-large. This was found to correlate with the poor retention rate of physicians with a J-1 Visa Waiver. Physicians participating in a placement program without J-1 Visa Waivers entering practice in rural communities had a significantly higher retention rate. Physicians with J-1 Visa Waivers appear to provide good care and work well in health care environments while fulfilling the waiver requirements. To keep these physicians practicing in these communities, successful integration into the community is important.

The effect of HMO penetration on physician retirement.

PubMed

Kletke, P R; Polsky, D; Wozniak, G D; Escarce, J J

2000-12-01

To examine the effect of HMO penetration on physician retirement. We linked together historical data from the Physician Masterfile of the American Medical Association for successive years to track changes in physicians' activity status between 1980 and 1997. We used a multivariate discrete-time survival model to examine how the probability of physician retirement was affected by the level of HMO penetration in the physician's market area, controlling for other physician and market characteristics. The study population included all active allopathic patient-care physicians in the United States who reached age 55 between the years of 1980 and 1996. The main outcome measure was physician retirements as reported on the Physician Masterfile. HMO penetration had a statistically significant positive effect on the retirement probabilities of generalists and medical/surgical specialists, but it s effect on hospital-based specialists and psychiatrists was not significant . For generalists regression-adjusted retirement probabilities were roughly 13 percent greater in high-penetration markets (HMO penetration of 45 percent ) than in low-penetration markets (HMO penetration of 5 percent ). For medical/surgical specialist s regression-adjusted retirement probabilities were roughly 17 percent greater in high-penetration markets than in low-penetration markets. Our findings suggest that many older physicians have found it preferable to retire rather than adapt their practices to an environment with a high degree of managed care penetration . Because the number of physicians entering the older age categories will increase rapidly over the next 20 years, the growth of managed care and other influences on physician retirement will play an increasingly important role in determining the size of the physician workforce.

Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries.

PubMed

Penm, Jonathan; MacKinnon, Neil J; Strakowski, Stephen M; Ying, Jun; Doty, Michelle M

2017-03-01

Care coordination has been identified as a key strategy in improving the effectiveness, safety, and efficiency of the US health care system. Our objective was to determine whether population or health care system issues are associated with primary care coordination gaps in the United States and other high-income countries. We analyzed data from the 2013 Commonwealth Fund International Health Policy (IHP) survey with multivariate logistic regression analysis. Respondents were adult primary care patients from 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and the United States. Poor primary care coordination was defined as participants reporting at least 3 gaps in the coordination of care out of a maximum of 5. Analyses were based on 13,958 respondents. The rate of poor primary care coordination was 5.2% (724/13,958 respondents) overall and highest in the United States, at 9.8% (137/1,395 respondents). Multivariate regression analysis among all respondents found that they were less likely to experience poor primary care coordination if their primary care physician often or always knew their medical history, spent sufficient time, involved them, and explained things well (odds ratio = 0.6 for each). Poor primary care coordination was more likely to occur among patients with chronic conditions (odds ratios = 1.4-2.1 depending on number) and patients younger than 65 years (odds ratios = 1.6-2.3 depending on age-group). Among US respondents, insurance status, health status, household income, and sex were not associated with poor primary care coordination. The United States had the highest rate of poor primary care coordination among the 11 high-income countries evaluated. An established relationship with a primary care physician was significantly associated with better care coordination, whereas being chronically ill or younger was associated with poorer care coordination. © 2017 Annals of Family Medicine, Inc.

Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries

PubMed Central

Penm, Jonathan; MacKinnon, Neil J.; Strakowski, Stephen M.; Ying, Jun; Doty, Michelle M.

2017-01-01

PURPOSE Care coordination has been identified as a key strategy in improving the effectiveness, safety, and efficiency of the US health care system. Our objective was to determine whether population or health care system issues are associated with primary care coordination gaps in the United States and other high-income countries. METHODS We analyzed data from the 2013 Commonwealth Fund International Health Policy (IHP) survey with multivariate logistic regression analysis. Respondents were adult primary care patients from 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and the United States. Poor primary care coordination was defined as participants reporting at least 3 gaps in the coordination of care out of a maximum of 5. RESULTS Analyses were based on 13,958 respondents. The rate of poor primary care coordination was 5.2% (724/13,958 respondents) overall and highest in the United States, at 9.8% (137/1,395 respondents). Multivariate regression analysis among all respondents found that they were less likely to experience poor primary care coordination if their primary care physician often or always knew their medical history, spent sufficient time, involved them, and explained things well (odds ratio = 0.6 for each). Poor primary care coordination was more likely to occur among patients with chronic conditions (odds ratios = 1.4–2.1 depending on number) and patients younger than 65 years (odds ratios = 1.6–2.3 depending on age-group). Among US respondents, insurance status, health status, household income, and sex were not associated with poor primary care coordination. CONCLUSIONS The United States had the highest rate of poor primary care coordination among the 11 high-income countries evaluated. An established relationship with a primary care physician was significantly associated with better care coordination, whereas being chronically ill or younger was associated with poorer care coordination. PMID:28289109

Directing Discipline: State Medical Board Responsiveness to State Legislatures.

PubMed

Lillvis, Denise F; McGrath, Robert J

2017-02-01

State medical boards are increasingly responsible for regulating medical and osteopathic licensure and professional conduct in the United States. Yet, there is great variation in the extent to which such boards take disciplinary action against physicians, indicating that some boards are more zealous regulators than others. We look to the political roots of such variation and seek to answer a simple, yet important, question: are nominally apolitical state medical boards responsive to political preferences? To address this question, we use panel data on disciplinary actions across sixty-four state medical boards from 1993 through 2006 and control for over-time changes in board characteristics (e.g., composition, independence, budgetary status), regulatory structure, and resources. We show that as state legislatures become more liberal [conservative], state boards increasingly [decreasingly] discipline physicians, especially during unified government and in the presence of highly professional legislatures. Our conclusions join others in emphasizing the importance of state medical boards and the contingent nature of political control of state regulation. In addition, we emphasize the roles that oversight capacity and strategy play in offsetting concerns regarding self-regulation of a powerful organized interest. Copyright © 2017 by Duke University Press.

Perspectives of physicians and nurses regarding end-of-life care in the intensive care unit.

PubMed

Festic, Emir; Wilson, Michael E; Gajic, Ognjen; Divertie, Gavin D; Rabatin, Jeffrey T

2012-02-01

The delivery of end-of-life care (EOLC) in the intensive care unit (ICU) varies widely among medical care providers. The differing opinions of nurses and physicians regarding EOLC may help identify areas of improvement. To explore the differences of physicians and nurses on EOLC in the ICU and how these differences vary according to self-reported proficiency level and primary work unit. Cross-sectional survey of 69 ICU physicians and 629 ICU nurses. Single tertiary care academic medical institution. A total of 50 physicians (72%) and 331 nurses (53%) participated in the survey. Significant differences between physicians and nurses were noted in the following areas: ability to safely raise concerns, do not resuscitate (DNR) decision making, discussion of health care directives, timely hospice referral, spiritual assessment documentation, utilization of social services, and the availability of EOLC education. In every domain of EOLC, physicians reported a more positive perception than nurses. Additional differences were noted among physicians based on experience, as well as among nurses based on their primary work unit and self-reported proficiency level. Even with an increased focus on improving EOLC, significant differences continue to exist between the perspectives of nurses and physicians, as well as physicians among themselves and nurses among themselves. These differences may represent significant barriers toward providing comprehensive, consistent, and coordinated EOLC in the ICU.

Geographic Accessibility of Pulmonologists for Adults With COPD: United States, 2013.

PubMed

Croft, Janet B; Lu, Hua; Zhang, Xingyou; Holt, James B

2016-09-01

Geographic clusters in prevalence and hospitalizations for COPD have been identified at national, state, and county levels. The study objective is to identify county-level geographic accessibility to pulmonologists for adults with COPD. Service locations of 12,392 practicing pulmonologists and 248,160 primary care physicians were identified from the 2013 National Provider Identifier Registry and weighted by census block-level populations within a series of circular distance buffer zones. Model-based county-level population counts of US adults ≥ 18 years of age with COPD were estimated from the 2013 Behavioral Risk Factor Surveillance System. The percentages of all estimated adults with potential access to at least one provider type and the county-level ratio of adults with COPD per pulmonologist were estimated for selected distances. Most US adults (100% in urbanized areas, 99.5% in urban clusters, and 91.7% in rural areas) had geographic access to a primary care physician within a 10-mile buffer distance; almost all (≥ 99.9%) had access to a primary care physician within 50 miles. At least one pulmonologist within 10 miles was available for 97.5% of US adults living in urbanized areas, but only for 38.3% in urban clusters and 34.5% in rural areas. When distance increased to 50 miles, at least one pulmonologist was available for 100% in urbanized areas, 93.2% in urban clusters, and 95.2% in rural areas. County-level ratios of adults with COPD per pulmonologist varied greatly across the United States, with residents in many counties in the Midwest having no pulmonologist within 50 miles. County-level geographic variations in pulmonologist access for adults with COPD suggest that those adults with limited access will have to depend on care from primary care physicians. Published by Elsevier Inc.

Comparisons and contrasts in the practice of nuclear cardiology in the United States and Japan.

