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Sample records for sonographers physicians physician

  1. Physician Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Physician Compare, which meets Affordable Care Act of 2010 requirements, helps you search for and select physicians and other healthcare professionals enrolled in...

  2. Physician suicide.

    Science.gov (United States)

    Preven, D W

    1981-01-01

    The topic of physician suicide has been viewed from several perspectives. The recent studies which suggest that the problem may be less dramatic statistically, do not lessen the emotional trauma that all experience when their lives are touched by the grim event. Keeping in mind that much remains to be learned about suicides in general, and physician suicide specifically, a few suggestions have been offered. As one approach to primary prevention, medical school curriculum should include programs that promote more self-awareness in doctors of their emotional needs. If the physician cannot heal himself, perhaps he can learn to recognize the need for assistance. Intervention (secondary prevention) requires that doctors have the capacity to believe that anyone, regardless of status, can be suicidal. Professional roles should not prevent colleague and friend from identifying prodromal clues. Finally, "postvention" (tertiary prevention) offers the survivors, be they family, colleagues or patients, the opportunity to deal with the searing loss in a therapeutic way.

  3. Physician Fee Schedule Search

    Data.gov (United States)

    U.S. Department of Health & Human Services — This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services,...

  4. Physicians' Job Satisfaction.

    African Journals Online (AJOL)

    AmL

    doctors and retention of the existing doctors, in addition to the ... an employee's well-being Examples of job resources are job ..... increase physician job satisfaction for ensuring the .... both pay and benefits physicians at private hospitals.

  5. Physician Appraisals: Key Challenges

    Directory of Open Access Journals (Sweden)

    Klich Jacek

    2017-06-01

    Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

  6. Physician heal thyself

    African Journals Online (AJOL)

    Compared to overweight or obese physicians, normal‑weight physicians were significantly more likely to discuss weight loss with their obese patients, according to a study among. 500 primary care physicians, undertaken by researchers at the Johns Hopkins Bloomberg School of Public Health.[4]. A recent, highly accessed ...

  7. Burnout among physicians

    OpenAIRE

    Romani, Maya; Ashkar, Khalil

    2014-01-01

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to ...

  8. Becoming a Physician

    Science.gov (United States)

    ... the Payment Process Physician Payment Resource Center Reinventing Medical Practice Managing Your Practice CPT® (Current Procedural Terminology) Medicare & Medicaid Private Payer Reform Claims Processing & Practice ...

  9. American College of Physicians

    Science.gov (United States)

    ... Plus In this Section Clinical Guidelines & Recommendations Performance Measures Journals & Publications Clinical Resources & Products High Value Care Ethics & Professionalism Practice Resources Physician and Practice Timeline Upcoming important dates ...

  10. Kentucky physicians and politics.

    Science.gov (United States)

    VonderHaar, W P; Monnig, W B

    1998-09-01

    Approximately 19% of Kentucky Physicians are KEMPAC members or contribute to state legislative and Gubernatorial candidates. This limited study of political activity indicates that a small percentage of physicians participate in the political process. Despite the small number of contributors to state legislative candidates, KMA's legislative and lobbying effort is highly effective and members receive high quality service and representation in the political arena.

  11. Hitler's Jewish Physicians.

    Science.gov (United States)

    Weisz, George M

    2014-07-01

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

  12. Physician Referral Patterns

    Data.gov (United States)

    U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

  13. Physician-Owned Hospitals

    Data.gov (United States)

    U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...

  14. Physician Shared Patient Patterns

    Data.gov (United States)

    U.S. Department of Health & Human Services — The physician referral data linked below was provided as a response to a Freedom of Information Act (FOIA) request. These files represent the number of encounters a...

  15. [Hippocrates' treatise physician].

    Science.gov (United States)

    Frøland, Anders

    2005-01-01

    This small treatise does not appear to have been published in Danish in its entirety. It gives a vivid picture of the physician in ancient Greece. The well known first chapter describes the attitudes and attributes of the doctor. It goes on discussing in some detail how the light should be in the surgery, the instruments to be used, the preparations of bandages and drugs, and the use of cupping instruments. The author stresses both the needs of the patient and the necessity of the physician's dignity and integrity.

  16. The African Family Physician

    African Journals Online (AJOL)

    North America and Europe, and these serve us well up to a point. When a colleague ... Maybe we need a different set of principles to work by in the Afri- ... base the balance. ... The African Family Physician is dedicated to life-long learning and.

  17. Physician self-care

    African Journals Online (AJOL)

    impact on patient care, increasing the number of medical errors, lowering both patient and physician satisfaction and lengthening the recovery phase.[1-3]. Joan Halifax[4] has taught at programmes in palliative care for health professional caregivers for many years. She identified frequent challenges facing healthcare ...

  18. Physician-owned companies.

    Science.gov (United States)

    Kostuik, John P

    2007-05-15

    The author relates his experience in the development of a spinal implant development company (K2M) that is significantly advised by physicians. To provide information about the development of a spinal implant company (K2M) advised by a group of professional spinal surgeons. To relate the federal laws (STARK and anti-kickback) as they pertain to surgeon-influenced companies. To discuss the role of a scientific advisory board. A self-developed company was developed together with significant, but minority physician financial input and majority scientific advice. A privately owned spinal implant development corporation (K2M) was developed 3 years ago. Physician financial participation was less than 20% (Stark laws state no more than 40%). Users of product are greater than 60% non-investor physicians. The development of a large scientific advisory board has been very influential in product development. A privately owned spinal implant company (K2M) has been developed strictly within Federal laws. Its board of scientific advisors that receives recompense commissurate only with effort significantly impacts the company policy.

  19. Physicians and Insider Trading.

    Science.gov (United States)

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

    2015-12-01

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

  20. [Burnout in physicians].

    Science.gov (United States)

    Kurzthaler, Ilsemarie; Kemmler, Georg; Fleischhacker, W Wolfgang

    2017-06-01

    Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

  1. Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

    Science.gov (United States)

    Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

    2017-05-01

    To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

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

    Science.gov (United States)

    Coyle, Susan L

    2002-03-05

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

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

    Science.gov (United States)

    Scott-Rotter, A E; Brown, J A

    1999-01-01

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

  4. Better Physician's 'Black Bags'

    Science.gov (United States)

    1976-01-01

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

  5. Medicare, physicians, and patients.

    Science.gov (United States)

    Hacker, Joseph F

    2004-05-01

    There are many other provisions to the MMA. It is important to remind our patients that these changes are voluntary. If patients are satisfied with their current Medicare benefits and plan, they need not change to these new plans. However, as physicians we should familiarize ourselves with these new Medicare options so as to better advise our patients. For more information, visit www.ama-assn.org. The Medical Society of Delaware will strive to keep you informed as these new changes are implemented.

  6. Development of physician leadership competencies: perceptions of physician leaders, physician educators and medical students.

    Science.gov (United States)

    McKenna, Mindi K; Gartland, Myles P; Pugno, Perry A

    2004-01-01

    Research regarding the development of healthcare leadership competencies is widely available. However, minimal research has been published regarding the development of physician leadership competencies, despite growing recognition in recent years of the important need for effective physician leadership. Usingdata from an electronically distributed, self-administered survey, the authors examined the perceptions held by 110 physician leaders, physician educators, and medical students regarding the extent to which nine competencies are important for effective physician leadership, ten activities are indicative of physician leadership, and seven methods are effective for the development of physician leadership competencies. Results indicated that "interpersonal and communication skills" and "professional ethics and social responsibility" are perceived as the most important competencies for effective physician leadership. Furthermore, respondents believe "influencing peers to adopt new approaches in medicine" and "administrative responsibility in a healthcare organization" are the activities most indicative of effective physician leadership. Finally, respondents perceive"coaching or mentoring from an experienced leader" and "on-job experience (e.g., a management position)" as the most effective methods for developing physician leadership competencies. The implications of these findings for the education and development of physician leaders are discussed.

  7. Views of physicians in training on the ethical and legal issues in preliminary reporting of echocardiographic data.

    Science.gov (United States)

    McDonald, R W; Rice, M J; Marcella, C P; Reller, M D; Imus, R L

    1991-01-01

    Cardiac sonographers may be pressured by physicians into giving diagnostic interpretations of echocardiographic data. This study investigated the issue of preliminary reporting of echocardiographic data. A questionnaire was sent to 292 physicians; 85 physicians (29%) responded. Seventy-two physicians (87%) thought they had more than a minimal knowledge of echocardiography, 94% wanted a written or verbal preliminary report, and 84% thought that giving a preliminary report should be part of the cardiac sonographer's job. If abnormalities were found, 80% wanted the results before a cardiologist reviewed the study, and 56% would want a diagnostic rather than a descriptive report. Fifty-four physicians (64%) would pressure the cardiac sonographer into giving a preliminary echocardiographic report and would use this information to manage the patient. The majority of the physicians thought that it is legal for the cardiac sonographer to give a preliminary echocardiogram report. Eighty percent said that the cardiac sonographer would not be "practicing medicine without a license," and 82% that the sonographer would not be "aiding and abetting the unauthorized practice of medicine." This data would indicate that physicians at Oregon Health Sciences University want the cardiac sonographer to give preliminary echocardiographic results, even though the sonographer may be breaking state statutes.

  8. The physician leader as logotherapist.

    Science.gov (United States)

    Washburn, E R

    1998-01-01

    Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.

  9. Family Violence and Family Physicians

    Science.gov (United States)

    Herbert, Carol P.

    1991-01-01

    The acronym IDEALS summarizes family physicians' obligations when violence is suspected: to identify family violence; document injuries; educate families and ensure safety for victims; access resources and coordinate care; co-operate in the legal process; and provide support for families. Failure to respond reflects personal and professional experience and attitudes, fear of legal involvement, and lack of knowledge. Risks of intervention include physician burnout, physician overfunctioning, escalation of violence, and family disruption. PMID:21228987

  10. Emergency Physicians at War.

    Science.gov (United States)

    Muck, Andrew E; Givens, Melissa; Bebarta, Vikhyat S; Mason, Phillip E; Goolsby, Craig

    2018-05-01

    Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military's health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.

  11. Physician revalidation in Europe.

    Science.gov (United States)

    Merkur, Sherry; Mossialos, Elias; Long, Morgan; McKee, Martin

    2008-08-01

    Despite the increasing attention on patient mobility, there remains a lack of European-level interest in assuring the sustained competence of health professionals. Specifically, the existing European legal framework fails to recognise the introduction of periodic revalidation and requirements to participate in continuing professional development in some countries. This study shows that the definitions and mechanisms of revalidation vary significantly across member states. While some countries, eg Austria, Germany and Spain, look to continuing medical education as a means to promote recertification and quality of care, other countries, eg Belgium, France and the Netherlands, also incorporate peer review. In the UK the proposed revalidation scheme would include elements of relicensure through appraisal and feedback as well as physician recertification. Divergence between countries also exists in monitoring and enforcement. The European Commission should explore the implications for professional mobility of the diversity in the regulation of the medical profession.

  12. Emergency Physicians at War

    Directory of Open Access Journals (Sweden)

    Melissa Givens

    2018-03-01

    Full Text Available Operation Enduring Freedom (OEF-A in Afghanistan and Operation Iraqi Freedom (OIF represent the first major, sustained wars in which emergency physicians (EPs fully participated as an integrated part of the military’s health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.

  13. Team physicians in college athletics.

    Science.gov (United States)

    Steiner, Mark E; Quigley, D Bradford; Wang, Frank; Balint, Christopher R; Boland, Arthur L

    2005-10-01

    There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes. A multidisciplinary team of physicians is necessary to treat college athletes. Most physician evaluations are for musculoskeletal injuries treated nonoperatively. Descriptive epidemiology study. For a 2-year period, a database was created that recorded information on team physician encounters with intercollegiate athletes at a major university. Data on imaging studies, hospitalizations, and surgeries were also recorded. The diagnoses for physician encounters with all undergraduates through the university's health service were also recorded. More initial athlete evaluations were for musculoskeletal diagnoses (73%) than for general medical diagnoses (27%) (P respiratory infections and dermatologic disorders, or multiple visits for concussions. Football accounted for 22% of all physician encounters, more than any other sport (P athletes did not require a greater number of physician encounters than did the general undergraduate pool of students on a per capita basis. Intercollegiate team physicians primarily treat musculoskeletal injuries that do not require surgery. General medical care is often single evaluations of common conditions and repeat evaluations for concussions.

  14. Social media: physicians-to-physicians education and communication.

    Science.gov (United States)

    Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K

    2017-06-01

    Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

  15. Should physicians have facial piercings?

    Science.gov (United States)

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

    2005-03-01

    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. Survey. Teaching hospital in the southeastern United States. Emergency department patrons and medical school faculty physicians. 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. 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. 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.

  16. Physicians' obligations in radiation issues

    International Nuclear Information System (INIS)

    Loken, M.K.

    1986-01-01

    Physicians have responsibilities to develop effective radiation programs that will (1) protect the public's physical and emotional health, (2) prevent and/or minimize illnesses and injury, and (3) treat and rehabilitate all exposed individuals. To accomplish these goals, physicians should understand the basic elements of radiation physics, radiation biology, benefit/risk, radiation regulations, nuclear power production, and world energy needs

  17. HMO penetration and physicians' earnings.

    Science.gov (United States)

    Hadley, J; Mitchell, J M

    1999-11-01

    The goal of this study is to estimate whether cross-sectional variations in enrollment in health maintenance organizations (HMOs) affected physicians' earnings and hourly income in 1990. Using data from a nationally representative sample of 4,577 younger physicians (penetration is endogenous and used the instrumental variables approach to obtain unbiased estimates. HMO penetration had a negative and statistically significant impact on physicians earnings in 1990. A doubling of the average level of HMO penetration in the market is estimated to reduce annual earnings by 7% to 10.7%, and hourly earnings by approximately 6% to 9%. It appears that HMOs were successful in reducing physicians' annual and per hour earnings in 1990, presumably through a combination of fewer visits and lower payment rates for people covered by HMOs. Although these results cannot be generalized to all physicians, the experience of a younger cohort of physicians may still be a good indicator of the future effects of HMOs because younger physicians may be more susceptible to market forces than older and more established physicians. Moreover, these results may be somewhat conservative because they reflect market behavior in 1990, several years before the rapid growth and more aggressive market behavior of HMOs in recent years.

  18. Physician Requirements-1990. For Cardiology.

    Science.gov (United States)

    Tracy, Octavious; Birchette-Pierce, Cheryl

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

  19. Administrative skills for academy physicians.

    Science.gov (United States)

    Aluise, J J; Schmitz, C C; Bland, C J; McArtor, R E

    To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.

  20. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

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

    Science.gov (United States)

    MacDougall, D Robert

    2013-09-01

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

  2. Physician self-referral and physician-owned specialty facilities.

    Science.gov (United States)

    Casalino, Lawrence P

    2008-06-01

    Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

  3. American College of Emergency Physicians

    Science.gov (United States)

    ... these... Read More More Than 850 Hours of Online Education Log In Now > Physicians Podcasts and Apps Reimbursement Quality Issues MOC Resource Center International Residents & Students Contracts & ... Medicine Foundation Online Buyers' Guide Emergency Care For You emCareers.org ...

  4. Physician Compare National Downloadable File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Physician Compare National Downloadable File is organized at the individual eligible professional level; each line is unique at the professional/enrollment...

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

    Science.gov (United States)

    Glick, Shimon; Schwarzfuchs, Dan

    2012-01-01

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

  6. Structuring competitive physician compensation models.

    Science.gov (United States)

    Mobley, Kim; Turcotte, Claire

    2010-12-01

    When developing and reviewing their physician compensation programs, healthcare organizations should: Understand the market data. Test outcomes of incentive plans for fair market value. Check total compensation for fair market value and reasonableness.

  7. The physician as a manager.

    Science.gov (United States)

    McDonagh, T J

    1982-02-01

    The practice of occupational medicine has undergone considerable change over the last decade. Increased awareness of potential health hazards associated with the workplace and its products and wastes, the interest of society and workers in these subjects, and related governmental regulation have resulted in expanded occupational health programs within industry. The occupational physician has become a key company resource in the optimal management of the business impacts of health-related issues. Health-related matters often have noteworthy business implications, and the occupational physician needs to spend considerable time as a manager in the planning, resourcing, implementation, evaluation, and stewardship of programs. Thus he is experiencing greater demands and often is inadequately prepared for this nonclinical, nonscientific role. Therefore, the preparation of occupational physicians to assume such managerial responsibilities needs to receive high priority. The physician must be willing to accept this challenge both to ensure the program's success and to retain a leadership position in occupational health programs.

  8. Administrative skills for academic physicians.

    Science.gov (United States)

    Aluise, J J; Scmitz, C C; Bland, C J; McArtor, R E

    1989-01-01

    To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.

  9. Influence of pharmacists expertise on physicians prescription ...

    African Journals Online (AJOL)

    the prescribing behaviour of physicians. ... Keywords: Physician prescription behaviour, Pharmacist factor, Collaboration, Trustworthiness ... provide information relating to drug prescription, ... processing [22], which takes into consideration.

  10. Unique Physician Identification Number (UPIN) Directory

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Unique Physician Identification Number (UPIN) Directory contains selected information on physicians, doctors of Osteopathy, limited licensed practitioners and...

  11. Abortion and compelled physician speech.

    Science.gov (United States)

    Orentlicher, David

    2015-01-01

    Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. © 2015 American Society of Law, Medicine & Ethics, Inc.

  12. Health practices of Canadian physicians.

    Science.gov (United States)

    Frank, Erica; Segura, Carolina

    2009-08-01

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

  13. Evaluation of Physicians' Cognitive Styles.

    Science.gov (United States)

    Djulbegovic, Benjamin; Beckstead, Jason W; Elqayam, Shira; Reljic, Tea; Hozo, Iztok; Kumar, Ambuj; Cannon-Bowers, Janis; Taylor, Stephanie; Tsalatsanis, Athanasios; Turner, Brandon; Paidas, Charles

    2014-07-01

    Patient outcomes critically depend on accuracy of physicians' judgment, yet little is known about individual differences in cognitive styles that underlie physicians' judgments. The objective of this study was to assess physicians' individual differences in cognitive styles relative to age, experience, and degree and type of training. Physicians at different levels of training and career completed a web-based survey of 6 scales measuring individual differences in cognitive styles (maximizing v. satisficing, analytical v. intuitive reasoning, need for cognition, intolerance toward ambiguity, objectivism, and cognitive reflection). We measured psychometric properties (Cronbach's α) of scales; relationship of age, experience, degree, and type of training; responses to scales; and accuracy on conditional inference task. The study included 165 trainees and 56 attending physicians (median age 31 years; range 25-69 years). All 6 constructs showed acceptable psychometric properties. Surprisingly, we found significant negative correlation between age and satisficing (r = -0.239; P = 0.017). Maximizing (willingness to engage in alternative search strategy) also decreased with age (r = -0.220; P = 0.047). Number of incorrect inferences negatively correlated with satisficing (r = -0.246; P = 0.014). Disposition to suppress intuitive responses was associated with correct responses on 3 of 4 inferential tasks. Trainees showed a tendency to engage in analytical thinking (r = 0.265; P = 0.025), while attendings displayed inclination toward intuitive-experiential thinking (r = 0.427; P = 0.046). However, trainees performed worse on conditional inference task. Physicians capable of suppressing an immediate intuitive response to questions and those scoring higher on rational thinking made fewer inferential mistakes. We found a negative correlation between age and maximizing: Physicians who were more advanced in their careers were less willing to spend time and effort in an

  14. Developing a Physician׳s Professional Identity Through Medical Education.

    Science.gov (United States)

    Olive, Kenneth E; Abercrombie, Caroline L

    2017-02-01

    Professionalism represents a fundamental characteristic of physicians. Professional organizations have developed professionalism competencies for physicians and medical students. The aim of teaching medical professionalism is to ensure the development of a professional identity in medical students. Professional identity formation is a process developed through teaching principles and appropriate behavioral responses to the stresses of being a physician. Addressing lapses and critical reflection is an important part of the educational process. The "hidden curriculum" within an institution plays an important role in professional identity formation. Assessment of professionalism involves multiple mechanisms. Steps in remediating professionalism lapses include (1) initial assessment, (2) diagnosis of problems and development of an individualized learning plan, (3) instruction encompassing practice, feedback and reflection and (4) reassessment and certification of competence. No reliable outcomes data exist regarding the effectiveness of different remediation strategies. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  15. Physician wages across specialties: informing the physician reimbursement debate.

    Science.gov (United States)

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

    2010-10-25

    Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

  16. Recruiting physicians without inviting trouble.

    Science.gov (United States)

    Hoch, L J

    1989-05-01

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

  17. Psychiatric rehabilitation education for physicians.

    Science.gov (United States)

    Rudnick, Abraham; Eastwood, Diane

    2013-06-01

    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011). (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  18. A physician's exposure to defamation.

    Science.gov (United States)

    Mandell, W J

    1992-01-01

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

  19. [Sherlock Holmes as amateur physician].

    Science.gov (United States)

    Madsen, S

    1998-03-30

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

  20. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Science.gov (United States)

    2010-10-01

    ... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians. (a...

  1. Hitler’s Jewish Physicians

    Science.gov (United States)

    Weisz, George M.

    2014-01-01

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

  2. Physician-centered management guidelines.

    Science.gov (United States)

    Pulde, M F

    1999-01-01

    The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

  3. Introducing Physician Assistants to Ontario

    Directory of Open Access Journals (Sweden)

    Meredith Vanstone

    2014-02-01

    Full Text Available In 2006, the Ontario Ministry of Health and Long-Term Care (MOHLTC introduced Physician Assistants (PAs through the announcement of demonstration projects, education and training programs, and subsequent funding. PAs are directly supervised by physicians and act as physician extenders by performing acts as delegated to them by their supervising physicians. PAs were proposed as a potential solution to help improve access to health care and reduce wait times throughout the province. Prior to the 2006 Ministry announcement, there was little public discussion regarding the acceptance of the PA role or its sustainability. Opposition from nursing and other groups emerged in response to the 2006 announcement and flared again when stakeholder comments were solicited in 2012 as part of the PA application for status as regulated health professionals. As a health reform, the introduction of PAs has neither succeeded nor failed. In 2013, the majority of PA funding continues to be provided by the MOHLTC, and it is unknown whether the PA role will be sustainable when the MOHTLC withdraws salary funding and health system employers must decide whether or not to continue employing PAs at their own expense.

  4. Physician assistant education in Germany

    NARCIS (Netherlands)

    M. Dierks; L. Kuilman; C. Matthews

    2013-01-01

    The first physician assistant (PA) program in Germany began in 2005. As of 2013 there are three PA programs operational, with a fourth to be inaugurated in the fall of 2013. The programs have produced approximately 100 graduates, all with a nursing background. The PA model of shifting tasks from

  5. American College of Chest Physicians

    Science.gov (United States)

    ... Foundation Participate in the e-Community Get Social Career Connection Publications CHEST Journal CHEST SEEK Guidelines & Consensus Statements CHEST Physician CHEST NewsBrief Coding for Chest Medicine Tobacco Dependence Toolkit (3rd Ed.) Mobile Websites and Apps CHEST Journal ...

  6. Hitler’s Jewish Physicians

    Directory of Open Access Journals (Sweden)

    George M. Weisz

    2014-07-01

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

  7. [The tragic fate of physicians].

    Science.gov (United States)

    Ohry, Avi

    2013-10-01

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

  8. The Mindful Physician and Pooh

    Science.gov (United States)

    Winter, Robin O.

    2013-01-01

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

  9. Business plan writing for physicians.

    Science.gov (United States)

    Cohn, Kenneth H; Schwartz, Richard W

    2002-08-01

    Physicians are practicing in an era in which they are often expected to write business plans in order to acquire, develop, and implement new technology or programs. This task is yet another reminder of the importance of business principles in providing quality patient care amid allocation of increasingly scarce resources. Unfortunately, few physicians receive training during medical school, residencies, or fellowships in performing such tasks. The process of writing business plans follows an established format similar to writing a consultation, in which the risks, benefits, and alternatives to a treatment option are presented. Although administrative assistance may be available in compiling business plans, it is important for physicians to understand the rationale, process, and pitfalls of business planning. Writing a business plan will serve to focus, clarify, and justify a request for scarce resources, and thus, increase its chance of success, both in terms of funding and implementation. A well-written business plan offers a plausible, coherent story of an uncertain future. Therefore, a business plan is not merely an exercise to obtain funding but also a rationale for investment that can help physicians reestablish leadership in health care.

  10. [Family physicians attitude towards quality indicator program].

    Science.gov (United States)

    Shani, Michal; Nakar, Sasson; Azuri, Yossi

    2012-10-01

    Quality indicator programs for primary care are implanted throughout the world improving quality in health care. In this study, we have assessed family physicians attitudes towards the quality indicators program in Israel. Questionnaires were distributed to family physicians in various continuing educational programs. The questionnaire addressed demographics, whether the physician dealt with quality indicators, time devoted by the physician to quality indicators, pressure placed on the physician related to quality indicators, and the working environment. A total of 140 questionnaires were distributed and 91 (65%) were completed. The average physician age was 49 years (range 33-65 years]; the average working experience as a family physician was 17.8 years (range 0.5-42); 58 physicians were family medicine specialist (65.9%). Quality indicators were part of the routine work of 94% of the physicians; 72% of the physicians noted the importance of quality indicators; 84% of the physicians noted that quality indicators demand better team work; 76% of the physicians noted that quality indicators have reduced their professional independence. Pressure to deal with quality indicators was noted by 72% of the family physicians. Pressure to deal with quality indicators was related to reduced loyalty to their employer (P = 0.001), reducing their interest to practice family medicine (p programs, without creating a heavy burden on the work of family physicians.

  11. Physician career satisfaction within specialties

    Directory of Open Access Journals (Sweden)

    Kravitz Richard L

    2009-09-01

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

  12. Vaccines provided by family physicians.

    Science.gov (United States)

    Campos-Outcalt, Doug; Jeffcott-Pera, Michelle; Carter-Smith, Pamela; Schoof, Bellinda K; Young, Herbert F

    2010-01-01

    This study was conducted to document current immunization practices by family physicians. In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consisted of questions regarding the demographics of the practice, vaccines that are provided at the physicians' clinical site, whether the practice refers patients elsewhere for vaccines, and participation in the Vaccines for Children (VFC) program. The response rate was 38.5%, 31.8% after non-office-based respondents were deleted. A high proportion of respondents (80% or more) reported providing most routinely recommended child, adolescent, and adult vaccines at their practice sites. The exceptions were rotavirus vaccine for children and herpes zoster vaccine for adults., A significant proportion, however, reported referring elsewhere for some vaccines (44.1% for children and adolescent vaccines and 53.5% for adult vaccines), with the most frequent referral location being a public health department. A higher proportion of solo and 2-physician practices than larger practices reported referring patients. A lack of adequate payment was listed as the reason for referring patients elsewhere for vaccines by one-half of those who refer patients. One-half of responders do not participate in the VFC program. Provision of recommended vaccines by most family physicians remains an important service. Smaller practices have more difficulty offering a full array of vaccine products, and lack of adequate payment contributes to referring patients outside the medical home. The reasons behind the lack of participation in the VFC program deserve further study.

  13. Ethical principles for physician rating sites.

    Science.gov (United States)

    Strech, Daniel

    2011-12-06

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

  14. Perceptions of trust in physician-managers.

    Science.gov (United States)

    Cregård, Anna; Eriksson, Nomie

    2015-01-01

    The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers. The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers. The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians' trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role. This paper's findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers. The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities. The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.

  15. Gainsharing Strategies, Physician Champions, Getting Physician Buy In.

    Science.gov (United States)

    Anoushiravani, Afshin A; Nunley, Ryan M

    2017-06-01

    As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives. Copyright © 2017. Published by Elsevier Inc.

  16. The relationship between physician humility, physician-patient communication, and patient health.

    Science.gov (United States)

    Ruberton, Peter M; Huynh, Ho P; Miller, Tricia A; Kruse, Elliott; Chancellor, Joseph; Lyubomirsky, Sonja

    2016-07-01

    Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit. Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction. Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient. The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients. Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Relation Between Physicians' Work Lives and Happiness.

    Science.gov (United States)

    Eckleberry-Hunt, Jodie; Kirkpatrick, Heather; Taku, Kanako; Hunt, Ronald; Vasappa, Rashmi

    2016-04-01

    Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. We sampled 2000 full-time physician members of the American Academy of Family Physicians. Respondents completed a demographics questionnaire, questions about workload, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Subjective Happiness Scale. We performed a hierarchical regression analysis with the burnout and wellness subscales as predictor variables and physician happiness as the outcome variable. Our response rate was 22%. Career purpose, personal accomplishment, and perception of workload manageability had significant positive correlations with physician happiness. Distress had a significant negative correlation with physician happiness. A sense of career meaning and accomplishment, along with a lack of distress, are important factors in determining physician happiness. The number of hours a physician works is not related to happiness, but the perceived ability to manage workload was significantly related to happiness. Wellness-promotion efforts could focus on assisting physicians with skills to manage the workload by eliminating unnecessary tasks or sharing workload among team members, improving feelings of work accomplishment, improving career satisfaction and meaning, and managing distress related to patient care.

  18. Patient–physician communication regarding electronic cigarettes

    Directory of Open Access Journals (Sweden)

    Michael B. Steinberg

    2015-01-01

    Discussion: Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

  19. Nigerian physicians' knowledge, attitude and practices regarding ...

    African Journals Online (AJOL)

    Nigerian physicians' knowledge, attitude and practices regarding diabetes ... conducted among physicians in four towns in four different States in Nigeria, ... Only 36.8% of the participants knew that children with diabetes should eat family diet.

  20. Medicares Physician Quality Reporting System (PQRS)...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicares Physician Quality Reporting System (PQRS) allows providers to report measures of process quality and health outcomes. The authors of Medicares Physician...

  1. Physician Asthma Management Practices in Canada

    Directory of Open Access Journals (Sweden)

    Robert Jin

    2000-01-01

    Full Text Available OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices.

  2. Medicare Provider Data - Physician and Other Supplier

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare...

  3. Liver transplantation for nontransplant physicians

    Directory of Open Access Journals (Sweden)

    Amany AbdelMaqsod Sholkamy

    2014-01-01

    Full Text Available Many of the nontransplant physicians who manage hepatic patients (internists and hepatologists keep asking about liver transplantation. The purpose of this article is to highlight important topics a nontransplant colleague may require in his practice. There are many topics in this respect; however, three most important topics need to be highlighted; those are; the time of referral to transplantation, the indications and contraindications and the metabolic issues regarding a transplanted patient. Still, there are no clear guidelines for the management of many of the metabolic issues regarding liver transplanted patients. And this why, collaborative efforts of transplant and nontransplant physicians are needed to conduct multicenter, long term randomized controlled trials and proper follow up programs.

  4. Physicians, radiologists, and quality control

    International Nuclear Information System (INIS)

    Payne, W.F.

    1973-01-01

    Factors involved in quality control in medical x-ray examinations to achieve the least possible exposure to the patient are discussed. It would be hoped that film quality will remain in the position of paramount importance that it must in order to achieve the greatest amount of diagnostic information on each radiographic examination. At the same time, it is hoped that this can be done by further reducing the exposure of the patient to ionizing radiation by the methods that have been discussed; namely, education of the physician, radiologist, and technologist, modern protective equipment and departmental construction, efficient collimation whether automatic or manual, calibration and output measurement of the radiographic and fluoroscopic units, ongoing programs of education within each department of radiographic facility, film badge monitoring, education of and cooperation with the nonradiologic physician, and hopefully, more intensive programs by the National and State Bureaus and Departments of Radiological Health in education and encouragement to the medical community. (U.S.)

  5. [Imhotep--builder, physician, god].

    Science.gov (United States)

    Mikić, Zelimir

    2008-01-01

    The medicine had been practiced in ancient Egypt since the earliest, prehistoric days, many millenia before Christ, and was quite developed in later periods. This is evident from the sceletal findings, surgical instruments found in tombs, wall printings, the reliefs and inscriptions, and most of all, from the sparse written material known as medical papyri. However, there were not many physicians from that time whose names had been recorded. The earliest physician in ancient Egypt known by name was Imhotep. WHO WAS IMHOTEP?: Imhotep lived and worked during the time of the 3rd Dynasty of Old Kingdom and served under the pharaoh Djoser (reigned 2667-2648 BC) as his vizier or chief minister, high priest, chief builder and carpenter. He obviously was an Egyptian polymath, a learned man and scribe and was credited with many inventions. As one of the highest officials of the pharaoh Djoser Imhotep is credited with designing and building of the famous Step Pyramid of Djoser at Saqqarah, near the old Egyptian capital of Memphis. Imhotep is also credited with inventing the method of stone-dressed building and using of columns in architecture and is considered to be the first architect in history known by name. It is believed that, as the high priest, Imhotel also served as the nation's chief physician in his time. As the builder of the Step Pyramid, and as a physician, he also had to take medical care of thousands of workers engaged in that great project. He is also credited with being the founder of Egyptian medicine and with being the author of the so-called Smith papirus containing a collection of 48 specimen clinical records with detailed accurate record of the features and treatment of various injuries. As such he emerges as the first physician of ancient Egypt known by name and, at the same time, as the first physician known by name in written history of the world. GOD: As Imhotep was considered by Egyptian people as the "inventor of healing", soon after the death, he

  6. Organizational commitment of military physicians.

    Science.gov (United States)

    Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay

    2009-09-01

    An individual's loyalty or bond to his or her employing organization, referred to as organizational commitment, influences various organizational outcomes such as employee motivation, job satisfaction, performance, accomplishment of organizational goals, employee turnover, and absenteeism. Therefore, as in other sectors, employee commitment is crucial also in the healthcare market. This study investigates the effects of organizational factors and personal characteristics on organizational commitment of military physicians using structural equation modeling (SEM) on a self-report, cross-sectional survey that consisted of 635 physicians working in the 2 biggest military hospitals in Turkey. The results of this study indicate that professional commitment and organizational incentives contribute positively to organizational commitment, whereas conflict with organizational goals makes a significantly negative contribution to it. These results might help develop strategies to increase employee commitment, especially in healthcare organizations, because job-related factors have been found to possess greater impact on organizational commitment than personal characteristics.