PubMed

DePuey, E Gordon

2016-12-01

There are interesting differences between the practice of Nuclear Cardiology in Japan and that in the United States and associated unique challenges. Differences in patient body habitus and the perceived importance of limiting patient radiation dose have resulted in different radiopharmaceutical and imaging protocol preferences. Governmental approval and reimbursement policies for various radiopharmaceuticals have promulgated adoption of different clinical applications. Both countries have experienced a significant decline in the number of nuclear cardiology studies performed, in part due to decreased governmental funding and reimbursement and to the emergence of competing modalities. Whereas precertification and test substitution have impacted negatively on the sustainability and growth of nuclear cardiology in the United States, in Japan those deterrents have not yet been encountered. Instead, communication barriers between nuclear medicine physicians and referring cardiologists are cited as a more significant barrier.

Body piercing medical concerns with cutting-edge fashion.

PubMed

Koenig, L M; Carnes, M

1999-06-01

To review the current information on medical complications, psychological implications, and legislative issues related to body piercing, a largely unregulated industry in the United States. We conducted a MEDLINE search of English language articles from 1966 until May 1998 using the search terms "body piercing" and "ear piercing." Bibliographies of these references were reviewed for additional citations. We also conducted an Internet search for "body piercing" on the World Wide Web. In this manuscript, we review the available body piercing literature. We conclude that body piercing is an increasingly common practice in the United States, that this practice carries substantial risk of morbidity, and that most body piercing in the United States is being performed by unlicensed, unregulated individuals. Primary care physicians are seeing growing numbers of patients with body pierces. Practitioners must be able to recognize, treat, and counsel patients on body piercing complications and be alert to associated psychological conditions in patients who undergo body piercing.

A cluster of cutaneous leishmaniasis associated with human smuggling.

PubMed

Cannella, Anthony P; Nguyen, Bichchau M; Piggott, Caroline D; Lee, Robert A; Vinetz, Joseph M; Mehta, Sanjay R

2011-06-01

Cutaneous leishmaniasis (CL) is rarely seen in the United States, and the social and geographic context of the infection can be a key to its diagnosis and management. Four Somali and one Ethiopian, in U.S. Border Patrol custody, came to the United States by the same human trafficking route: Djibouti to Dubai to Moscow to Havana to Quito; and then by ground by Columbia/Panama to the United States-Mexico border where they were detained. Although traveling at different times, all five patients simultaneously presented to our institution with chronic ulcerative skin lesions at different sites and stages of evolution. Culture of biopsy specimens grew Leishmania panamensis. Soon thereafter, three individuals from East Africa traveling the identical route presented with L. panamensis CL to physicians in Tacoma, WA. We document here the association of a human trafficking route and new world CL. Clinicians and public health officials should be aware of this emerging infectious disease risk.

HIV primary care by the infectious disease physician in the United States - extending the continuum of care.

PubMed

Lakshmi, Seetha; Beekmann, Susan E; Polgreen, Philip M; Rodriguez, Allan; Alcaide, Maria L

2018-05-01

Models of care for people living with HIV (PLWH) have varied over time due to long term survival, development of HIV-associated non-AIDS conditions, and HIV specific primary care guidelines that differ from those of the general population. The objectives of this study are to assess how often infectious disease (ID) physicians provide primary care for PLWH, assess their practice patterns and barriers in the provision of primary care. We used a 6-item survey electronically distributed to ID physician members of Emerging Infections Network (EIN). Of the 1248 active EIN members, 644 (52%) responded to the survey. Among the 644 respondents, 431 (67%) treated PLWH. Of these 431 responders, 326 (75%) acted as their primary care physicians. Responders who reported always/mostly performing a screening assessment as recommended per guidelines were: (1) Screening specific to HIV (tuberculosis 95%, genital chlamydia/gonorrhoea 77%, hepatitis C 67%, extra genital chlamydia/gonorrhoea 47%, baseline anal PAP smear for women 36% and men 34%); (2) Primary care related screening (fasting lipids 95%, colonoscopy 95%, mammogram 90%, cervical PAP smears 88%, depression 57%, osteoporosis in postmenopausal women 55% and men >50 yrs 33%). Respondents who worked in university hospitals, had <5 years of ID experience, and those who cared for more PLWH were most likely to provide primary care to all or most of their patients. Common barriers reported include: refusal by patient (72%), non-adherence to HIV medications (43%), other health priorities (44%), time constraints during clinic visit (43%) and financial/insurance limitations (40%). Most ID physicians act as primary care providers for their HIV infected patients especially if they are recent ID graduates and work in university hospitals. Current screening rates are suboptimal. Interventions to increase screening practices and to decrease barriers are urgently needed to address the needs of the aging HIV population in the United States.

Regulatory tasks of national medical associations - international comparison and the Israeli case

PubMed Central

2013-01-01

Background In many countries, NMAs, along with other stakeholders, play a part in the regulation of physicians. The purpose of this paper is to compare and explain the level of involvement of NMAs in physician regulation in several developed countries, with a specific emphasis on Israel. Methods The authors conducted a review of the literature on physician regulation, focusing on licensing and registration, postgraduate training and physician disciplinary measures. Detailed country specific information was also obtained via the websites of relevant NMAs and regulatory bodies and correspondence with select NMAs. Five test cases were examined in detail: Germany, Israel, the Netherlands, the United Kingdom and the United States. The Israeli case will be discussed at greater length. Results Medical licensing usually lies in the hands of the government (on the national or state level). Specialist training, on the other hand, is often self-regulated and entrusted in the hands of the profession, frequently under the direct responsibility of the NMA, as in Israel, the Netherlands and Germany. In all the countries presented, other than Germany, the NMA is not involved in instituting disciplinary procedures in cases of alleged physician misconduct. Discussion The extent to which NMAs fulfill regulatory functions varies greatly from country to country. The relationship between government and the profession in the area of regulation often parallels the dominant mode of governance in the health care system as a whole. Specifically, the level of involvement of the Israeli Medical Association in medical regulation is a result of political, historical and ideological arrangements shaped vis-à-vis the government over the years. Conclusions In Continental Europe, co-operation between the NMA and the government is more common than in the USA and the UK. The Israeli regulatory model emerged in a European-like fashion, closer to the Netherlands than to Germany. The Israeli case, as well as the others, demonstrates the importance of history and ideology in shaping contemporary regulatory models. PMID:23425333

Facets of career satisfaction for women physicians in the United States: a systematic review.

PubMed

Rizvi, Rabab; Raymer, Lindsay; Kunik, Mark; Fisher, Joslyn

2012-01-01

Women make up a growing proportion of the physician workforce, and their career satisfaction may affect their health. The authors hypothesized that many facets adversely affecting career satisfaction in women physicians were extrinsic, therefore, preventable or modifiable. The authors conducted a systematic review of the literature in English published through February 2010 to examine facets of career satisfaction of U.S. women physicians. The authors used the women physician AND job satisfaction OR career satisfaction Medical Subject Headings (MeSH) terms, and reviewed bibliographies of key articles to ensure inclusion of relevant studies. The authors used the "Strengthening the Reporting of Observation Studies in Epidemiology" quality tool. Of an initial 1,000 studies, only 30 met the inclusion criteria. Facets reported most frequently to influence career satisfaction for women physicians were income/prestige, practice characteristics, and personal/family characteristics. Overall, career satisfaction for women and men physicians was 73.4% (range = 56.4% to 90%) and 73.2% (range = 59% to 90%), respectively. When compared with men, women physicians were more concerned with perceived lack of time for relationships with patients, colleagues, and family; less satisfied with mentoring relationships and support from all sources; and less satisfied with career-advancement opportunities, recognition, and salary. Career satisfaction can affect health, as well as health and safety of patients. Many factors adversely affecting career satisfaction for women physicians are extrinsic and, therefore, modifiable.

Assessment of Israeli Physicians' Knowledge, Experience and Attitudes towards Medical Cannabis: A Pilot Study.

PubMed

Ebert, Tanya; Zolotov, Yuval; Eliav, Shani; Ginzburg, Orit; Shapira, Irena; Magnezi, Racheli

2015-07-01

Cannabis has been used throughout history for different purposes but was outlawed in the United States in 1937; many countries followed suit. Although recently reintroduced as a medical treatment in several countries, the use of cannabis in Israel is permitted for some medical purposes but is still controversial, eliciting heated public and professional debate. The few published studies on physicians' attitudes to medical cannabis found them to be generally unsupportive. To examine, for the first time, the experience, knowledge and attitudes of Israeli physicians towards medical cannabis (MC). A 32 item questionnaire reflected physicians' demographics, knowledge of and experience with MC and their attitudes to this treatment. Seventy-two physicians participated in this study. Physicians generally agreed that MC treatment could be helpful for chronic and for terminally ill patients (n = 61, 79.2%). Oncologists and pain specialists did not agree unanimously that MC can undermine mental health, whereas other physicians did (P < 0.001, df = 4). Physicians who recommended MC in the past (once or more) agreed, more than physicians who did not, with the statement "MC treatment in Israel is accessible to patients who need it" (P < 0.05, df = 2). In contrast to other studies we found partial acceptance of MC as a therapeutic agent. Further in-depth studies are needed to address regulatory and educational needs.

Role of physician assistants in dialysis units and nephrology.

PubMed

Anderson, J E; Torres, J R; Bitter, D C; Anderson, S C; Briefel, G R

1999-04-01

We surveyed physician assistants who work in nephrology to report their experience level, primary employer, salary, job responsibilities, and job satisfaction. Additional data were obtained from the Nephrology Manpower Study. The 67 responding physician assistants of 97 surveyed have 10.8 +/- 6.5 years (mean +/- standard deviation) total experience (6.2 +/- 5.0 years in nephrology). Typically, nephrologists (56.1%) or hospitals (30.3%) employ them. The majority (74%) earn $49,999 to $75,000; 79.1% work in outpatient units, 52.4% in inpatient units, 52.4% in hospitals, 43.3% in outpatient offices, and 23.9% in transplant units. In outpatient units, they manage 111 +/- 111 patients, mostly in free-standing (71.1%), for-profit (69.7%), corporately owned (87.3%) units in urban (80%) or suburban (18%) areas. Most (>85%) manage all dialysis- and nondialysis-related problems, including health maintenance; 84.3% are contacted first by staff, and 78% see patients more often than physicians. Of nephrologists who responded to the Manpower Study, 8.9% work with physician assistants and 20.7% work with nurse practitioners. Nephrologists in academic practice or private nephrology groups are more likely to use physician assistants (P < 0.05) and nurse practitioners (P < 0.005) than those in solo practice or multispecialty groups. Nephrologists with physician assistants (33.8 +/- 19.5 v 41.7 +/- 16.8 h/wk) or nurse practitioners (35.8 +/- 18.1 v 42.7 +/- 16.9 h/wk) tended to spend less time in direct patient care than those without physician extenders (P < 0.001). Nephrologists with renal fellows, however, spent the least time of all in direct patient care (30.0 +/- 15.9 v 47.3 +/- 14.9 h/wk; P < 0.001). Physician assistants can perform nearly all the medical tasks in dialysis units. They may offer one approach to providing effective and complete care for patients if nephrology manpower becomes limited.

Sexual Activity and Counseling in the First Month After Acute Myocardial Infarction (AMI) Among Younger Adults in the United States and Spain: Prospective, Observational Study

PubMed Central

Lindau, Stacy Tessler; Abramsohn, Emily M; Bueno, Héctor; D'Onofrio, Gail; Lichtman, Judith H; Lorenze, Nancy P; Sanghani, Rupa Mehta; Spatz, Erica S; Spertus, John A; Strait, Kelly; Wroblewski, Kristen; Zhou, Shengfan; Krumholz, Harlan M

2015-01-01

Background United States and European cardiovascular society guidelines recommend physicians counsel patients about resuming sexual activity after acute myocardial infarction (AMI), but little is known about patients’ experience with counseling about sexual activity after AMI. Methods and Results The prospective, longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, conducted at 127 hospitals in the U.S. and Spain, was designed, in part, to evaluate gender differences in baseline sexual activity, function and patient experience with physician counseling about sexual activity after an AMI. This study used baseline and 1-month data collected from the 2:1 sample of women (N=2349) and men (N=1152) ages 18-55 years with AMI. Median age was 48 years. Among those who reported discussing sexual activity with a physician in the month after AMI (12% of women, 19% of men), 68% were given restrictions: limit sex (35%), take a more passive role (26%), and/or keep the heart rate down (23%). In risk-adjusted analyses, factors associated with not discussing sexual activity with a physician included: female gender (RR 1.07, 95% CI 1.03-1.11), age (RR 1.05 per 10 years, 95% CI 1.02-1.08) and sexual inactivity at baseline (RR 1.11, 95% CI 1.08-1.15). Among patients who received counseling, women in Spain were significantly more likely to be given restrictions than U.S. women (RR 1.36, 95% CI 1.11-1.66). Conclusions Very few patients reported counseling for sexual activity after AMI. Those who did were commonly given restrictions not supported by evidence or guidelines. PMID:25512442

Medical Nutrition Education, Training, and Competencies to Advance Guideline-Based Diet Counseling by Physicians: A Science Advisory From the American Heart Association.

PubMed

Aspry, Karen E; Van Horn, Linda; Carson, Jo Ann S; Wylie-Rosett, Judith; Kushner, Robert F; Lichtenstein, Alice H; Devries, Stephen; Freeman, Andrew M; Crawford, Allison; Kris-Etherton, Penny

2018-06-05

Growing scientific evidence of the benefits of heart-healthy dietary patterns and of the massive public health and economic burdens attributed to obesity and poor diet quality have triggered national calls to increase diet counseling in outpatients with atherosclerotic cardiovascular disease or risk factors. However, despite evidence that physicians are willing to undertake this task and are viewed as credible sources of diet information, they engage patients in diet counseling at less than desirable rates and cite insufficient knowledge and training as barriers. These data align with evidence of large and persistent gaps in medical nutrition education and training in the United States. Now, major reforms in undergraduate and graduate medical education designed to incorporate advances in the science of learning and to better prepare physicians for 21st century healthcare delivery are providing a new impetus and novel ways to expand medical nutrition education and training. This science advisory reviews gaps in undergraduate and graduate medical education in nutrition in the United States, summarizes reforms that support and facilitate more robust nutrition education and training, and outlines new opportunities for accomplishing this goal via multidimensional curricula, pedagogies, technologies, and competency-based assessments. Real-world examples of efforts to improve undergraduate and graduate medical education in nutrition by integrating formal learning with practical, experiential, inquiry-driven, interprofessional, and population health management activities are provided. The authors conclude that enhancing physician education and training in nutrition, as well as increasing collaborative nutrition care delivery by 21st century health systems, will reduce the health and economic burdens from atherosclerotic cardiovascular disease to a degree not previously realized. © 2018 American Heart Association, Inc.

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 health rotation for physicians-in-training and how these challenges were overcome.

Point of care hand hygiene-where's the rub? A survey of US and Canadian health care workers' knowledge, attitudes, and practices.

PubMed

Kirk, Jane; Kendall, Anson; Marx, James F; Pincock, Ted; Young, Elizabeth; Hughes, Jillian M; Landers, Timothy

2016-10-01

Hand hygiene at the point of care is recognized as a best practice for promoting compliance at the moments when hand hygiene is most critical. The objective of this study was to compare knowledge, attitudes, and practices of US and Canadian frontline health care personnel regarding hand hygiene at the point of care. Physicians and nurses in US and Canadian hospitals were invited to complete a 32-question online survey based on evidence supporting point of care hand hygiene. Eligible health care personnel were in direct clinical practice at least 50% of the time. Three hundred fifty frontline caregivers completed the survey. Among respondents, 57.1% were from the United States and 42.9% were from Canada. Respondents were evenly distributed between physician and nurses. The US and Canadian respondents gave identical ranking to their perceived barriers to hand hygiene compliance. More than half of the respondents from both the United States and Canada agreed or strongly agreed that they would be more likely to clean their hands when recommended if alcohol-based handrub was closer to the patient. This survey demonstrates that similarities between Canada and the United States were more common than not, and the survey raises, or suggests, potential knowledge gaps that require further illumination. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Tonsillectomy in Maine: Regulation Versus Education as Modulators of Medical Care

PubMed Central

Moore, Francis D.; Pratt, Loring W.

1981-01-01

The reduction in the rate of tonsillectomy, using the state of Maine as an example, and the causes thereof are addressed. Are federal and state regulations required to change the behavior of physicians and the public, or is education of greater importance? A study of tonsillectomy in the state of Maine was based on data covering a period of approximately 30 years. The data were based on direct contact with hospitals, in which we achieved the cooperation of virtually all of the hospitals of Maine, encompassing 98% of the hospital beds. These data were placed in context by information provided by the Maine Health Data Service, and by information for the northeastern United States, for the eastern United States, and for the entire United States, from the Department of Health, Education and Welfare. The operation of tonsillectomy and its variants, including adenoidectomy, has declined remarkably in the past 30 years, most drastically in the past eight years. It now occupies only 4.5% of the total operative admissions for the State, where it formerly was 17%. It now has a populational incidence for the State of 3.3 operations per thousand population per year, whereas it formerly was at a level of about 10.0. From this study, as well as from physicians in Maine, to whom an informal questionnaire was sent, it is clear that this reduction has come about largely because of education of physicians and the public. Increased awareness by the public, pediatricians and general practitioners of the limitations of this operation has been significant. In addition, there is a general sense of improved general health of young people in Maine, with fewer chronic respiratory infections. Some negative opinions were expressed, including the possibility that peritonsillar abcesses may be more frequent in the future and that some pediatricians and general practitioners overuse antibiotics. Federal regulations, state regulations, Medicare, Medicaid, Blue Cross or Blue Shield regulations concerning tonsillectomy were not instituted at any point in the State of Maine, during the period under study. There were no alterations in payment, second opinion programs or other restrictions or constraints placed on the operation at any level of official or hospital regulation. Formerly performed in large numbers by general practitioners, family practitioners, and general surgeons, the operation(s) is now predominantly carried out by trained otolaryngologists, largely board certified. Evidence is presented to support the view that concentration of this operation in the hands of fewer, more highly trained surgical specialists has been positively associated with its sharper indications and declining frequency. The conclusion is offered that increased education of physicians, both specialists and general practitioners as well as family doctors, and of the public as a whole, is the most important single factor in producing this significant alteration in the behavior of the health care system in the State of Maine. Effective limitation of the operation to specialists has been an important feature both of this educational process and of the more rational use of the operation(s). PMID:7259351

Tonsillectomy in Maine: regulation versus education as modulators of medical care.