  7. Empowering Physicians with Financial Literacy.

    Science.gov (United States)

    Bar-Or, Yuval

    2015-01-01

    Most doctors complete their medical training without sufficient knowledge of business and finance. This leads to inefficient financial decisions, avoidable losses, and unnecessary anxiety. A big part of the problem is that the existing options for gaining financial knowledge are flawed. The ideal solution is to provide a simple framework of financial literacy to all students: one that can be adapted to their specific circumstances. That framework must be delivered by an objective expert to young physicians before they complete medical training.

  8. Bhagavad gita for the physician

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2017-01-01

    Full Text Available This communication presents verses from the Bhagavad Gita which help define a good clinician's skills and behavior. Using the teachings of Lord Krishna, these curated verses suggest three essential skills that a physician must possess: Excellent knowledge, equanimity, and emotional attributes. Three good behaviors are listed (Pro-work ethics, Patient-centered care, and Preceptive leadership and supported by thoughts written in the Gita.

  9. Nurse-physician communication - An integrated review.

    Science.gov (United States)

    Tan, Tit-Chai; Zhou, Huaqiong; Kelly, Michelle

    2017-12-01

    To present a comprehensive review of current evidence on the factors which impact on nurse-physician communication and interventions developed to improve nurse-physician communication. The challenges in nurse-physician communication persist since the term 'nurse-doctor game' was first used in 1967, leading to poor patient outcomes such as treatment delays and potential patient harm. Inconsistent evidence was found on the factors and interventions which foster or impair effective nurse-physician communication. An integrative review was conducted following a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. Five electronic databases were searched from 2005 to April 2016 using key search terms: "improve*," "nurse-physician," "nurse," "physician" and "communication" in five electronic databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Science Direct and Scopus. A total of 22 studies were included in the review. Four themes emerged from the data synthesis, namely communication styles; factors that facilitate nurse-physician communication; barriers to effective nurse-physician communication; and interventions to improve nurse-physician communication. This integrative review suggests that nurse-physician communication still remains ineffective. Current interventions only address information needs of nurses and physicians in limited situations and specific settings but cannot adequately address the interprofessional communication skills that are lacking in practice. The disparate views of nurses and physicians on communication due to differing training backgrounds confound the effectiveness of current interventions or strategies. Cross-training and interprofessional educational from undergraduate to postgraduate programmes will better align the training of nurses and physicians to communicate effectively. Further research is needed to determine the

  10. Changing physician behavior: what works?

    Science.gov (United States)

    Mostofian, Fargoi; Ruban, Cynthiya; Simunovic, Nicole; Bhandari, Mohit

    2015-01-01

    There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice. Systematic review of reviews. We searched electronic databases (MEDLINE, EMBASE, and PubMed) for systematic reviews published in English that evaluated the effectiveness of different implementation methods. Two reviewers independently assessed eligibility for inclusion and methodological quality, and extracted relevant data. Fourteen reviews covering a wide range of interventions were identified. The intervention methods used include: audit and feedback, computerized decision support systems, continuing medical education, financial incentives, local opinion leaders, marketing, passive dissemination of information, patient-mediated interventions, reminders, and multifaceted interventions. Active approaches, such as academic detailing, led to greater effects than traditional passive approaches. According to the findings of 3 reviews, 71% of studies included in these reviews showed positive change in physician behavior when exposed to active educational methods and multifaceted interventions. Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.

  11. 38 CFR 51.150 - Physician services.

    Science.gov (United States)

    2010-07-01

    ... case of an emergency. (e) Physician delegation of tasks. (1) Except as specified in paragraph (e)(2) of... by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability of physicians for emergency care. The facility management...

  12. 22 CFR 62.27 - Alien physicians.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate medical...

  13. Physicians' fees and public medical care programs.

    Science.gov (United States)

    Lee, R H; Hadley, J

    1981-01-01

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

  14. Internship for physicians in Slovenia

    Directory of Open Access Journals (Sweden)

    Gaber Plavc

    2016-05-01

    Full Text Available Background: Well-educated and highly-trained physicians are an essential part of high-quality health care. Therefore, quality assurance in medical education must be one of the priorities of health systems. We researched and analysed responses from physicians after completion of internship (IS and their mentors to questions regarding preparedness to IS and IS itself.Methods: In this cross-sectional study electronic surveys were sent to 298 physicians, having completed the IS between February 2014 and February 2015, and to their 200 mentors. Ordinal reponses of two independent groups were compared by Mann-Whitney-U test, while Kruskal-Wallis test was used for comparing more than two groups. Frequency distributions of practical procedures that were completed by interns in required quantities were compared between institutions by χ²-test. The same test was used for comparing frequency distributions of binary responses between clinical departments.Results: Statistically significant differences were found in the following: in reported preparedness for IS between graduates of the two Slovenian medical faculties; in realisation of practical procedures in quantities as prescribed in the IS program between different health institutions; in agreement with statements about satisfaction between different clinical departments and different institutions; and in reported active participation in patient care between different clinical departments.Conclusions: In this study we identified differences in phisicians' preparedness for IS between the graduates of the two Slovenian medical faculties, as well as differences in realization of IS program between health institutions and clinical departments. Alongside presented descriptive statistics these data allow evaluation of the current quality of IS in Slovenia. Furthermore, the results of this study will permit assessment of quality improvement after realisation of planned IS program renovation.

  15. Clinical Databases for Chest Physicians.

    Science.gov (United States)

    Courtwright, Andrew M; Gabriel, Peter E

    2018-04-01

    A clinical database is a repository of patient medical and sociodemographic information focused on one or more specific health condition or exposure. Although clinical databases may be used for research purposes, their primary goal is to collect and track patient data for quality improvement, quality assurance, and/or actual clinical management. This article aims to provide an introduction and practical advice on the development of small-scale clinical databases for chest physicians and practice groups. Through example projects, we discuss the pros and cons of available technical platforms, including Microsoft Excel and Access, relational database management systems such as Oracle and PostgreSQL, and Research Electronic Data Capture. We consider approaches to deciding the base unit of data collection, creating consensus around variable definitions, and structuring routine clinical care to complement database aims. We conclude with an overview of regulatory and security considerations for clinical databases. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  16. Difficult physician-patient relationships.

    Science.gov (United States)

    Reifsteck, S W

    1998-01-01

    Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system.

  17. Childhood Bullying: Implications for Physicians.

    Science.gov (United States)

    Stephens, Mary M; Cook-Fasano, Hazel T; Sibbaluca, Katherine

    2018-02-01

    Childhood bullying is common and can lead to serious adverse physical and mental health effects for both the victim and the bully. In teenagers, risk factors for becoming a victim of bullying include being lesbian, gay, bisexual, or transgender; having a disability or medical condition such as asthma, diabetes mellitus, a skin condition, or food allergy; or being an outlier in weight and stature. An estimated 20% of youth have been bullied on school property, and 16% have been bullied electronically in the past year. Bullying can result in emotional distress, depression, anxiety, social isolation, low self-esteem, school avoidance/refusal, and substance abuse for the victim and the bully. Preventive measures include encouraging patients to find enjoyable activities that promote confidence and self-esteem, modeling how to treat others with kindness and respect, and encouraging patients to seek positive friendships. For those who feel concern or guilt about sharing their experiences, it may be useful to explain that revealing the bullying may not only help end the cycle for them but for others as well. Once bullying has been identified, family physicians have an important role in screening for its harmful effects, such as depression and anxiety. A comprehensive, multitiered approach involving families, schools, and community resources can help combat bullying. Family physicians are integral in recognizing children and adolescents who are affected by bullying-as victims, bullies, or bully- victims-so they can benefit from the intervention process.

  18. [Burnout syndrome among family physicians].

    Science.gov (United States)

    Sánchez-Cruz, Juan; Mugártegui-Sánchez, Sharon

    2013-01-01

    burnout syndrome is a state of physical and emotional exhaustion that can occur among workers who interact directly with others. This could affect job performance. The objective was to determine the prevalence of this syndrome and its associated factors among family physicians. a cross-sectional survey applying the Maslach Burnout Inventory was conducted in a selected convenience non-probability sampling of family physicians. Central tendency and dispersion measures were used in determining the prevalence of burnout syndrome; the associated factors were analysed by χ(2) test. there were 59 cases of burnout syndrome, 36 had involvement in a single component, 15 in 2 and 8 were affected in 3 components; we observed that 35 % of positive cases reported doing an average of 10 extra shifts a month (p = 0.013). Having a second job was associated with positive cases of burnout syndrome. the results are consistent with similar studies. Working extra shifts or having a second job were the related factors most associated to this syndrome.

  19. Verbal Aggressiveness Among Physicians and Trainees.

    Science.gov (United States)

    Lazarus, Jenny Lynn; Hosseini, Motahar; Kamangar, Farin; Levien, David H; Rowland, Pamela A; Kowdley, Gopal C; Cunningham, Steven C

    2016-01-01

    To better understand verbal aggressiveness among physicians and trainees, including specialty-specific differences. The Infante Verbal Aggressiveness Scale (IVAS) was administered as part of a survey to 48 medical students, 24 residents, and 257 attending physicians. The 72 trainees received the IVAS and demographic questions, whereas the attending physicians received additional questions regarding type of practice, career satisfaction, litigation, and personality type. The IVAS scores showed high reliability (Cronbach α = 0.83). Among all trainees, 56% were female with mean age 28 years, whereas among attending physicians, 63% were male with mean age 50 years. Average scores of trainees were higher than attending physicians with corresponding averages of 1.88 and 1.68, respectively. Among trainees, higher IVAS scores were significantly associated with male sex, non-US birthplace, choice of surgery, and a history of bullying. Among attending physicians, higher IVAS scores were significantly associated with male sex, younger age, self-reported low-quality of patient-physician relationships, and low enjoyment talking to patients. General surgery and general internal medicine physicians were significantly associated with higher IVAS scores than other specialties. General practitioners (surgeons and medical physicians) had higher IVAS scores than the specialists in their corresponding fields. No significant correlation was found between IVAS scores and threats of legal action against attending physicians, or most personality traits. Additional findings regarding bullying in medical school, physician-patient interactions, and having a method to deal with inappropriate behavior at work were observed. Individuals choosing general specialties display more aggressive verbal communication styles, general surgeons displaying the highest. The IVAS scoring system may identify subgroups of physicians with overly aggressive (problematic) communication skills and may provide a

  20. Overview of physician-hospital ventures.

    Science.gov (United States)

    Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard

    2005-01-01

    An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

  1. Physicians in transition: practice due diligence.

    Science.gov (United States)

    Paterick, Timothy E

    2013-01-01

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

  2. [Addicted colleagues: a blind spot amongst physicians?].

    Science.gov (United States)

    Rode, Hans; de Rond, Marlies; Dam, Ingrid

    2013-01-01

    Physician impairment due to substance abuse or dependence is at least as prevalent as amongst non-physicians and is a real challenge. Not only for the impaired physicians themselves, but also for their colleagues, family members and patients. A 68-year-old physician describes her experiences of being an alcoholic as well as a patient with concomitant psychiatric disorders, including the hurdles she had to get over to deal with her disease and remain abstinent. Although colleagues knew what was going on, some of them took no action. The initial treatment by her general practitioner proved compromised. Addressing addiction amongst fellow physicians can be challenging and for this reason the Royal Dutch Medical Association (KNMG) has started the ABS Programme. On prompt and adequate intervention, treatment in specialised facilities has proved to be highly and durably effective. Addicted physicians who have been successfully treated should be monitored and supported, thus enabling their safe return to practice.

  3. Physician fees and managed care plans.

    Science.gov (United States)

    Zwanziger, Jack

    2002-01-01

    One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

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

    Science.gov (United States)

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

    2001-01-01

    Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of 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 adversarial, most physicians are…

  5. Physician-patient communication in managed care.

    OpenAIRE

    Gordon, G H; Baker, L; Levinson, W

    1995-01-01

    The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent ...

  6. Still on physicians' attitude to medical marijuana

    OpenAIRE

    Olukayode Abayomi; Emmanuel Babalola

    2014-01-01

    Desai and Patel highlighted in a recent review that and ldquo;there are several issues related to medical marijuana, which concern public health such as its medical use, harmful effects, laws and physicians role. and rdquo; Certainly, physician's perspectives and position on the relative harm and benefits of marijuana contribute to the growing controversy over its legalization in western countries. Interestingly, the seeming resistance of physicians in western countries to marijuana prescrip...

  7. Physician burnout: contributors, consequences and solutions.

    Science.gov (United States)

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

    2018-06-01

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

  8. Spirituality and the physician executive.

    Science.gov (United States)

    Kaiser, L R

    2000-01-01

    The "s" word can now be spoken without flinching in health care organizations. Spirituality is becoming a common topic in management conferences around the world. Many U.S. corporations are recognizing the role of spirituality in creating a new humanistic capitalism that manages beyond the bottom line. Spirituality refers to a broad set of principles that transcend all religions. It is the relationship between yourself and something larger, such as the good of your patient or the welfare of the community. Spirituality means being in right relationship to all that is and understanding the mutual interdependence of all living beings. Physician executives should be primary proponents of spirituality in their organizations by: Modeling the power of spirituality in their own lives; integrating spiritual methodologies into clinical practice; fostering an integrative approach to patient care; encouraging the organization to tithe its profits for unmet community health needs; supporting collaborative efforts to improve the health of the community; and creating healing environments.

  9. Literary Library for Physicians (II

    Directory of Open Access Journals (Sweden)

    Fernando A. NAVARRO

    2015-10-01

    Full Text Available The adequate practice of medicine is a difficult job if some intimate and deep feelings of patients, such pain, loneliness, depression and helplessness facing an incurable disease or the fear of dying, are not fully understood. A good way to gain a satisfactory understanding of such feelings might be the reading of the great literary works of all times. In this “Medical library for physicians” an essential list of seventy literary works from the Modern to the Contemporary periods has been collected. Their plot is about the disease, the madness, the hospital, the professionalism and the historical and social images of the physicians. In the second part of the article, a brief review of the last thirty?five books is carried out. It considers from Sinuhe egyptiläinen (1945 by Mika Waltari to Nemesis (1943 by Philip Roth.

  10. Physician assistant education: five countries.

    Science.gov (United States)

    Hooker, Roderick S; Kuilman, Luppo

    2011-01-01

    Physician assistant (PA) education has undergone substantial change since the late 1960s. After four decades of development, other countries have taken a page from the American experience and launched their own instructional initiatives. The diversity in how different countries approach education and produce a PA for their nation's needs provides an opportunity to make comparisons. The intent of this study was to document and describe PA programs in Australia, Canada, the United Kingdom, The Netherlands, and the United States. We reviewed the literature and contacted a network of academics in various institutions to obtain primary information. Each contact was asked a set of basic questions about the country, the PA program, and the deployment of graduates. Information on US PA programs was obtained from the Physician Assistant Education Association. At year's end 2010, the following was known about PA development: Australia, one program; Canada, four programs; United Kingdom, four programs; The Netherlands, five programs; the United States, 154 programs. Trends in program per capita growth remain the largest in the United States, followed by The Netherlands and Canada. The shortest program length was 24 months and the longest, 36 months. Outside the United States, almost all programs are situated in an academic health center ([AHC] defined as a medical university, a teaching hospital, and a nursing or allied health school), whereas only one-third of US PA programs are in AHCs. All non-US programs receive public/government funding whereas American programs are predominately private and depend on tuition to fund their programs. The PA movement is a global phenomenon. How PAs are being educated, trained, and deployed is known only on the basic level. We identify common characteristics, unique aspects, and trends in PA education across five nations, and set the stage for collaboration and analysis of optimal educational strategies. Additional information is needed on

  11. Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators.

    Science.gov (United States)

    Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M

    2006-01-01

    Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

  12. Career satisfaction and burnout among Ghanaian physicians.

    Science.gov (United States)

    Opoku, Samuel T; Apenteng, Bettye A

    2014-03-01

    Thus far, there has been limited inquiry into the factors associated with physician career satisfaction and burnout in Ghana, although the two have been linked to the brain drain problem. The objective of this study was to assess career satisfaction and burnout among physicians practicing in a developing nation, Ghana. A 21-item instrument was used to assess career satisfaction among actively practicing Ghanaian physicians, using items adapted from the Physician Worklife Study survey. Burnout was assessed using the Abbreviated Maslach's Burnout Inventory. Two hundred physicians participated in the online survey from December 2012 to February 2013. Generally, physicians in Ghana expressed moderate overall career satisfaction. However, they were least satisfied with the availability of resources, their compensation and work-life balance. Overall, burnout was low in the study population; however physicians exhibited moderate levels of emotional exhaustion. Career satisfaction was negatively associated with the burnout dimensions of depersonalization, emotional exhaustion and low personal accomplishment. Health policy-makers in Ghana should address issues relating to resource adequacy, compensation and the work-life balance of physicians in order to improve the overall career satisfaction of an already dwindling physician workforce.

  13. Difficulties facing physician mothers in Japan.

    Science.gov (United States)

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

    2011-11-01

    Despite recent increases in the number of female physicians graduating in Japan, their premature resignations after childbirth are contributing to the acute shortage of physicians. Previous Japanese studies have explored supportive measures in the workplace, but have rarely focused on the specific problems or concerns of physician-mothers. Therefore, this study explored the challenges facing Japanese physician-mothers in efforts to identify solutions for their retention. Open-ended questionnaires were mailed to 646 alumnae of Juntendo University School of Medicine. We asked subjects to describe their opinions about 'The challenges related to female physicians' resignations'. Comments gathered from alumnae who graduated between 6 and 30 years ago and have children were analyzed qualitatively. Overall, 249 physicians returned the questionnaire (response rate 38.5%), and 73 alumnae with children who graduated in the stated time period provided comments. The challenges facing physician-mothers mainly consisted of factors associated with Japanese society, family responsibilities, and work environment. Japanese society epitomized by traditional gender roles heightened stress related to family responsibilities and promoted gender discrimination at work environment. Additionally, changing Japanese society positively influenced working atmosphere and husband's support. Moreover, the introduction of educational curriculums that alleviated traditional gender role was proposed for pre- and post- medical students. Traditional gender roles encourage discrimination by male physicians or work-family conflicts. The problems facing female physicians involve more than just family responsibilities: diminishing the notion of gender role is key to helping retain them in the workforce. © 2011 Tohoku University Medical Press

  14. Physicians' preferences for asthma guidelines implementation.

    Science.gov (United States)

    Kang, Min-Koo; Kim, Byung-Keun; Kim, Tae-Wan; Kim, Sae-Hoon; Kang, Hye-Ryun; Park, Heung-Woo; Chang, Yoon-Seok; Kim, Sun-Sin; Min, Kyung-Up; Kim, You-Young; Cho, Sang-Heon

    2010-10-01

    Patient care based on asthma guidelines is cost-effective and leads to improved treatment outcomes. However, ineffective implementation strategies interfere with the use of these recommendations in clinical practice. This study investigated physicians' preferences for asthma guidelines, including content, supporting evidence, learning strategies, format, and placement in the clinical workplace. We obtained information through a questionnaire survey. The questionnaire was distributed to physicians attending continuing medical education courses and sent to other physicians by airmail, e-mail, and facsimile. A total of 183 physicians responded (male to female ratio, 2.3:1; mean age, 40.4±9.9 years); 89.9% of respondents were internists or pediatricians, and 51.7% were primary care physicians. Physicians preferred information that described asthma medications, classified the disease according to severity and level of control, and provided methods of evaluation/treatment/monitoring and management of acute exacerbation. The most effective strategies for encouraging the use of the guidelines were through continuing medical education and discussions with colleagues. Physicians required supporting evidence in the form of randomized controlled trials and expert consensus. They preferred that the guidelines be presented as algorithms or flow charts/flow diagrams on plastic sheets, pocket cards, or in electronic medical records. This study identified the items of the asthma guidelines preferred by physicians in Korea. Asthma guidelines with physicians' preferences would encourage their implementation in clinical practice.

  15. Colorado family physicians' attitudes toward medical marijuana.

    Science.gov (United States)

    Kondrad, Elin; Reid, Alfred

    2013-01-01

    Over the last decade, the use of medical marijuana has expanded dramatically; it is now permitted in 16 states and the District of Columbia. Our study of family physicians in Colorado is the first to gather information about physician attitudes toward this evolving practice. We distributed an anonymous web-based electronic survey to the 1727 members of the Colorado Academy of Family Physicians' listserv. Items included individual and practice characteristics as well as experience with and attitudes toward medical marijuana. Five hundred twenty family physicians responded (30% response rate). Of these, 46% did not support physicians recommending medical marijuana; only 19% thought that physicians should recommend it. A minority thought that marijuana conferred significant benefits to physical (27%) and mental (15%) health. Most agreed that marijuana poses serious mental (64%) and physical (61%) health risks. Eighty-one percent agreed that physicians should have formal training before recommending medical marijuana, and 92% agreed that continuing medical education about medical marijuana should be available to family physicians. Despite a high prevalence of use in Colorado, most family physicians are not convinced of marijuana's health benefits and believe its use carries risks. Nearly all agreed on the need for further medical education about medical marijuana.

  16. Patient-physician communication regarding electronic cigarettes.

    Science.gov (United States)

    Steinberg, Michael B; Giovenco, Daniel P; Delnevo, Cristine D

    2015-01-01

    Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician-patient communication regarding e-cigarettes. A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient-provider e-cigarette communication, and attitudes towards tobacco harm reduction. Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

  17. Developing a competency framework for academic physicians.

    Science.gov (United States)

    Daouk-Öyry, Lina; Zaatari, Ghazi; Sahakian, Tina; Rahal Alameh, Boushra; Mansour, Nabil

    2017-03-01

    There is a mismatch between the requirements of the multifaceted role of academic physicians and their education. Medical institutions use faculty development initiatives to support their junior academic physicians, however, these rarely revolve around academic physician competencies. The aim of this study was to identify these academic physician competencies and develop a competency framework customized to an organizational context. The authors conducted semi-structured interviews and Critical Incident Technique with 25 academic physicians at a teaching medical center in the Middle East region inquiring about the behaviors of academic physicians in teaching, clinical, research, and administrative roles. Using content analysis, the authors identified 16 competencies: five "Supporting Competencies", common to all four roles of academic physicians, and 11 "Function-Specific Competencies", specific to the role being fulfilled. The developed framework shared similarities with frameworks reported in the literature but also had some distinctions. The framework developed represents a step towards closing the gap between the skills medical students are taught and the skills required of academic physicians. The model was customized to the context of the current organization and included a future orientation and addressed the literature calling for increasing focus on the administrative skills of academic physicians.

  18. Analysis of emergency physicians' Twitter accounts.

    Science.gov (United States)

    Lulic, Ileana; Kovic, Ivor

    2013-05-01

    Twitter is one of the fastest growing social media networks for communication between users via short messages. Technology proficient physicians have demonstrated enthusiasm in adopting social media for their work. To identify and create the largest directory of emergency physicians on Twitter, analyse their user accounts and reveal details behind their connections. Several web search tools were used to identify emergency physicians on Twitter with biographies completely or partially written in English. NodeXL software was used to calculate emergency physicians' Twitter network metrics and create visualisation graphs. The authors found 672 Twitter accounts of self-identified emergency physicians. Protected accounts were excluded from the study, leaving 632 for further analysis. Most emergency physicians were located in USA (55.4%), had created their accounts in 2009 (43.4%), used their full personal name (77.5%) and provided a custom profile picture (92.2%). Based on at least one published tweet in the last 15 days, there were 345 (54.6%) active users on 31 December 2011. Active users mostly used mobile devices based on the Apple operating system to publish tweets (69.2%). Visualisation of emergency physicians' Twitter network revealed many users with no connections with their colleagues, and a small group of most influential users who were highly interconnected. Only a small proportion of registered emergency physicians use Twitter. Among them exists a smaller inner network of emergency physicians with strong social bonds that is using Twitter's full potentials for professional development.

  19. Physician buy-in for EMRs.

    Science.gov (United States)

    Yackanicz, Lori; Kerr, Richard; Levick, Donald

    2010-01-01

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

  20. Physicians Care for Connecticut, Inc. Business philosophy.

    Science.gov (United States)

    Czarsty, C W; Coffey, J R

    1997-03-01

    Physicians Care will distinguish itself from competitors in the marketplace through the introduction of products with significant value. Physicians Care is dedicated to working closely with providers to identify the contributions made by each party to the building of product value and to appropriately reward providers for those efforts. The ultimate goal is the development of an insurance company in which physicians are truly invested and committed to best clinical practices and who exercise enhanced autonomy in managing their patient's care with clinical and administrative support from Physicians Care.

  1. [Family and career planning in young physicians].

    Science.gov (United States)

    Buddeberg-Fischer, Barbara; Stamm, Martina; Klaghofer, Richard

    2008-01-01

    The study investigates in what way physicians integrate their desire to have children into their career planning. Within the framework of a prospective cohort study of Swiss medical school graduates on career development of young physicians, beginning in 2001, 534 participants (285 women, 249 men) were assessed in January 2007, in terms of having children, planning to have children, the career aspired to and the work-family balance used or planned. Among the study participants, 19% (54) of the women and 24% (59) of the men have children. Of the others 88% plan to start a family in the future. Female physicians with children are less advanced in their careers than women without children; for male physicians no such difference can be observed. Of the female physicians with children or the desire for children 42% aspire to work in a practice, 28% to a clinical and only 4% to an academic career. Of the male physicians with children or the desire for children one third aspire to work in a practice, one third to a clinical and 14% to an academic career. The preferred model of work repartition of female physicians with children is father full time/mother part time or both parents part time; the preferred model of male physicians is father full time/mother part time or not working. Children are an important factor in the career and life planning of physicians, female physicians paying more attention to an even work-family balance than male physicians. Copyright 2008 S. Karger AG, Basel.

  2. Physicians' perceptions of physician-nurse interactions and information needs in China.

    Science.gov (United States)

    Wen, Dong; Guan, Pengcheng; Zhang, Xingting; Lei, Jianbo

    2018-01-01

    Good communication between physicians and nurses is important for the understanding of disease status and treatment feedback; however, certain issues in Chinese hospitals could lead to suboptimal physician-nurse communication in clinical work. Convenience sampling was used to recruit participants. Questionnaires were sent to clinical physicians in three top tertiary Grade-A teaching hospitals in China and six hundred and seventeen physicians participated in the survey. (1) Common physician-nurse interactions were shift-change reports and provisional reports when needed, and interactions expected by physicians included face-to-face reports and communication via a phone or mobile device. (2) Most respondents believed that the need for information in physician-nurse interactions was high, information was moderately accurate and timely, and feedback regarding interaction time and satisfaction indicated that they were only average and required improvement. (3) Information needs in physician-nurse interactions differed significantly according to hospital category, role, workplace, and educational background (p < .05). There was a considerable need for information within physician-nurse interactions, and the level of satisfaction with the information obtained was average; requirements for the improvement of communication differed between physicians and nurses because of differences in their characteristics. Currently, the use of information technology in physician-nurse communication was less common but was highly expected by physicians.

  3. Physician Job Satisfaction across Six Major Specialties

    Science.gov (United States)

    Duffy, Ryan D.; Richard, George V.

    2006-01-01

    A random sample of 763 physicians was surveyed to examine the relation of 18 critical work-related factors to job satisfaction. On the whole, physicians reported that they were satisfied with their careers and believed that caring for patients, sense of accomplishment, continuity of care, autonomy, and personal time were the five most important…

  4. Influence of pharmacists expertise on physicians prescription ...

    African Journals Online (AJOL)

    Purpose: To explore the influence of pharmacist factors on prescription decisions of physicians. Methods: A survey of literature was carried out across online databases and 12 relevant articles were identified. The influence of pharmacist factors on physician prescription decisions was identified in the articles. A conceptual ...

  5. Evaluation of Physicians' Requests for Autopsies.

    Science.gov (United States)

    Kesler, Richard W.; And Others

    1983-01-01

    Chaplains and seminary students enrolled in the University of Virginia Medical Center's Clinical Pastoral Program were asked to judge physicians' performances while requesting autopsies by completing a confidential evaluation form. The results of the evaluations were correlated with the physicians' success in obtaining autopsies. (MLW)

  6. Physician Performance Assessment: Prevention of Cardiovascular Disease

    Science.gov (United States)

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

    2013-01-01

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

  7. The physician executive in a changing world.

    Science.gov (United States)

    Kaiser, L R

    1999-01-01

    Physicians are losing their historic franchise as sole and primary providers of medical care. In addition to eroding moral and scientific authority, physicians are also losing income and status. It is no wonder that physicians are retrenching--confused and angry about the increasing marginalization of their profession and about society's changing expectations. Physicians are caught in a transition zone between the world that was and the one that will soon be. This is destabilizing and causes great anxiety. Rather than being buffeted by changing social and cultural definitions of health care, physicians must become proactively involved in the future of their profession. Physicians can only do this by offering a better mental model of health, medicine, and the community. This cannot be a defensive retreat from engagement. Rather, it must be an imaginative vision, vigorously set forth--a vision that will enlist the support of all constituencies involved in the effort to improve the health and well-being of all members of our society. The physician executive needs to work with physicians to orchestrate this effort to create a new vision of health in the 21st century.

  8. Physician assisted death in psychiatric practice

    NARCIS (Netherlands)

    Groenewoud, J.H.; van der Maas, P.J.; van der Wal, G.; Hengeveld, M.W.; Tholen, A.J.; Schudel, W.J.; van der Heide, A.

    1997-01-01

    Background: In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician- assisted suicide and euthanasia in psychiatric practice in the Netherlands.

  9. A Management Development Course for Physicians

    Science.gov (United States)

    Plovnick, Mark S.; And Others

    1977-01-01

    Developed and tested by the Health Management Project at the MIT Sloan School of Management, this course was designed to provide a more accurate understanding of the relevance and usefulness of management education to physicians and to train physicians in some basic management skills. Its content and field tests are described. (LBH)

  10. Religious characteristics of US women physicians.

    Science.gov (United States)

    Frank, E; Dell, M L; Chopp, R

    1999-12-01

    Physicians' religious attributes are unknown, and may affect patient care. The Women Physicians' Health Study (WPHS) is a random sample (n = 4501 respondents, 59% response rate) of US women physicians aged 30-70; the first large, national study of US women physicians. In this study US women physicians were less likely to be Christian than were other Americans (61.2% of women physicians versus 85.1% of the general population), but were more likely to be Jewish (13.2% vs 2.0%), Buddhist (1.4% vs 0.3%), Hindu (3.9% vs 0.4%), or atheist/agnostic (5.9% vs 0.6%). Protestantism (29.3% of the population) and Catholicism (24.9%) were the most commonly reported religious identities. The strongest religious identity was claimed by Mormons and Seventh Day Adventists. Thus, women physicians' religious beliefs differ from those of the general population in the US. This may be particularly important for physicians practicing with patient populations with different religious affiliations, and in addressing clinical questions with ethical or religious dimensions.

  11. Physicians cannot prepare for nuclear disaster

    International Nuclear Information System (INIS)

    Geiger, H.J.

    1985-01-01

    In this paper, the author argues that medical preparations for nuclear war are futile. Not only would few physicians survive a nuclear attack, but these physicians would have the impossible task of caring for hundreds of thousands of injured and dying victims

  12. 38 CFR 52.150 - Physician services.

    Science.gov (United States)

    2010-07-01

    ... acute care when it is indicated. (d) Availability of physicians for emergency care. In case of an emergency, the program management must provide or arrange for the provision of physician services when the... assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section...

  13. [Suicide in female and male physicians

    NARCIS (Netherlands)

    Lagro-Janssen, A.L.M.; Luijks, H.D.P.

    2008-01-01

    OBJECTIVE: To determine whether there are gender differences in the incidence of suicide in physicians, and whether there are differences in the methods used by male and female physicians to commit suicide. DESIGN: Systematic literature search. METHOD: A literature search was performed in the

  14. Physicians' Mandatory Reporting of Elder Abuse.

    Science.gov (United States)

    Daniels, R. Steven; And Others

    1989-01-01

    Evaluated physicians' responses to Alabama state elder abuse reporting statutes in Alabama Protective Services Act of 1976. Survey responses from over 100 Alabama physicians suggest that they have reservations about their ability to diagnose abuse, operation of the law, and their willingness to report abuse. (Author/NB)

  15. Health care workplace discrimination and physician turnover.

    Science.gov (United States)

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

    2009-12-01

    To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value workplace discrimination, p value Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

  16. Tailoring hospital marketing efforts to physicians' needs.

    Science.gov (United States)

    Mackay, J M; Lamb, C W

    1988-12-01

    Marketing has become widely recognized as an important component of hospital management (Kotler and Clarke 1987; Ludke, Curry, and Saywell 1983). Physicians are becoming recognized as an important target market that warrants more marketing attention than it has received in the past (Super 1987; Wotruba, Haas, and Hartman 1982). Some experts predict that hospitals will begin focusing more marketing attention on physicians and less on consumers (Super 1986). Much of this attention is likely to take the form of practice management assistance, such as computer-based information system support or consulting services. The survey results reported here are illustrative only of how one hospital addressed the problem of physician need assessment. Other potential target markets include physicians who admit patients only to competitor hospitals and physicians who admit to multiple hospitals. The market might be segmented by individual versus group practice, area of specialization, or possibly even physician practice life cycle stage (Wotruba, Haas, and Hartman 1982). The questions included on the survey and the survey format are likely to be situation-specific. The key is the process, not the procedure. It is important for hospital marketers to recognize that practice management assistance needs will vary among markets (Jensen 1987). Therefore, hospitals must carefully identify their target physician market(s) and survey them about their specific needs before developing and implementing new physician marketing programs. Only then can they be reasonably confident that their marketing programs match their customers' needs.