PubMed

Moore, F D; Pratt, L W

1981-08-01

The reduction in the rate of tonsillectomy, using the state of Maine as an example, and the causes thereof are addressed. Are federal and state regulations required to change the behavior of physicians and the public, or is education of greater importance? A study of tonsillectomy in the state of Maine was based on data covering a period of approximately 30 years. The data were based on direct contact with hospitals, in which we achieved the cooperation of virtually all of the hospitals of Maine, encompassing 98% of the hospital beds. These data were placed in context by information provided by the Maine Health Data Service, and by information for the northeastern United States, for the eastern United States, and for the entire United States, from the Department of Health, Education and Welfare. The operation of tonsillectomy and its variants, including adenoidectomy, has declined remarkably in the past 30 years, most drastically in the past eight years. It now occupies only 4.5% of the total operative admissions for the State, where it formerly was 17%. It now has a populational incidence for the State of 3.3 operations per thousand population per year, whereas it formerly was at a level of about 10.0. From this study, as well as from physicians in Maine, to whom an informal questionnaire was sent, it is clear that this reduction has come about largely because of education of physicians and the public. Increased awareness by the public, pediatricians and general practitioners of the limitations of this operation has been significant. In addition, there is a general sense of improved general health of young people in Maine, with fewer chronic respiratory infections. Some negative opinions were expressed, including the possibility that peritonsillar abcesses may be more frequent in the future and that some pediatricians and general practitioners overuse antibiotics. Federal regulations, state regulations, Medicare, Medicaid, Blue Cross or Blue Shield regulations concerning tonsillectomy were not instituted at any point in the State of Maine, during the period under study. There were no alterations in payment, second opinion programs or other restrictions or constraints placed on the operation at any level of official or hospital regulation. Formerly performed in large numbers by general practitioners, family practitioners, and general surgeons, the operation(s) is now predominantly carried out by trained otolaryngologists, largely board certified. Evidence is presented to support the view that concentration of this operation in the hands of fewer, more highly trained surgical specialists has been positively associated with its sharper indications and declining frequency. The conclusion is offered that increased education of physicians, both specialists and general practitioners as well as family doctors, and of the public as a whole, is the most important single factor in producing this significant alteration in the behavior of the health care system in the State of Maine. Effective limitation of the operation to specialists has been an important feature both of this educational process and of the more rational use of the operation(s).

Physician training in critical care in the United States: Update 2018.

PubMed

Napolitano, Lena M; Rajajee, Venkatakrishna; Gunnerson, Kyle J; Maile, Michael D; Quasney, Michael; Hyzy, Robert C

2018-06-01

Critical care fellowship training in the United States differs based on specific specialty and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine, and neurocritical care training pathways. We provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education and specialty boards (American Board of Internal Medicine, American Board of Surgery, American Board of Anesthesiology, American Board of Pediatrics American Board of Emergency Medicine) and the United Council for Neurologic Subspecialties for the last 16 years (2001-2017). The number of critical care fellowship training programs has increased 22.6%, with a 49.4% increase in the number of on-duty residents annually, over the last 16 years. This is in contrast to the period of 1995 to 2000 when the number of physicians enrolled in critical care fellowship programs had decreased or remained unchanged. Although more than 80% of intensivists in the US train in internal medicine critical care Accreditation Council for Graduate Medical Education-approved fellowships, there has been a significant increase in the number of residents from surgery, anesthesiology, pediatrics, emergency medicine, and other specialties who complete specialty fellowship training and certification in critical care. Matriculation in neurocritical care fellowships is rapidly rising with 60 programs and over 1,200 neurocritical care diplomates. Critical care is now an increasingly popular fellowship in all specialties. This rapid growth of all critical care specialties highlights the magnitude of the heterogeneity that will exist between intensivists in the future.

The Second Annual Primary Care Conference--Programming to eliminate health disparities among ethnic minority populations: an introduction to proceedings.

PubMed

Heisler, Michael; Blumenthal, Daniel S; Rust, George; Dubois, Anne M

2003-01-01

From October 31, 2002 through November 2, 2002, the Second Annual Primary Care Conference was held, sponsored by the Morehouse School of Medicine's National Center for Primary Care and its Prevention Research Center. The conference was designed as a collaborative activity with the Atlanta Regional Health Forum; The Carter Center; Emory University's School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Georgia Chapter of the American College of Physicians/American Society of Internal Medicine; Georgia Nurses Foundation; Southeastern Primary Care Consortium, Inc./Atlanta Area Health Education Center; St. Joseph's Mercy Care Services; United States Department of Health and Human Services: Agency for Healthcare Research and Quality; Centers for Disease Control and Prevention; Health and Human Services (Region IV); Health Resources and Services Administration; Office of Minority Health (Region IV); and Office on Women's Health (Region IV). The 2 and a half-day conference featured 5 plenary sessions and 3 tracks of medical education for primary care physicians and other healthcare providers. The tracks were categorized as: Track A: Adult Health; Track B: Public Health and Prevention; and Track C: Maternal/Child/Youth Health. Within each track, 6 working sessions were presented on topic areas including diabetes, obesity, cardiovascular disease, cancer, mental health, infectious disease, behavioral and social health, women's health, stroke, and asthma. A total of 18 working sessions took place and each working session included 3 presentations. Continuing medical education credits or continuing education units were granted to participants. In all, 485 individuals participated in the conference, with the majority of the participants from the southeastern United States. Of the attendees, 35% were physicians (MD); 13% were nurses (RN); 12% held master-level degrees; and 12% held other doctorate-level degrees.

[Is the ICU staff satisfied with the computerized physician order entry? A cross-sectional survey study].

PubMed

Fumis, Renata Rego Lins; Costa, Eduardo Leite Vieira; Martins, Paulo Sergio; Pizzo, Vladimir; Souza, Ivens Augusto; Schettino, Guilherme de Paula Pinto

2014-01-01

To evaluate the satisfaction of the intensive care unit staff with a computerized physician order entry and to compare the concept of the computerized physician order entry relevance among intensive care unit healthcare workers. We performed a cross-sectional survey to assess the satisfaction of the intensive care unit staff with the computerized physician order entry in a 30-bed medical/surgical adult intensive care unit using a self-administered questionnaire. The questions used for grading satisfaction levels were answered according to a numerical scale that ranged from 1 point (low satisfaction) to 10 points (high satisfaction). The majority of the respondents (n=250) were female (66%) between the ages of 30 and 35 years of age (69%). The overall satisfaction with the computerized physician order entry scored 5.74±2.14 points. The satisfaction was lower among physicians (n=42) than among nurses, nurse technicians, respiratory therapists, clinical pharmacists and diet specialists (4.62±1.79 versus 5.97±2.14, p<0.001); satisfaction decreased with age (p<0.001). Physicians scored lower concerning the potential of the computerized physician order entry for improving patient safety (5.45±2.20 versus 8.09±2.21, p<0.001) and the ease of using the computerized physician order entry (3.83±1.88 versus 6.44±2.31, p<0.001). The characteristics independently associated with satisfaction were the system's user-friendliness, accuracy, capacity to provide clear information, and fast response time. Six months after its implementation, healthcare workers were satisfied, albeit not entirely, with the computerized physician order entry. The overall users' satisfaction with computerized physician order entry was lower among physicians compared to other healthcare professionals. The factors associated with satisfaction included the belief that digitalization decreased the workload and contributed to the intensive care unit quality with a user-friendly and accurate system and that digitalization provided concise information within a reasonable time frame.

Reason-Giving and Medical Futility: Contrasting Legal and Social Discourse in the United States With the United Kingdom and Ontario, Canada.

PubMed

Bosslet, Gabriel T; Baker, Mary; Pope, Thaddeus M

2016-09-01

Disputes regarding life-prolonging treatments are stressful for all parties involved. These disagreements are appropriately almost always resolved with intensive communication and negotiation. Those rare cases that are not require a resolution process that ensures fairness and due process. We describe three recent cases from different countries (the United States, United Kingdom, and Ontario, Canada) to qualitatively contrast the legal responses to intractable, policy-level disputes regarding end-of-life care in each of these countries. In so doing, we define the continuum of clinical and social utility among different types of dispute resolution processes and emphasize the importance of public reason-giving in the societal discussion regarding policy-level solutions to end-of-life treatment disputes. We argue that precedential, publicly available, written rulings for these decisions most effectively help to move the social debate forward in a way that is beneficial to clinicians, patients, and citizens. This analysis highlights the lack of such rulings within the United States. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Improving care of patients with diabetes and CKD: a pilot study for a cluster-randomized trial.

PubMed

Cortés-Sanabria, Laura; Cabrera-Pivaral, Carlos E; Cueto-Manzano, Alfonso M; Rojas-Campos, Enrique; Barragán, Graciela; Hernández-Anaya, Moisés; Martínez-Ramírez, Héctor R

2008-05-01

Family physicians may have the main role in managing patients with type 2 diabetes mellitus with early nephropathy. It is therefore important to determine the clinical competence of family physicians in preserving renal function of patients. The aim of this study is to evaluate the effect of an educational intervention on family physicians' clinical competence and subsequently determine the impact on kidney function of their patients with type 2 diabetes mellitus. Pilot study for a cluster-randomized trial. Primary health care units of the Mexican Institute of Social Security, Guadalajara, Mexico. The study group was composed of 21 family physicians from 1 unit and a control group of 19 family physicians from another unit. 46 patients treated by study physicians and 48 treated by control physicians also were evaluated. An educative strategy based on a participative model used during 6 months in the study group. Allocation of units to receive or not receive the educative intervention was randomly established. Clinical competence of family physicians and kidney function of patients. To evaluate clinical competence, a validated questionnaire measuring family physicians' capability to identify risk factors, integrate diagnosis, and correctly use laboratory tests and therapeutic resources was applied to all physicians at the beginning and end of educative intervention (0 and 6 months). In patients, serum creatinine level, estimated glomerular filtration rate, and albuminuria were evaluated at 0, 6, and 12 months. At the end of the intervention, more family physicians from the study group improved clinical competence (91%) compared with controls (37%; P = 0.001). Family physicians in the study group who increased their competence improved renal function significantly better than physicians in the same group who did not increase competence and physicians in the control group (with or without increase in competence): change in estimated glomerular filtration rate, 0.9 versus -33, -21, and -16 mL/min/1.73 m(2) (P < 0.05); and change in urinary albumin excretion of -18 versus 226, 142, and 288 mg/d, respectively (P < 0.05). Compared with other groups, study family physicians with clinical competence also controlled systolic blood pressure significantly better and were more likely to increase the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins and to discontinue nonsteroidal anti-inflammatory drugs. Our analysis did not adjust for clustering. Physicians in only 2 units were randomly assigned; thus, it is not possible to distinguish the effect of the intervention from the effect of the unit. Educative intervention to primary physicians is feasible. Our data may be the basis for additional prospective studies with a cluster-randomized trial design and larger numbers of centers, physicians, and patients.

Efficacy of a physician's words of empathy: an overview of state apology laws.

PubMed

Saitta, Nicole; Hodge, Samuel D

2012-05-01

Apology laws are gaining traction in the United States, prompting health care professionals to offer words of condolence for adverse medical outcomes without the fear of being sued for malpractice. Although these laws vary by jurisdiction, they have been shown to reduce the financial consequences of a medical malpractice lawsuit. The authors provide an overview of the laws regarding this issue and discuss apologies as a means to reduce medical malpractice claims.

Racial Attitudes, Physician-Patient Talk Time Ratio, and Adherence in Racially Discordant Medical Interactions

PubMed Central

Hagiwara, Nao; Penner, Louis A.; Gonzalez, Richard; Eggly, Susan; Dovidio, John F.; Gaertner, Samuel L.; West, Tessa; Albrecht, Terrance L.

2013-01-01

Physician racial bias and patient perceived discrimination have each been found to influence perceptions of and feelings about racially discordant medical interactions. However, to our knowledge, no studies have examined how they may simultaneously influence the dynamics of these interactions. This study examined how (a) non-Black primary care physicians’ explicit and implicit racial bias and (b) Black patients’ perceived past discrimination affected physician-patient talk time ratio (i.e., the ratio of physician to patient talk time) during medical interactions and the relationship between this ratio and patients’ subsequent adherence. We conducted a secondary analysis of self-report and video-recorded data from a prior study of clinical interactions between 112 low-income, Black patients and their 14 non-Black physicians at a primary care clinic in the Midwestern United States between June, 2006 and February, 2008. Overall, physicians talked more than patients; however, both physician bias and patient perceived past discrimination affected physician-patient talk time ratio. Non-Black physicians with higher levels of implicit, but not explicit, racial bias had larger physician-patient talk time ratios than did physicians with lower levels of implicit bias, indicating that physicians with more negative implicit racial attitudes talked more than physicians with less negative racial attitudes. Additionally, Black patients with higher levels of perceived discrimination had smaller physician-patient talk time ratios, indicating that patients with more negative racial attitudes talked more than patients with less negative racial attitudes. Finally, smaller physician-patient talk time ratios were associated with less patient subsequent adherence, indicating that patients who talked more during the racially discordant medical interactions were less likely to adhere subsequently. Theoretical and practical implications of these findings are discussed in the context of factors that affect the dynamics of racially discordant medical interactions. PMID:23631787

Educating Nurses in the United States about Pressure Injuries.

PubMed

Ayello, Elizabeth A; Zulkowski, Karen; Capezuti, Elizabeth; Jicman, Wendy Harris; Sibbald, R Gary

2017-02-01

To provide information about the current state of educating nurses about wound care and pressure injuries with recommendations for the future. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Discuss the importance of pressure injury education and wound care for nurses and identify the current state of nursing education on the subject. 2. Identify strategies that can be used to put improved wound care and pressure injury education into practice. Wound care nursing requires knowledge and skill to operationalize clinical guidelines. Recent surveys and studies have revealed gaps in nurses' knowledge of wound care and pressure injuries and their desire for more education, both in their undergraduate programs and throughout their careers. Data from baccalaureate programs in the United States can pinpoint areas for improvement in nursing curriculum content. Lifelong learning about wound care and pressure injuries starts with undergraduate nursing education but continues through the novice-to-expert Benner categories that are facilitated by continuing professional development. This article introduces a pressure injury competency skills checklist and educational strategies based on Adult Learning principles to support knowledge acquisition (in school) and translation (into clinical settings). The responsibility for lifelong learning is part of every nurse's professional practice.

Performance measurement for ambulatory care: moving towards a new agenda.

PubMed

Roski, J; Gregory, R

2001-12-01

Despite a shift in care delivery from inpatient to ambulatory care, performance measurement efforts for the different levels in ambulatory care settings such as individual physicians, individual clinics and physician organizations have not been widely instituted in the United States (U.S.). The Health Plan Employer Data and Information Set (HEDIS), the most widely used performance measurement set in the U.S., includes a number of measures that evaluate preventive and chronic care provided in ambulatory care facilities. While HEDIS has made important contributions to the tracking of ambulatory care quality, it is becoming increasingly apparent that the measurement set could be improved by providing quality of care information at the levels of greatest interest to consumers and purchasers of care, namely for individual physicians, clinics and physician organizations. This article focuses on the improvement opportunities for quality performance measurement systems in ambulatory care. Specific challenges to creating a sustainable performance measurement system at the level of physician organizations, such as defining the purpose of the system, the accountability logic, information and reporting needs and mechanisms for sustainable implementation, are discussed.

Americans with Disabilities Act: physician-shareholder practice groups and ADA compliance.

PubMed

Odem, Nathan; Blanck, Peter

2003-02-01

This article examines the application of Americans with Disabilities Act requirements to professional associations like physician practice groups. In general, employers with 15 or more full-time employees must comply with the Act. However, the definition of an employee is sometimes unclear, especially as applied to business entities commonly used by physician practice groups. A recent case decided by the United States Court of Appeals for the Ninth Circuit held that physician-shareholders of a professional corporation are employees for Americans with Disabilities Act coverage purposes. Analogous cases in other federal circuits have held differently, likening the "owners" of professional corporations to partners in a partnership, who are not considered employees. Similar questions arise for popular business entities, such as Limited Liability Companies and Limited Liability Partnerships. This article discusses the nature of the business forms commonly used by physician practice groups and how their characteristics impact employee status for Americans with Disabilities Act coverage. It then suggests that examination is useful beyond business formation characteristics to the purpose of the Americans with Disabilities Act and other employment antidiscrimination statutes.

Physician-Pharmacist collaboration in a pay for performance healthcare environment.

PubMed

Farley, T M; Izakovic, M

2015-01-01

Healthcare is becoming more complex and costly in both European (Slovak) and American models. Healthcare in the United States (U.S.) is undergoing a particularly dramatic change. Physician and hospital reimbursement are becoming less procedure focused and increasingly outcome focused. Efforts at Mercy Hospital have shown promise in terms of collaborative team based care improving performance on glucose control outcome metrics, linked to reimbursement. Our performance on the Centers for Medicare and Medicaid Services (CMS) post-operative glucose control metric for cardiac surgery patients increased from a 63.6% pass rate to a 95.1% pass rate after implementing interventions involving physician-pharmacist team based care.Having a multidisciplinary team that is able to adapt quickly to changing expectations in the healthcare environment has aided our institution. As healthcare becomes increasingly saturated with technology, data and quality metrics, collaborative efforts resulting in increased quality and physician efficiency are desirable. Multidisciplinary collaboration (including physician-pharmacist collaboration) appears to be a viable route to improved performance in an outcome based healthcare system (Fig. 2, Ref. 12).

The value of survival analyses for evidence-based rural medical workforce planning.