  17. A Study of the Educationally Influential Physician.

    Science.gov (United States)

    Kaufman, David M.; Ryan, Kurt; Hodder, Ian

    1999-01-01

    A survey of 172 family doctors found that they approached educationally influential (EI) physicians they knew through their hospitals; only 20% used e-mail and 40% the Internet for medical information; EI physicians helped extend their knowledge and validate innovations found in the literature; and health care reform was negatively affecting…

  18. Construction of a Physician Skills Inventory

    Science.gov (United States)

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

    2012-01-01

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

  19. Religious and Spiritual Beliefs of Physicians.

    Science.gov (United States)

    Robinson, Kristin A; Cheng, Meng-Ru; Hansen, Patrick D; Gray, Richard J

    2017-02-01

    The aim of this study is to describe religious and spiritual beliefs of physicians and examine their influence on the decision to pursue medicine and daily medical practice. An anonymous survey was e-mailed to physicians at a large, multidisciplinary tertiary referral center with satellite clinics. Data were collected from January 2014 through February 2014. There were 2097 respondents (69.1 % men), and number of practicing years ranged from ≤1 to ≥30. Primary care physicians or medical specialists represented 74.1 %, 23.6 % were in surgical specialties, and 2.3 % were psychiatrists. The majority of physicians believe in God (65.2 %), and 51.2 % reported themselves as religious, 24.8 % spiritual, 12.4 % agnostic, and 11.6 % atheist. This self-designation was largely independent of specialty except for psychiatrists, who were more likely report agnosticism (P = 0.003). In total, 29.0 % reported that religious or spiritual beliefs influenced their decision to become a physician. Frequent prayer was reported by 44.7 % of physicians, but only 20.7 % reported having prayed with patients. Most physicians consider themselves religious or spiritual, but the rates of agnosticism and atheism are higher than the general population. Psychiatrists are the least religious group. Despite the influence of religion on physicians' lives and medical practice, the majority have not incorporated prayer into patient encounters.

  20. Peseshet--the first female physician?

    Science.gov (United States)

    Harer, W B; el-Dawakhly, Z

    1989-12-01

    Excavation of the tomb of Akhet-Hetep at Giza revealed a monument dedicated to his mother Peseshet, who is identified by many important titles including "Overseer of Women Physicians." She is probably the world's earliest known woman physician. She practiced at the time of the building of the great pyramids in Egypt, about 2500 BC.

  1. Physician morality and perinatal decisions.

    Science.gov (United States)

    Minkoff, Howard; Zafra, Katherine; Amrita, Sabharwal; Wilson, Tracey E; Homel, Peter

    2016-11-01

    Given the same set of "facts" (e.g. fetal prognosis) different physicians may not give the same advice to patients. Studies have shown that people differ in how they prioritize moral domains, but how those domains influence counseling and management has not been assessed among obstetricians. Our objective was to see if, given the same set of facts, obstetricians' counseling would vary depending on their prioritization of moral domains. Obstetricians completed questionnaires that included validated scales of moral domains (e.g. autonomy, community, divinity), demographic data, and hypothetical scenarios (e.g. how aggressively they would pursue the interests of a potentially compromised child, the degree of deference they gave to parents' choices, and their relative valuation of fetal rights and women's rights). Multivariate logistic regression using backwards conditional selection was used to explore how participants responded to the moral dilemma scenarios. Among the 249 participating obstetricians there was wide variation in counseling, much of which reflected differences in prioritization of moral domains. For example, requiring a higher likelihood of neonatal survival before recommending a cesarean section with cord prolapse was associated with Fairness/Reciprocity, an autonomy domain which emphasizes treating individuals equally (OR=1.42, 90% CI=1.06-1.89, p=0.05). Honoring parents' request to wait longer to suspend attempts to resuscitate an infant with no heart rate or pulse was associated with the community domains (involving concepts of loyalty and hierarchy) of In-Group/Loyalty; OR 1.30, 90% CI=1.04-1.62, p=0.05 and Authority/Respect (OR=1.34, 90% CI=1.06-1.34, p=0.045). Carrying out an unconsented cesarean section was associated with In-Group Loyalty (OR=1.26, 90% CI=1.01-1.56, p=0.08) and religiosity (OR=1.08, 90% CI=1.00-1.16, p=0.08). The advice that patients receive may vary widely depending on the underlying moral values of obstetricians. Physicians

  2. Can complexity science inform physician leadership development?

    Science.gov (United States)

    Grady, Colleen Marie

    2016-07-04

    Purpose The purpose of this paper is to describe research that examined physician leadership development using complexity science principles. Design/methodology/approach Intensive interviewing of 21 participants and document review provided data regarding physician leadership development in health-care organizations using five principles of complexity science (connectivity, interdependence, feedback, exploration-of-the-space-of-possibilities and co-evolution), which were grouped in three areas of inquiry (relationships between agents, patterns of behaviour and enabling functions). Findings Physician leaders are viewed as critical in the transformation of healthcare and in improving patient outcomes, and yet significant challenges exist that limit their development. Leadership in health care continues to be associated with traditional, linear models, which are incongruent with the behaviour of a complex system, such as health care. Physician leadership development remains a low priority for most health-care organizations, although physicians admit to being limited in their capacity to lead. This research was based on five principles of complexity science and used grounded theory methodology to understand how the behaviours of a complex system can provide data regarding leadership development for physicians. The study demonstrated that there is a strong association between physician leadership and patient outcomes and that organizations play a primary role in supporting the development of physician leaders. Findings indicate that a physician's relationship with their patient and their capacity for innovation can be extended as catalytic behaviours in a complex system. The findings also identified limiting factors that impact physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development. Practical Implications This research provides practical

  3. Physicians' group seeks nuclear arms ban.

    Science.gov (United States)

    Litwin, M S

    1985-08-02

    The history and recent activities of the International Physicians for the Prevention of Nuclear War (IPPNW) are reported. Founded in 1980 by cardiologists Bernard Lown of the United States and Eugene Chazov of the Soviet Union, the group has attracted well over 100,000 members from 51 countries. Following the organization's fifth congress in Budapest in June 1985, a four-city tour of the United States by three American and four Soviet physicians was co-sponsored by IPPNW, Physicians for Social Responsibility, and the Soviet Committee of Physicians for the Prevention of Nuclear War. Through separate lecture series aimed at physicians and laypersons, the doctors sought to persuade colleagues to take an active stand against nuclear war, and to increase public awareness of the medical realities of a nuclear attack. A similar tour of the Soviet Union is planned.

  4. Issues for the Traveling Team Physician.

    Science.gov (United States)

    Kaeding, Christopher C; Borchers, James

    2016-07-01

    This article outlines the value of having the team physician traveling with athletes to away venues for competitions or training sessions. At present, this travel presents several issues for the team physician who crosses state lines for taking care of the athletes. In this article, these issues and their possible remedies are discussed. A concern for the travelling team physician is practicing medicine while caring for the team in a state where the physician is not licensed. Another issue can be the transportation of controlled substances in the course of providing optimal care for the team athletes. These two issues are regulatory and legislative issues at both the state and federal levels. On the practical side of being a team physician, the issues of emergency action plans, supplies, and when to transport injured or ill patients are also reviewed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Pharmaceutical marketing research and the prescribing physician.

    Science.gov (United States)

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

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

    Science.gov (United States)

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

    2012-03-01

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

  7. [Physician's professional retirement. Family dynamics].

    Science.gov (United States)

    Aguirre Gas, Héctor G

    2011-01-01

    Human beings have a natural resistance to think about their old age, both personally and professionally. Governments have targeted efforts to successfully prolong the life of the population, situation which already is a social and economic problem. “Old is a person with physical, intellectual and emotional limitations, who has a reduced autonomy and welfare, as a result of the years lived”. Not everyone ages at the same age; it will depend on health, habits, physical and intellectual activity, nutritional status, vices and attitude towards life. A physician may decide not to continue exercising medicine due to: health problems, because they do not want to, because they do not feel competent, because of the risk of having to deal with a complaint or a lawsuit, to have a new life project, or because they have no patients. The options available for a doctor at the time of retirement will depend on his/her age, health status, stage of the aging process: autonomy, dependency or old age; his/her physical and mental condition, professional development, economic situation and family environment. A doctor may remain independent, join another family or seek shelter in a retirement home.

  8. An intervention to increase patients' trust in their physicians. Stanford Trust Study Physician Group.

    Science.gov (United States)

    Thom, D H; Bloch, D A; Segal, E S

    1999-02-01

    To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients' levels of trust and on outcomes of care. In 1994, the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians' practices. Ten of the physicians (the intervention group) were randomly assigned to receive a one-day training course in building and maintaining patients' trust. Outcomes were patients' trust in their physicians, patients' and physicians' satisfaction with the office visit, continuity in the patient-physician relationship, patients' adherence to their treatment plans, and the numbers of diagnostic tests and referrals. Physicians and patients in the intervention and control groups were similar in demographic and other data. There was no significant difference in any outcome. Although their overall ratings were not statistically significantly different, the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group. The trust-building workshop had no measurable effect on patients' trust or on outcomes hypothesized to be related to trust.

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

    Science.gov (United States)

    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.

  10. The Burnout Syndrome and its Intervention Strategies for Physicians ...

    African Journals Online (AJOL)

    Studies on physician burnout showed that physicians are vulnerable to burnout. The consequences of physician burnout include ineffective quality of care of patients and it can also lead to poor physical and mental health of affected physicians. The resultant poor physical and mental health of the burnout physician is likely ...

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

    Science.gov (United States)

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

    2015-12-30

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

  12. Psychosocial challenges facing physicians of today.

    Science.gov (United States)

    Arnetz, B B

    2001-01-01

    Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico-chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the

  13. In defense of industry-physician relationships.

    Science.gov (United States)

    Nakayama, Don K

    2010-09-01

    The objective was to examine the economic, ethical, and legal foundations for conflict of interest restrictions between physicians and pharmaceutical and medical device industries ("industry"). Recently academic medical centers and professional organizations have adopted policies that restrict permissible interactions between industry and physicians. The motive is to avoid financial conflicts of interest that compromise core values of altruism and fiduciary relationships. Productive relationships between industry and physicians provide novel drugs and devices of immense benefit to society. The issues are opposing views of medical economics, profit motives, medical professionalism, and extent to which interactions should be lawfully restricted. Industry goals are congruent with those of physicians: patient welfare, safety, and running a profitable business. Profits are necessary to develop drugs and devices. Physician collaborators invent products, refine them, and provide feedback and so are appropriately paid. Marketing is necessary to bring approved products to patients. Economic realities limit the extent to which physicians treat their patients altruistically and as fiduciaries. Providing excellent service to patients may be a more realistic standard. Statements from industry and the American College of Surgeons appropriately guide professional behavior. Preservation of industry-physician relationships is vital to maintain medical innovation and progress.

  14. Regulatory focus affects physician risk tolerance.

    Science.gov (United States)

    Veazie, Peter J; McIntosh, Scott; Chapman, Benjamin P; Dolan, James G

    2014-01-01

    Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention-regulatory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention-focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention-focused manipulation (p = 0.01). The Cohen's d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of practice variation. Results also provide marginal evidence that chronic regulatory focus is associated with risk tolerance (p = 0.05), but the mechanism remains unclear. Research and intervention targeting physician risk tolerance may benefit by considering situational regulatory focus as an explanatory factor.

  15. Communication Skills of Physicians and Patients’ Satisfaction

    Science.gov (United States)

    Biglu, Mohammad-Hossein; Nateq, Farnaz; Ghojazadeh, Morteza; Asgharzadeh, Ali

    2017-01-01

    Background: The communication skills of physicians is an effective step of making effective relationship between doctor and patient. It plays essential role through diagnosis and treatment processes. This current study was performed to investigate the impact of communication skillfulness of physicians on patients’ satisfaction. Methods: A cross-sectional descriptive study was done to determine the impact of communication capability of practitioners on patients’ satisfaction. The DiMatto’s Patient Satisfaction Scale was administered among patients referring to the all 8 specialized clinics of Tabriz University of Medical Sciences. The validity and reliability of Persian translation of questionnaire of DiMatto’s Patient Satisfaction was verified by 10 specialists. The validity of the questionnaire was measured by content and structural analysis, and Cronbach’s alpha coefficients. The data were analyzed by software package of SPSS version 16 using Pearson’s correlation coefficient, U Mann-Whitney, Kruskal-wallis Test, Regression. Results: The study showed that there was a significant correlation between patients’ satisfaction and the communication skills of physicians (devoting the appropriate time for visiting the patients, explaining diagnosis and treatment procedures). In addition, the therapeutic skills of physicians, their friendly manners, respecting the patients’ feelings, and careful examination of patients by physician, revealed a significant correlation with patient satisfaction (P Communication skills of physician play an important role on patients’ satisfaction; therefore, we propose strongly to improve the communication skills of physicians by improving the communication skills through related training courses. PMID:29109665

  16. Medicare payment changes and physicians' incomes.

    Science.gov (United States)

    Weeks, William B; Wallace, Amy E

    2002-01-01

    An effort to control the physician portion of Medicare expenditures and to narrow the income gap between primary care and procedure-based physicians was effected through t he enactment of the Medicare Fee Schedule (MFS). To determine whether academic and private sector physicians' incomes had demonstrated changes consistent with payment changes, we collected income information from surveys of private sector physicians and academic physicians in six specialties: (1) family practice; (2) general internal medicine; (3) psychiatry; (4) general surgery; (5) radiology; and (6) anesthesiology. With the exception of general internal medicine, the anticipated changes in Medicare revenue were not closely associated with income changes in either the academic or private sector group. Academic physicians were underpaid, relative to their private sector counterparts, but modestly less so at the end of the period examined. Our findings suggest that using changes in payment schedules to change incomes in order to influence the attractiveness of different specialties, even with a very large payer, may be ineffective. Should academic incomes remain uncompetitive with private sector incomes, it may be increasingly difficult to persuade physicians to enter academic careers.

  17. Communication Skills of Physicians and Patients' Satisfaction.

    Science.gov (United States)

    Biglu, Mohammad-Hossein; Nateq, Farnaz; Ghojazadeh, Morteza; Asgharzadeh, Ali

    2017-09-01

    The communication skills of physicians is an effective step of making effective relationship between doctor and patient. It plays essential role through diagnosis and treatment processes. This current study was performed to investigate the impact of communication skillfulness of physicians on patients' satisfaction. A cross-sectional descriptive study was done to determine the impact of communication capability of practitioners on patients' satisfaction. The DiMatto's Patient Satisfaction Scale was administered among patients referring to the all 8 specialized clinics of Tabriz University of Medical Sciences. The validity and reliability of Persian translation of questionnaire of DiMatto's Patient Satisfaction was verified by 10 specialists. The validity of the questionnaire was measured by content and structural analysis, and Cronbach's alpha coefficients. The data were analyzed by software package of SPSS version 16 using Pearson's correlation coefficient, U Mann-Whitney, Kruskal-wallis Test, Regression. The study showed that there was a significant correlation between patients' satisfaction and the communication skills of physicians (devoting the appropriate time for visiting the patients, explaining diagnosis and treatment procedures). In addition, the therapeutic skills of physicians, their friendly manners, respecting the patients' feelings, and careful examination of patients by physician, revealed a significant correlation with patient satisfaction (P Communication skills of physician play an important role on patients' satisfaction; therefore, we propose strongly to improve the communication skills of physicians by improving the communication skills through related training courses.

  18. Family physicians and HIV infection.

    Science.gov (United States)

    Hall, N; Crochette, N; Blanchi, S; Lavoix, A; Billaud, E; Baron, C; Abgueguen, P; Perré, P; Rabier, V

    2015-01-01

    We aimed to describe the current and desired involvement of family physicians (FPs) in the treatment of HIV patients (screening practices, potential training and patient follow-up) to reduce the duration and frequency of their hospital treatment. We conducted a descriptive cross-sectional survey between 2011 and 2012 with the support of COREVIH (Regional Coordinating Committee on HIV). We sent a self-assessment questionnaire to all FPs of the Pays de la Loire region to enquire about their HIV screening practices and expectations for the management of HIV patients. A total of 871 FPs completed the questionnaire (response rate: 30.4%). A total of 54.2% said to provide care to HIV patients; the mean number of HIV patients per FP was estimated at 1.4. With regard to HIV screening, 12.2% systematically suggest an HIV serology to their patients and 72.7% always suggest it to pregnant women. About 45.4% of responding FPs said to be willing to manage HIV patients (clinical and biological monitoring, compliance checks and prescription renewal). FPs mainly reported the lack of training and the low number of HIV patients as a barrier to their further involvement in the management of HIV patients. The responding FPs provide care to very few HIV patients. They are, however, willing to be more involved in the routine care of these patients. Medical training provided by COREVIH would help improve HIV screening. The management of HIV patients could thus be handed over to willing FPs. Copyright © 2015. Published by Elsevier SAS.

  19. Family physicians' perspectives regarding palliative radiotherapy

    International Nuclear Information System (INIS)

    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.

    2006-01-01

    Purpose: To assess family physicians' views on common indications for palliative radiotherapy and to determine whether this influences patient referral. Methods and materials: A 30-item questionnaire evaluating radiotherapy knowledge and training developed at the Ottawa Regional Cancer Centre (ORCC) was mailed to a random sample of 400 family physicians in eastern Ontario, Canada. The completed surveys were collected and analyzed, and form the basis of this study. Results: A total of 172 completed surveys were received for a net response rate of 50% among practicing family physicians. Almost all of the physicians (97%) had recently seen cancer patients in their offices, with 85% regularly caring for patient with advanced cancer. Fifty-four percent had referred patients in the past for radiotherapy and 53% had contacted a radiation oncologist for advice. Physicians who were more knowledgeable about the common indications for palliative radiotherapy were significantly more likely to refer patients for radiotherapy (P<0.01). Inability to contact a radiation oncologist was correlated with not having referred patients for radiotherapy (P<0.01). Only 10% of the physicians had received radiotherapy education during their formal medical training. Conclusions: Many of the family physicians surveyed were unaware of the effectiveness of radiotherapy in a variety of common palliative situations, and radiotherapy referral was correlated with knowledge about the indications for palliative radiotherapy. This was not surprising given the limited education they received in this area and the limited contact they have had with radiation oncologists. Strategies need to be developed to improve continuing medical education opportunities for family physicians and to facilitate more interaction between these physicians and radiation oncologists

  20. Childhood immunization: when physicians and parents disagree.

    Science.gov (United States)

    Gilmour, Joan; Harrison, Christine; Asadi, Leyla; Cohen, Michael H; Vohra, Sunita

    2011-11-01

    Persistent fears about the safety and efficacy of vaccines, and whether immunization programs are still needed, have led a significant minority of parents to refuse vaccination. Are parents within their rights when refusing to consent to vaccination? How ought physicians respond? Focusing on routine childhood immunization, we consider the ethical, legal, and clinical issues raised by 3 aspects of parental vaccine refusal: (1) physician counseling; (2) parental decision-making; and (3) continuing the physician-patient relationship despite disagreement. We also suggest initiatives that could increase confidence in immunization programs.

  1. Job satisfaction among obstetrician-gynecologists: a comparison between private practice physicians and academic physicians.

    Science.gov (United States)

    Bell, Darrel J; Bringman, Jay; Bush, Andrew; Phillips, Owen P

    2006-11-01

    Physician job satisfaction has been the subject of much research. However, no studies have been conducted comparing academic and private practice physician satisfaction in obstetrics and gynecology. This study was undertaken to measure satisfaction levels for academic and private practice obstetrician-gynecologists and compare different aspects of their practice that contributed to their satisfaction. A survey was mailed to randomly selected obstetrician-gynecologists in Memphis, TN; Birmingham, AL; Little Rock, AR; and Jackson, MS. Physicians were asked to respond to questions concerning demographics and career satisfaction. They were also asked to assess the contribution of 13 different aspects of their practice in contributing to their job selection and satisfaction using a Likert scale. A score of 1 meant the physician completely disagreed with a statement regarding a factor's contribution or was completely dissatisfied; a score of 5 meant the physician completely agreed with a factor's contribution or was completely satisfied. Simple descriptive statistics, as well as the 2-sample t test, were used. Likert scale values were assumed to be interval measurements. Of the 297 questionnaires mailed, 129 (43%) physicians responded. Ninety-five (74%) respondents rated their overall satisfaction as 4 or 5. No significant difference was found between academic and private physicians when comparing overall job satisfaction (P = .25). When compared to private practice physicians, the aspects most likely contributing to overall job satisfaction for academic physicians were the ability to teach, conduct research, and practice variety (P = .0001, P = .0001, and P = .007, respectively). When compared with academic physicians, the aspects most likely contributing to job satisfaction for private practice physicians were autonomy, physician-patient relationship, and insurance reimbursement (P = .0058, P = .0001, and P = .0098, respectively). When choosing a practice setting

  2. Physicians' professional performance: an occupational health psychology perspective

    NARCIS (Netherlands)

    Scheepers, Renée A.

    2017-01-01

    Physician work engagement is considered to benefit physicians' professional performance in clinical teaching practice. Following an occupational health psychology perspective, this PhD report presents research on how physicians' professional performance in both doctor and teacher roles can be

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

    Compton, Michael T; Frank, Erica

    2011-01-01

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

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

    Science.gov (United States)

    Quinn, Joann Farrell; Perelli, Sheri

    2016-06-20

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

  6. Access to care: the physician's perspective.

    Science.gov (United States)

    Tice, Alan; Ruckle, Janessa E; Sultan, Omar S; Kemble, Stephen

    2011-02-01

    Private practice physicians in Hawaii were surveyed to better understand their impressions of different insurance plans and their willingness to care for patients with those plans. Physician experiences and perspectives were investigated in regard to reimbursement, formulary limitations, pre-authorizations, specialty referrals, responsiveness to problems, and patient knowledge of their plans. The willingness of physicians to accept new patients from specific insurance company programs clearly correlated with the difficulties and limitations physicians perceive in working with the companies (p<0.0012). Survey results indicate that providers in private practice were much more likely to accept University Health Alliance (UHA) and Hawaii Medical Services Association (HMSA) Commercial insurance than Aloha Care Advantage and Aloha Quest. This was likely related to the more favorable impressions of the services, payments, and lower administrative burden offered by those companies compared with others. Hawaii Medical Journal Copyright 2011.

  7. Medicare Physician and Other Supplier Interactive Dataset

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data - Physician and Other...

  8. Marketing to physicians in a digital world.

    Science.gov (United States)

    Manz, Christopher; Ross, Joseph S; Grande, David

    2014-11-13

    Pharmaceutical marketing can lead to overdiagnosis, overtreatment, and overuse of medications. Digital advertising creates new pathways for reaching physicians, allowing delivery of marketing messages at the point of care, when clinical decisions are being made.

  9. Legal issues confronting the occupational physician.

    Science.gov (United States)

    Lewis, Kenneth S; Kleper, Ann-Louise

    2002-01-01

    Occupational physicians are frequently participants in a legal arena in which the interests of the patient are in conflict with those of the patient's employer. What is best for the patient may be viewed as financially burdensome or damaging to the employer. Pressures may be brought to bear upon the doctor, who is also concerned with furthering business relationships with the employer, to take action that is inimical to the patient's well-being. This article addresses legal liability and ethical responsibility in three situations: (1) when limitations or constraints are placed upon the physician's professional judgment in treating the patient; (2) when demands are made upon the physician to release medical information regarding a patient; and (3) when the physician is asked to perform a medical evaluation for purposes of litigation.

  10. Can visual arts training improve physician performance?

    Science.gov (United States)

    Katz, Joel T; Khoshbin, Shahram

    2014-01-01

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

  11. Can Visual Arts Training Improve Physician Performance?

    Science.gov (United States)

    Katz, Joel T.; Khoshbin, Shahram

    2014-01-01

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

  12. The physicians and the nuclear war

    International Nuclear Information System (INIS)

    Arruda, W.O.

    1985-01-01

    This paper shows that a lot of physicians in the world are worried about a new nuclear war and they created the International Physicians for Prevention of Nuclear War. The main objectives of the IPPNNW are to amplify the public or people knowledge of the medical aspects of the nuclear war and promote and coordinate researches about the medical and psychological effects of the nuclear weapon race. (author)

  13. Physician alignment strategies and real estate.

    Science.gov (United States)

    Czerniak, Thomas A

    2012-06-01

    When addressing locations of facilities after acquiring physician practices, hospitals should: Acknowledge the hospital's ambulatory plan is the driver rather than real estate assumed with the physician practices, Review the hospital ambulatory service plan for each submarket, Review the location of facilities within the service area and their proximity to one another, Sublease or sell existing facilities that are not appropriate, Ensure that the size and characteristics of each facility in the market are appropriate and consistent with the hospital's image.

  14. Time management: a review for physicians.

    Science.gov (United States)

    Brunicardi, F. C.; Hobson, F. L.

    1996-01-01

    This article reviews the basic concepts and techniques of time management as they relate to a medical lifestyle. Essential tools are described to help the physician reassess and sharpen skills for handling intensifying demands and constraints of juggling patient care, research, teaching, and family responsibilities. The historical background and principles of time management for three popular "best selling" techniques are critiqued. In addition, a fourth technique, or model, of time management is introduced for physician use. PMID:8855650

  15. U.K. physicians' attitudes toward active voluntary euthanasia and physician-assisted suicide.

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Nir Eyal

    2016-03-01

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

  17. Patient-physician trust: an exploratory study.

    Science.gov (United States)

    Thom, D H; Campbell, B

    1997-02-01

    Patients' trust in their physicians has recently become a focus of concern, largely owing to the rise of managed care, yet the subject remains largely unstudied. We undertook a qualitative research study of patients' self-reported experiences with trust in a physician to gain further understanding of the components of trust in the context of the patient-physician relationship. Twenty-nine patients participants, aged 26 to 72, were recruited from three diverse practice sites. Four focus groups, each lasting 1.5 to 2 hours, were conducted to explore patients' experiences with trust. Focus groups were audio-recorded, transcribed, and coded by four readers, using principles of grounded theory. The resulting consensus codes were grouped into seven categories of physician behavior, two of which related primarily to technical competence (thoroughness in evaluation and providing appropriate and effective treatment) and five of which were interpersonal (understanding patient's individual experience, expressing caring, communicating clearly and completely, building partnership/sharing power and honesty/respect for patient). Two additional categories were predisposing factors and structural/staffing factors. Each major category had multiple subcategories. Specific examples from each major category are provided. These nine categories of physician behavior encompassed the trust experiences related by the 29 patients. These categories and the specific examples provided by patients provide insights into the process of trust formation and suggest ways in which physicians could be more effective in building and maintaining trust.

  18. How physicians' organizations compete: protectionism and efficiency.

    Science.gov (United States)

    Page, Stephen

    2004-02-01

    This article develops a framework that distinguishes four types of competitive strategies that physicians' organizations can adopt in their interactions with health plans. Two types of strategies protect physicians' incomes and autonomy from incursion and control by insurers; the other two enhance the efficiency of health care markets by controlling costs and embedding physicians' caregiving in a community of professionals. The mix of strategies that each organization adopts at any given time depends on the market conditions and regulatory policies it faces, as well as its organizational capacity. The article reviews recent developments in the field that indicate that today's markets and regulations create neither the pressures nor the capacity for physicians' organizations to adopt strategies that enhance efficiency. The managed care backlash has led to a relaxation of pressures to control costs, and the lack of a business case for quality has discouraged embedded caregiving. These developments instead have encouraged and enabled physicians' organizations to adopt strategies that protect their members from the bargaining power and micromanagement of health plans. The article therefore proposes changes in purchasing and regulatory policies to alter the pressures and improve the capacity of physicians' organizations to pursue efficiency and eschew protectionism.

  19. Job Satisfaction Among Academic Family Physicians.

    Science.gov (United States)

    Agana, Denny Fe; Porter, Maribeth; Hatch, Robert; Rubin, Daniel; Carek, Peter

    2017-09-01

    Family physicians report some of the highest rates of burnout among their physician peers. Over the past few years, this rate has increased and work-life balance has decreased. In academic medicine, many report lack of career satisfaction and have considered leaving academia. Our aim was to explore the factors that contribute to job satisfaction and burnout in faculty members in a family medicine department. Six academic family medicine clinics were invited to participate in this qualitative study. Focus groups were conducted to allow for free-flowing, rich dialogue between the moderator and the physician participants. Transcripts were analyzed in a systematic manner by independent investigators trained in grounded theory. The constant comparison method was used to code and synthesize the qualitative data. Six main themes emerged: time (62%), benefits (9%), resources (8%), undervalue (8%), physician well-being (7%), and practice demand (6%). Within the main theme of time, four subthemes emerged: administrative tasks/emails (61%), teaching (17%), electronic medical records (EMR) requirements (13%), and patient care (9%). Academic family physicians believe that a main contributor to job satisfaction is time. They desire more resources, like staff, to assist with increasing work demands. Overall, they enjoy the academic primary care environment. Future directions would include identifying the specific time restraints that prevent them from completing tasks, the type of staff that would assist with the work demands, and the life stressors the physicians are experiencing.

  20. Supplementary physicians' fees: a sustainable system?

    Science.gov (United States)

    Calcoen, Piet; van de Ven, Wynand P M M

    2018-01-25

    In Belgium and France, physicians can charge a supplementary fee on top of the tariff set by the mandatory basic health insurance scheme. In both countries, the supplementary fee system is under pressure because of financial sustainability concerns and a lack of added value for the patient. Expenditure on supplementary fees is increasing much faster than total health expenditure. So far, measures taken to curb this trend have not been successful. For certain categories of physicians, supplementary fees represent one-third of total income. For patients, however, the added value of supplementary fees is not that clear. Supplementary fees can buy comfort and access to physicians who refuse to treat patients who are not willing to pay supplementary fees. Perceived quality of care plays an important role in patients' willingness to pay supplementary fees. Today, there is no evidence that physicians who charge supplementary fees provide better quality of care than physicians who do not. However, linking supplementary fees to objectively proven quality of care and limiting access to top quality care to patients able and willing to pay supplementary fees might not be socially acceptable in many countries. Our conclusion is that supplementary physicians' fees are not sustainable.

  1. Family physician perspectives on primary immunodeficiency diseases

    Directory of Open Access Journals (Sweden)

    Jordan eOrange

    2016-03-01

    Full Text Available Primary immunodeficiency diseases (PID include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed family practice physicians, of whom 44% reported following ≥1 patient with a PID. Selective immunoglobulin A (IgA, deficiency (21%, and chronic granulomatous disease (11% were most common and were followed by significantly more subspecialist immunologists (P<.0001. Use of intravenously administered Ig, and live viral vaccinations across PID was significantly different (P<.0001. Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4% vs. 79% of subspecialist immunologists, P<.0001. Family practice physicians will likely encounter patients with a PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care.

  2. Matrix organization increases physician, management cooperation.

    Science.gov (United States)

    Boissoneau, R; Williams, F G; Cowley, J L

    1984-04-01

    Because of the development of multihospital systems and the establishment of diagnosis related groups, hospitals increasingly will establish matrix organizations for their corporate structures. St. Luke's Hospital adopted the matrix concept in the mid-1970s, utilizing program administrators for each specialty service or "clinical center of excellence." Such centers have been developed in digestive diseases, cardiovascular and pulmonary medicine, orthopedics and rheumatology, ophthalmology, and behavioral health. The program administrator's functions are diverse: To serve as primary liaison between physicians and the hospital; To project levels of program utilization and patient and physician satisfaction, to identify areas requiring administrative and marketing emphasis, and to develop the program's marketing plan; To develop, implement, and evaluate the program's strategic, operational, and financial plans; To recruit physicians to practice at St. Luke's and to cultivate referrals from outside physicians; To participate in selecting members of all board and medical staff committees relating to the particular specialty area; and To determine the need for new programs within the specialty area and to develop services. As indicated by a medical staff survey, most physicians at St. Luke's believe that the program administrator system has improved communication with the hospital administration, that the program administrator is able to respond effectively to physician requests and problems, and that the quality of patient care has been enhanced. A great majority said they would recommend the system to other hospitals.