PubMed

Russell, Deborah J; Humphreys, John S; McGrail, Matthew R; Cameron, W Ian; Williams, Peter J

2013-12-11

Globally, abundant opportunities exist for policymakers to improve the accessibility of rural and remote populations to primary health care through improving workforce retention. This paper aims to identify and quantify the most important factors associated with rural and remote Australian family physician turnover, and to demonstrate how evidence generated by survival analysis of health workforce data can inform rural workforce policy making. A secondary analysis of longitudinal data collected by the New South Wales (NSW) Rural Doctors Network for all family physicians working in rural or remote NSW between January 1(st) 2003 and December 31(st) 2012 was performed. The Prentice, Williams and Peterson statistical model for survival analysis was used to identify and quantify risk factors for rural NSW family physician turnover. Multivariate modelling revealed a higher (2.65-fold) risk of family physician turnover in small, remote locations compared to that in small closely settled locations. Family physicians who graduated from countries other than Australia, United Kingdom, United States of America, New Zealand, Ireland, and Canada also had a higher (1.45-fold) risk of turnover compared to Australian trained family physicians. This was after adjusting for the effects of conditional registration. Procedural skills and public hospital admitting rights were associated with a lower risk of turnover. These risks translate to a predicted median survival of 11 years for Australian-trained family physician non-proceduralists with hospital admitting rights working in small coastal closely settled locations compared to 3 years for family physicians in remote locations. This study provides rigorous empirical evidence of the strong association between population size and geographical location and the retention of family physicians in rural and remote NSW. This has important policy ramifications since retention grants for rural and remote family physicians in Australia are currently based on a geographical 'remoteness' classification rather than population size. In addition, this study demonstrates how survival analysis assists health workforce planning, such as through generating evidence to assist in benchmarking 'reasonable' lengths of practice in different geographic settings that might guide service obligation requirements.

The value of survival analyses for evidence-based rural medical workforce planning

PubMed Central

2013-01-01

Background Globally, abundant opportunities exist for policymakers to improve the accessibility of rural and remote populations to primary health care through improving workforce retention. This paper aims to identify and quantify the most important factors associated with rural and remote Australian family physician turnover, and to demonstrate how evidence generated by survival analysis of health workforce data can inform rural workforce policy making. Methods A secondary analysis of longitudinal data collected by the New South Wales (NSW) Rural Doctors Network for all family physicians working in rural or remote NSW between January 1st 2003 and December 31st 2012 was performed. The Prentice, Williams and Peterson statistical model for survival analysis was used to identify and quantify risk factors for rural NSW family physician turnover. Results Multivariate modelling revealed a higher (2.65-fold) risk of family physician turnover in small, remote locations compared to that in small closely settled locations. Family physicians who graduated from countries other than Australia, United Kingdom, United States of America, New Zealand, Ireland, and Canada also had a higher (1.45-fold) risk of turnover compared to Australian trained family physicians. This was after adjusting for the effects of conditional registration. Procedural skills and public hospital admitting rights were associated with a lower risk of turnover. These risks translate to a predicted median survival of 11 years for Australian-trained family physician non-proceduralists with hospital admitting rights working in small coastal closely settled locations compared to 3 years for family physicians in remote locations. Conclusions This study provides rigorous empirical evidence of the strong association between population size and geographical location and the retention of family physicians in rural and remote NSW. This has important policy ramifications since retention grants for rural and remote family physicians in Australia are currently based on a geographical ‘remoteness’ classification rather than population size. In addition, this study demonstrates how survival analysis assists health workforce planning, such as through generating evidence to assist in benchmarking ‘reasonable’ lengths of practice in different geographic settings that might guide service obligation requirements. PMID:24330603

U.K. physicians' attitudes toward active voluntary euthanasia and physician-assisted suicide.

PubMed

Dickinson, George E; Lancaster, Carol J; Clark, David; Ahmedzai, Sam H; Noble, William

2002-01-01

A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.

Uveitis and Systemic Inflammatory Markers in Convalescent Phase of Ebola Virus Disease.

PubMed

Chancellor, John R; Padmanabhan, Sriranjani P; Greenough, Thomas C; Sacra, Richard; Ellison, Richard T; Madoff, Lawrence C; Droms, Rebecca J; Hinkle, David M; Asdourian, George K; Finberg, Robert W; Stroher, Ute; Uyeki, Timothy M; Cerón, Olga M

2016-02-01

We report a case of probable Zaire Ebola virus-related ophthalmologic complications in a physician from the United States who contracted Ebola virus disease in Liberia. Uveitis, immune activation, and nonspecific increase in antibody titers developed during convalescence. This case highlights immune phenomena that could complicate management of Ebola virus disease-related uveitis during convalescence.

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

ERIC Educational Resources Information Center

van Zanten, Marta; Boulet, John R.

2013-01-01

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

Cost Containment: An Economist's View

PubMed Central

Neuhauser, Duncan

1980-01-01

Rising medical care costs are not the problem they seem to be, in part because quality of care is not considered. The problem may be more the absence of choice of alternative health benefit packages with price differences. The future of health services in the United States will have more competing alternatives requiring physicians to be more cost conscious. PMID:6992461

Dietary Management in Diabetes Mellitus. Nutrition in Primary Care Series, Number 10.

ERIC Educational Resources Information Center

Bossetti, Brenda; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Normal Diet: Age of Parental Control. Nutrition in Primary Care Series, Number 5.

ERIC Educational Resources Information Center

Tuckermanty, Elizabeth; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Normal Diet: Age of Dependency. Nutrition in Primary Care Series, Number 4.

ERIC Educational Resources Information Center

Cox, Janice Hovasi; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Preventing Hospital and Home Malnutrition. Nutrition in Health Promotion Series, Number 25.

ERIC Educational Resources Information Center

Hurley, Roberta Smith

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

An Analysis of Factors Affecting the Retention of Medical Officers in the United States Navy

DTIC Science & Technology

1986-12-01

Others, such as the Berry Plan <BP) and the Medi cal / Osteopathi c Scholarship Program (MOSP) were terminated in 1973 and 1977, respectively CRef. 15...Length-of -Servi ce Doctor of Osteopathy (OSTEO) Marital Status Age Medical School Eligible to Retire 66 VARIABLE SOURCE OF ENTRY PHYSICIAN SPECIALTY

Normal Diet: Pregnancy and Lactation. Nutrition in Primary Care Series, Number 7.

ERIC Educational Resources Information Center

Cox, Janice Hovasi; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Intelligent Cells and the Body as Conversation: The Democratic Rhetoric of Mindbody Medicine.

ERIC Educational Resources Information Center

Darwin, Thomas J.

1999-01-01

Discusses how "mindbody" medicine has become the most prominent version of alternative medicine in the United States. Notes that it advocates an equality of patient and physicians in the deliberative process of treating illness and maintaining health; it also argues, on scientific grounds, that the body is a vast cellular democracy,…

Gender Differences in Examinee Performance on the Step 2 Clinical Skills[R] Data Gathering (DG) and Patient Note (PN) Components

ERIC Educational Resources Information Center

Swygert, Kimberly A.; Cuddy, Monica M.; van Zanten, Marta; Haist, Steven A.; Jobe, Ann C.

2012-01-01

Multiple studies examining the relationship between physician gender and performance on examinations have found consistent significant gender differences, but relatively little information is available related to any gender effect on interviewing and written communication skills. The United States Medical Licensing Examination (USMLE[R]) Step 2…

Hot Jobs for the 21st Century. Facts on Working Women No. 97-4.

ERIC Educational Resources Information Center

Women's Bureau (DOL), Washington, DC.

Between 1994 and 2005, employment in the United States will rise to 144.7 million from 172 million, an increase of 14 percent, with women's labor force growth expected to be twice that of men. Growing occupations requiring a Bachelor's degree or above include the following: lawyers, physicians, systems analysts, computer engineers, management…

Eligibility | Cancer Prevention Fellowship Program

Cancer.gov

Both courses are open to physicians, scientists, other health professionals, fellows, and students who have an interest in cancer prevention and control. Acceptance into the CPFP is not necessary for participation in either course. Former participants represented cancer centers, universities, health departments, industry, and the U.S. Federal Government,  and were from across the United States and around the world.

Dietary Management for Alcoholic Patients. Nutrition in Primary Care Series, Number 14.

ERIC Educational Resources Information Center

Hurley, Roberta Smith; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Dietary Management in Gastrointestinal Diseases. Nutrition in Primary Care Series, Number 13.

ERIC Educational Resources Information Center

Stein, Joan Z.; Gallagher-Allred, Charlette R.

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Suicide Prevention: Efforts To Increase Research and Education in Palliative Care. Report to Congressional Requesters.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

Currently, the extent of palliative care instruction varies considerably across and within the three major phases of the physician education and training process. This analysis of current educational efforts in palliative care is based on information obtained from a survey conducted of all United States medical schools, surveys conducted on United…

Does Physician Education on Depression Management Improve Treatment in Primary Care?

PubMed Central

Lin, Elizabeth H B; Simon, Gregory E; Katzelnick, David J; Pearson, Steven D

2001-01-01

OBJECTIVE To assess the effect of physician training on management of depression. DESIGN Primary care physicians were randomly assigned to a depression management intervention that included an educational program. A before-and-after design evaluated physician practices for patients not enrolled in the intervention trial. SETTING One hundred nine primary care physicians in 2 health maintenance organizations located in the Midwest and Northwest regions of the United States. PATIENTS/PARTICIPANTS Computerized pharmacy and visit data from a group of 124,893 patients who received visits or prescriptions from intervention and usual care physicians. INTERVENTIONS Primary care physicians received education on diagnosis and optimal management of depression over a 3-month training period. Methods of education included small group interactive discussions, expert demonstrations, role-play, and academic detailing of pharmacotherapy, criteria for urgent psychiatric referrals, and case reviews with psychiatric consultants. MEASUREMENTS AND MAIN RESULTS Pharmacy and visit data provided indicators of physician management of depression: rate of newly diagnosed depression, new prescription of antidepressant medication, and duration of pharmacotherapy. One year after the training period, intervention and usual care physicians did not differ significantly in the rate of new depression diagnosis (P = .95) or new prescription of antidepressant medicines (P = .10). Meanwhile, patients of intervention physicians did not differ from patients of usual care physicians in adequacy of pharmacotherapy (P = .53) as measured by 12 weeks of continuous antidepressant treatment. CONCLUSIONS After education on optimal management of depression, intervention physicians did not differ from their usual care colleagues in depression diagnosis or pharmacotherapy. PMID:11556942

Cooperation not confrontation: the imperative of a nuclear age. The message from Budapest.

PubMed

Lown, B; Chazov, E

1985-08-02

Reprinted here is the text of a speech to the Fifth Congress of the International Physicians for the Prevention of Nuclear War (IPPNW), delivered in Budapest on 29 June 1985 by the group's co-founders, Dr. Bernard Lown from the United States and Dr. Eugene Chazov from the U.S.S.R. After reminding the delegates that 1985 marked the 40th anniversary of the bombings of Hiroshima and Nagasaki and the founding of the United Nations, the two physicians review the work of the IPPNW in alerting the world to the dangers of nuclear warfare. They warn that the chances of nuclear confrontation have increased, and urge their colleagues to foster cooperation between East and West. Lown and Chazov identify nuclear war as the greatest public health threat of all, and call for a moratorium on all nuclear explosions.

Physicians' propensity to collaborate and their attitude towards EBM: A cross-sectional study

PubMed Central

2011-01-01

Background The healthcare management literature states that physicians often coordinate their activities within and between organizations through social networks. Previous studies have also documented the relationship between professional networks and physicians' attitudes toward evidence-based medicine (EBM). The present study sought associations between physicians' self-reported attitudes toward EBM and the formation of inter-physician collaborative network ties. Methods Primary data were collected from 297 clinicians at six hospitals belonging to one of the largest local health units of the Italian National Health Service. Data collection used a survey questionnaire that inquired about professional networks and physicians' characteristics. Social network analysis was performed to describe inter-physician professional networks. Multiple regression quadratic assignment procedures were performed to assess the relationship between self-reported attitudes toward EBM and clinicians' propensity to collaborate. Results Physicians who reported similar attitudes toward EBM were more likely to exchange information and advice through collaborative relationships (β = 0.0198; p < 0.05). Similarities in other characteristics, such as field of specialization (β = 0.1988; p < 0.01), individual affiliations with hospital sites (β = 0.0845; p < 0.01), and organizational clinical directorates (β = 0.0459; p < 0.01), were also significantly related to physicians' propensity to collaborate. Conclusions Communities of practice within healthcare organizations are likely to contain separate clusters of physicians whose members are highly similar. Organizational interventions are needed to foster heterophily whenever multidisciplinary cooperation is required to provide effective health care. PMID:21787395

Determining customer satisfaction in anatomic pathology.

PubMed

Zarbo, Richard J

2006-05-01

Measurement of physicians' and patients' satisfaction with laboratory services has become a standard practice in the United States, prompted by national accreditation requirements. Unlike other surveys of hospital-, outpatient care-, or physician-related activities, no ongoing, comprehensive customer satisfaction survey of anatomic pathology services is available for subscription that would allow continual benchmarking against peer laboratories. Pathologists, therefore, must often design their own local assessment tools to determine physician satisfaction in anatomic pathology. To describe satisfaction survey design that would elicit specific information from physician customers about key elements of anatomic pathology services. The author shares his experience in biannually assessing customer satisfaction in anatomic pathology with survey tools designed at the Henry Ford Hospital, Detroit, Mich. Benchmarks for physician satisfaction, opportunities for improvement, and characteristics that correlated with a high level of physician satisfaction were identified nationally from a standardized survey tool used by 94 laboratories in the 2001 College of American Pathologists Q-Probes quality improvement program. In general, physicians are most satisfied with professional diagnostic services and least satisfied with pathology services related to poor communication. A well-designed and conducted customer satisfaction survey is an opportunity for pathologists to periodically educate physician customers about services offered, manage unrealistic expectations, and understand the evolving needs of the physician customer. Armed with current information from physician customers, the pathologist is better able to strategically plan for resources that facilitate performance improvements in anatomic pathology laboratory services that align with evolving clinical needs in health care delivery.

Pediatricians', obstetricians', gynecologists', and family medicine physicians' experiences with and attitudes about breast-feeding.

PubMed

Anchondo, Inés; Berkeley, Lizabeth; Mulla, Zuber D; Byrd, Theresa; Nuwayhid, Bahij; Handal, Gilbert; Akins, Ralitsa

2012-05-01

Investigate physicians' breast-feeding experiences and attitudes using a survey based on two behavioral theories: theory of reasoned action (TRA) and the health belief model (HBM). There were 73 participants included in the investigation. These participants were resident and faculty physicians from pediatrics, obstetrics/gynecology, and family medicine at a university campus, located on the US-Mexico border. The sample was reduced to 53 and 56 records for the attitude and confidence variables, respectively. Physicians answered a survey about their breast-feeding experiences and attitudes to learn about intention and ability applying constructs from TRA and HBM. An attitude scale, confidence variable (from self-efficacy items), and a lactation training index were created for the analysis. Analysis of the association between physicians' breastfeeding experiences and their attitudes revealed physicians are knowledgeable about breast-feeding and have positive attitudes towards breast-feeding. They did not seem to remember how long they breast-fed their children or whether they enjoyed breast-feeding, but they wanted to continue breast-feeding. Physicians cite work as a main reason for not continuing to breast-feed. Physicians' attitudes toward breast-feeding are positive. They are expected to practice health-promotion behavior including breast-feeding; however, physicians' breast-feeding rates are low and although they are knowledgeable about breast-feeding their training lacks on didactic depth and hands-on experience. If physicians learn more about breast-feeding and breast-feed exclusively and successfully, the rates in the United States would increase naturally.

Consent for donation after cardiac death: a survey of organ procurement organizations.

PubMed

Kalkbrenner, Kathy J; Hardart, George E

2012-01-01

Despite the increasing number of policies governing organ donation after cardiac death (DCD), nothing is presently known about the informed consent process for DCD. Without guidelines, organ procurement organizations (OPOs) are likely to structure the consent process similarly to that for organ donation after brain death (DBD), despite important ethical differences between the 2 modes of organ recovery. To describe informed consent practices used by OPOs for DCD. Cross-sectional, internet-based survey of the 58 OPOs in the United States. OPO policies and reported levels of physician participation in the consent process for DCD. Seventeen OPOs completed the survey (29%). Responders and nonresponders did not differ by DCD volume over the last year or last 5 years. None of the OPO's policies require physician involvement in obtaining written informed consent; 94% of policies require only the OPO representative to obtain written consent for DCD and 6% state that either the OPO representative or the treating physician may obtain consent; 71% of OPOs reported that discussions with family regarding DCD occur with the treating physician present less than 51% of the time and 82% indicated that the OPO representative is solely involved in obtaining consent for DCD in the majority of cases. A total of 24% of OPOs require physicians to participate in obtaining consent for procedures performed prior to death exclusively for organ preservation. No differences were found between the OPO consent practices for DCD and DBD. None of the OPOs responding to this survey have a policy requirement for physician involvement in obtaining consent for DCD. These findings raise questions about the role of physicians in DCD and how best to maintain a patient- and family-centered focus on care for patients at the end of life while supporting organ recovery efforts.

Attrition from emergency medicine clinical practice in the United States.