  3. Influences on physicians' choices of intravenous colloids.

    Science.gov (United States)

    Miletin, Michael S; Stewart, Thomas E; Norton, Peter G

    2002-07-01

    Controversy over the optimal intravenous fluid for volume resuscitation continues unabated. Our objectives were to characterize the demographics of physicians who prescribe intravenous colloids and determine factors that enter into their decision to choose a colloid. Questionnaire with 61 items. Ten percent ( n = 364) of frequent intravenous fluid prescribers in the province of Ontario, Canada. The response rate was 74%. Colloid use in the past year was reported by 79% of the responding physicians. Important reasons for choosing a colloid included blood loss and manipulation of oncotic pressure. Physicians tended to prefer either albumin or pentastarch, but no important reasons were found for choosing between the two. Albumin with or without crystalloid was preferred in 5/13 scenarios by more than 50% of the respondents, whereas pentastarch was not favored by more than 50% of respondents in any scenario. Physicians practising in critical care areas and teaching hospitals generally preferred pentastarch to albumin. Physicians reporting pentastarch as representing greater than 90% of total colloid use were more likely to have been visited by a drug detailer for pentastarch than those who used less synthetic colloid (54 vs 22%, p distribution. Although albumin appeared to be preferred in more clinical niches, most physicians did not state reasons for choosing between products. Marketing, specialty, location of practice and clinical scenario appear to play significant roles in the utilization of colloid products.

  4. Discussion of “Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems”

    DEFF Research Database (Denmark)

    Bates, D. W.; Baysari, M. T.; Dugas, M.

    2013-01-01

    With these comments on the paper “Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems”, written by Martin Jung and coauthors, with Dr. Elske Ammenwerth as senior author, the journal wants to stimulate a broad discussion on computerized physician order...... entry systems. An international group of experts have been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper....

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

    Science.gov (United States)

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

    2013-08-28

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

  6. Higher fees paid to US physicians drive higher spending for physician services compared to other countries.

    Science.gov (United States)

    Laugesen, Miriam J; Glied, Sherry A

    2011-09-01

    Higher health care prices in the United States are a key reason that the nation's health spending is so much higher than that of other countries. Our study compared physicians' fees paid by public and private payers for primary care office visits and hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States. We also compared physicians' incomes net of practice expenses, differences in financing the cost of medical education, and the relative contribution of payments per physician and of physician supply in the countries' national spending on physician services. Public and private payers paid somewhat higher fees to US primary care physicians for office visits (27 percent more for public, 70 percent more for private) and much higher fees to orthopedic physicians for hip replacements (70 percent more for public, 120 percent more for private) than public and private payers paid these physicians' counterparts in other countries. US primary care and orthopedic physicians also earned higher incomes ($186,582 and $442,450, respectively) than their foreign counterparts. We conclude that the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending, particularly in orthopedics.

  7. Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians.

    Science.gov (United States)

    Voltmer, Edgar; Rosta, Judith; Siegrist, Johannes; Aasland, Olaf G

    2012-10-01

    This study examined job satisfaction and job stress of German compared to Norwegian physicians in private practice. A representative sample of physicians in private practice of Schleswig-Holstein, Germany (N = 414) and a nationwide sample of Norwegian general practitioners and private practice specialists (N = 340) were surveyed in a cross-sectional design in 2010. The questionnaire comprised the standard instruments "Job Satisfaction Scale (JSS)" and a short form of the "Effort-Reward Imbalance Questionnaire (ERI)". Norwegian physicians scored significantly higher (job satisfaction scale compared to German physicians (M 5.57, SD 0.74 vs. M 4.78, SD 1.01). The effect size was highest for the items freedom to choose method (d = 1.012), rate of pay (d = 0.941), and overall job satisfaction (d = 0.931). While there was no significant difference in the mean of the overall effort scale between German and Norwegian physicians, Norwegian physicians scored significantly higher (p job satisfaction. Job satisfaction and reward were significantly higher in Norwegian than in German physicians. An almost threefold higher proportion of German physicians exhibited a high level of work-related stress. Findings call for active prevention and health promotion among stressed practicing physicians, with a special focus on improved working conditions.

  8. Box-ticking and Olympic high jumping - Physicians' perceptions and acceptance of national physician validation systems.

    Science.gov (United States)

    Sehlbach, Carolin; Govaerts, Marjan J B; Mitchell, Sharon; Rohde, Gernot G U; Smeenk, Frank W J M; Driessen, Erik W

    2018-05-24

    National physician validation systems aim to ensure lifelong learning through periodic appraisals of physicians' competence. Their effectiveness is determined by physicians' acceptance of and commitment to the system. This study, therefore, sought to explore physicians' perceptions and self-reported acceptance of validation across three different physician validation systems in Europe. Using a constructivist grounded-theory approach, we conducted semi-structured interviews with 32 respiratory specialists from three countries with markedly different validation systems: Germany, which has a mandatory, credit-based system oriented to continuing professional development; Denmark, with mandatory annual dialogs and ensuing, non-compulsory activities; and the UK, with a mandatory, portfolio-based revalidation system. We analyzed interview data with a view to identifying factors influencing physicians' perceptions and acceptance. Factors that influenced acceptance were the assessment's authenticity and alignment of its requirements with clinical practice, physicians' beliefs about learning, perceived autonomy, and organizational support. Users' acceptance levels determine any system's effectiveness. To support lifelong learning effectively, national physician validation systems must be carefully designed and integrated into daily practice. Involving physicians in their design may render systems more authentic and improve alignment between individual ambitions and the systems' goals, thereby promoting acceptance.

  9. Relationships of multitasking, physicians' strain, and performance: an observational study in ward physicians.

    Science.gov (United States)

    Weigl, Matthias; Müller, Andreas; Sevdalis, Nick; Angerer, Peter

    2013-03-01

    Simultaneous task performance ("multitasking") is common in hospital physicians' work and is implicated as a major determinant for enhanced strain and detrimental performance. The aim was to determine the impact of multitasking by hospital physicians on their self reported strain and performance. A prospective observational time-and-motion study in a Community Hospital was conducted. Twenty-seven hospital physicians (surgical and internal specialties) were observed in 40 full-shift observations. Observed physicians reported twice on their self-monitored strain and performance during the observation time. Associations of observed multitasking events and subsequent strain and performance appraisals were calculated. About 21% of the working time physicians were engaged in simultaneous activities. The average time spent in multitasking activities correlated significantly with subsequently reported strain (r = 0.27, P = 0.018). The number of instances of multitasking activities correlated with self-monitored performance to a marginally significant level (r = 0.19, P = 0.098). Physicians who engage in multitasking activities tend to self-report better performance but at the cost of enhanced psychophysical strain. Hence, physicians do not perceive their own multitasking activities as a source for deficient performance, for example, medical errors. Readjustment of workload, improved organization of work for hospital physicians, and training programs to improve physicians' skills in dealing with multiple clinical demands, prioritization, and efficient task allocation may be useful avenues to explore to reduce the potentially negative impact of simultaneous task performance in clinical settings.

  10. Physician-patient communication in HIV disease: the importance of patient, physician, and visit characteristics.

    Science.gov (United States)

    Wilson, I B; Kaplan, S

    2000-12-15

    Although previous work that considered a variety of chronic conditions has shown that higher quality physician-patient communication care is related to better health outcomes, the quality of physician-patient communication itself for patients with HIV disease has not been well studied. To determine the relationship of patient, visit, physician, and physician practice characteristics to two measures of physician-patient communication for patients with HIV disease. Cross-sectional survey of physicians and patients. Cohort study enrolling patients from throughout eastern Massachusetts. 264 patients with HIV disease and their their primary HIV physicians (n = 69). Two measures of physician-patient communication were used, a five-item general communication measure (Cronbach's alpha = 0.93), and a four-item HIV-specific communication measure that included items about alcohol, drug use, and sexual behaviors (Cronbach's alpha = 0.92). The mean age of patients was 39. 5 years, 24% patients were women, 31.1% were nonwhite, and 52% indicated same-sex contact as their principal HIV risk factor. The mean age of physicians was 39.1 years, 33.3% were female, 39.7% were specialists, and 25.0% self-identified as gay, lesbian, or bisexual. In multivariable models relating patient and visit characteristics to general communication, longer reported visit length (pbetter communication. The interaction of patient gender and visit length was also significant (p =.02); longer visit length was more strongly associated with better general communication for male than female patients. In similar models relating patient and visit characteristics to HIV-specific communication, longer visit length (p better communication. In multivariable models relating physician and practice characteristics to general communication no variables were significant. However, both female physician gender (p =.002) and gay/lesbian/bisexual sexual preference (p =.003) were significantly associated with better HIV

  11. Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives.

    Science.gov (United States)

    Weeks, William B; Lazarus, Arthur; Wallace, Amy E

    2008-01-01

    In a survey of 568 physician members of the American College of Physician Executives (ACPE), most of whom had advanced management degrees (MBA, MMM, MPH), approximately 90% of respondents reported that their investment in the education was "worth it." The return on investment was independent of the quality of the academic institution, although primary care physicians stood to gain more relative to specialists. Salary comparisons showed that female physicians had approximately 20% lower incomes than male physicians, confirming the presence of a "glass ceiling" for female physician executives as seen in other medical specialties. These findings have implications for early and mid-career physicians and physician recruiters.

  12. Demands, values, and burnout: relevance for physicians.

    Science.gov (United States)

    Leiter, Michael P; Frank, Erica; Matheson, Timothy J

    2009-12-01

    T o explore the interaction between workload and values congruence (personal values with health care system values) in the context of burnout and physician engagement and to explore the relative importance of these factors by sex, given the distinct work patterns of male and female physicians. National mailed survey. Canada. A random sample of 8100 Canadian physicians (response rate 40%, N = 3213); 2536 responses (from physicians working more than 35 hours per week) were analyzed. Levels of burnout, values congruence, and workload, by sex, measured by the Maslach Burnout Inventory-General Scale and the Areas of Worklife Scale. Results showed a moderate level of burnout among Canadian physicians, with relatively positive scores on exhaustion, average scores on cynicism, and mildly negative scores on professional efficacy. A series of multiple regression analyses confirmed parallel main effect contributions from manageable workload and values congruence. Both workload and values congruence predicted exhaustion and cynicism for men and women (P = .001). Only values congruence provided a significant prediction of professional efficacy for both men and women (P = .001) These predictors interacted for women on all 3 aspects of burnout (exhaustion, cynicism, and diminished efficacy). Howevever, overall levels of the burnout indicators departed only modestly from normative levels. W orkload and values congruence make distinct contributions to physician burnout. Work overload contributes to predicting exhaustion and cynicism; professional values crises contribute to predicting exhaustion, cynicism, and low professional efficacy. The interaction of values and workload for women in particular has implications for the distinct work-life patterns of male and female physicians. Specifically, the congruence of individual values with values inherent in the health care system appeared to be of greater consequence for women than for men.

  13. Clinical Criteria for Physician Aid in Dying.

    Science.gov (United States)

    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.

  14. Female Physicians and the Future of Endocrinology.

    Science.gov (United States)

    Pelley, Elaine; Danoff, Ann; Cooper, David S; Becker, Carolyn

    2016-01-01

    Given that approximately 70% of current endocrinology fellows are women, female physicians will compose the majority of the future endocrinology workforce. This gender shift partly reflects an apparent waning of interest in endocrinology among male trainees. It also coincides with a projected shortage of endocrinologists overall. Female physicians face unique challenges in the workplace. To continue to attract trainees to the specialty and support their success, it is imperative that these challenges be recognized, understood, and addressed. A PubMed search using the terms "female physician" and "physician gender" covering the years 2000-2015 was performed. Additional references were identified through review of the citations of the retrieved articles. The following topics were identified as key to understanding the impact of this gender shift: professional satisfaction, work-life balance, income, parenthood, academic success, and patient satisfaction. Several changes can be predicted to occur as endocrinology becomes a female-predominant specialty. Although professional satisfaction should remain stable, increased burnout rates are likely. Work-life balance challenges will likely be magnified. The combined effects of occupational gender segregation and a gender pay gap are predicted to negatively impact salaries of endocrinologists of both genders. The underrepresentation of women in academic leadership may mean a lesser voice for endocrinology in this arena. Finally, gender biases evident in patient satisfaction measures--commonly used as proxies for quality of care--may disproportionately impact endocrinology. Endocrinology is predicted to become the most female-predominant subspecialty of internal medicine. The specialty of endocrinology should take a lead role in advocating for changes that support the success of female physicians. Strengthening and supporting the physician workforce can only serve to attract talented physicians of both genders to the

  15. Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating.

    Science.gov (United States)

    Kadry, Bassam; Chu, Larry F; Kadry, Bayan; Gammas, Danya; Macario, Alex

    2011-11-16

    Many online physician-rating sites provide patients with information about physicians and allow patients to rate physicians. Understanding what information is available is important given that patients may use this information to choose a physician. The goals of this study were to (1) determine the most frequently visited physician-rating websites with user-generated content, (2) evaluate the available information on these websites, and (3) analyze 4999 individual online ratings of physicians. On October 1, 2010, using Google Trends we identified the 10 most frequently visited online physician-rating sites with user-generated content. We then studied each site to evaluate the available information (eg, board certification, years in practice), the types of rating scales (eg, 1-5, 1-4, 1-100), and dimensions of care (eg, recommend to a friend, waiting room time) used to rate physicians. We analyzed data from 4999 selected physician ratings without identifiers to assess how physicians are rated online. The 10 most commonly visited websites with user-generated content were HealthGrades.com, Vitals.com, Yelp.com, YP.com, RevolutionHealth.com, RateMD.com, Angieslist.com, Checkbook.org, Kudzu.com, and ZocDoc.com. A total of 35 different dimensions of care were rated by patients in the websites, with a median of 4.5 (mean 4.9, SD 2.8, range 1-9) questions per site. Depending on the scale used for each physician-rating website, the average rating was 77 out of 100 for sites using a 100-point scale (SD 11, median 76, range 33-100), 3.84 out of 5 (77%) for sites using a 5-point scale (SD 0.98, median 4, range 1-5), and 3.1 out of 4 (78%) for sites using a 4-point scale (SD 0.72, median 3, range 1-4). The percentage of reviews rated ≥75 on a 100-point scale was 61.5% (246/400), ≥4 on a 5-point scale was 57.74% (2078/3599), and ≥3 on a 4-point scale was 74.0% (740/1000). The patient's single overall rating of the physician correlated with the other dimensions of care that

  16. Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda

    Directory of Open Access Journals (Sweden)

    Vasan Ashwin

    2009-08-01

    Full Text Available Abstract Background The scarcity of physicians in sub-Saharan Africa – particularly in rural clinics staffed only by non-physician health workers – is constraining access to HIV treatment, as only they are legally allowed to start antiretroviral therapy in the HIV-positive patient. Here we present a pilot study from Uganda assessing agreement between non-physician clinicians (nurses and clinical officers and physicians in their decisions as to whether to start therapy. Methods We conducted the study at 12 government antiretroviral therapy sites in three regions of Uganda, all of which had staff trained in delivery of antiretroviral therapy using the WHO Integrated Management of Adult and Adolescent Illness guidelines for chronic HIV care. We collected seven key variables to measure patient assessment and the decision as to whether to start antiretroviral therapy, the primary variable of interest being the Final Antiretroviral Therapy Recommendation. Patients saw either a clinical officer or nurse first, and then were screened identically by a blinded physician during the same clinic visit. We measured inter-rater agreement between the decisions of the non-physician health workers and physicians in the antiretroviral therapy assessment variables using simple and weighted Kappa analysis. Results Two hundred fifty-four patients were seen by a nurse and physician, while 267 were seen by a clinical officer and physician. The majority (> 50% in each arm of the study were in World Health Organization Clinical Stages I and II and therefore not currently eligible for antiretroviral therapy according to national antiretroviral therapy guidelines. Nurses and clinical officers both showed moderate to almost perfect agreement with physicians in their Final Antiretroviral Therapy Recommendation (unweighted κ = 0.59 and κ = 0.91, respectively. Agreement was also substantial for nurses versus physicians for assigning World Health Organization Clinical

  17. Motivational determinants among physicians in Lahore, Pakistan.

    Science.gov (United States)

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

    2010-07-09

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

  18. Motivational determinants among physicians in Lahore, Pakistan

    Directory of Open Access Journals (Sweden)

    Souares Aurélia

    2010-07-01

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

  19. Physician-Hospital Alignment in Orthopedic Surgery.

    Science.gov (United States)

    Bushnell, Brandon D

    2015-09-01

    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery. Copyright 2015, SLACK Incorporated.

  20. A Physician's Perspective On Vertical Integration.

    Science.gov (United States)

    Berenson, Robert A

    2017-09-01

    Vertical integration has been a central feature of health care delivery system change for more than two decades. Recent studies have demonstrated that vertically integrated health care systems raise prices and costs without observable improvements in quality, despite many theoretical reasons why cost control and improved quality might occur. Less well studied is how physicians view their newfound partnerships with hospitals. In this article I review literature findings and other observations on five aspects of vertical integration that affect physicians in their professional and personal lives: patients' access to physicians, physician compensation, autonomy versus system support, medical professionalism and culture, and lifestyle. I conclude that the movement toward physicians' alignment with and employment in vertically integrated systems seems inexorable but that policy should not promote such integration either intentionally or inadvertently. Instead, policy should address the flaws in current payment approaches that reward high prices and excessive service use-outcomes that vertical integration currently produces. Project HOPE—The People-to-People Health Foundation, Inc.

  1. Cognitive analysis of physicians' medication ordering activity.

    Science.gov (United States)

    Pelayo, Sylvia; Leroy, Nicolas; Guerlinger, Sandra; Degoulet, Patrice; Meaux, Jean-Jacques; Beuscart-Zéphir, Marie-Catherine

    2005-01-01

    Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.

  2. The physician in the technological age.

    Science.gov (United States)

    Jaspers, K

    1989-09-01

    Translator's summary and notes: Karl Jaspers (1883-1969) argues that modern advances in the natural sciences and in technology have exerted transforming influence on the art of clinical medicine and on its ancient Hippocratic ideal, even though Plato's classical argument about slave physicians and free physicians retains essential relevance for the physician of today. Medicine should be rooted not only in science and technology, but in the humanity of the physician as well. Jaspers thus shows how, within the mind of every medical person, the researcher contests with the physician and the technician with the humanist. Jaspers therefore opposes all modern tendencies that regard men as abstractions. As a creative existentialist influenced by Kierkegaard, Nietzsche, and Husserl, he reasons that clinical medicine should always treat patients as irreducable individuals, and his thinking on psychotherapy argues for a realm of interiority, freedom, intelligibility, and existential communication that transcends the reach of the causal thinking of natural science. This essay, written in 1959, reflects Jaspers' lifelong preoccupation with the philosophical meaning of medicine (he received his MD degree in 1909) and the totality of the human person. It should significantly enhance our own comprehension of medical power, dangers, reasoning, and accomplishments.

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

    Science.gov (United States)

    Beagan, Brenda; Fredericks, Erin; Bryson, Mary

    2015-01-01

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

  4. [Determinants in the careers of male and female physicians from the viewpoint of chief physicians].

    Science.gov (United States)

    Buddeberg-Fischer, B; Spindler, A; Peter, Y; Buddeberg, C

    2003-01-03

    Chief physicians play an important role for physicians' careers by providing advanced training and allocating time and research resources. This study examined which characteristics will help physicians to achieve a leadership position and how chief physicians conduct career promotion. All 532 chief physicians in Switzerland's German speaking cantons with medical schools were approached with a questionnaire covering professional motivation and personal attributes of career-oriented physicians career-promoting personal and institutional factors, and type of career promotion. 207 chief physicians (189 men, 18 women; participation rate 38.9 %;) participated. Respondents rated achievement motivation combined with professional interest and job enjoyment (intrinsic), and interest in advancement and social prestige (extrinsic motivation) as beneficial. Extraprofessional concerns such as family obligations and leisure interests were viewed as less important. Instrumental attributes were rated as advantageous. Expressive qualities were also seen as beneficial but less crucial. Ratings were independent of respondents' age, specialty, or type of workplace. The following personal factors were named: professional commitment, professional and social competence, goal orientation, endurance, and strength of character. The institutional factors referred to quality of training and teaching, a good work atmosphere, a transparent and flexible clinic structure. Career promotion was offered predominantly in the form of coaching, career planning, and support in job search. Career promotion should be more targeted and structured, e. g. be conducted in mentoring programmes, thus providing the prerequisites for a truly equal career promotion of female and male physicians.

  5. Associations Between Physician Empathy, Physician Characteristics, and Standardized Measures of Patient Experience.

    Science.gov (United States)

    Chaitoff, Alexander; Sun, Bob; Windover, Amy; Bokar, Daniel; Featherall, Joseph; Rothberg, Michael B; Misra-Hebert, Anita D

    2017-10-01

    To identify correlates of physician empathy and determine whether physician empathy is related to standardized measures of patient experience. Demographic, professional, and empathy data were collected during 2013-2015 from Cleveland Clinic Health System physicians prior to participation in mandatory communication skills training. Empathy was assessed using the Jefferson Scale of Empathy. Data were also collected for seven measures (six provider communication items and overall provider rating) from the visit-specific and 12-month Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) surveys. Associations between empathy and provider characteristics were assessed by linear regression, ANOVA, or a nonparametric equivalent. Significant predictors were included in a multivariable linear regression model. Correlations between empathy and CG-CAHPS scores were assessed using Spearman rank correlation coefficients. In bivariable analysis (n = 847 physicians), female sex (P empathy scores. In multivariable analysis, female sex (P empathy scores. Of the seven CG-CAHPS measures, scores on five for the 583 physicians with visit-specific data and on three for the 277 physicians with 12-month data were positively correlated with empathy. Specialty and sex were independently associated with physician empathy. Empathy was correlated with higher scores on multiple CG-CAHPS items, suggesting improving physician empathy might play a role in improving patient experience.

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

    Directory of Open Access Journals (Sweden)

    Brenda Beagan

    2015-04-01

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

  7. Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses.

    Science.gov (United States)

    Esmaeilpour-Bandboni, Mohammad; Vaismoradi, Mojtaba; Salsali, Mahvash; Snelgrove, Sherrill; Sheldon, Lisa Kennedy

    2017-08-01

    Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

  8. Clinical trials attitudes and practices of Latino physicians.

    Science.gov (United States)

    Ramirez, Amelie G; Wildes, Kimberly; Talavera, Greg; Nápoles-Springer, Anna; Gallion, Kipling; Pérez-Stable, Eliseo J

    2008-07-01

    Ethnic differences in physicians' attitudes and behaviors related to clinical trials might partially account for disparities in clinical trial participation among Latino patients. Literature regarding Latino physicians' clinical trials attitudes and practices, in comparison to White physicians, was lacking. Cross-sectional data from randomly selected physicians (N=695), stratified by ethnicity, were analyzed to test associations of ethnicity with physicians' participation in and attitudes toward referral of patients to clinical trials. Chi-square analyses showed significant (pLatino physicians were significantly less involved in clinical trials than White physicians and found less scientific value in them, highlighting areas for future education and intervention.

  9. HIPAA for physicians in the information age.

    Science.gov (United States)

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

    2014-08-01

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

  10. Senior academic physicians and retirement considerations.

    Science.gov (United States)

    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.

  11. Naval Maritime Physician : Roles and Challenges

    Directory of Open Access Journals (Sweden)

    Ranjan Sarkar

    2016-01-01

    Roles and challenges: Good maritime medicalpractice involves meeting numerous challenges of clinical, occupational, emergency, trauma and psychiatric medicine, in addition on board physicians must also have, in depth knowledge of pschycosomatic conditions due to stress andfatigue of crew and special conditions such as diving accidents and accidents involving aquatic animals. The situation on board requires extraordinary skills as interventions are difficult, both physically and technically, because the conditions at sea are often acrobatic and at certain times evacuation is also not possible due to weather and operational constraints. Thus the role naval doctor on board ships is truly of an all round physicians, a team mate and a good leader. Conclusion: In conclusion, responsibilities of Naval Maritime Physician is not limited to clinical activities but is multifaceted and objective training about the specifics of warships′ environment and related health problems is the key to achieve professional excellence in every sphere.

  12. Family physicians' attitude and interest toward participation in urban family physician program and related factors

    Directory of Open Access Journals (Sweden)

    Masoumeh Sadeghi

    2016-01-01

    Full Text Available Introduction: Every family physician has a key role in achieving the goals of the family physician program (FPP. Low satisfaction of physicians in certain areas of Iran and their low maintenance level in the program is quite challenging. The aims of the present study were; (1 to assess the attitude of rural/rural-urban family physicians about FPP and (2 to investigate their interest toward participation in urban FPP and (3 to explore the influencing factors. Methods: This cross-sectional study was performed on 137 family physicians who were working in rural/rural-urban FPP in Mashhad University of Medical Sciences (Iran. A self-designed valid and reliable questionnaire including demographic data and thirty questions on the participants' attitudes toward the FPP in Likert scale were used. Data were analyzed by multiple logistic regression models using SPSS software. Results: 49.3% of physicians were interested in continuing their cooperation in the urban-FPP. The mean total attitude score was 62.18 out of 100. The highest agreement and positive attitude of physicians were related to achievements of the program goals dimension. Multiple analyses showed that gender (odds ratio [OR] =5.5; male vs. female and employment status (OR = 16.7 and 10.9 for permanent employment and by contract compared to legal obligation, respectively were significantly associated with physicians' willingness toward participation in the urban-FPP. Conclusion: About half of the studied physicians were interested toward participation in the urban-FPP; Male physicians more than females and permanent employees more than others were willing and interested to participate in the urban-FPP.

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Using internal communication as a marketing strategy: gaining physician commitment.

    Science.gov (United States)

    Heine, R P

    1990-01-01

    In the ambulatory care industry, increased competition and promotional costs are pressuring managers to design more creative and effective marketing strategies. One largely overlooked strategy is careful monitoring of the daily communication between physicians and ambulatory care staff providing physician services. Satisfying physician communication needs is the key to increasing physician commitment and referrals. This article outlines the steps necessary to first monitor, then improve the quality of all communication provided to physicians by ambulatory care personnel.

  15. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Science.gov (United States)

    2010-10-01

    ... HEALTH SERVICES Physicians and Other Practitioners § 414.50 Physician or other supplier billing for... services through such billing physician or other supplier. The “substantially all” requirement will be satisfied if, at the time the billing physician or other supplier submits a claim for a service furnished by...

  16. Workplace discrimination: experiences of practicing physicians.

    Science.gov (United States)

    Coombs, Alice A Tolbert; King, Roderick K

    2005-04-01

    In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status.

  17. Deferred Personal Life Decisions of Women Physicians.

    Science.gov (United States)

    Bering, Jamie; Pflibsen, Lacey; Eno, Cassie; Radhakrishnan, Priya

    2018-05-01

    Inadequate work-life balance can have significant implications regarding individual performance, retention, and on the future of the workforce in medicine. The purpose of this study was to determine whether women physicians defer personal life decisions in pursuit of their medical career. We conducted a survey study of women physicians ages 20-80 from various medical specialties using a combination of social media platforms and women physicians' professional listservs with 801 survey responses collected from May through November 2015. The primary endpoint was whether women physicians deferred personal life decisions in pursuit of their medical career. Secondary outcomes include types of decisions deferred and correlations with age, hours worked per week, specialty, number of children, and career satisfaction. Respondents were categorized into deferred and nondeferred groups. Personal decision deferments were reported by 64% of respondents. Of these, 86% reported waiting to have children and 22% reported waiting to get married. Finally, while 85% of women in the nondeferment group would choose medicine again as a career, only 71% of women in the deferment group would do so (p job satisfaction, and insurance/administrative burden. The results of this survey have significant implications on the future of the workforce in medicine. Overall, our analysis shows that 64% of women physicians defer important life decisions in pursuit of their medical career. With an increase in the number of women physicians entering the workforce, lack of support and deferred personal decisions have a potential negative impact on individual performance and retention. Employers must consider the economic impact and potential workforce shortages that may develop if these issues are not addressed.

  18. Assessing physician job satisfaction and mental workload.

    Science.gov (United States)

    Boultinghouse, Oscar W; Hammack, Glenn G; Vo, Alexander H; Dittmar, Mary Lynne

    2007-12-01

    Physician job satisfaction and mental workload were evaluated in a pilot study of five physicians engaged in a telemedicine practice at The University of Texas Medical Branch at Galveston Electronic Health Network. Several previous studies have examined physician satisfaction with specific telemedicine applications; however, few have attempted to identify the underlying factors that contribute to physician satisfaction or lack thereof. One factor that has been found to affect well-being and functionality in the workplace-particularly with regard to human interaction with complex systems and tasks as seen in telemedicine-is mental workload. Workload is generally defined as the "cost" to a person for performing a complex task or tasks; however, prior to this study, it was unexplored as a variable that influences physician satisfaction. Two measures of job satisfaction were used: The Job Descriptive Index and the Job In General scales. Mental workload was evaluated by means of the National Aeronautics and Space Administration Task Load Index. The measures were administered by means of Web-based surveys and were given twice over a 6-month period. Nonparametric statistical analyses revealed that physician job satisfaction was generally high relative to that of the general population and other professionals. Mental workload scores associated with the practice of telemedicine in this environment are also high, and appeared stable over time. In addition, they are commensurate with scores found in individuals practicing tasks with elevated information-processing demands, such as quality control engineers and air traffic controllers. No relationship was found between the measures of job satisfaction and mental workload.

  19. Early pregnancy failure management among family physicians.

    Science.gov (United States)

    Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K

    2013-03-01

    Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

  20. Online professional networks for physicians: risk management.

    Science.gov (United States)

    Hyman, Jon L; Luks, Howard J; Sechrest, Randale

    2012-05-01

    The rapidly developing array of online physician-only communities represents a potential extraordinary advance in the availability of educational and informational resources to physicians. These online communities provide physicians with a new range of controls over the information they process, but use of this social media technology carries some risk. The purpose of this review was to help physicians manage the risks of online professional networking and discuss the potential benefits that may come with such networks. This article explores the risks and benefits of physicians engaging in online professional networking with peers and provides suggestions on risk management. Through an Internet search and literature review, we scrutinized available case law, federal regulatory code, and guidelines of conduct from professional organizations and consultants. We reviewed the OrthoMind.com site as a case example because it is currently the only online social network exclusively for orthopaedic surgeons. Existing case law suggests potential liability for orthopaedic surgeons who engage with patients on openly accessible social network platforms. Current society guidelines in both the United States and Britain provide sensible rules that may mitigate such risks. However, the overall lack of a strong body of legal opinions, government regulations as well as practical experience for most surgeons limit the suitability of such platforms. Closed platforms that are restricted to validated orthopaedic surgeons may limit these downside risks and hence allow surgeons to collaborate with one another both as clinicians and practice owners. Educating surgeons about the pros and cons of participating in these networking platforms is helping them more astutely manage risks and optimize benefits. This evolving online environment of professional interaction is one of few precedents, but the application of risk management strategies that physicians use in daily practice carries over

  1. Physician dual practice: A review of literature

    DEFF Research Database (Denmark)

    Socha, Karolina; Bech, Mickael

    2010-01-01

    Objectives A combination of public and private practice by physicians, referred to as physician dual practice, has been receiving attention in connection with arguments about its negative impact for the public health care. This paper aims to review and critically discuss findings on the subject...... of dual practice effects for the public health care. Methods A systematic literature review identified 23 positions on the subject consisting of journal articles, academic working papers, book chapter, and publications of the WHO. Results The subject is short on evidence. Theoretical analyses indicate...

  2. Contract law for physicians. The basics.

    Science.gov (United States)

    Eelkema, R

    1989-02-01

    As part of the Minnesota Medical Association's ongoing contract review process, this article provides information to help educate physicians about the major managed care contracts being offered to them. The information provided is not intended to, nor should it be a substitute for legal advice pertaining to an individual's practice and specific contracts with third parties. The MMA will not be making recommendations regarding the merits of any particular contract. A decision to enter into a contract rests with the physician and his or her clinic in consultation with private legal counsel.

  3. Healthcare economics for the emergency physician.

    Science.gov (United States)

    Propp, Douglas A; Krubert, Christopher; Sasson, Andres

    2003-01-01

    Although the principles of healthcare economics are not usually part of the fundamental education of emergency physicians, an understanding of these elements will enhance our ability to contribute to improved health-care value. This article introduces the practical aspects of microeconomics, insurance, the supply-and-demand relationship, competition, and costs as they affect the practice of medicine on a daily basis. Being cognizant of how these elements create a dynamic interplay in the health-care industry will allow physicians to better understand the expanded role they need to assume in the ongoing cost and quality debate. Copyright 2003, Elsevier Science (USA). All rights reserved.)

  4. Screening for hepatocellular carcinoma by Egyptian physicians

    Institute of Scientific and Technical Information of China (English)

    Sahar; M; Hassany; Ehab; F; Abdou; Moustafa; Mohamed; El; Taher; Afaf; Adel; Abdeltwab; Hubert; E; Blum

    2015-01-01

    AIM: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma(HCC). METHODS: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts:(1) personal information regarding the physician(name, age, specialty and type of health care setting); and(2) professional experience in the care of patients at risk for HCC development(screening, knowledge about the cause and natural course of liver diseases and HCC risk). RESULTS: Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus(HCV) genotype as risk factor for HCC development(P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis(P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health(MOH) doctors consider HCV infection as the leading cause of HCC in Egypt(P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening(P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo(P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation.CONCLUSION: In Egypt, physicians

  5. Physicians and architects - not an odd couple.

    Science.gov (United States)

    Ohry, Avi

    2013-01-01

    One may think that there is no apparent interface between so different occupations as medicine and architecture. The historical and present-day connections between these academic fields resulted in the creation of healthy environment, housing and hospital. This article also speaks about another meeting point of these professions: physicians who became architects (or amateur-architects) and personal friendships between physicians, scientists, and architects which resulted in fruitful and progressive architectural creations. Both professions may be regard as art and science as well.

  6. Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction.

    Science.gov (United States)

    Weng, Hui-Ching

    2008-01-01

    Much of the literature pertinent to management indicates that service providers with high emotional intelligence (EI) receive higher customer satisfaction scores. Previous studies offer limited evidence regarding the impact of physician's EI on patient-physician relationship. Using a multilevel and multisource data approach, the current study aimed to build a model that demonstrated the impact of a physician's EI on the patient's trust and the patient-physician relationship. The survey sample included 983 outpatients and 39 physicians representing 11 specialties. Results of path analyses demonstrated that the ratio of patient's follow-up visits (p impact of patient's trust on patient's satisfaction was mediated by the patient-physician relationship at a significant level (p relationship had a significantly positive effect on patient's satisfaction (p relationship; however, mutual trust and professional respect between nurses and physicians play a critical role in reinforcing the patient-physician relationship to effect improvements in the provision of patient-centered care.

  7. Professional activity. How is family physicians' work time changing?

    Science.gov (United States)

    Woodward, C A; Ferrier, B; Cohen, M; Brown, J

    2001-07-01

    To examine hours worked professionally, work preferences, and changes in both of these and their correlates. Repeated surveys done in 1993 and 1999. Ontario family practices. Cohort of physicians certified in family medicine between 1989 and 1991 after family medicine residency who were surveyed in 1993 when they resided in Ontario. Self-reported hours spent weekly on professional activities, desired hours of professional work, and balance between work and other activities. Fifty-three percent (293) of 553 physicians responded to the 1999 survey; 91% had remained family physicians; 85% of these had participated in the 1993 survey. The difference between the hours that family physicians preferred to work professionally and their actual hours of work had increased since 1993. Childless physicians, women physicians with preschool children, and women physicians married to other physicians worked fewer hours professionally than other physicians in 1999. Female physicians and physicians without children worked closer to their preferred hours than other physicians. Reporting a preference to work fewer hours professionally in 1993 was linked with a reduction in professional activities by 1999. Greater attention should be paid in physician resource planning to the family life cycle of female physicians. Lifestyle changes could lead to a reduction in professional activity among these physicians.

  8. Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians.

    Science.gov (United States)

    Stevens, Kenneth R

    2006-01-01

    This is a review and evaluation of medical and public literature regarding the reported emotional and psychological effects of participation in physician-assisted suicide (PAS) and euthanasia on the involved physicians. Articles in medical journals, legislative investigations and the public press were obtained and reviewed to determine what has been reported regarding the effects on physicians who have been personally involved in PAS and euthanasia. The physician is centrally involved in PAS and euthanasia, and the emotional and psychological effects on the participating physician can be substantial. The shift away from the fundamental values of medicine to heal and promote human wholeness can have significant effects on many participating physicians. Doctors describe being profoundly adversely affected, being shocked by the suddenness of the death, being caught up in the patient's drive for assisted suicide, having a sense of powerlessness, and feeling isolated. There is evidence of pressure on and intimidation of doctors by some patients to assist in suicide. The effect of countertransference in the doctor-patient relationship may influence physician involvement in PAS and euthanasia. Many doctors who have participated in euthanasia and/or PAS are adversely affected emotionally and psychologically by their experiences.

  9. Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children.

    Science.gov (United States)

    King, Marta A; Nkoy, Flory L; Maloney, Christopher G; Mihalopoulos, Nicole L

    2015-10-01

    To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2-18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. [Physicians--victims or promoters of corruption?].

    Science.gov (United States)

    Kind, M

    2002-01-01

    According to the media the recent physician bribery scandal in Germany draws ever further sets. The public prosecutor determines against hospital physicians and coworkers of a pharmaceutical firm. The suspicion: Physicians were recompensed for using up medicines particularly with pleasure trips. Which is qualified in Germany regularly as bribery and advantage grant as well as aid for tax evasion, is punishable in Austria as unfaithfulness, gift acceptance as well as bribery. The following contribution lights up--from Austrian view--the criminal page of the narrow burr between permitted sponsoring and undue corruption in the medicine. Bribery is globally punishable in Austria. Allowances to physicians can be for the payee in particular gift acceptance (section 153a StGB) or gift acceptance by leading employees of a public enterprise (section 305 StGB), for the giver in particular bribery (section 307 StGB). Occasional allowances, which are not located in connection to a concrete business, but only promoted the sympathetic consideration of the recipient, are not usually punishable. The punishing frameworks for offensces reach up to three years imprisonment. In addition still the absorption of enriching comes (section 20 StGB).

  11. [Assessment of moral competence of physicians].

    Science.gov (United States)

    Agurto, Mariela; Tello, Daniel; Elgueta, Alfredo; Larrea, Ricardo; Minaeff, Tamara; Miranda, Alejandro; Parodi, Ezio; Salas, Juan M; Vukusich, Antonio; Llanos, Semiramis; Daza, Pamela; López, Sebastián

    2017-09-01

    Moral competence (MC) in physicians is fundamental, given the increasing complexity of medicine. The "Moral Competence Test" (MCT © Lind) evaluates this feature and its indicator is the C Index (CI). To explore moral competence and its associated factors among physicians working in Chile. The MCT was answered by 236 physicians from two medical centers who voluntarily participated in the study. Besides the test, participants completed an encrypted form giving information about gender, years in practice and post-graduate studies. The average CI value of the participants was 20,9. Post-graduate studies had a significant positive influence on CI. There was a significant decrease in CI, between 16 and 20 years of professional exercise. Gender and the area of post-graduate studies did not have a significant influence. The studied physicians showed a wide range of CI which was positively affected by the postgraduate studies performed. The years of professional practice had a negative influence. Expanding training opportunities during professional practice could have a positive effect on CM as measured by CI.

  12. Perceptions, Experiences and Expectations of Physicians ...

    African Journals Online (AJOL)

    research assistant explained the study aims and the various parts of the questionnaire to the physicians. Data collection was conducted by a single trained research assistant to ensure consistency. The questionnaire used in this investigation was adapted with minor modifications from previously published studies [12-15].

  13. Training the physician assistant in the Netherlands

    NARCIS (Netherlands)

    Spenkelink-Schut, G.; ten Cate, O.Th.J.; Kort, H.S.M.

    2008-01-01

    The concept of the physician assistant (PA) in the United States has served as a model for other countries in providing one solution for the challenges in their health care systems. In the Netherlands there is a growing shortage of adequately trained health care workers, an increasing demand for

  14. The National Day for the Libyan Physician

    Directory of Open Access Journals (Sweden)

    Elmahdi A. Elkhammas

    2007-03-01

    Full Text Available The health sector is a vital component of the growth and maintenance of every economy. When you examine any country’s annual budget, you immediately recognize that a large proportion goes to the healthcare sector. You may also see it is a part of expenditure and not of productivity. In other words, healthcare is a liability item when it comes to the budget. Libya is no exception.The goal of the health planners is to allocate the healthcare budget in ways that will ultimately result in a healthier society. In Libya, unfortunately, it is not clear how much of the budget goes to the health profession and health care delivery, and how much of it is spent on administrative issues. When you focus on the health sector you discover that it is really a significant mover of the productivity line. It is very simple. Healthy citizens are more likely to go to school and be educated. They are also more likely to have steady employment and be productive members of the society. That is not the subject of these comments. No one can deny that the Libyan physicians are on the frontline when it comes to criticism of the health services in Libya. I agree that they should be on the frontline. After all, medical schools in Libya started many years before the creation of other colleges for allied health professionals. They have a major share of responsibility in keeping our citizens healthy. It is also their responsibility to treat those who become sick. This requires a health system with a solid, transparent, ethical, and well organized structure. This is not the subject of my comments either. The purpose of my comments today is to draw attention to the Libyan physicians and recognize them once a year. I feel that they are busy with their work and the basic ingredients of life in a developing country. I also believe that they are relatively forgotten by society. What I would like to propose is the creation of a national observation for the Libyan physician. I think

  15. 42 CFR 483.40 - Physician services.

    Science.gov (United States)

    2010-10-01

    ... services 24 hours a day, in case of an emergency. (e) Physician delegation of tasks in SNFs. (1) Except as... this chapter or, in the case of a clinical nurse specialist, is licensed as such by the State; (ii) Is... practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability...

  16. Navigating Government Service as a Physician

    Science.gov (United States)

    Koh, Howard K.

    2016-01-01

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

  17. THERAPEUTIC DECISION-MAKING OF PHYSICIANS

    NARCIS (Netherlands)

    DENIG, P; HAAIJER-RUSKAMP, FM

    1992-01-01

    In this review the therapeutic decision-making process of physicians is described. This process is divided into two steps: the generation of a limited set of possible options (the 'evoked set') and the selection from this evoked set of a treatment for a specific patient. Factors that are important

  18. Physicians and administrators can work together.

    Science.gov (United States)

    Fuller, G W; Beaupre, E M

    1979-10-01

    This article describes the working relationship between the administration and medical staff of the Mid-Maine Medical Center which is comprised of two separate modern hospitals. The authors advocate the philosophy that "a hospital which harnesses the medical staff's considerable talent and expertise through sound organizational input will be a stronger institution." They explain that patient care is becoming increasingly complex and that management decisions impact heavily on the care provided. In 1973, the Medical Center changed from its traditional organizational form of having a full-time medical director and an administrator report to the board of directors, to a modified corporate model designed to increase physician involvement. In the new organization, the vice president of finance and a part-time chief of staff (acting as vice president for medical affairs) report to the president (former medical director) who, in turn, is responsible to the board of trustees. The authors attribute the success of the reorganization to the CEO's willingness to delegate and share authority, not to the CEO's physician background. Planning at the institution involves a committee of six physicians, four administrators, and one full-time planner. A budgeting committee of three physicians and three administrators is responsible for the review of the budget as well as for making recommendations for the executive board for the expected volume of services. It is concluded that there is no perfect way to run a hospital, but the involvement of doctors in hospital decisions is necessary.

  19. AN EXPLORATORY STUDY OF PHYSICIANS KNOWLEDGE ON ...

    African Journals Online (AJOL)

    drclement

    2009-12-01

    Dec 1, 2009 ... PHYSICIANS KNOWLEDGE ON CANCER BASIC FACTS. *E. P. Gharoro, *M. C. Ezeanochie, *E. J. Enabudoso. ... practice had good knowledge about human papilloma virus compared to those in combined practice ... appropriate at 95% confidence level with a P value of <0.05 as significant. RESULTS.

  20. Interference with the patient-physician relationship

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-11-01

    Full Text Available No abstract available. Article truncated at 150 words. “Life is like a boomerang. Our thoughts, deeds and words return to us sooner or later, with astounding accuracy.”-Brant M. Bright, former project leader with IBM A recent sounding board in the New England Journal of Medicine discussed legislative interference with the patient-physician relationship (1. The authors, the executive staff leadership of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons believe that legislators should abide by principles that put patients’ best interests first. Critical to achieving this goal is respect for the importance of scientific evidence, patient autonomy, and the patient-physician relationship. According to the authors, lawmakers are increasingly intruding into the realm of medical practice, often to satisfy political agendas without regard to established, evidence-based guidelines for care. The article goes on to cite examples including: The Florida ….

  1. Behavior Modification: A Patient and Physician's Perspective.

    Science.gov (United States)

    Swanson, Elizabeth; Primack, Craig

    2017-03-01

    This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient's experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.

  2. Physician Fee Schedule National Payment Amount File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The significant size of the Physician Fee Schedule Payment Amount File-National requires that database programs (e.g., Access, dBase, FoxPro, etc.) be used to read...

  3. Physician Self-Audit: A Scoping Review

    Science.gov (United States)

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

    2011-01-01

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

  4. Depression-Burnout Overlap in Physicians

    Science.gov (United States)

    Wurm, Walter; Vogel, Katrin; Holl, Anna; Ebner, Christoph; Bayer, Dietmar; Mörkl, Sabrina; Szilagyi, Istvan-Szilard; Hotter, Erich; Kapfhammer, Hans-Peter; Hofmann, Peter

    2016-01-01

    Background Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three “core” components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians. Methods In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI), the Hamburg Burnout Inventory (HBI), as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8%) participated. The data of 5897 participants were suitable for analysis. Results Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21–4.06) for physicians with mild, 10.14 (95% CI 7.58–13.59) for physicians with moderate, 46.84 (95% CI 35.25–62.24) for physicians with severe burnout and 92.78 (95% CI 62.96–136.74) for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components). The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization) tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy) than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92) explained more HBI_sum variance than the three “core” components (adj.R2 = 0.85) of burnout combined. Cronbach’s alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three

  5. Depression-Burnout Overlap in Physicians.

    Directory of Open Access Journals (Sweden)

    Walter Wurm

    Full Text Available Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three "core" components (emotional exhaustion, depersonalization and low personal accomplishment are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians.In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI, the Hamburg Burnout Inventory (HBI, as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8% participated. The data of 5897 participants were suitable for analysis.Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21-4.06 for physicians with mild, 10.14 (95% CI 7.58-13.59 for physicians with moderate, 46.84 (95% CI 35.25-62.24 for physicians with severe burnout and 92.78 (95% CI 62.96-136.74 for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components. The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92 explained more HBI_sum variance than the three "core" components (adj.R2 = 0.85 of burnout combined. Cronbach's alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three "core" components.This study demonstrates the

  6. The Influence of Physician Communication Style on Overweight Patients’ Perceptions of Length of Encounter and Physician Being Rushed

    Science.gov (United States)

    Gulbrandsen, Pål; Østbye, Truls; Lyna, Pauline; Dolor, Rowena J.; Tulsky, James A.; Alexander, Stewart C.; Pollak, Kathryn I.

    2012-01-01

    BACKGROUND AND OBJECTIVES Little is known about how patients and physicians perceive time and the extent to which they perceive the physician being rushed during encounters. One aim of this paper is to examine whether patient and physician characteristics and physician communication influence patient perception of the duration of the encounter and their perception of physicians being rushed. Another aim is to examine the relationship between patient and physician perceptions of physicians feeling rushed. METHODS We audiorecorded 461 encounters of overweight or obese patients with 40 primary care physicians and included 320 encounters in which weight was discussed. We calculated time spent with physician and coded all communication about weight using the Motivational Interview Treatment Integrity scale (MITI). Patients completed post-visit questionnaires in which they reported the estimated duration of the encounter and how rushed they thought the physician was during the encounter. Physicians reported how rushed they felt. RESULTS Patients estimated encounters to be longer than they actually were by an average of 2.6 minutes (SD=11.0). When physicians used reflective statements when discussing weight, patients estimated the encounter to be shorter than when physicians did not use reflective statements (1.17 versus 4.56 minutes more than actual duration). Whites perceived the encounter as shorter than African Americans (1.45 versus 4.28 minutes more than actual duration). Physicians felt rushed in 66% of visits; however, most patients did not perceive this. Internists were perceived to be more rushed than family physicians. CONCLUSIONS There is wide variation in patients’ ability to estimate the length of time they spend with their physician. Some physician and patient characteristics were related to patient perceptions of the length of the encounter. Reflective statements might lead patients to perceive encounters as shorter. Physicians, especially family

  7. Implementing technology in healthcare: insights from physicians.

    Science.gov (United States)

    Ruiz Morilla, Maria Dolors; Sans, Mireia; Casasa, Albert; Giménez, Nuria

    2017-06-27

    Technology has significantly changed the way health organizations operate. However, the role it plays in healthcare systems remains unclear. This aim of this study was to evaluate the opinion of physicians regarding e-health and determine what factors influence their opinion and describe the advantages, inconveniences and threats they may perceive by its use. A cross-sectional questionnaire-based study. A questionnaire which had been previously designed and validated by the authors was used to interview physicians from the Barcelona Medical Association. 930 physicians were contacted by phone to participate in the study. Seven hundred sixty physicians responded to the questionnaire (response rate: 82%). The usefulness of telemedicine scored 7.4 (SD 1.8) on a scale from 1-10 (from the lowest to the highest) and the importance of the Internet in the workplace was 8.2 points (SD 1.8). Therapeutic compliance (7.0 -SD 1.8-) and patient health (7.0 -SD 1.7-) showed the best scores, and there were differences between professionals who had and had not previously participated in a telemedicine project (p technology outweigh its possible difficulties and shortcomings. Physicians demanded projects with appropriate funding and technology, as well as specific training to improve their technological abilities. The relationship of users with technology differs according to their personal or professional life. Although a 2.0 philosophy has been incorporated into many aspects of our lives, healthcare systems still have a long way to go in order to adapt to this new understanding of the relationship between patients and their health.

  8. Physician-Rating Web Sites: Ethical Implications.

    Science.gov (United States)

    Samora, Julie Balch; Lifchez, Scott D; Blazar, Philip E

    2016-01-01

    To understand the ethical and professional implications of physician behavior changes secondary to online physician-rating Web sites (PRWs). The American Society for Surgery of the Hand (ASSH) Ethics and Professionalism Committee surveyed the ASSH membership regarding PRWs. We sent a 14-item questionnaire to 2,664 active ASSH members who practice in both private and academic settings in the United States. We received 312 responses, a 12% response incidence. More than 65% of the respondents had a slightly or highly unfavorable impression of these Web sites. Only 34% of respondents had ever updated or created a profile for PRWs, although 62% had observed inaccuracies in their profile. Almost 90% of respondents had not made any changes in their practice owing to comments or reviews. One-third of respondents had solicited favorable reviews from patients, and 3% of respondents have paid to improve their ratings. PRWs are going to become more prevalent, and more research is needed to fully understand the implications. There are several ethical implications that PRWs pose to practicing physicians. We contend that it is morally unsound to pay for good reviews. The recourse for physicians when an inaccurate and potentially libelous review has been written is unclear. Some physicians have required patients to sign a waiver preventing them from posting negative comments online. We propose the development of a task force to assess the professional, ethical, and legal implications of PRWs, including working with companies to improve accuracy of information, oversight, and feedback opportunities. It is expected that PRWs will play an increasing role in the future; it is unclear whether there will be a uniform reporting system, or whether these online ratings will influence referral patterns and/or quality improvement. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  9. Burnout Among Anesthetists and Intensive Care Physicians.

    Science.gov (United States)

    Mikalauskas, Audrius; Benetis, Rimantas; Širvinskas, Edmundas; Andrejaitienė, Judita; Kinduris, Šarūnas; Macas, Andrius; Padaiga, Žilvinas

    2018-01-01

    Burnout is a syndrome of depersonalization, emotional exhaustion, and low personal accomplishment. Little is known about burnout in physicians. Our objective was to determine the prevalence of burnout among anesthetists and intensive care physicians, and associations between burnout and personal, as well as professional, characteristics. In total, 220 anesthetists and intensive care physicians were contacted by email, asking them to participate in the study. For depression screening the PHQ-2 questionnaire, for problem drinking, CAGE items were used. Burnout was measured by the Maslach Burnout Inventory. Overall, 34% anesthetists and intensive care physicians indicated high levels of emotional exhaustion, 25% indicated high levels of depersonalization, and 38% showed low personal accomplishment. Burnout was found more frequent among subjects with problem drinking (OR 3.2, 95% CI 1.5-6.8), depressiveness (OR 10.2, 95% CI 4.6-22.6), cardiovascular disorders (OR 3.4, 95% CI 1.7-7.1), and digestive disorders (OR 2.2, 95% CI 1.2-4.0). Some favorite after-work activities positively correlated with burnout, such as sedative medications abuse (OR 4.8, 95% CI 1.8-12.5), alcohol abuse (OR 2.4, 95% CI 1.3-4.5), eating more than usual (OR 1.9, 95% CI 1.1-3.5), and transferring the accumulated stress to relatives (OR 2.8, 95% CI 1.4-5.5). In contrast, reading of non-medical literature seemed to have a protective effect (OR 0.5, 95% CI 0.2-0.9). Burnout was highly prevalent among anesthetists and intensive care physicians with two fifths of them meeting diagnostic criteria. It was strongly correlated with problem drinking, depressiveness, cardiovascular and digestive disorders, use of sedatives and overeating.

  10. Grit, anxiety, and stress in emergency physicians.

    Science.gov (United States)

    Wong, Matthew L; Anderson, Jared; Knorr, Thomas; Joseph, Joshua W; Sanchez, Leon D

    2018-02-26

    The personality traits of emergency physicians are infrequently studied, though interest in physician wellness is increasing. The objective of this study is to acquire pilot data about the amount of grit, anxiety, and stress in emergency physicians using established psychological survey instruments, and to examine their associations of each of these traits with each other. Thirty-six emergency medicine resident and attending physicians from an urban academic medical center consented for enrollment. Participants were administered the Duckworth 12-point Grit Scale, the State-Trait Anxiety Inventory (STAI), and the Perceived Stress Scale (PSS), which measure grit, anxiousness, and perceived stress, respectively. These are the gold standard psychological instruments for each of their areas. We analyzed the results with descriptive statistics, Spearman correlations, and linear regression. Nineteen residents and 17 attending physicians completed the surveys during the first quarter of a new academic year. The mean grit score was 3.7 (95% CI 3.5-3.8, SD: 0.56), the mean trait-anxiety score was 32.61 (95% CI 30.15-35.07, SD: 7.26), and the mean PSS score was 12.28 (95% CI 10.58-13.97, SD: 4.99). Only trait-anxiety and perceived stress were significantly correlated (Spearman's rho: 0.70, panxious reported more stress. Levels of grit were not associated with trait-anxiety. These psychological concepts should be studied further as they relate to the function and health of emergency medicine providers. Copyright © 2018. Published by Elsevier Inc.

  11. Breaking bad news among cancer physicians

    Directory of Open Access Journals (Sweden)

    Sami Ayed Alshammary

    2017-01-01

    Full Text Available Background: Breaking bad news to patients with cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and prognosis must be well-discussed in the most gentle and comfortable manner. It is important that the disclosure is performed in a way that patients will not lose all hope and get very depressed, leading them to undergo an abrupt change of their outlook in life. Objective: The aim of this study was to explore the physicians' perceptions and perspectives of breaking bad news to cancer patients. Methods: A cross-sectional survey of all comprehensive cancer centre physicians currently working in a university teaching hospital in the Middle East was conducted from August to September 2016. Results: Sixty-eight percent responded to the survey. Eighty-four percent were comfortable with breaking bad news, and 70% had training in breaking bad news. Eighty-six percent of responders stated that patients should be told about their cancer. Almost 30% of the respondents stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that they would only tell the details to the patients if asked while 67% of them disagreed that patients should be told about the diagnoses only if the relatives consent. About 51% of physicians wanted to discuss the bad news with the family members and patient together, whereas 24% stated that the patient alone should be involved in the discussion. Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into considerations, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

  12. Treating a physician patient with psychosis.

    Science.gov (United States)

    Freedman, Jacob L; Crow, Fredrick F; Gutheil, Thomas G; Sanchez, Luis T; Suzuki, Joji

    2012-06-01

    The authors present a case of a psychotic female patient who is a former graduate of a locally prestigious medical school and has subsequently been diagnosed with schizophrenia. The patient entered treatment in an outpatient clinic following discharge from her 11th hospitalization. This hospitalization was initiated after the patient's physician friend had called the police and notified them that the patient was significantly disorganized to warrant further evaluation. Treatment was characterized by significant transference and counter-transference reactions amongst her clinicians - both treatment-promoting and treatment-interfering - based on her status as a physician. The problem of insight was a significant hurdle in the treatment of the patient as her medical knowledge of mental illness was substantially greater than her insight into her own mental illness. Throughout treatment, a number of medical-legal and ethical issues arose. Initially, the question was raised as to the legality of the actions by the patient's friend-having made a clinical assessment without having a clinical role in the patient's care. As the patient's clinical status improved and she sought to re-enter the medical field as a resident, new medical legal issues surfaced. What were the roles of the patient's treaters in maintaining confidentiality and simultaneously ensuring the safety of patients that the psychotic physician might care for? This case highlights the universality of psychiatric vulnerability. Insight in psychosis as well as the transference and counter-transference issues involved in caring for a psychotic physician are discussed. Additionally, a thorough medical-legal discussion addresses the various complexities of caring for a psychotic physician. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Financial transparency and physicians: the physician leader's guide to sharing numbers.

    Science.gov (United States)

    Paskert, James P

    2014-01-01

    Review critical factors such as length of stay, case mix, financial statements, ratios and days cash on hand that physicians need to understand to adequately manage hospital patients and engage in the success of the organization.

  14. The Relationships among Physician Nonverbal Immediacy and Measures of Patient Satisfaction with Physician Care.

    Science.gov (United States)

    Conlee, Connie J.; And Others

    1993-01-01

    Examines the relationship among four dimensions of patient satisfaction with physician care and nonverbal immediacy. Finds a significant positive correlation between nonverbal immediacy and overall patient satisfaction, with the strongest correlation to the attention/respect factor. (SR)

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

    Science.gov (United States)

    Fujioka, Yuki; Stewart, Erin

    2013-01-01

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

  16. Social Media Use Among Physicians and Trainees: Results of a National Medical Oncology Physician Survey.

    Science.gov (United States)

    Adilman, Rachel; Rajmohan, Yanchini; Brooks, Edward; Urgoiti, Gloria Roldan; Chung, Caroline; Hammad, Nazik; Trinkaus, Martina; Naseem, Madiha; Simmons, Christine; Adilman, Rachel; Rajmohan, Yanchini; Brooks, Edward; Roldan Urgoiti, Gloria; Chung, Caroline; Hammad, Nazik; Trinkaus, Martina; Naseem, Madiha; Simmons, Christine

    2016-01-01

    Cancer management requires coordinated care from many health care providers, and its complexity requires physicians be up to date on current research. Web-based social media support physician collaboration and information sharing, but the extent to which physicians use social media for these purposes remains unknown. The complex field of oncology will benefit from increased use of online social media to enhance physician communication, education, and mentorship. To facilitate this, patterns of social media use among oncologists must be better understood. A nine-item survey investigating physician social media use, designed using online survey software, was distributed via e-mail to 680 oncology physicians and physicians in training in Canada. Responses were analyzed using descriptive statistics. A total of 207 responses (30%) were received; 72% of respondents reported using social media. Social media use was highest, at 93%, in respondents age 25 to 34 years and lowest, at 39%, in those age 45 to 54 years. This demonstrates a significant gap in social media use between younger users and mid- to late-career users. The main barrier to use was lack of free time. The identified gap in social media use between age cohorts may have negative implications for communication in oncology. Despite advancements in social media and efforts to integrate social media into medical education, most oncologists and trainees use social media rarely, which, along with the age-related gap in use, may have consequences for collaboration and education in oncology. Investigations to further understand barriers to social media use should be undertaken to enhance physician collaboration and knowledge sharing through social media.

  17. Effects of various methodologic strategies: survey response rates among Canadian physicians and physicians-in-training.

    Science.gov (United States)

    Grava-Gubins, Inese; Scott, Sarah

    2008-10-01

    To increase the overall 2007 response rate of the National Physician Survey (NPS) from the survey's 2004 rate of response with the implementation of various methodologic strategies. Physicians were stratified to receive either a long version (12 pages) or a short version (6 pages) of the survey (38% and 62%, respectively). Mixed modes of contact were used-58% were contacted by e-mail and 42% by regular mail-with multiple modes of contact attempted for nonrespondents. The self-administered, confidential surveys were distributed in either English or French. Medical residents and students received e-mail surveys only and were offered a substantial monetary lottery incentive for completing their surveys. A professional communications firm assisted in marketing the survey and delivered advance notification of its impending distribution. Canada. A total of 62 441 practising physicians, 2627 second-year medical residents, and 9162 medical students in Canada. Of the practising physicians group, 60 811 participants were eligible and 19 239 replied, for an overall 2007 study response rate of 31.64% (compared with 35.85% in 2004). No difference in rate of response was found between the longer and shorter versions of the survey. If contacted by regular mail, the response rate was 34.1%; the e-mail group had a response rate of 29.9%. Medical student and resident response rates were 30.8% and 27.9%, respectively (compared with 31.2% and 35.6% in 2004). Despite shortening the questionnaires, contacting more physicians by e-mail, and enhancing marketing and follow-up, the 2007 NPS response rate for practising physicians did not surpass the 2004 NPS response rate. Offering a monetary lottery incentive to medical residents and students was also unsuccessful in increasing their response rates. The role of surveys in gathering information from physicians and physicians-in-training remains problematic. Researchers need to investigate alternative strategies for achieving higher rates of

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

    Science.gov (United States)

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

    2016-07-07

    Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice.

  19. Do family physicians, emergency department physicians, and pediatricians give consistent sport-related concussion management advice?

    Science.gov (United States)

    Stoller, Jacqueline; Carson, James D; Garel, Alisha; Libfeld, Paula; Snow, Catherine L; Law, Marcus; Frémont, Pierre

    2014-06-01

    To identify differences and gaps in recommendations to patients for the management of sport-related concussion among FPs, emergency department physicians (EDPs), and pediatricians. A self-administered, multiple-choice survey was e-mailed to FPs, EDPs, and pediatricians. The survey had been assessed for content validity. Two community teaching hospitals in the greater Toronto area in Ontario. Two hundred seventy physicians, including FPs, EDPs, and pediatricians, were invited to participate. Identification of sources of concussion management information, usefulness of concussion diagnosis strategies, and whether physicians use common terminology when explaining cognitive rest strategies to patients after sport-related concussions. The response rate was 43.7%. Surveys were completed by 70 FPs, 23 EDPs, and 11 pediatricians. In total, 49% of FP, 52% of EDP, and 27% of pediatrician respondents reported no knowledge of any consensus statements on concussion in sport, and 54% of FPs, 86% of EDPs, and 78% of pediatricians never used the Sport Concussion Assessment Tool, version 2. Only 49% of FPs, 57% of EDPs, and 36% of pediatricians always advised cognitive rest. This study identified large gaps in the knowledge of concussion guidelines and implementation of recommendations for treating patients with sport-related concussions. Although some physicians recommended physical and cognitive rest, a large proportion failed to consistently advise this strategy. Better knowledge transfer efforts should target all 3 groups of physicians. Copyright© the College of Family Physicians of Canada.

  20. Physicians' attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators.

    Science.gov (United States)

    Klinar, Ivana; Ferhatovic, Lejla; Banozic, Adriana; Raguz, Marija; Kostic, Sandra; Sapunar, Damir; Puljak, Livia

    2013-06-01

    Interprofessional collaboration is the process in which different professional groups work together to positively impact health care. We aimed to explore physicians' attitudes toward interprofessional collaboration in the context of chronic pain management with the implication that if attitudes are not positive, appropriate interventions could be developed. A quantitative attitudes study. The ethical committee approved the study. A web-based survey about interprofessional treatment of chronic pain was administered to physicians. Outcome measures were as follows: physicians' demographic and workplace information, previous experience of working within an interprofessional team, and attitudes towards interprofessional collaboration in chronic pain management. There were 90 physicians who responded to the survey. Physicians had positive attitudes towards team work in the context of chronic pain, but they were undecided about sharing their role within an interprofessional team. The family physician was singled out as the most important as well as the most common collaborator in chronic pain treatment. Interprofessional educational seminars and workshops were suggested as methods for improving interprofessional collaboration. Interprofessional collaboration may be enhanced with continuing medical education that will bring together different healthcare professionals, enable them to exchange experiences and learn about their potential roles within a team. © 2012 Nordic College of Caring Science.

  1. Investigating performance of rural family physicians in Fars province working as part of Family Physician Program

    Directory of Open Access Journals (Sweden)

    Mansour Kashfi

    2016-09-01

    Full Text Available Background & Objective: Health family physician program is a complete system which eliminates the bewilderment of people and increases the satisfaction with health services as its most important results in medical care. The aim of this study was to evaluate the performance of family physicians and their strengths and weaknesses. Material & Methods: In this study, 52 family physicians were chosen via Random Stratified Sampling to participate in the study. A questionnaire titled “Performance of Family Physicians” with 5 domains of management, performance, contract guidelines, community involvement and results was used to collect data. Data were analyzed using SPSS-19 via t-test, ANOVA, Pearson correlation coefficient, and non-parametric tests. Results: Among the 52 studied family physicians, 56.9% were female and 43.1% were male. The lowest and the highest scores were obtained for the community involvement and results, respectively. Based on the results of this study, there were significant relationships among most of the domains. However, there was no significant correlation between the gender and different domains. Conclusion: In order to solve the problems of family physician program and improve the quality of services, more researches should be carried out soon to determine the types and causes of referring to the family physicians. Accordingly, appropriate interventions should be implemented to reduce the burden of visits and improve the quality of health services by guiding the society towards the prevention measures.

  2. Hope and persuasion by physicians during informed consent.

    Science.gov (United States)

    Miller, Victoria A; Cousino, Melissa; Leek, Angela C; Kodish, Eric D

    2014-10-10

    To describe hopeful and persuasive messages communicated by physicians during informed consent for phase I trials and examine whether such communication is associated with physician and parent ratings of the likelihood of benefit, physician and parent ratings of the strength of the physician's recommendation to enroll, parent ratings of control, and parent ratings of perceived pressure. Participants were children with cancer (n = 85) who were offered a phase I trial along with their parents and physicians. Informed consent conferences (ICCs) were audiotaped and coded for physician communication of hope and persuasion. Parents completed an interview (n = 60), and physicians completed a case-specific questionnaire. The most frequent hopeful statements related to expectations of positive outcomes and provision of options. Physicians failed to mention no treatment and/or palliative care as options in 68% of ICCs and that the disease was incurable in 85% of ICCs. When physicians mentioned no treatment and/or palliative care as options, both physicians and parents rated the physician's strength of recommendation to enroll in the trial lower. Hopes and goals other than cure or longer life were infrequently mentioned, and a minority of physicians communicated that the disease was incurable and that no treatment and/or palliative care were options. These findings are of concern, given the low likelihood of medical benefit from phase I trials. Physicians have an important role to play in helping families develop alternative goals when no curative options remain. © 2014 by American Society of Clinical Oncology.