PubMed

Ginde, Adit A; Sullivan, Ashley F; Camargo, Carlos A

2010-08-01

We estimate the annual attrition from emergency medicine clinical practice. We performed a cross-sectional analysis of the American Medical Association's 2008 Physician Masterfile, which includes data on all physicians who have ever obtained a medical license in at least 1 US state. We restricted the analysis to physicians who completed emergency medicine residency training or who obtained emergency medicine board certification. We defined attrition as not being active in emergency medicine clinical practice. Attrition was reported as cumulative and annualized rates, with stratification by years since training graduation. Death rates were estimated from life tables for the US population. Of the 30,864 emergency medicine-trained or emergency medicine board-certified physicians, 26,826 (87%) remain active in emergency medicine clinical practice. Overall, type of attrition was 45% to non-emergency medicine clinical practice, 22% retired, 14% administration, and 10% research/teaching. Immediate attrition (<2 years since training graduation) was 6.5%. The cumulative attrition rates from 2 to 15 years postgraduation were stable (5% to 9%) and thereafter were progressively higher, with 18% having left emergency medicine clinical practice at 20 years postgraduation and 25% at 30 years postgraduation. Annualized attrition rates were highest for the first 5 years postgraduation and after 40 years postgraduation; between 5 and 40 years, the rates remained low (<1%). The overall annual attrition rate from emergency medicine clinical practice, including estimated death rate, was approximately 1.7%. Despite the high stress and demands of emergency medicine, overall attrition remains low and compares favorably with that of other medical specialties. These data have positive implications for the emergency physician workforce and are important for accurate estimation of and planning for emergency physician workforce needs. 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

International Atomic Energy Agency study with referring physicians on patient radiation exposure and its tracking: a prospective survey using a web-based questionnaire

PubMed Central

Rehani, Madan M; Berris, Theocharis

2012-01-01

Objectives To assess the following themes among referring physicians: (A) importance of acquiring information about previous diagnostic exposures; (B) knowledge about radiation doses involved, familiarity with radiation units and, age-related radiosensitivity; (C) opinion on whether patients should be provided information about radiation dose and (D) self-assessment of appropriateness of referrals. Design A prospective survey using a web-based questionnaire. Setting International survey among referring physicians. Participants Referring physicians from 28 countries. Main outcome measures Knowledge, opinion and practice of the four themes of the survey. Results All 728 responses from 28 countries (52.3% from developed and 47.7% from developing countries) indicated that while the vast majority (71.7%) of physicians feel that being aware of history of CT scans would always or mostly lead them to a better decision on referring patients for CT scans, only 43.4% often enquire about it. The majority of referring physicians (60.5%) stated that having a system that provides quick information about patient exposure history would be useful. The knowledge about radiation doses involved is poor, as only one-third (34.7%) of respondents chose the correct option of the number of chest x-rays with equivalence of a CT scan. In total, 70.9% of physicians stated that they do not feel uncomfortable when patients ask about radiation risk from CT scans they prescribe. Most physicians (85.6%) assessed that they have rarely prescribed CT scans of no clinical use in patient management. Conclusions This first ever multinational survey among referring physicians from 28 countries indicates support for a system that provides radiation exposure history of the patient, demonstrates poor knowledge about radiation doses, supports radiation risk communication with patients and mandatory provisions for justification of a CT examination. PMID:22997065

The physician-scientist in Canadian psychiatry.

PubMed

Honer, William G; Linseman, Mary Ann

2004-01-01

The objective of the study was to determine whether physician-scientists in psychiatry in Canada are in decline, as was reported for medicine overall during the 1990s in the United States. Federal databases were searched to study grant applications in the area of mental health submitted by physician-scientists compared with PhD-scientists for the period 1985-2001. A survey of Canadian Residency Training Program Directors was carried out for the graduating class of 2000. The Canadian publicly funded university system. Applicants to the Medical Research Council of Canada and its successor, the Canadian Institutes of Health Research, for operating grant support and Residency Training Program Directors. None. Comparison over time between MD and PhD applicants regarding the number of grant applications submitted, the proportion of applications funded and the number of new applications submitted, with separation of applications submitted to a predominantly "biomedical" peer review committee and to a predominantly "clinical research" peer review committee. The survey obtained information about a number of variables related to research training. The situation for physician-scientists in psychiatry in Canada appeared remarkably similar to general findings in US studies. Relative to PhD applicants, fewer grant proposals were being made by physicians (paired t16 = 7.08, p < 0.001) and, in consequence, fewer proposals were funded. The proportion of proposals funded was similar for MD and PhD applicants (paired t16 = 0.27, p = 0.79). Grant applications made to the predominantly biomedical committee were more likely to be funded than applications to the committee with an orientation toward clinical research (paired t7 = 5.53, p < 0.001). Applications by PhD-scientists to the biomedical committee showed the largest increase over time and were the most successful. From the survey of graduating classes, close to one-third of residents had authored or co-authored a publication during residency. Only 7% were proceeding to research fellowship training. The remuneration available for fellowship training was about one-third of what graduating classmates could expect to earn in the first year of practice. Quantitative data indicate that physician-scientists in psychiatry in Canada are experiencing the same pressures and challenges as physician-scientists in the United States. A plan of action tailored to the needs of the psychiatric community in Canada needs to be developed.

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.

Journals of the plague years: documenting the history of the AIDS epidemic in the United States.

PubMed Central

Markel, H

2001-01-01

This commentary discusses several journalistic, literary, and historical accounts of the AIDS epidemic as it has unfolded in the United States over the past 2 decades. By examining the different ways that different types of storytellers chronicle the political, social, public health, medical, and economic aspects of epidemic disease, this essay will demonstrate why the AIDS epidemic has been of such intense interest not only to physicians and public health experts but also to journalists, novelists, playwrights, memoirists, and historians. AIDS is a particularly fascinating example of society's broad concern with epidemics because it both is a global pandemic and, in recent years, has become a chronic disease. PMID:11441724

Gastrointestinal and hepatic manifestations of tickborne diseases in the United States.

PubMed

Zaidi, Syed Ali; Singer, Carol

2002-05-01

Signs and symptoms related to the gastrointestinal tract and liver may provide important clues for the diagnosis of various tickborne diseases prevalent in different geographic areas of the United States. We review clinical and laboratory features that may be helpful in detecting a tickborne infection. Physicians evaluating patients who live in or travel to areas where tickborne diseases are endemic and who present with an acute febrile illness and gastrointestinal manifestations should maintain a high index of suspicion for one of these disease entities, particularly if the patient has received a tick bite. If detected early, many of these potentially serious illnesses can be easily and effectively treated, thereby avoiding serious morbidity and even death.

Journals of the plague years: documenting the history of the AIDS epidemic in the United States.

PubMed

Markel, H

2001-07-01

This commentary discusses several journalistic, literary, and historical accounts of the AIDS epidemic as it has unfolded in the United States over the past 2 decades. By examining the different ways that different types of storytellers chronicle the political, social, public health, medical, and economic aspects of epidemic disease, this essay will demonstrate why the AIDS epidemic has been of such intense interest not only to physicians and public health experts but also to journalists, novelists, playwrights, memoirists, and historians. AIDS is a particularly fascinating example of society's broad concern with epidemics because it both is a global pandemic and, in recent years, has become a chronic disease.

Physicians in US Prisons in the Era of Mass Incarceration

PubMed Central

Allen, Scott A.; Wakeman, Sarah E.; Cohen, Robert L.; Rich, Josiah D.

2011-01-01

The United States leads the world in creating prisoners, incarcerating one in 100 adults and housing 25% of the world’s prisoners. Since the 1976, the US Supreme Court ruling that mandated health care for inmates, doctors have been an integral part of the correctional system. Yet conditions within corrections are not infrequently in direct conflict with optimal patient care, particularly for those suffering from mental illness and addiction. In addition to providing and working to improve clinical care for prisoners, physicians have an opportunity and an obligation to advocate for reform in the system of corrections when it conflicts with patient well-being. PMID:22049298

The Oklahoma City bombing: a personal account.

PubMed

Spengler, C

1995-09-01

On April 19, 1995, Oklahoma City (and the United States) lost its innocence. Almost all Oklahomans can relate exactly what they were doing either at 9:02 AM that day or when they first learned of the bombing. Of course, the whole world watched the events unfold through around-the-clock television coverage. One of the resident physicians in the University Hospital Emergency Medicine program, Dr Carl Spengler, was the first physician on the scene and directed early triage efforts. Because the Journal of Child Neurology is the only major biomedical journal with editorial offices in Oklahoma, we considered it appropriate that his personal account of this disaster be published in JCN.

Improving the preparticipation exam process.

PubMed

Reed, F E

2001-08-01

The Preparticipation Exam for too long has been a mandatory yearly athletic exam and not the base from which a process of continuous athletic care took place. The purpose of this article is not only to introduce improvements in the exam itself but to also describe some extensions of the process that allow us to improve athletic care in South Carolina. It is hoped that a software scanning program will allow compiling of demographic data from individual and group examinations and thus support the method of exam preferred by all physicians in our state. Standard forms will also facilitate communication within the Athletic Care Unit and between physicians involved in athletic care.

The Interservice Physician Assistant Program: Education quantity and quality.

PubMed

Harrison, Randolph Scott; Adamson, Katherine Justen; Kroger, Shan Michael

2015-12-01

The Interservice Physician Assistant Program (IPAP) was formed in 1996 by the assimilation of three service programs (Army, Air Force, and Navy). Applicants are selected from each service and upon successful completion of the program become commissioned officers within their respective medical corps. Clinical training takes place within military treatment facilities across the United States. Located in San Antonio, Texas, the program graduates about 169 PAs a year. Graduates are deployed to attend to service personnel, refugees, civilians, and victims of epidemics. The IPAP is unique in that it is the largest PA program in the world and its applicant pool is restricted to military personnel.

Patients' Expectations as to Doctors' Behaviors During Appointed Visits.

PubMed

Sobczak, Krzysztof; Leoniuk, Katarzyna; Janaszczyk, Agata; Pietrzykowska, Małgorzata

2017-04-01

Numerous guidelines for students and medical professionals provide the instructions of proper behavior during encounters with patients in a doctor's office. However, they quite often do not consider cultural differences that may affect the doctor-patient relationship. In our study we analyzed Polish patients' expectations (N = 976) for their physicians' actual behavior. We compared our results with analogue studies performed in the United States. We determined that patient expectations concerning a desirable form of verbal and nonverbal communication with a physician vary to a considerable degree. Relatively universal, however, is the wish that the doctors introduce themselves and apply personalized forms of contact.