  3. The catastrophic collapse of morale among hospital physicians in Japan

    Directory of Open Access Journals (Sweden)

    Hideo Yasunaga

    2008-11-01

    Full Text Available Hideo YasunagaDepartment of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo, JapanAbstract: The past few decades have witnessed bleak pictures of unhappy physicians worldwide. Japanese physicians working in hospitals are particularly distressed. Today, Japan’s healthcare system is near collapse because physicians are utterly demoralized. Their loss of morale is due to budget constraints, excessive demands, physician shortages, poor distribution, long working hours, hostile media, increasing lawsuits, and violence by patients. Severe cost-saving policies, inadequate distribution of healthcare resources, and the failure to communicate risks has damaged physicians’ morale and created conflicts between physicians and society. Physicians should communicate the uncertainty, limitations, and risks of modern medicine to all members of society. No resolution can be achieved unless trust exists between physicians, patients, the public, the media, bureaucrats, politicians and jurists.Keywords: physician’s morale, physician shortages, overwork, health policy

  4. The neglected repercussions of a physician advertising ban.

    Science.gov (United States)

    Zwier, Sandra

    2014-03-01

    Although the adverse implications of physician advertising are the subject of a fierce and sustained debate, there is almost no scholarly discussion on the ethical repercussions of physician advertising bans. The present paper draws attention to these repercussions as they exist today in most of the world, with particular focus on three serious implications for the public: (a) uncertainty about the physician's interests, namely, that patients must trust the physician to put patient wellbeing ahead of possible gains when taking medical decisions; (b) uncertainty about alternative treatments, namely, that patients must trust in the physician's treatment decisions; and (c) uncertainty about the exclusive patient-physician relationship, namely, that patients must develop and maintain a good relationship with one physician. Physician advertising bans continue to tell the public in most of the modern world that these are irrelevant or inappropriate issues, meaning that they are effectively left to the public to resolve.

  5. Shared governance: one way to engage employed physicians.

    Science.gov (United States)

    Sanford, Kathleen D

    2012-09-01

    To work better with employed physicians, finance leaders should: Understand classic management theories on what motivates employees. Learn from shared governance models with nurses at Magnet hospitals. Apply best practices in management to all employees, not just physicians.

  6. Physician-assisted death in psychiatric practice in the Netherlands

    NARCIS (Netherlands)

    J.H. Groenewoud (Hanny); P.J. van der Maas (Paul); G. van der Wal (Gerrit); M.W. Hengeveld (Michiel); A.J. Tholen; W.J. Schudel (Willem); A. van der Heide (Agnes)

    1997-01-01

    textabstractBACKGROUND: In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in

  7. Physician leadership. Learning to be a leader.

    Science.gov (United States)

    Zaher, C A

    1996-09-01

    As the business role of health care delivery expands and complex reform is imposed, physicians must assume leadership roles and imprint medical expertise on business dynamics. Before the end of this century, health care and its delivery will likely become unrecognizable to those who ended their practices only a decade ago. Traditional management will wither away to be replaced by self-managed, self-trained, and self-motivated workers, no longer employed in jobs but working through processes, projects, and assignments in integrative health care delivery systems. Becoming a leader is an active and arduous process that can no longer be approached haphazardly. To be effective, the physician must plot a course with clear and calculated intent and effort, which requires acquiring organizational tools and administrative skills to innovatively alter medical care for the good of all.

  8. Physician recruitment in Ontario Provincial Psychiatric Hospitals.

    Science.gov (United States)

    Draper, R; Galbraith, D; Frost, B

    1989-11-01

    Recruitment of Physicians/Psychiatrists to staff the Ontario Provincial Psychiatric Hospitals remains an ongoing problem despite the introduction of measures such as University Affiliation and Incentive Grants. Historically there has been heavy reliance upon Foreign Medical Graduates (GOFM's) who have been denied the possibility of professional mobility and advancement because of restrictive licences. Recent changes in regulations have severely restricted the recruitment of GOFM's. During 1987, details of all physicians employed in the provincial hospitals during the preceeding five years were entered into a computerized data base. This paper presents some initial analyses which indicate that Canadian graduates have provided low levels of service, especially outside major urban centres, quite insufficient to replace the GOFM's. These findings raise urgent social and professional concerns.

  9. Professional and spatial mobility of osteopathic physicians.

    Science.gov (United States)

    Hassinger, E W; Gill, L S; Hobbs, D J; Hageman, R L

    1979-12-01

    The study examines changes in location of osteopathic and medical doctors in a 20-county area of rural Missouri over a 14-year period. Losses of osteopathic physicians were greater than medical doctors. However, there was a convergence over the 14-year period in background characteristics of the two types of physicians. The finding of greater spatial mobility of DOs is placed in the context of professional mobility of osteopathy. It is also argued that as practice opportunities for DOs increase, background factors associated with early socialization become more influential in choice of practice sites. The relationship of practice opportunities to choice of practice sites can be extended to foreign medical school graduates and "new health practitioners."

  10. Physician executives straddle the digital divide.

    Science.gov (United States)

    Coile, R C

    2001-01-01

    e-Health is here to stay and experts predict that the Internet will become the hub of health care. Rapid advancements in biotechnology and medical research, increasingly curious patients who surf the Internet for medical information, and pressures from managed care companies to contain costs and speed treatments are the central components driving e-health. Despite physician reluctance to embrace the e-revolution, many hospitals and medical groups are employing the Internet and information technology to improve their customer interface, as well as to reduce business costs. This article offers seven e-strategies for health care performance improvement: (1) Supply chain management; (2) e-transactions; (3) care management; (4) improving quality; (5) boosting revenues; (6) outsourcing; and (7) provider networks (Intranets). By helping to incorporate these key e-solutions, physician executives can position their organizations for success in the new millennium.

  11. Physicians' subjectivity in evaluating oxytocin challenge tests.

    Science.gov (United States)

    Peck, T M

    1980-07-01

    Five physicians subspecializing in maternal-fetal medicine individually evaluated 50 oxytocin challenge tests (OCTs), of which 33 were originally read as positive. There was considerable disagreement among the study physicians (SPs) such that 2 SPs would agree, on the average, only 52% of the time on any one OCT. The SPs were also asked to evaluate fetal heart rate (FHR) reactivity patterns, if present. Again, there was great disagreement. When the majority (3 of 5 or more) of SPs agreed on the OCT result and/or reactivity, there was reasonable correlation with neonatal outcome, indicating the validity of the physiologic premise of the test. In particular, the presence or absence of FHR accelerations with fetal motion, regardless of the OCT reading, correlated extremely well with eventual neonatal outcome. This indicates that the most significant variable in antepartum FHR monitoring is the FHR acceleration pattern.

  12. Resident physicians in Mexico: tradition or humiliation

    Directory of Open Access Journals (Sweden)

    Donovan Casas Patiño

    2013-08-01

    Full Text Available Mexico has a great history and tradition in relation to the training of resident physicians, but what we find behind this process?, Power relations implied and not implied, unnoticed or ignored for convenience by the academic and health institutions, with the aggravation of forgetting its commitment to the training of men and women "professionals" and limited to meet another indicator of "human resources for health." The resident physician in academic and scientific training is immersed in this dehumanized maelstrom and ends up becoming a character for the domain of knowledge as power, forgetting that his act and its rationale lies in the principle of "primum non nocere" to that we would add: nor your person, nor your fellowman, much less whom you have the moral, ethical and civic responsibility to convey some of your knowledge and your experience, that is, part of your essence”.

  13. [The occupational physician and communication to workers].

    Science.gov (United States)

    Perbellini, L; di Leo, E; Goio, I

    2010-01-01

    Communication ability is essential for the Physician to the proper management of ambulatory activity and corporate training. The aim of this work is describe the communication strategies to be adopted in everyday healthcare practice. When the occupational physician relates with an employee his message must act both verbal both non-verbal. The medical history should be collected carefully and during the physical examination is important to put the employee at ease by adopting a discreet and attentive attitude. The clinical findings and the capacity to work with any limitations will be discussed at the end of health surveillance using understandable terminology to the worker. During the training-information process is important to define the primary objectives, organize the program and bring the display materials. The worker should be actively involved and encouraged to learn throughout the course information. In the text will also be shown the main aspects of information on line.

  14. Physician self-awareness: the neglected insight.

    OpenAIRE

    Longhurst, M

    1988-01-01

    Self-awareness is vital to a physician's development. Understanding the impact of our internal subjective world on our attitudes and values and on the fantasies we have of reality is important to us as doctors. Some of the means of acquiring this self-knowledge include accurately perceiving the reflection of one's self in patients, understanding one's learning style, studying and enjoying the humanities, expressing one's self creatively, maintaining a sense of humour and examining one's react...

  15. Justification: How to get referring physicians involved

    International Nuclear Information System (INIS)

    Remedios, D.

    2011-01-01

    Barriers to involvement of clinicians in the process of justification include an already overloaded knowledge base, lack of time, inconsistent guidance and disproportionate patient expectations. Strategies to improve referring physicians' input include education, use of imaging referral guidelines, clinical audit and regulation. This article discusses and reviews evidence for approaches to encourage greater participation in justification by clinicians. Approaches are best summarised by 'Awareness, appropriateness and audit'. (authors)

  16. Physician Self-directed Learning and Education

    Directory of Open Access Journals (Sweden)

    Masami Tagawa

    2008-07-01

    Full Text Available Physicians are expected to be life-long learners because updated and effective patient care should be provided while medical and clinical knowledge and skills and social requirements for patient care are rapidly changing. Also, qualified clinical competence needs long periods of training and each physician has to continually learn as long as he/she works as a professional. Self-directed learning is an important factor in adult learning. Medical students' readiness for self-directed learning is not high, and should be improved by medical school and postgraduate training curricula. Garrison proposed a comprehensive model of self-directed learning, and it has dimensions of motivation (entering and task, self-monitoring (responsibility, and self-management (responsibility. To teach individual self-directed learning competencies, the following are important: (1 situate learners to experience “real” problems; (2 encourage learners to reflect on their own performance; (3 create an educational atmosphere in clinical training situations. In 2005, a 2-year mandatory residency program was implemented in Japan, and fewer medical school graduates took residency programs in medical school hospitals and advanced specialty programs provided by medical school departments. Medical school departments provide traditional, but life-long clinical training opportunities. Under the new residency program, an additional postgraduate and continuing medical training system has to be built up to maintain and confirm a physician's competencies. If physicians do clinical work using a scholarly way of thinking with critical analysis of their own competencies and improvement by reflection, they will become an excellent life-long learner.

  17. Primary Care Physicians' Perspectives About HPV Vaccine.

    Science.gov (United States)

    Allison, Mandy A; Hurley, Laura P; Markowitz, Lauri; Crane, Lori A; Brtnikova, Michaela; Beaty, Brenda L; Snow, Megan; Cory, Janine; Stokley, Shannon; Roark, Jill; Kempe, Allison

    2016-02-01

    Because physicians' practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3)identify characteristics associated with not discussing it. A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined. Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11-12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1-3.5), be male (aOR: 1.8 [95% CI: 1.1-3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3-4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1-6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4-17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8-6.4]). Addressing physicians' perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates. Copyright © 2016 by the American Academy of Pediatrics.

  18. Fertility and Childbearing Among American Female Physicians.

    Science.gov (United States)

    Stentz, Natalie Clark; Griffith, Kent A; Perkins, Elena; Jones, Rochelle DeCastro; Jagsi, Reshma

    2016-10-01

    Female physicians may experience unique challenges regarding fertility and family planning. We sought to determine childbearing patterns and decision-making among American female physicians. In 2012-2013, we surveyed a random sample of 600 female physicians who graduated medical school between 1995 and 2000. Primary outcome measures included fertility and childbearing history, reflections regarding decision-making, perceptions of workplace support, and estimations of childbearing potential. Response rate was 54.5% (327/600). A majority (82.0%) of the sample were parents, 77.4% had biological children with an average of 2.3 children. Average age at medical school graduation was 27.5 years, at completion of training (completion of medical school, residency, and/or fellowship) was 31.6 years, and at first pregnancy was 30.4 years. Nearly one quarter (24.1%) of respondents who had attempted conception were diagnosed with infertility, with an average age at diagnosis of 33.7 years. Among those with infertility, 29.3% reported diminished ovarian reserve. When asked what they would do differently in retrospect, most respondents (56.8%) would do nothing differently regarding fertility/conception/childbearing, 28.6% would have attempted conception earlier, 17.1% would have gone into a different specialty, and 7.0% would have used cryopreservation to extend fertility. Fewer of those whose first pregnancy was in medical school perceived substantial workplace support (68.2%) than those whose first pregnancies followed training (88.6%). A substantial proportion of female physicians have faced infertility or have regrets about family planning decisions and career decision-making. Combining a medical career with motherhood continues to pose challenges, meriting further investigation and targeted support.

  19. Queen Victoria, her physicians, and her cataracts.

    Science.gov (United States)

    Ravin, J G

    1994-01-01

    Decreasing vision due to cataracts became a significant problem for Queen Victoria toward the end of the 19th century. Her personal physician, Sir James Reid, obtained consultations with two eminent British ophthalmologists, George Lawson and Edward Nettleship. The Queen was not satisfied, and requested an opinion from the German professor Hermann Pagenstecher. All the doctors agreed on the diagnosis, but the Queen never underwent surgery.

  20. Lifetime earnings for physicians across specialties.

    Science.gov (United States)

    Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Romano, Patrick S; Kravitz, Richard L

    2012-12-01

    Earlier studies estimated annual income differences across specialties, but lifetime income may be more relevant given physicians' long-term commitments to specialties. Annual income and work hours data were collected from 6381 physicians in the nationally representative 2004-2005 Community Tracking Study. Data regarding years of residency were collected from AMA FREIDA. Present value models were constructed assuming 3% discount rates. Estimates were adjusted for demographic and market covariates. Sensitivity analyses included 4 alternative models involving work hours, retirement, exogenous variables, and 1% discount rate. Estimates were generated for 4 broad specialty categories (Primary Care, Surgery, Internal Medicine and Pediatric Subspecialties, and Other), and for 41 specific specialties. The estimates of lifetime earnings for the broad categories of Surgery, Internal Medicine and Pediatric Subspecialties, and Other specialties were $1,587,722, $1,099,655, and $761,402 more than for Primary Care. For the 41 specific specialties, the top 3 (with family medicine as reference) were neurological surgery ($2,880,601), medical oncology ($2,772,665), and radiation oncology ($2,659,657). The estimates from models with varying rates of retirement and including only exogenous variables were similar to those in the preferred model. The 1% discount model generated estimates that were roughly 150% larger than the 3% model. There was considerable variation in the lifetime earnings across physician specialties. After accounting for varying residency years and discounting future earnings, primary care specialties earned roughly $1-3 million less than other specialties. Earnings' differences across specialties may undermine health reform efforts to control costs and ensure adequate numbers of primary care physicians.

  1. The ties that bind: a reflection on physician grief.

    Science.gov (United States)

    Giddings, Gordon

    2010-10-01

    Physician grief remains a prevalent yet largely unacknowledged problem in the medical profession. Several techniques can be employed to improve coping in physicians that deal frequently with patients approaching the end of life that can be integrated into medical training programs and physician practices. The author recounts his own experience of physician grief having cared for a patient on his dying journey and using it as an opportunity for personal growth.

  2. Physician offices marketing: assessing patients' views of office visits.

    Science.gov (United States)

    Emmett, Dennis; Chandra, Ashish

    2010-01-01

    Physician offices often lack the sense of incorporating appropriate strategies to make their facilities as marketer of their services. The patient experience at a physician's office not only incorporates the care they receive from the physician but also the other non-healthcare related aspects, such as the behavior of non-health professionals as well as the appearance of the facility itself. This paper is based on a primary research conducted to assess what patients assess from a physician office visit.

  3. Physician job satisfaction related to actual and preferred job size

    OpenAIRE

    Schmit Jongbloed, Lodewijk J.; Cohen-Schotanus, Janke; Borleffs, Jan C. C.; Stewart, Roy E.; Schonrock-Adema, Johanna

    2017-01-01

    Background: Job satisfaction is essential for physicians' well-being and patient care. The work ethic of long days and hard work that has been advocated for decades is acknowledged as a threat for physicians' job satisfaction, well-being, and patient safety. Our aim was to determine the actual and preferred job size of physicians and to investigate how these and the differences between them influence physicians' job satisfaction. Method: Data were retrieved from a larger, longitudinal study a...

  4. When Patients Divorce: The Family Physician's Legal Position

    OpenAIRE

    Mesbur, Ruth E.

    1983-01-01

    When divorce and family disintegration loom, the family physician is often the first outsider on the scene. The family physician may, indeed, have a critical role to play in handling the crisis; he may advise, refer to other professionals like therapists or lawyers, or appear in court as an expert witness. The physician must consider his legal position. Is reconciliation counselling confidential, privileged information? Can he recommend a lawyer for a patient? What is the physician's vulnerab...

  5. House Calls: Physicians in the US Congress, 2005-2015.

    Science.gov (United States)

    Goldenberg, Matthew N

    2015-11-01

    Physicians occupy a prominent position in the US healthcare system, and physicians who serve in Congress may bring a particular perspective, expertise, and influence to health-related legislation. The purpose of this study was to describe physician membership in the US Congress between 2005 and 2015. Congressional biographical records were searched to identify physicians who served in the US Congress from 2005 to 2015. Political and demographic characteristics of physician-members were compared with those of nonphysician-members of Congress and of all US physicians. The numbers of physicians in recent Congresses also were compared with those in each Congress since 1945. A total of 27 physicians representing 17 states have served in Congress since 2005. There has been a significant increase in physician representation since 1987, reaching a high of 20 members (3.7%) in the Congresses immediately following passage of the Patient Protection and Affordable Care Act. Physician-members were mostly men (93%) and more likely than their Congressional colleagues to be Republican (78% vs 53% of all members, P = 0.007) and from the South (63% vs 35% of all members, P = 0.003). Compared with physicians in general, physicians in Congress were more likely to be men (93% vs 70%, P = 0.009) and surgeons (26% vs 11%, P = 0.01). Physician representation in Congress has increased substantially since 2000, potentially reflecting the greater political prominence of healthcare issues, as well as increased interest by and recruitment of physician-candidates. Physicians in Congress differ from their colleagues and from physicians in general in various demographic and political characteristics.

  6. Total expenditures per patient in hospital-owned and physician-owned physician organizations in California.

    Science.gov (United States)

    Robinson, James C; Miller, Kelly

    Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and

  7. Medical school type and physician income.

    Science.gov (United States)

    Weeks, William B; Wallace, Tanner A

    2008-01-01

    We wanted to determine whether the type of medical school attended--private US, public US, or foreign medical school--is associated with practice characteristics or incomes of physicians. Therefore, we used survey responses obtained during the 1990s from 10,436 actively practicing white male physicians who worked in one of 13 medical specialties and who graduated from a public US (5,702), private US (3,797), or international (937) medical school. We used linear regression modeling to determine the association between type of medical school attended and physicians' annual incomes after controlling for specialty, work hours, provider characteristics, and practice characteristics. We found that, for most specialties, international medical school graduates worked longer hours, were less likely to be board certified, had practiced medicine for fewer years, and were less likely to work in rural settings than US medical school graduates. After controlling for key variables, international medical school graduates' annual incomes were 2.6 percent higher (95% CI: 0.1%, 4.4%, p = .043) and public US medical school graduates' were 2.2 percent higher (95% CI: -0.9% -6.1%, p = 0.2) than private US medical school graduates' incomes. Because of their lower tuition expenses, international and public US medical school graduates may experience higher returns on educational investment than their counterparts who graduated from private US medical schools.

  8. Principal forensic physicians as educational supervisors.

    Science.gov (United States)

    Stark, Margaret M

    2009-10-01

    This research project was performed to assist the Faculty of Forensic and Legal Medicine (FFLM) with the development of a training programme for Principal Forensic Physicians (PFPs) (Since this research was performed the Metropolitan Police Service have dispensed with the services of the Principal Forensic Physicians so currently (as of January 2009) there is no supervision of newly appointed FMEs or the development training of doctors working in London nor any audit or appraisal reviews.) to fulfil their role as educational supervisors. PFPs working in London were surveyed by questionnaire to identify the extent of their knowledge with regard to their role in the development training of all forensic physicians (FPs) in their group, the induction of assistant FPs and their perceptions of their own training needs with regard to their educational role. A focus group was held at the FFLM annual conference to discuss areas of interest that arose from the preliminary results of the questionnaire. There is a clear need for the FFLM to set up a training programme for educational supervisors in clinical forensic medicine, especially with regard to appraisal. 2009 Elsevier Ltd and Faculty of Forensic and Legal Medicine.

  9. Are Australasian academic physicians an endangered species?

    Science.gov (United States)

    Wilson, A

    2007-11-01

    It has been stated that academic medicine is in a worldwide crisis. Is this decline in hospital academic practice a predictable consequence of modern clinical practice with its emphasis on community and outpatient-based services as well as a corporate health-care ethos or does it relate to innate problems in the training process and career structure for academic clinicians? A better understanding of the barriers to involvement in academic practice, including the effect of gender, the role and effect of overseas training, expectation of further research degrees and issues pertaining to the Australian academic workplace will facilitate recruitment and retention of the next generation of academic clinicians. Physician-scientists remain highly relevant as medical practice and education evolves in the 21st century. Hospital-based academics carry out a critical role in the ongoing mentoring of trainees and junior colleagues, whose training is still largely hospital based in most specialty programmes. Academic clinicians are uniquely placed to translate the rapid advances in medical biology into the clinical sphere, by guiding and carrying out translational research as well as leading clinical studies. Academic physicians also play key leadership in relations with government and industry, in professional groups and medical colleges. Thus, there is a strong case to assess the problems facing recruitment and retention of physician-scientists in academic practice and to develop workable solutions.

  10. [Is there a physician on board?].

    Science.gov (United States)

    Andersen, H T

    1998-11-01

    Physicians responding to emergency calls on board airliners in intercontinental traffic may not be aware of certain legal complications which may arise. For instance, the medical practitioner may hold a license valid in one country, the air carrier may be registered in another, and the patient may be a third state national. Legislation varies between nations, as do court decisions. Physicians may be aware neither of the laws and regulations which apply nor the subtle differences between terms and interpretations used in formal language. This article contains a scenario description from a commercial air liner in intercontinental transit carrying a patient unknown to the physician who responds to a call for medical assistance. The main considerations to be made, the more likely diagnoses and various strategies for immediate interventions are reviewed. Likewise, appraisal and use of medical equipment on board are discussed, as are issues concerning responsibility and liability when equipment is used in supposedly "trained hands". Main themes in the current international medico-legal debate are considered with emphasis on the "Good Samaritan Principle", the responsibility of commercial air carriers, and telemedicine with insurance against law suits. The article concludes with some practical advice to the travelling medical community.

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

    Science.gov (United States)

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

    2015-01-01

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

  12. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper.

    Science.gov (United States)

    Snyder Sulmasy, Lois; Mueller, Paul S

    2017-10-17

    Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end. However, the ACP believes that the ethical arguments against legalizing physician-assisted suicide remain the most compelling. On the basis of substantive ethics, clinical practice, policy, and other concerns articulated in this position paper, the ACP does not support legalization of physician-assisted suicide. It is problematic given the nature of the patient-physician relationship, affects trust in the relationship and in the profession, and fundamentally alters the medical profession's role in society. Furthermore, the principles at stake in this debate also underlie medicine's responsibilities regarding other issues and the physician's duties to provide care based on clinical judgment, evidence, and ethics. Society's focus at the end of life should be on efforts to address suffering and the needs of patients and families, including improving access to effective hospice and palliative care. The ACP remains committed to improving care for patients throughout and at the end of life.

  13. Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians

    Directory of Open Access Journals (Sweden)

    Vanessa Schultz

    2013-07-01

    Full Text Available Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018. Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006. Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019. Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024. Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013. When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015, whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054. Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.

  14. Are physicians and patients in agreement? Exploring dyadic concordance.

    Science.gov (United States)

    Coran, Justin J; Koropeckyj-Cox, Tanya; Arnold, Christa L

    2013-10-01

    Dyadic concordance in physician-patient interactions can be defined as the extent of agreement between physicians and patients in their perceptions of the clinical encounter. The current research specifically examined two types of concordance: informational concordance-the extent of agreement in physician and patient responses regarding patient information (education, self-rated health, pain); and interactional concordance-the extent of physician-patient agreement regarding the patient's level of confidence and trust in the physician and the perceived quality of explanations concerning diagnosis and treatment. Using a convenience sample of physicians and patients (N = 50 dyads), a paired survey method was tested, which measured and compared physician and patient reports to identify informational and interactional concordances. Factors potentially related to dyadic concordance were also measured, including demographic characteristics (patient race, gender, age, and education) and clinical factors (whether this was a first visit and physician specialty in family medicine or oncology). The paired survey showed informational discordances, as physicians tended to underestimate patients' pain and overestimate patient education. Interactional discordances included overestimating patients' understanding of diagnosis and treatment explanations and patients' level of confidence and trust. Discordances were linked to patient dissatisfaction with physician listening, having unanswered questions, and feeling the physician had not spent enough time. The paired survey method effectively identified physician-patient discordances that may interfere with effective medical practice; this method may be used in various settings to identify potential areas of improvement in health communication and education.

  15. Physician-Based Tobacco Smoking Cessation Counseling in Belgrade, Serbia

    Science.gov (United States)

    Merrill, Ray; Harmon, Tanner; Gagon, Heather

    2009-01-01

    This study examined physician attitudes and practices pertaining to patient counseling about smoking in Belgrade, Serbia. Data were collected using a cross-sectional survey of 86 physicians at multiple health care facilities. Approximately 74% of physicians agreed that they should routinely ask patients about their smoking habits and 79% agreed…

  16. Health Seeking Behavior of Physicians at the Jos University ...

    African Journals Online (AJOL)

    Background: Physicians who have the task of caring for the sick also need to be cared for when they take ill. Healthseeking habits of physicians have been found to be poor in most developed countries. Utilization of health services by physicians in developing countries is not known. We sought to describe the health seeking ...

  17. Aligning Career Expectations with the Practice of Medicine: Physician Satisfaction

    Science.gov (United States)

    Gibson, Denise D.; Borges, Nicole J.

    2009-01-01

    This study examined physicians' level of satisfaction with their job and the match between expectations and actual practice of specialty. Quantitative results suggested that physicians (N = 211) had a moderately high level of overall job satisfaction with no significant differences found between men and women physicians. Among those in primary…

  18. Burnout syndrome among physicians working in primary health care ...

    African Journals Online (AJOL)

    Objective: The aim of the study was to reveal extent of burnout problem among primary care physicians and the socio-demographic factors affecting its occurrence. Methods: The target population included all physicians working in these two health regions in Kuwait. Two hundred physicians working in the primary health ...

  19. Anger Management and Factors that Influence Anger in Physicians

    Directory of Open Access Journals (Sweden)

    Emel Koçer

    2011-03-01

    Full Text Available Objective: There are limited data regarding anger and its management with respect to physicians and many other professionals. Our objective was to evaluate anger expression and control in physicians. Material and Methods: The physicians of the Düzce School of Medicine were the participants in the study. Physicians were assigned to either an internal medicine or a surgery study group. Each group contained physicians from several specialties. The Spielberger State-Trait Anger Expression Inventory, and the Beck Anxiety and Depression Inventories were administered to all participants. The physicians (n=158 were evaluated and compared with controls (n=105 in terms of anger control and sociodemographic variables. Results: Anger-control scores were higher in physicians (p<0.01 and in those who willingly chose the medical profession (p<0.05. Age, number of years as a physician, and the specialty were negatively correlated with anger management in physicians working in the surgical disciplines (p<0.01. Only Beck anxiety and depression scores were positively correlated with anger-trait scores and anger-in scores for physicians working in the internal medicine disciplines (p<0.01.Conclusion: Physicians were relatively successful in coping with anger. A willingness to choose the medical profession was a factor influencing anger control. Age was the major factor affecting anger management in physicians.

  20. Communication skills of physicians during patient interaction in an in ...

    African Journals Online (AJOL)

    Background: Physician-patient relationship is foremost among the numerous qualities needed for sound patient care. In the Ethiopian clinical setting, a vast majority of patients complain that physicians do not interact with them properly. Objective: Assess behavior of physicians (verbal and nonverbal) when interacting with ...

  1. Variation in Physician Practice Styles within and across Emergency Departments.

    Directory of Open Access Journals (Sweden)

    Jessica Van Parys

    Full Text Available Despite the significant responsibility that physicians have in healthcare delivery, we know surprisingly little about why physician practice styles vary within or across institutions. Estimating variation in physician practice styles is complicated by the fact that patients are rarely randomly assigned to physicians. This paper uses the quasi-random assignment of patients to physicians in emergency departments (EDs to show how physicians vary in their treatment of patients with minor injuries. The results reveal a considerable degree of variation in practice styles within EDs; physicians at the 75th percentile of the spending distribution spend 20% more than physicians at the 25th percentile. Observable physician characteristics do not explain much of the variation across physicians, but there is a significant degree of sorting between physicians and EDs over time, with high-cost physicians sorting into high-cost EDs as they gain experience. The results may shed light on why some EDs remain persistently higher-cost than others.

  2. Contraceptive use by female physicians in the United States.

    Science.gov (United States)

    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.

  3. In their own words: describing Canadian physician leadership.

    Science.gov (United States)

    Snell, Anita J; Dickson, Graham; Wirtzfeld, Debrah; Van Aerde, John

    2016-07-04

    Purpose This is the first study to compile statistical data to describe the functions and responsibilities of physicians in formal and informal leadership roles in the Canadian health system. This mixed-methods research study offers baseline data relative to this purpose, and also describes physician leaders' views on fundamental aspects of their leadership responsibility. Design/methodology/approach A survey with both quantitative and qualitative fields yielded 689 valid responses from physician leaders. Data from the survey were utilized in the development of a semi-structured interview guide; 15 physician leaders were interviewed. Findings A profile of Canadian physician leadership has been compiled, including demographics; an outline of roles, responsibilities, time commitments and related compensation; and personal factors that support, engage and deter physicians when considering taking on leadership roles. The role of health-care organizations in encouraging and supporting physician leadership is explicated. Practical implications The baseline data on Canadian physician leaders create the opportunity to determine potential steps for improving the state of physician leadership in Canada; and health-care organizations are provided with a wealth of information on how to encourage and support physician leaders. Using the data as a benchmark, comparisons can also be made with physician leadership as practiced in other nations. Originality/value There are no other research studies available that provide the depth and breadth of detail on Canadian physician leadership, and the embedded recommendations to health-care organizations are informed by this in-depth knowledge.

  4. [Availability of physicians in Chile at the year 2004].

    Science.gov (United States)

    Román, Oscar; Acuña, Miguel; Señoret, Miriam

    2006-08-01

    The number of physicians available in a given country, their efficiency, quality and specialization is of utmost epidemiological importance. To evaluate the availability of physicians in Chile. The information about the number of physicians in Chile up to the year 2004, was obtained from the Ministry of Health, national universities and the register of immigrant physicians since 1950. The total number of physicians licensed to practice was 25,542, of whom 2,700 are immigrants. The physician/inhabitant ratio increased from 1/921 in 1998 to 1/612 in 2004. The greater impact in the increment of available physicians was given by the immigration of professionals and by the increase in the number of physicians graduated from national universities, mainly from the new private universities. Forty two percent of physicians work at public services and 61% of these are certified specialists. The regional distribution of general practitioners and basic specialists is adequate. Along the country, the mean physician/beneficiary ratio is 8.45/10,000, the specialist/beneficiary ratio is 4.9/10,000 and the general practitioner/beneficiary ratio is 2.3/10,000. The national information of available physicians, especially in the private sector, should be improved. Immigration of physicians should be regulated, maintaining validation examinations and a National Medical Test to assess medical proficiency should be instituted.

  5. Stereotyping of medical disability claimants' communication behaviour by physicians: towards more focused education for social insurance physicians

    NARCIS (Netherlands)

    van Rijssen, H.J.; Schellart, A.J.M.; Berkhof, M.; Anema, J.R.; van der Beek, A.J.

    2010-01-01

    Background: Physicians who hold medical disability assessment interviews (social insurance physicians) are probably influenced by stereotypes of claimants, especially because they have limited time available and they have to make complicated decisions. Because little is known about the influences of

  6. Thinking Styles and Regret in Physicians.

    Science.gov (United States)

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

    2015-01-01

    Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper. A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection) were administered through a web-based survey to physicians of the University of South Florida. Bonferroni's adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni's correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret. 165 trainees and 56 attending physicians (age range 25 to 69) participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; prational-analytical thinking (r=-0.422; p<0.001), need for cognition (r=-0.340; p<0.001), and objectivism (r=-0.309; p=0.003) and positively correlated with ambiguity intolerance (r=0.285; p=0.012). However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001), while it was negatively associated with satisficing (r=-0.257; p=0.020) and objectivism (r=-0.267; p=0.034). We found no statistically significant relationship between regret and overall accuracy on conditional inferential tasks. Regret in physicians is strongly associated with their tendency to maximize; i.e. the

  7. Thinking Styles and Regret in Physicians.

    Directory of Open Access Journals (Sweden)

    Mia Djulbegovic

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

  8. [Sleep disorders among physicians on shift work].

    Science.gov (United States)

    Schlafer, O; Wenzel, V; Högl, B

    2014-11-01

    Sleep disorders in physicians who perform shift work can result in increased risks of health problems that negatively impact performance and patient safety. Even those who cope well with shift work are likely to suffer from sleep disorders. The aim of this manuscript is to discuss possible causes, contributing factors and consequences of sleep disorders in physicians and to identify measures that can improve adaptation to shift work and treatment strategies for shift work-associated sleep disorders. The risk factors that influence the development of sleep disorders in physicians are numerous and include genetic factors (15 % of the population), age (> 50 years), undiagnosed sleep apnea,, alcohol abuse as well as multiple stress factors inherent in clinical duties (including shift work), research, teaching and family obligations. Several studies have reported an increased risk for medical errors in sleep-deprived physicians. Shift workers have an increased risk for psychiatric and cardiovascular diseases and shift work may also be a contributing factor to cancer. A relationship has been reported not only with sleep deprivation and changes in food intake but also with diabetes mellitus, obesity, hypertension and coronary heart disease. Nicotine and alcohol consumption are more frequent among shift workers. Increased sickness and accident rates among physicians when commuting (especially after night shifts) have a socioeconomic impact. In order to reduce fatigue and to improve performance, short naps during shiftwork or naps plus caffeine, have been proposed as coping strategies; however, napping during adverse circadian phases is less effective, if not impossible when unable to fall asleep. Bright and blue light supports alertness during a night shift. After shiftwork, direct sunlight exposure to the retina can be avoided by using dark sunglasses or glasses with orange lenses for commuting home. The home environment for daytime sleeping after a night shift should be

  9. Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants

    International Nuclear Information System (INIS)

    Kelvin, Joanne Frankel; Moore-Higgs, Giselle J.; Maher, Karen E.; Dubey, Ajay K.; Austin-Seymour, Mary M.; Daly, Nancy Riese; Mendenhall, Nancy Price; Kuehn, Eric F.

    1999-01-01

    Purpose: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role. Methods: Review of the literature and personal perspective. Conclusions: Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy

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

    Science.gov (United States)

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

    2014-01-01

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

  11. Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences.

    Science.gov (United States)

    Carrard, Valérie; Schmid Mast, Marianne; Jaunin-Stalder, Nicole; Junod Perron, Noëlle; Sommer, Johanna

    2018-05-01

    A physician who communicates in a patient-centered way is a physician who adapts his or her communication style to what each patient needs. In order to do so, the physician has to (1) accurately assess each patient's states and traits (interpersonal accuracy) and (2) possess a behavioral repertoire to choose from in order to actually adapt his or her behavior to different patients (behavioral adaptability). Physician behavioral adaptability describes the change in verbal or nonverbal behavior a physician shows when interacting with patients who have different preferences in terms of how the physician should interact with them. We hypothesized that physician behavioral adaptability to their patients' preferences would lead to better patient outcomes and that physician interpersonal accuracy was positively related to behavioral adaptability. To test these hypotheses, we recruited 61 physicians who completed an interpersonal accuracy test before being videotaped during four consultations with different patients. The 244 participating patients indicated their preferences for their physician's interaction style prior to the consultation and filled in a consultation outcomes questionnaire directly after the consultation. We coded the physician's verbal and nonverbal behavior for each of the consultations and compared it to the patients' preferences to obtain a measure of physician behavioral adaptability. Results partially confirmed our hypotheses in that female physicians who adapted their nonverbal (but not their verbal) behavior had patients who reported more positive consultation outcomes. Moreover, the more female physicians were accurate interpersonally, the more they showed verbal and nonverbal behavioral adaptability. For male physicians, more interpersonal accuracy was linked to less nonverbal adaptability.

  12. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study

    NARCIS (Netherlands)

    Lovink, M.H.; Persoon, A.; Vught, A.J. van; Schoonhoven, L.; Koopmans, R.T.C.M.; Laurant, M.G.H.

    2017-01-01

    INTRODUCTION: In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of

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

    Science.gov (United States)

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

    2010-01-01

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

  14. Supply and Distribution of Physicians and Physician Extenders. A Background Paper Prepared for the Graduate Medical Education National Advisory Committee

    Science.gov (United States)

    Health Resources Administration (DHEW/PHS), Bethesda, MD. Div. of Medicine.

    Inequities of access to health care and service provisions are considered to be major problems by health policy-makers today. These inequities result from disparities in physician distribution by specialty and geography that are concealed by aggregate analyses of physician supply. This paper describes what is presently known about physician supply…

  15. ACOG Committee Opinion No. 587: Effective patient-physician communication.

    Science.gov (United States)

    2014-02-01

    Physicians' ability to effectively and compassionately communicate information is key to a successful patient-physician relationship. The current health care environment demands increasing clinical productivity and affords less time with each patient, which can impede effective patient-physician communication. The use of patient-centered interviewing, caring communication skills, and shared decision making improves patient-physician communication. Involving advanced practice nurses or physician assistants may improve the patient's experience and understanding of her visit. Electronic communication with established patients also can enhance the patient experience in select situations.

  16. Smoking habits and attitudes towards smoking among Estonian physicians.

    Science.gov (United States)

    Pärna, K; Rahu, K; Rahu, M

    2005-05-01

    This study examined the smoking habits and attitudes towards smoking among Estonian physicians. Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey. The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models. This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians' attitudes towards smoking. The results provide an important challenge to medical education in Estonia.

  17. A profile of solo/two-physician practices.

    Science.gov (United States)

    Lee, Doohee; Fiack, Kelly James; Knapp, Kenneth Michael

    2014-01-01

    Understanding practice behaviors of solo/dual physician ownership and associated factors at the national level is important information for policymakers and clinicians in response to the Affordable Care Act (ACA) of 2010, but poorly understood in the literature. We analyzed nationally representative data (n = 4,720). The study results reveal nearly 33% of the sample reported solo/two-physician practices. Male/minority/older physicians, psychiatrists, favor small practices. Greater market competition was perceived and less charity care was given among solo/two-physician practitioners. The South region was favored by small physician practitioners. Physicians in solo or two-person practices provided fewer services to chronic patients and were dissatisfied with their overall career in medicine. Small practices were favored by international medical graduates (IMGs) and primary care physicians (PCPs). Overall our data suggest that the role of solo/dual physician practices is fading away in the delivery of medicine. Our findings shed light on varied characteristics and practice behaviors of solo/two-physician practitioners, but more research may be needed to reevaluate the potential role of small physician practitioners and find a way to foster a private physician practice model in the context of the newly passed ACA of 2010.

  18. Assessment of Turkish junior male physicians' exposure to mobbing behavior.

    Science.gov (United States)

    Sahin, Bayram; Cetin, Mehmet; Cimen, Mesut; Yildiran, Nuri

    2012-08-01

    To determine the extent of Turkish junior male physicians' exposure to mobbing behavior and its correlation with physicians' characteristics. The study included physicians recruited for compulsory military service in April 2009. No sampling method was used, questionnaires were delivered to all physicians, and 278 of 292 (95%) questionnaires were returned. We used Leymann Inventory of Psychological Terror including 45 items for data collection and structural equation model for data analysis. A total of 87.7% of physicians experienced mobbing behavior. Physicians who worked more than 40 hours a week, single physicians, physicians working in university hospitals and private hospitals, and physicians who did not have occupational commitment were more exposed to mobbing (PMobbing was not associated with specialty status, service period, age, and personality variables (P>0.05). All goodness-of- fit indices of the model were acceptable (χ(2)=1.449, normed fit index=0.955, Tucker Lewis index=0.980, comparative fit index=0.985, and root mean square error of approximation=0.040). Workplace mobbing is a critical problem for junior male physicians in Turkey. We suggest an introduction of a reporting system and education activities for physicians in high-risk groups.

  19. Physician views on practicing professionalism in the corporate age.

    Science.gov (United States)

    Castellani, B; Wear, D

    2000-07-01

    Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today's corporate health care system. Corporate health care administrators agree: Physicians enter the workforce unskilled in contract negotiation, evidence-based medicine, navigating bureaucratic systems, and so forth. What about practicing physicians? Do they agree as well? According to this study, they do. Feeling like decentered double agents and unprepared, physicians find themselves professionally lost, struggling to balance issues of cost and care and expressing lots of negativity toward the cultures of medicine and managed care. However, physicians are resilient. A group of physicians, who may be called proactive, are meeting the professional demands of corporate health care by becoming sophisticated about its bureaucratic organization and the ways in which their professional and personal commitments fit within the system. Following the lead of proactive physicians, the authors support Relman's thesis and education for both students and physicians requires a major overhaul.

  20. Physician Wellness Is an Ethical and Public Health Issue.

    Science.gov (United States)

    Walker, Rosandra; Pine, Harold

    2018-06-01

    Attention to physician well-being has traditionally focused on substance abuse, usually with disciplinary implications. But, in recent years, greater notice has been granted toward physician burnout and overall wellness. Burnout and its sequelae not only affect physicians and physicians-in-training as individuals, but the impact then multiplies as it affects these physicians' patients, colleagues, and hospital systems. In addition, the American Medical Association Code of Medical Ethics charges physicians with a responsibility to maintain their own health and wellness as well as promote that of their colleagues. Therefore, the question of physician wellness has both public health and ethical implications. The causes of burnout are multifactorial, and the solutions to sustainable change are multitiered.

  1. Prepaid entitlements. A new challenge for physician-patient relationships.

    Science.gov (United States)

    Schroeder, J L; Clarke, J T; Webster, J R

    1985-12-06

    The transition from a fee-for-service model to a prepaid health care system creates new challenges for both physicians and patients. Occasionally both can feel trapped in the new setting and must rely on new or different strategies to reach sometimes divergent objectives. This may alter the physician-patient relationship in ways that neither likes. Based on our experience in a large multispecialty academic group practice, we have developed management strategies to mitigate such stresses on both parties. These include review of marketing efforts; education of new patients to foster realistic expectations; a physician-generated, prospective internal policy for dealing with dissatisfied patients and physicians; a strong central administrative physician to serve as a "lightning rod" and counselor; and continuing physician orientation and education to improve judgment and attitudes. These strategies promote the physician's role as expert consultant-educator with the best interests of the patient as the first priority.

  2. Electronic Health Record Use a Bitter Pill for Many Physicians.

    Science.gov (United States)

    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.

  3. Validation of the Physician-Pharmacist Collaborative Index for physicians in Malaysia.

    Science.gov (United States)

    Sellappans, Renukha; Ng, Chirk Jenn; Lai, Pauline Siew Mei

    2015-12-01

    Establishing a collaborative working relationship between doctors and pharmacists is essential for the effective provision of pharmaceutical care. The Physician-Pharmacist Collaborative Index (PPCI) was developed to assess the professional exchanges between doctors and pharmacists. Two versions of the PPCI was developed: one for physicians and one for pharmacists. However, these instruments have not been validated in Malaysia. To determine the validity and reliability of the PPCI for physicians in Malaysia. An urban tertiary hospital in Malaysia. This prospective study was conducted from June to August 2014. Doctors were grouped as either a "collaborator" or a "non-collaborator". Collaborators were doctors who regularly worked with one particular clinical pharmacist in their ward, while non-collaborators were doctors who interacted with any random pharmacist who answered the general pharmacy telephone line whenever they required assistance on medication-related enquiries, as they did not have a clinical pharmacist in their ward. Collaborators were firstly identified by the clinical pharmacist he/she worked with, then invited to participate in this study through email, as it was difficult to locate and approach them personally. Non-collaborators were sampled conveniently by approaching them in person as these doctors could be easily sampled from any wards without a clinical pharmacist. The PPCI for physicians was administered at baseline and 2 weeks later. Validity (face validity, factor analysis and discriminative validity) and reliability (internal consistency and test-retest) of the PPCI for physicians. A total of 116 doctors (18 collaborators and 98 non-collaborators) were recruited. Confirmatory factor analysis confirmed that the PPCI for physicians was a 3-factor model. The correlation of the mean domain scores ranged from 0.711 to 0.787. "Collaborators" had significantly higher scores compared to "non-collaborators" (81.4 ± 10.1 vs. 69.3 ± 12.1, p Malaysia.

  4. (Re)disclosing physician financial interests: rebuilding trust or making unreasonable burdens on physicians?

    Science.gov (United States)

    Sperling, Daniel

    2017-06-01

    Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in America. These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved.

  5. Possible reasons why female physicians publish fewer scientific articles than male physicians - a cross-sectional study.

    Science.gov (United States)

    Fridner, Ann; Norell, Alexandra; Åkesson, Gertrud; Gustafsson Sendén, Marie; Tevik Løvseth, Lise; Schenck-Gustafsson, Karin

    2015-04-02

    The proportion of women in medicine is approaching that of men, but female physicians are still in the minority as regards positions of power. Female physicians are struggling to reach the highest positions in academic medicine. One reason for the disparities between the genders in academic medicine is the fact that female physicians, in comparison to their male colleagues, have a lower rate of scientific publishing, which is an important factor affecting promotion in academic medicine. Clinical physicians work in a stressful environment, and the extent to which they can control their work conditions varies. The aim of this paper was to examine potential impeding and supportive work factors affecting the frequency with which clinical physicians publish scientific papers on academic medicine. Cross-sectional multivariate analysis was performed among 198 female and 305 male Swedish MD/PhD graduates. The main outcome variable was the number of published scientific articles. Male physicians published significantly more articles than female physicians p articles, as was collaborating with a former PhD advisor for both female physicians (OR = 2.97; 95% CI 1.22-7.20) and male physicians (OR = 2.10; 95% CI 1.08-4.10). Control at work was significantly associated with a higher number of published articles for male physicians only (OR = 1.50; 95% CI 1.08-2.09). Exhaustion had a significant negative impact on number of published articles among female physicians (OR = 0.29; 95% CI 0.12-0.70) whilst the publishing rate among male physicians was not affected by exhaustion. Women physicians represent an expanding sector of the physician work force; it is essential that they are represented in future fields of research, and in academic publications. This is necessary from a gender perspective, and to ensure that physicians are among the research staff in biomedical research in the future.

  6. Emergency Physicians' Knowledge of Cannabinoid Designer Drugs

    Directory of Open Access Journals (Sweden)

    Patrick M Lank

    2013-09-01

    Full Text Available Introduction: The use of synthetic drugs of abuse in the United States has grown in the last few years, with little information available on how much physicians know about these drugs and how they are treating patients using them. The objective of this study was to assess emergency physician (EP knowledge of synthetic cannabinoids (SC.Methods: A self-administered internet-based survey of resident and attending EPs at a large urban emergency department (ED was administered to assess familiarity with the terms Spice or K2 and basic knowledge of SC, and to describe some practice patterns when managing SC intoxication in the ED.Results: Of the 83 physicians invited to participate, 73 (88% completed surveys. The terms “Spice” and “K2” for SC were known to 25/73 (34% and 36/73 (49% of respondents. Knowledge of SC came most commonly (72% from non-medical sources, with lay publications and the internet providing most respondents with information. Among those with previous knowledge of synthetic cannabinoids, 25% were not aware that SC are synthetic drugs, and 17% did not know they are chemically most similar to marijuana. Among all participants, 80% felt unprepared caring for a patient in the ED who had used synthetic cannabinoids.Conclusion: Clinically active EPs are unfamiliar with synthetic cannabinoids. Even those who stated they had heard of synthetic cannabinoids answered poorly on basic knowledge questions. More education is needed among EPs of all ages and levels of training on synthetic cannabinoids. [West J Emerg Med. 2013;14(5:467–470.

  7. Comparison of the quality of patient referrals from physicians, physician assistants, and nurse practitioners.

    Science.gov (United States)

    Lohr, Robert H; West, Colin P; Beliveau, Margaret; Daniels, Paul R; Nyman, Mark A; Mundell, William C; Schwenk, Nina M; Mandrekar, Jayawant N; Naessens, James M; Beckman, Thomas J

    2013-11-01

    To compare the quality of referrals of patients with complex medical problems from nurse practitioners (NPs), physician assistants (PAs), and physicians to general internists. We conducted a retrospective comparison study involving regional referrals to an academic medical center from January 1, 2009, through December 31, 2010. All 160 patients referred by NPs and PAs combined and a random sample of 160 patients referred by physicians were studied. Five experienced physicians blinded to the source of referral used a 7-item instrument to assess the quality of referrals. Internal consistency, interrater reliability, and dimensionality of item scores were determined. Differences between item scores for patients referred by physicians and those for patients referred by NPs and PAs combined were analyzed by using multivariate ordinal logistical regression adjusted for patient age, sex, distance of the referral source from Mayo Clinic, and Charlson Index. Factor analysis revealed a 1-dimensional measure of the quality of patient referrals. Interrater reliability (intraclass correlation coefficient for individual items: range, 0.77-0.93; overall, 0.92) and internal consistency for items combined (Cronbach α=0.75) were excellent. Referrals from physicians were scored higher (percentage of agree/strongly agree responses) than were referrals from NPs and PAs for each of the following items: referral question clearly articulated (86.3% vs 76.0%; P=.0007), clinical information provided (72.6% vs 54.1%; P=.003), documented understanding of the patient's pathophysiology (51.0% vs 30.3%; P<.0001), appropriate evaluation performed locally (60.3% vs 39.0%; P<.0001), appropriate management performed locally (53.5% vs 24.1%; P<.0001), and confidence returning patient to referring health care professional (67.8% vs 41.4%; P<.0001). Referrals from physicians were also less likely to be evaluated as having been unnecessary (30.1% vs 56.2%; P<.0001). The quality of referrals to an

  8. Physician performance feedback in a Canadian academic center.

    Science.gov (United States)

    Garvin, Dennis; Worthington, James; McGuire, Shaun; Burgetz, Stephanie; Forster, Alan J; Patey, Andrea; Gerin-Lajoie, Caroline; Turnbull, Jeffrey; Roth, Virginia

    2017-10-02

    Purpose This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization. Design/methodology/approach A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions. Findings This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met. Originality/value This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement.

  9. Physicians' professional performance: an occupational health psychology perspective.

    Science.gov (United States)

    Scheepers, Renée A

    2017-12-01

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

  10. Physician relationships: make your first impression count.

    Science.gov (United States)

    Crepeau, Jason

    2012-05-01

    Strategies for physician recruitment should include the following: Consider creating an in-house recruiting system to save money and to "own" the health system's first impression. Gain a competitive advantage by nurturing relationships with prospects over the long-term. Use innovative recruitment techniques, such as video interviewing and electronic reference checking, to better coordinate recruitment, follow-up, and mentoring. Make a new hire's job satisfaction and home life a top priority during the first 90 days of employment, and then plan regular follow-ups to maintain a positive relationship.

  11. [Poet-physicians in German literature].

    Science.gov (United States)

    Perels, C

    1991-12-17

    Starting with standards arising from the relationship between medicine and art in classical antiquity, biblical tradition and teutonic-pagan antiquity, this article roams through german literature from the Middle Ages up to the 20th century, from Hildegard of Bingen to Gottfried Benn and Alfred Döblin, guided by the question, how strongly medical knowledge and medical practise are reflected in the poetry of writing physicians. Individual dispositions and epoque-specific features are discussed. Special attention is given to Paul Fleming and Angelus Silesius, Albrecht von Haller and Friedrich Schiller, romanticism and Georg Büchner.

  12. Physician practice management companies: a failed concept.

    Science.gov (United States)

    Kraft, Stephen

    2002-01-01

    Is there a lesson? Famed investor Warren Buffet claims he never buys a company unless he personally understands the business. He admits he has missed a few real opportunities in the high technology sector. However, he is pleased to have avoided many disasters. Many physicians entered into PPMC deals without completely understanding the concept. Perhaps the lesson is to simply avoid a deal that does not make sense. Understand the market. Understand the business. If you, as a buyer, seller or partner cannot clearly understand how a transaction creates value that you can capture, walk away.

  13. Mapping and modeling of physician collaboration network.

    Science.gov (United States)

    Uddin, Shahadat; Hamra, Jafar; Hossain, Liaquat

    2013-09-10

    Effective provisioning of healthcare services during patient hospitalization requires collaboration involving a set of interdependent complex tasks, which needs to be carried out in a synergistic manner. Improved patients' outcome during and after hospitalization has been attributed to how effective different health services provisioning groups carry out their tasks in a coordinated manner. Previous studies have documented the underlying relationships between collaboration among physicians on the effective outcome in delivering health services for improved patient outcomes. However, there are very few systematic empirical studies with a focus on the effect of collaboration networks among healthcare professionals and patients' medical condition. On the basis of the fact that collaboration evolves among physicians when they visit a common hospitalized patient, in this study, we first propose an approach to map collaboration network among physicians from their visiting information to patients. We termed this network as physician collaboration network (PCN). Then, we use exponential random graph (ERG) models to explore the microlevel network structures of PCNs and their impact on hospitalization cost and hospital readmission rate. ERG models are probabilistic models that are presented by locally determined explanatory variables and can effectively identify structural properties of networks such as PCN. It simplifies a complex structure down to a combination of basic parameters such as 2-star, 3-star, and triangle. By applying our proposed mapping approach and ERG modeling technique to the electronic health insurance claims dataset of a very large Australian health insurance organization, we construct and model PCNs. We notice that the 2-star (subset of 3 nodes in which 1 node is connected to each of the other 2 nodes) parameter of ERG has significant impact on hospitalization cost. Further, we identify that triangle (subset of 3 nodes in which each node is connected to

  14. A Greek physician's portrait in Windsor Castle.

    Science.gov (United States)

    Bartsocas, Christos S

    2017-01-01

    To the visitor to Windsor Castle, the Thomas Lawrence portraits in the Waterloo Chamber represent the most important contributors to the military defeat of Napoleon Bonaparte, by British, Prussian, Russian and Austrian forces at the Battle of Waterloo. Nevertheless, only few individuals realise that a Greek physician, Count Ioannis Capodistrias, a native of the island of Corfu, stands among these leading personalities as a diplomat, the Russian Minister of Foreign Affairs, who contributed remarkably to European unity in the early nineteenth century and as a statesman ('Governor' of Greece) with a tragic end to his life, after establishing a Greek State practically from ruins.

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

    Science.gov (United States)

    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.

  16. Gun Violence, mental health, and Connecticut physicians.

    Science.gov (United States)

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

    2014-01-01

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

  17. Violence against women: the physician's role.

    Science.gov (United States)

    Schmuel, E; Schenker, J G

    1998-10-01

    Violence against women is one reflection of the unequal power relationship between men and women in societies. Reflections of this inequality include marriage at a very young age, lack of information or choice about fertility control and forced pregnancy within marriage. The different forms of violence against women are: domestic violence and rape, genital mutilation or, gender-based violence by police and security forces, gender-based violence against women during armed conflict, gender-based violence against women refugees and asylum-seekers, violence associated with prostitution and pornography, violence in the workplace, including sexual harassment. Violence against women is condemned, whether it occurs in a societal setting or a domestic setting. It is not a private or family matter. The FIGO Committee for the Study of Ethical Aspects of Human Reproduction released statements to physicians treating women on this issue. Physicians are ethically obliged to inform themselves about the manifestations of violence and recognize cases, to treat the physical and psychological results of violence, to affirm to their patients that violent acts toward them are not acceptable and to advocate for social infrastructures to provide women the choice of seeking secure refuge and ongoing counselling.

  18. Noncognitive Attributes in Physician Assistant Education.

    Science.gov (United States)

    Brenneman, Anthony E; Goldgar, Constance; Hills, Karen J; Snyder, Jennifer H; VanderMeulen, Stephane P; Lane, Steven

    2018-03-01

    Physician assistant (PA) admissions processes have typically given more weight to cognitive attributes than to noncognitive ones, both because a high level of cognitive ability is needed for a career in medicine and because cognitive factors are easier to measure. However, there is a growing consensus across the health professions that noncognitive attributes such as emotional intelligence, empathy, and professionalism are important for success in clinical practice and optimal care of patients. There is also some evidence that a move toward more holistic admissions practices, including evaluation of noncognitive attributes, can have a positive effect on diversity. The need for these noncognitive attributes in clinicians is being reinforced by changes in the US health care system, including shifting patient demographics and a growing emphasis on team-based care and patient satisfaction, and the need for clinicians to help patients interpret complex medical information. The 2016 Physician Assistant Education Association Stakeholder Summit revealed certain behavioral and affective qualities that employers of PAs value and sometimes find lacking in new graduates. Although there are still gaps in the evidence base, some tools and technologies currently exist to more accurately measure noncognitive variables. We propose some possible strategies and tools that PA programs can use to formalize the way they select for noncognitive attributes. Since PA programs have, on average, only 27 months to educate students, programs may need to focus more resources on selecting for these attributes than teaching them.

  19. HIPPA privacy regulations: practical information for physicians.

    Science.gov (United States)

    McMahon, E B; Lee-Huber, T

    2001-07-01

    After much debate and controversy, the Bush administration announced on April 12, 2001, that it would implement the Health Insurance Portability and Accountability Act (HIPAA) privacy regulations issued by the Clinton administration in December of 2000. The privacy regulations became effective on April 14, 2001. Although the regulations are considered final, the Secretary of the Department of Health and Human Services has the power to modify the regulations at any time during the first year of implementation. These regulations affect how a patient's health information is used and disclosed, as well as how patients are informed of their privacy rights. As "covered entities," physicians have until April 14, 2003, to comply fully with the HIPAA privacy regulations, which are more than 1,500 pages in length. This article presents a basic overview of the new and complex regulations and highlights practical information about physicians' compliance with the regulations. However, this summary of the HIPAA privacy regulations should not be construed as legal advice or an opinion on specific situations. Please consult an attorney concerning your compliance with HIPAA and the regulations promulgated thereunder.

  20. Physicians' Migration: Perceptions of Pakistani Medical Students.

    Science.gov (United States)

    Hossain, Nazli; Shah, Nusrat; Shah, Tahira; Lateef, Sidra Binte

    2016-08-01

    To study the perceptions of medical students about factors responsible for physicians'migration. Cross-sectional survey. Dow Medical College and Civil Hospital, Karachi, from April to May 2015. Aself-administered structured questionnaire was used including demographic details, attitudes about push and pull factors of migration, and reasons for migrating or not migrating abroad. Final year students and interns were included. Likert scale from 1 to 4 (1=strongly disagree to 4=strongly agree) was used to assess attitudes. Data was analyzed by SPSS version 16. Atotal of 240 medical students, mostly females (n=181, 75%) (60% final year and 40% interns), participated in the study. Majority wished to go abroad (n=127; 54%) with United States being the favourite destination (n=80; 66.1%) and internal medicine fields being the preferred choice for specialization (n=126; 54%). The major pull factors were better quality of postgraduate education abroad (n=110; 48.2%) and economic prospects (80; 35.2%); while the push factors were a weak healthcare system (n=219; 94.3%), inadequate salary structure (n=205; 88.3%), insecurity (n=219; 93.9%) and increasing religious intolerance in Pakistan (n=183; 78.5%). This survey highlights the continuing trend of physician migration from Pakistan owing to an interplay of various push and pull factors. Majority of our medical students wish to migrate, mainly due to low salaries, poor job structure, and insecurity. Urgent interventions are required to reverse this trend of medical brain-drain.

  1. Environmental market factors associated with physician career satisfaction.

    Science.gov (United States)

    Mazurenko, Olena; Menachemi, Nir

    2012-01-01

    Previous research has found that physician career satisfaction is declining, but no study has examined the relationship between market factors and physician career satisfaction. Using a theoretical framework, we examined how various aspects of the market environment (e.g., munificence, dynamism, complexity) are related to overall career satisfaction. Nationally representative data from the 2008 Health Tracking Physician Survey were combined with environmental market variables from the 2008 Area Resource File. After controlling for physician and practice characteristics, at least one variable each representing munificence, dynamism, and complexity was associated with satisfaction. An increase in the market number of primary care physicians per capita was positively associated with physician career satisfaction (OR = 2.11, 95% CI: 1.13 to 3.9) whereas an increase in the number of specialists per capita was negatively associated with physician satisfaction (OR = 0.68, 95% CI: 0.48 to 0.97). Moreover, an increase in poverty rates was negatively associated with physician career satisfaction (OR = 0.95, 95% CI: 0.91 to 1.01). Lastly, physicians practicing in states with a malpractice crisis (OR = 0.81, 95% CI: 0.68 to 0.96) and/or those who perceived high competition in their markets (OR = 0.76, 95% CI: 0.61 to 0.95) had lower odds of being satisfied. A better understanding of an organization's environment could assist healthcare managers in shaping their policies and strategies to increase physician satisfaction.

  2. How female and male physicians' communication is perceived differently.

    Science.gov (United States)

    Mast, Marianne Schmid; Kadji, Keou Kambiwa

    2018-06-07

    This paper is based on a 2017 Baltimore International Conference on Communication in Healthcare (ICCH) plenary presentation by the first author and addresses how female and male physicians' communication is perceived and evaluated differently. Female physicians use patient-centered communication which is the interaction style clearly preferred by patients. Logically, patients should be much more satisfied with female than male physicians. However, research shows that this is not the case. This article provides an overview on how female and male physician communication is evaluated and perceived differently by patients and discusses whether and how gender stereotypes can explain these differences in perception and evaluation. Male physicians obtain good patient outcomes when verbally expressing patient-centeredness while female physicians have patients who report better outcomes when they adapt their nonverbal communication to the different needs of their patients. The analysis reveals that existing empirical findings cannot simply be explained by the adherence or not to gender stereotypes. Female physicians do not always get credit for showing gender role congruent behavior. All in all, female and male physicians do not obtain credit for the same behaviors. Physician communication training might put different accents for female and male physicians. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Clinical decision-making: physicians' preferences and experiences

    Directory of Open Access Journals (Sweden)

    White Martha

    2007-03-01

    Full Text Available Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1 physician preferences for different styles of clinical decision-making; 2 styles of clinical decision-making physicians perceive themselves as practicing; and 3 the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate physicians responded to the survey. Of these, 780 (75% preferred to share decision-making with their patients, 142 (14% preferred paternalism, and 118 (11% preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

  4. Conscientious refusals to refer: Findings from a national physician survey

    Science.gov (United States)

    Combs, Michael P.; Antiel, Ryan M.; Tilburt, Jon C.; Mueller, Paul S.; Curlin, Farr A.

    2014-01-01

    Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method We conducted a cross-sectional survey of a random sample of 2000 U.S. physicians from all specialties. Our primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. Fifty-seven percent of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one’s practice (multivariable odds ratios, 1.6 to 2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. PMID:21335574

  5. Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective

    NARCIS (Netherlands)

    Buiting, H. M.; Gevers, J. K. M.; Rietjens, J. A. C.; Onwuteaka-Philipsen, B. D.; van der Maas, P. J.; van der Heide, A.; van Delden, J. J. M.

    2008-01-01

    Introduction: The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient's suffering should be unbearable

  6. Rural Family Physicians Are Twice as Likely to Use Telehealth as Urban Family Physicians.

    Science.gov (United States)

    Jetty, Anuradha; Moore, Miranda A; Coffman, Megan; Petterson, Stephen; Bazemore, Andrew

    2018-04-01

    Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. Nationally representative randomly sampled survey of 5,000 FPs. Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.

  7. Physician recruitment and retention in Manitoba: results from a survey of physicians' preferences for rural jobs.

    Science.gov (United States)

    Witt, Julia

    2017-01-01

    Rural recruitment and retention continues to present challenges to health workforce planners. This paper reports and analyzes the results of a survey sent to physicians in Manitoba, eliciting their opinions regarding rural jobs. A survey was sent to all physicians in Manitoba. Part 1 of the survey included questions about background and demographic information; part 2 was a set of job satisfaction questions regarding respondents' current job; and part 3 included 2 sets of stated-choice questions eliciting preferences for a set of attributes relevant to rural recruitment and retention. Of the 2487 physicians who received surveys, 561 (22.6%) responded. Respondents indicated that income, hours worked and on-call frequency are very important: overall job satisfaction increased with income and decreased with hours worked. Income, hours and on-call frequency were ranked "very important" by the largest proportions of physicians. The estimated compensation for on-call more frequent than 1-in-4 was very high (82% of average income), and additional hours worked were worth $183 per hour. Other attributes that were important included professional interaction, housing availability and community incentives during the first year, which were valued at 11%-31% of annual income. Work-life balance is a key consideration for rural jobs, and there are incentives that can compensate for less desirable attributes.

  8. Physician Religion and End-of-Life Pediatric Care: A Qualitative Examination of Physicians' Perspectives.

    Science.gov (United States)

    Bateman, Lori Brand; Clair, Jeffrey Michael

    2015-01-01

    Physician religion/spirituality has the potential to influence the communication between physicians and parents of children at the end of life. In order to explore this relationship, the authors conducted two rounds of narrative interviews to examine pediatric physicians' perspectives (N=17) of how their religious/spiritual beliefs affect end-of-life communication and care. Grounded theory informed the design and analysis of the study. As a proxy for religiosity/spirituality, physicians were classified into the following groups based on the extent to which religious/spiritual language was infused into their responses: Religiously Rich Responders (RRR), Moderately Religious Responders (MRR), and Low Religious Responders (LRR). Twelve of the 17 participants (71%) were classified into the RRR or MRR groups. The majority of participants suggested that religion/spirituality played a role in their practice of medicine and communication with parents in a myriad of ways and to varying degrees. Participants used their religious/spiritual beliefs to support families' spirituality, uphold hope, participate in prayer, and alleviate their own emotional distress emerging from their patients' deaths.

  9. Japanese practicing physicians' relationships with pharmaceutical representatives: a national survey.

    Directory of Open Access Journals (Sweden)

    Sayaka Saito

    Full Text Available BACKGROUND: Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. METHODS AND FINDINGS: From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%, received drug samples (85% and stationery (96%, and participated in industry-sponsored continuing medical education (CME events at the workplace (80% and outside the workplace (93%. Half accepted meals outside the workplace (49% and financial subsidies to attend CME events (49%. Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to

  10. Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey.

    Science.gov (United States)

    Tak, Hyo Jung; Curlin, Farr A; Yoon, John D

    2017-07-01

    Although intrinsic motivating factors play important roles in physician well-being and productivity, most studies have focused on extrinsic motivating factors such as salary and work environment. To examine the association of intrinsic motivators with physicians' career satisfaction, life satisfaction, and clinical commitment, while accounting for established extrinsic motivators as well. A nationally representative survey of 2000 US physicians, fielded October to December 2011. Outcome variables were five measures of physician well-being: career satisfaction, life satisfaction, high life meaning, commitment to direct patient care, and commitment to clinical practice. Primary explanatory variables were sense of calling, personally rewarding hours per day, meaningful, long-term relationships with patients, and burnout. Multivariate logit models with survey design provided nationally representative individual-level estimates. Among 1289 respondents, 85.8% and 86.5% were satisfied with their career and life, respectively; 88.6% had high life meaning; 54.5% and 79.5% intended to retain time in direct patient care and continue clinical practice, respectively. Sense of calling was strongly positively associated with high life meaning (odds ratio [OR] 5.14, 95% confidence interval [95% CI] 2.87-9.19) and commitment to direct patient care (OR 2.50, 95% CI 1.53-4.07). Personally rewarding hours per day were most strongly associated with career satisfaction (OR 5.28, 95% CI 2.72-10.2), life satisfaction (OR 4.46, 95% CI 2.34-8.48), and commitment to clinical practice (OR 3.46, 95% CI 1.87-6.39). Long-term relationships with patients were positively associated with career and life satisfaction and high life meaning. Burnout was strongly negatively associated with all measures of physician well-being. Intrinsic motivators (e.g., calling) were associated with each measure of physician well-being (satisfaction, meaning, and commitment), but extrinsic motivators (e.g., annual

  11. [Euthanasia and physician-assisted suicide : Attitudes of physicians and nurses].

    Science.gov (United States)

    Zenz, J; Tryba, M; Zenz, M

    2015-04-01

    The current debate about end-of-life decisions in Germany focuses on physician-assisted suicide (PAS). However, there is only limited information available on physicians' attitudes towards euthanasia or PAS, and no data on nurses' attitudes. The aim is to explore attitudes of physicians and nurses with a special interest in palliative care and pain medicine using a case-related questionnaire. An anonymous questionnaire, consisting of eight questions, was distributed to all participants of a palliative care congress and a pain symposium. The questions focused on two scenarios: (1) a patient with an incurable fatal illness, (2) a patient with an incurable but nonfatal illness. The question was: Should euthanasia or physician-assisted suicide (PAS) be allowed. In addition, the participants were asked what they wanted for themselves if they were the patient concerned. A total of 317 questionnaires were analyzed; the return rate was 70 %. The general support for euthanasia and PAS was high: 40.5 % supported euthanasia in case of a fatal illness ("definitely…", "probably should be allowed"), 53.5 % supported PAS. The support decreased in case of a nonfatal illness; however, it increased when the participants were asked about their attitudes if they were the patient concerned. Nurses were more open towards euthanasia and PAS. In physicians the rejection of PAS was directly related to a higher level of qualification in the field of palliative care. The fact that nurses had a more positive attitude towards euthanasia and PAS and that all respondents accepted life-ending acts for themselves more than for their patients hints to still existing severe deficits in Germany.

  12. Burnout, job satisfaction, and medical malpractice among physicians.

    Science.gov (United States)

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

    2013-01-01

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

  13. Euthanasia and physician-assisted suicide in cases of terminal cancer: the opinions of physicians and nurses in Greece.

    Science.gov (United States)

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Vlahos, Lambros

    2008-10-01

    The aim of this study was to investigate the opinions of physicians and nurses on euthanasia and physician-assisted suicide in advanced cancer patients in Greece. Two hundred and fifteen physicians and 250 nurses from various hospitals in Greece completed a questionnaire concerning issues on euthanasia and physician-assisted suicide. More physicians (43.3%) than nurses (3.2%, p < 0.0005) reported that in the case of a cardiac or respiratory arrest, they would not attempt to revive a terminally ill cancer patient. Only 1.9% of physicians and 3.6% of nurses agreed on physician-assisted suicide. Forty-seven per cent of physicians and 45.2% of nurses would prefer the legalization of a terminally ill patient's hastened death; in the case of such a request, 64.2% of physicians and 55.2% of nurses (p = 0.06) would consider it if it was legal. The majority of the participants tended to disagree with euthanasia or physician-assisted suicide in terminally ill cancer patients, probably due to the fact that these acts in Greece are illegal.

  14. Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician-patient encounters.

    Science.gov (United States)

    Roberts, C A; Aruguete, M S

    2000-02-01

    The purpose of the present study is to assess social interaction and reciprocity theories as explanations for patient responses to a physician in a medical consultation. Social interaction theory predicts that patients mostly recognize and react to socioemotional behavior of their physicians due to a lack of understanding of physician task behaviors or a preoccupation with anxiety. Reciprocity theory predicts that patients recognize socioemotional and task behaviors of their physicians, and they respond to these behaviors in thematically similar ways. We examined these hypotheses by having subjects view one of four videotapes which varied in physician task behavior (thorough or minimum levels of explanation of etiology, symptoms, and treatment) and physician socioemotional behavior (high or low levels of concern and affection displayed verbally and non-verbally). Results supported the general proposition of social interaction theory in that high levels of socioemotional behavior of the physician increased measures of patient self-disclosure, trust, satisfaction, and likelihood of recommending the physician. Physician task behavior had no effect on patient response to the physician, a finding inconsistent with reciprocity theory.

  15. Paediatric physician-researchers: coping with tensions in dual accountability.

    Science.gov (United States)

    Boydell, Katherine; Shaul, Randi Zlotnik; D'Agincourt-Canning, Lori; Da Silva, Michael; Simpson, Christy; Czoli, Christine D; Rashkovan, Natalie; Kim, Celine C; Levin, Alex V; Schneider, Rayfel

    2012-01-01

    Potential conflicts between the roles of physicians and researchers have been described at the theoretical level in the bioethics literature (Czoli, et al., 2011). Physicians and researchers are generally in mutually distinct roles, responsible for patients and participants respectively. With increasing emphasis on integration of research into clinical settings, however, the role divide is sometimes unclear. Consequently, physician-researchers must consider and negotiate salient ethical differences between clinical- and research-based obligations (Miller et al, 1998). This paper explores the subjective experiences and perspectives of 30 physician-researchers working in three Canadian paediatric settings. Drawing on qualitative interviews, it identifies ethical challenges and strategies used by physician-researchers in managing dual roles. It considers whether competing obligations could have both positive and adverse consequences for both physician-researchers and patients. Finally, we discuss how empirical work, which explores the perspectives of those engaged in research and clinical practice, can lead the way to understanding and promoting best practice.

  16. Consultation and referral between physicians in new medical practice environments.

    Science.gov (United States)

    Schaffer, W A; Holloman, F C

    1985-10-01

    The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.

  17. Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

    Science.gov (United States)

    Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E

    2017-10-01

    Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.

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

    Science.gov (United States)

    Oostra, Randall D

    2016-01-01

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

  19. The significance of appearance in physician-nurse collaboration

    DEFF Research Database (Denmark)

    Konradsen, H.; Christensen, O.M.; Berthelsen, C.

    2009-01-01

    INTRODUCTION: According to nurses' assessment, physician-nurse collaboration is problematic. The aim of the study was to investigate whether nurses believe physicians' appearances is significant for their ability to collaborate. MATERIAL AND METHODS: This is a single-blinded, quasi-experimental i......-depth interviews to achieve harmonic interaction leading to a prolific and close future collaboration Udgivelsesdato: 2009/12/14......INTRODUCTION: According to nurses' assessment, physician-nurse collaboration is problematic. The aim of the study was to investigate whether nurses believe physicians' appearances is significant for their ability to collaborate. MATERIAL AND METHODS: This is a single-blinded, quasi....... The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration will be used for baseline and follow-up study of the nurses' assessment. RESULTS: Due to ethical considerations, researchers had difficulties finding surgeons prepared to perform procedures aiming at weakening the physicians' physical...

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

    Science.gov (United States)

    Dubinsky, Isser; Feerasta, Nadia; Lash, Rick

    2015-01-01

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

  1. Learning from Physicians with Disabilities and Their Patients.

    Science.gov (United States)

    DeLisa, Joel A; Lindenthal, Jacob Jay

    2016-10-01

    Although progress has been made in diversifying medical school admissions and faculty, this has not extended to physicians with physical disabilities. To improve our understanding of medical students and physicians with physical and sensory disabilities, the authors propose systematically gathering information on the needs and experiences of four groups: physicians who had disabilities before beginning practice, physicians whose disabilities were incurred during their medical careers, physicians drawn from those two groups, and patients of physicians with disabilities. It is hoped these data would be used by counselors, administrators, and admissions committees in advising medical school applicants with disabilities and in revising institutional policies with a view to increasing matriculation and graduation rates of medical students with disabilities. © 2016 American Medical Association. All Rights Reserved.

  2. Physicians' attitudes toward the legalization of marijuana use.

    Science.gov (United States)

    Linn, L S; Yager, J; Leake, B

    1989-06-01

    We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.

  3. Critical factors in recruiting health maintenance organization physicians.

    Science.gov (United States)

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

    1993-01-01

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

  4. Family Physicians Managing Medical Requests From Family and Friends.

    Science.gov (United States)

    Giroldi, Esther; Freeth, Robin; Hanssen, Maurice; Muris, Jean W M; Kay, Margareth; Cals, Jochen W L

    2018-01-01

    Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians' experiences with and attitudes toward managing medical requests from nonpatients. We conducted a qualitative study with 7 focus groups with junior and senior physicians. We performed a thematic analysis during an iterative cycle of data collection and analysis. When confronted with a medical request from a nonpatient, physicians first oriented themselves to the situation: who is this person, what is he or she asking of me, and where are we? Physicians next considered the following interrelated factors: (1) nature/strength of the relationship with the nonpatient, (2) amount of trust in his/her own knowledge and skills, (3) expected consequences of making mistakes, (4) importance of work-life balance, and (5) risk of disturbing the physician-patient process. Senior physicians applied more nuanced considerations when deciding whether to respond, whereas junior physicians experienced more difficulties dealing with these requests, were less inclined to respond, and were more concerned about disturbing the existing relationship that a person had with his/her own physician. This study provides insight into the complexity that physicians face when managing medical questions and requests from nonpatients. Facilitated group discussions during which experiences are shared can help junior physicians become more confident in dealing with these complex issues as they formulate their own personal strategy regarding provision of medical advice or treatment to family and friends. © 2018 Annals of Family Medicine, Inc.

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

    Science.gov (United States)

    Jiang, H Joanna; Begun, James W

    2002-05-01

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

  6. Differences in Physician Income by Gender in a Multiregion Survey.

    Science.gov (United States)

    Apaydin, Eric A; Chen, Peggy G C; Friedberg, Mark W

    2018-05-11

    Previous studies have documented income differences between male and female physicians. However, the implications of these differences are unclear, since previous studies have lacked detailed data on the quantity and composition of work hours. We sought to identify the sources of these income differences using data from a novel survey of physician work and income. To compare differences in income between male and female physicians. We estimated unadjusted income differences between male and female physicians. We then adjusted these differences for total hours worked, composition of work hours, percent of patient care time spent providing procedures, specialty, compensation type, age, years in practice, race, ethnicity, and state and practice random effects. We surveyed 656 physicians in 30 practices in six states and received 439 responses (67% response rate): 263 from males and 176 from females. Self-reported annual income. Male physicians had significantly higher annual incomes than female physicians (mean $297,641 vs. $206,751; difference $90,890, 95% CI $27,769 to $154,011) and worked significantly more total hours (mean 2470 vs. 2074; difference 396, 95% CI 250 to 542) and more patient care hours (mean 2203 vs. 1845; difference 358, 95% CI 212 to 505) per year. Male physicians were less likely than female physicians to specialize in primary care (49.1 vs. 70.5%), but more likely to perform procedures with (33.1 vs. 15.5%) or without general anesthesia (84.3 vs. 73.1%). After adjustment, male physicians' incomes were $27,404 (95% CI $3120 to $51,688) greater than female physicians' incomes. Adjustment for multiple possible confounders, including the number and composition of work hours, can explain approximately 70% of unadjusted income differences between male and female physicians; 30% remains unexplained. Additional study and dedicated efforts might be necessary to identify and address the causes of these unexplained differences.

  7. Physician office readiness for managing Internet security threats.

    Science.gov (United States)

    Keshavjee, K; Pairaudeau, N; Bhanji, A

    2006-01-01

    Internet security threats are evolving toward more targeted and focused attacks.Increasingly, organized crime is involved and they are interested in identity theft. Physicians who use Internet in their practice are at risk for being invaded. We studied 16 physician practices in Southern Ontario for their readiness to manage internet security threats. Overall, physicians have an over-inflated sense of preparedness. Security practices such as maintaining a firewall and conducting regular virus checks were not consistently done.

  8. Parental awareness and use of online physician rating sites.

    Science.gov (United States)

    Hanauer, David A; Zheng, Kai; Singer, Dianne C; Gebremariam, Achamyeleh; Davis, Matthew M

    2014-10-01

    The US public is increasingly using online rating sites to make decisions about a variety of consumer goods and services, including physicians. We sought to understand, within the context of other types of rating sites, parents' awareness, perceptions, and use of physician-rating sites for choosing primary care physicians for their children. This cross-sectional, nationally representative survey of 3563 adults was conducted in September 2012. Participants were asked about rating Web sites in the context of finding a primary care physician for their children and about their previous experiences with such sites. Overall, 2137 (60%) of participants completed the survey. Among these respondents, 1619 were parents who were included in the present analysis. About three-quarters (74%) of parents were aware of physician-rating sites, and about one-quarter (28%) had used them to select a primary care physician for their children. Based on 3 vignettes for which respondents were asked if they would follow a neighbor's recommendation about a primary care physician and using multivariate analyses, respondents exposed to a neighbor's recommendation and positive online physician ratings were significantly more likely to choose the recommended physician (adjusted odds ratio: 3.0 [95% confidence interval: 2.1-4.4]) than respondents exposed to the neighbor's recommendation alone. Conversely, respondents exposed to the neighbor's recommendation and negative online ratings were significantly less likely to choose the neighbor children's physician (adjusted odds ratio: 0.09 [95% confidence interval: 0.03-0.3]). Parents are beginning to use online physician ratings, and these ratings have the potential to influence choices of their children's primary care physician. Copyright © 2014 by the American Academy of Pediatrics.

  9. Physician job satisfaction related to actual and preferred job size.

    Science.gov (United States)

    Schmit Jongbloed, Lodewijk J; Cohen-Schotanus, Janke; Borleffs, Jan C C; Stewart, Roy E; Schönrock-Adema, Johanna

    2017-05-11

    Job satisfaction is essential for physicians' well-being and patient care. The work ethic of long days and hard work that has been advocated for decades is acknowledged as a threat for physicians' job satisfaction, well-being, and patient safety. Our aim was to determine the actual and preferred job size of physicians and to investigate how these and the differences between them influence physicians' job satisfaction. Data were retrieved from a larger, longitudinal study among physicians starting medical training at Groningen University in 1982/83/92/93 (N = 597). Data from 506 participants (85%) were available for this study. We used regression analysis to investigate the influence of job size on physicians' job satisfaction (13 aspects) and ANOVA to examine differences in job satisfaction between physicians wishing to retain, reduce or increase job size. The majority of the respondents (57%) had an actual job size less than 1.0 FTE. More than 80% of all respondents preferred not to work full-time in the future. Respondents' average actual and preferred job sizes were .85 FTE and .81 FTE, respectively. On average, respondents who wished to work less (35% of respondents) preferred a job size reduction of 0.18 FTE and those who wished to work more (12%) preferred an increase in job size of 0.16 FTE. Job size influenced satisfaction with balance work-private hours most (β = -.351). Physicians who preferred larger job sizes were - compared to the other groups of physicians - least satisfied with professional accomplishments. A considerable group of physicians reported a gap between actual and preferred job size. Realizing physicians' preferences as to job size will hardly affect total workforce, but may greatly benefit individual physicians as well as their patients and society. Therefore, it seems time for a shift in work ethic.

  10. Legal examination of physician advertising on the internet.

    Science.gov (United States)

    Carroll, Jenny

    2006-02-01

    The Internet provides an invaluable resource to physicians seeking to market healthcare services to consumers. No longer considered an unethical practice, physician advertising has transformed over the years into an indispensable business tool in the medical community. While the Internet creates opportunities to reach vast numbers of individuals in a timely and cost-effective manner, physicians must be vigilant in adhering to laws, rules, and regulations designed to protect the public from false and deceptive practices.

  11. Why Don’t Physicians Use Their Personal Digital Assistants?

    OpenAIRE

    Lu, Yen-Chiao; Lee, Jin (Janet) Kyung; Xiao, Yan; Sears, Andrew; Jacko, Julie A.; Charters, Kathleen

    2003-01-01

    As the Personal Digital Assistant (PDA) user population continues to expand, there is a need to design more useful devices and applications to facilitate the utilization of PDAs. We conducted a structured interview study to examine PDA usage and non-usage patterns among physicians. The purpose of this descriptive study was to identify the barriers that impede physicians in their PDA use. A data collection tool was developed to record: 1) how physicians use their PDAs, 2) functions and applica...

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

    OpenAIRE

    Dewa, Carolyn S; Loong, Desmond; Bonato, Sarah; Thanh, Nguyen Xuan; Jacobs, Philip

    2014-01-01

    Background Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding it...

  13. Medical anthropology and the physician assistant profession.

    Science.gov (United States)

    Henry, Lisa R

    2015-01-01

    Medical anthropology is a subfield of anthropology that investigates how culture influences people's ideas and behaviors regarding health and illness. Medical anthropology contributes to the understanding of how and why health systems operate the way they do, how different people understand and interact with these systems and cultural practices, and what assets people use and challenges they may encounter when constructing perceptions of their own health conditions. The goal of this article is to highlight the methodological tools and analytical insights that medical anthropology offers to the study of physician assistants (PAs). The article discusses the field of medical anthropology; the advantages of ethnographic and qualitative research; and how medical anthropology can explain how PAs fit into improved health delivery services by exploring three studies of PAs by medical anthropologists.

  14. Do higher salaries lower physician migration?

    Science.gov (United States)

    Okeke, Edward N

    2014-08-01

    It is believed that low wages are an important reason why doctors and nurses in developing countries migrate, and this has led to a call for higher wages for health professionals in developing countries. In this paper, we provide some of the first estimates of the impact of raising health workers' salaries on migration. Using aggregate panel data on the stock of foreign doctors in 16 Organization for Economic Cooperation and Development countries, we explore the effect of a wage increase programme in Ghana on physician migration. We find evidence that 6 years after the implementation of this programme, the foreign stock of Ghanaian doctors abroad had fallen by approximately 10% relative to the estimated counterfactual. This result should be interpreted with caution, however, given the sensitivity of the results to changes in model specification. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  15. Strategic career planning for physician-scientists.

    Science.gov (United States)

    Shimaoka, Motomu

    2015-05-01

    Building a successful professional career in the physician-scientist realm is rewarding but challenging, especially in the dynamic and competitive environment of today's modern society. This educational review aims to provide readers with five important career development lessons drawn from the business and social science literatures. Lessons 1-3 describe career strategy, with a focus on promoting one's strengths while minimizing fixing one's weaknesses (Lesson 1); effective time management in the pursuit of long-term goals (Lesson 2); and the intellectual flexibility to abandon/modify previously made decisions while embracing emerging opportunities (Lesson 3). Lesson 4 explains how to maximize the alternative benefits of English-language fluency (i.e., functions such as signaling and cognition-enhancing capabilities). Finally, Lesson 5 discusses how to enjoy happiness and stay motivated in a harsh, zero-sum game society.

  16. [Georg Friedrich Nicolai: war physician against war].

    Science.gov (United States)

    van Bergen, L

    2017-01-01

    Georg Friedrich Nicolai was a German professor and heart specialist who was one of the few who protested against the war at the beginning of World War I. As a result, he lost his job and was convicted. After the war, right-wing nationalist students and lack of support from his university superiors made it impossible for him to teach. He left Germany in 1922, never to return. In his book, Die Biologie des Krieges (The Biology of War), which was published in neutral Switzerland in 1917, he contradicted the social Darwinist idea - supported by many physicians as well - that war strengthened humanity, people and races, physically and mentally. On the contrary, he argued, war is biologically counterproductive.

  17. Qualitative Research on Emergency Medicine Physicians

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Musaeus, Peter

    2012-01-01

    Aim: This study aims to systematically review the qualitative research studying Emergency Medicine (EM) physicians in Emergency Departments (ED). Background: Qualitative research aims to study complex social phenomena. EM is a highly complex medical and social environment that can be investigated...... with qualitative research. Methods: Electronic databases of English peer-reviewed articles were searched from 1971 to 2012 using Medline through PubMed and PsychINFO. This search was supplemented with hand-searches of Academic Emergency Medicine and Emergency Medicine Journal from 1999 to 2012 and cross references...... and training, communication, professional roles, and organizational factors, and into 12 sub-themes. Conclusion: The strength of qualitative research is its ability to grasp and operationalize complex relations within EM. Although qualitative research methodologies have gained in rigour in recent years and few...

  18. A retraining program for inactive physicians.

    Science.gov (United States)

    Brown, M; Sakai, F J; Selzer, A

    1969-11-01

    During the past two years a pilot project was conducted in which 19 inactive physicians were retrained in preparation for resumption of active practice. The initial program consisted of a flexible training program of six months to one year patterned after conventional internship-residency concepts. During the second year the program was modified by providing an initial condensed indoctrination period of two months' duration especially designed for this purpose, followed by a preceptorship type of training. The project was considered successful in permitting trainees to enter some form of active medical work, or to enroll in formal specialty training. The observations made by the faculty of the program and its accomplishments are discussed in the light of the effort expended and the cost of the project.

  19. [Physician versus 'off-label" ordinance].

    Science.gov (United States)

    Kordus, Katarzyna; Spiewak, Radosław

    2015-01-01

    Polish physicians are obliged by legislation to prescribe drugs authorized for the sale in the Republic of Poland, based on registration documentation, including the Summaries of Product Characteristics (SPC). So called 'off label' treatment occurs in case of the conflict between prescription and information contained in the SPC, which may be considered as a 'medical experiment'. In case of adverse drug reactions, such classification excludes the responsibility of the marketing authorization holders, and damages are not covered by obligatory third party insurance, which can pose financial and legal consequences to the doctor. Deviations from SPC-compliant prescription may include a different way of drug administration, drug administration compliant with the indications yet in patients for whom there is no specified drug dosage, or in case of an indication not contained in the SPC. Medicinal products with equivalent active component, form and dose can have different registration indications in the SPC, and the actively promoted dispensation of less expensive substitutes by the pharmacists may, against doctor's will, result in the use that is non-compliant with registration of the substitute drug. Pharmacotherapy of 'orphan diseases', for which there are no registered medicinal products, also becomes an essential issue as it forces doctors into 'off-label' prescriptions. Moreover, the reimbursement of drugs in most cases is limited to medicinal products that are prescribed according to the registration indications. The pleas by medical professionals to make ordination and reimbursement of drugs depend on active pharmaceutical ingredient and evidence of efficacy, as well as to introduce Evidence Based Medicine (EBM) standards for the treatment of diseases, did not receive proper attention from the governing bodies. Therefore, a fundamental question remains unanswered as to what should be the principal gauge for physicians' therapeutic decision: the ethics, conscience

  20. Factors driving physician-hospital alignment in orthopaedic surgery.

    Science.gov (United States)

    Page, Alexandra E; Butler, Craig A; Bozic, Kevin J

    2013-06-01

    The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.

  1. The Role of Physicians in State-Sponsored Corporal Punishment.

    Science.gov (United States)

    Muaygil, Ruaim

    2016-07-01

    The question of whether there is justification for physicians to participate in state-sanctioned corporal punishment has prompted long and heated debates around the world. Several recent and high-profile sentences requiring physician assistance have brought the conversation to Saudi Arabia. Whether a physician is asked to participate actively or to assess prisoners' ability to withstand this form of punishment, can there be an ethical justification for medical training and skills being put toward these purposes? The aim of this article is to examine aspects of Islamic law along with the different professional and religious obligations of Saudi Arabian physicians, and how these elements may inform the debate.

  2. Intervention improves physician counseling on teen driving safety.

    Science.gov (United States)

    Campbell, Brendan T; Borrup, Kevin; Saleheen, Hassan; Banco, Leonard; Lapidus, Garry

    2009-07-01

    As part of a statewide campaign, we surveyed physician attitudes and practice regarding teen driving safety before and after a brief intervention designed to facilitate in office counseling. A 31-item self-administered survey was mailed to Connecticut physicians, and this was followed by a mailing of teen driving safety materials to physician practices in the state. A postintervention survey was mailed 8 months after the presurvey. A total of 102 physicians completed both the pre and postsurveys. Thirty-nine percent (39%) reported having had a teen in their practice die in a motor vehicle crash in the presurvey, compared with 49% in the postsurvey. Physician counseling increased significantly for a number of issues: driving while impaired from 86% to 94%; restrictions on teen driving from 53% to 64%; teen driving laws from 53% to 63%; safe vehicle from 32% to 42%; parents model safe driving from 29% to 44%; and teen-parent written contract from 15% to 37%. At baseline, the majority of physicians who provide care to teenagers in Connecticut report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduate driver licensing laws or related issues. After a brief intervention, there was a significant increase in physician counseling of teens on teen driving laws and on the use of teen-parent contracts. Additional interventions targeting physician practices can improve physician counseling to teens and their parents on issues of teen driving safety.

  3. Physician Communication to Enhance Patient Acupuncture Engagement in Family Medicine.

    Science.gov (United States)

    Fisher, Carla L; Ledford, Christy J W; Moss, David A; Crawford, Paul

    2018-04-09

    Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.

  4. Physicians, patients, and Facebook: Could you? Would you? Should you?

    Science.gov (United States)

    Peluchette, Joy V; Karl, Katherine A; Coustasse, Alberto

    2016-01-01

    This article investigates the opinions of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. We analyzed 290 comments posted on online discussion boards and found that most (51.7%) were opposed to physicians being Facebook "friends" with patients and many (42%) were opposed to physicians having any kind of Facebook presence. Some believed that health care organizations should have a social media policy and provide social media training. We conclude with suggestions for how health care administrators can provide assistance to physicians and effectively manage their social media presence.

  5. Physicians' opinions on palliative care and euthanasia in the Netherlands.

    Science.gov (United States)

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Heide, Agnes; van der Wal, Gerrit; van der Maas, Paul J

    2006-10-01

    In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. Cross-sectional. Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.

  6. Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

    Science.gov (United States)

    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.

  7. Mobile health apps in Sweden: what do physicians recommend?

    Science.gov (United States)

    Zhang, Yiping; Koch, Sabine

    2015-01-01

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

  8. The risks and rewards of setting physician compensation internally.

    Science.gov (United States)

    Johnson, Jen

    2013-01-01

    To establish physician compensation internally, finance leaders should: Educate decision makers on basic regulatory guidance and valuation theory. Determine fair market value. Consider using a compensation calculator.

  9. Disclosing medical mistakes: a communication management plan for physicians.

    Science.gov (United States)

    Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

    2013-01-01

    There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

  10. "Docs vs. Glocks" and the Regulation of Physicians' Speech.

    Science.gov (United States)

    Appelbaum, Paul S

    2017-07-01

    Physicians increasingly have recognized the importance of asking patients whether they own firearms and suggesting safe means of storage. Florida's legislature perceived these questions as threats to patients' rights to keep guns and passed a law restricting physicians from making such inquiries. When a number of physicians and their organizations challenged the law in 2011, a six-year odyssey through the courts ensued. In the end, the U.S. 11th Circuit Court of Appeals struck down the statute, recognizing that physicians' free speech rights extend to communications with patients, a decision that may influence other attempts to restrict clinicians' speech.

  11. Attitudes of Chinese Oncology Physicians Toward Death with Dignity.

    Science.gov (United States)

    Chen, Hui-Ping; Huang, Bo-Yan; Yi, Ting-Wu; Deng, Yao-Tiao; Liu, Jie; Zhang, Jie; Wang, Yu-Qing; Zhang, Zong-Yan; Jiang, Yu

    2016-08-01

    Death with dignity (DWD) refers to the refusal of life-prolonging measures for terminally ill patients by "living wills" forms in advance. More and more oncology physicians are receiving DWD requests from advance cancer patients in mainland China. The study objective was to investigate the attitudes of Chinese oncology physicians toward the legalization and implementation of DWD. A questionnaire investigating the understanding and attitudes toward DWD was administered to 257 oncology physicians from 11 hospitals in mainland China. The effective response rate was 86.8% (223/257). The majority of oncology physicians (69.1%) had received DWD requests from patients. Half of the participants (52.5%) thought that the most important reason was the patients' unwillingness to maintain survival through machines. One-third of participants (33.0%) attributed the most important reason to suffering from painful symptoms. Most oncology physicians (78.9%) had knowledge about DWD. A fifth of respondents did not know the difference between DWD and euthanasia, and a few even considered DWD as euthanasia. The majority of oncology physicians supported the legalization (88.3%) and implementation (83.9%) of DWD. Many Chinese oncology physicians have received advanced cancer patients' DWD requests and think that DWD should be legalized and implemented. Chinese health management departments should consider the demands of physicians and patients. It is important to inform physicians about the difference between DWD and euthanasia, as one-fifth of them were confused about it.

  12. The ethical ideologies of psychologists and physicians: a preliminary comparison.

    Science.gov (United States)

    Hadjistavropoulos, Thomas; Malloy, David C; Sharpe, Donald; Fuchs-Lacelle, Shannon

    2003-01-01

    The ethical ideologies of psychologists (who provide health services) and physicians were compared using the Ethics Position Questionnaire. The findings reveal that psychologists tend to be less relativistic than physicians. Further, we explored the degree to which physicians and psychologists report being influenced by a variety of factors (e.g., family views) in their ethical decision making. Psychologists were more influenced by their code of ethics and less influenced by family views, religious background, and peer attitudes than were physicians. We argue that these differences reflect the varied professional cultures in which practitioners are trained and socialized.

  13. Physicians' Counseling of Adolescents Regarding E-Cigarette Use.

    Science.gov (United States)

    Pepper, Jessica K; Gilkey, Melissa B; Brewer, Noel T

    2015-12-01

    Electronic cigarette (e-cigarette) use now surpasses the use of conventional cigarettes among U.S. adolescents. Given the important role of physicians in preventing adolescent risk behaviors, we sought to understand how physicians communicate about e-cigarettes when counseling adolescent patients and their parents. We also explored physicians' support for regulations aimed at discouraging adolescents' e-cigarette use. A national U.S. sample of 776 pediatricians and family medicine physicians who provide primary care to adolescent patients completed an online survey in Spring 2014. Many physicians (41%) would, if asked, tell their patients that e-cigarettes are less harmful than cigarettes, and a substantial minority (24%) would recommend e-cigarettes to adolescents for smoking cessation. Most physicians reported routinely screening adolescent patients for cigarette smoking but few routinely screened for e-cigarette use (86% vs. 14%; p buying e-cigarettes. Physicians infrequently screen or counsel their adolescent patients about e-cigarette use, although e-cigarettes often come up during visits. Additional efforts by physicians could help prevent future use by adolescents. Recommending e-cigarettes as a smoking cessation aid to adolescent patients is inadvisable given the lack of evidence for efficacy in that population. As federal regulation of e-cigarettes remains in limbo, pediatricians and family medicine physicians can offer a powerful voice for informing regulations aimed at reducing use by adolescents. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  14. Physicians with MBA degrees: change agents for healthcare improvement.

    Science.gov (United States)

    Lazarus, Arthur

    2010-01-01

    Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.

  15. Scale and structure of capitated physician organizations in California.

    Science.gov (United States)

    Rosenthal, M B; Frank, R G; Buchanan, J L; Epstein, A M

    2001-01-01

    Physician organizations in California broke new ground in the 1980s by accepting capitated contracts and taking on utilization management functions. In this paper we present new data that document the scale, structure, and vertical affiliations of physician organizations that accept capitation in California. We provide information on capitated enrollment, the share of revenue derived by physician organizations from capitation contracts, and the scope of risk sharing with health maintenance organizations (HMOs). Capitation contracts and risk sharing dominate payment arrangements with HMOs. Physician organizations appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures, and consolidating into larger entities.

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

    Science.gov (United States)

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

    2004-02-23

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

  17. Designing a physician leadership development program based on effective models of physician education.

    Science.gov (United States)

    Hopkins, Joseph; Fassiotto, Magali; Ku, Manwai Candy; Mammo, Dagem; Valantine, Hannah

    2017-02-02

    Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management. The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance. The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011). Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members. All participants completed a team project during the program, adding value to the institution. Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system. Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care

  18. The metrics and correlates of physician migration from Africa

    Directory of Open Access Journals (Sweden)

    Arah Onyebuchi A

    2007-05-01

    Full Text Available Abstract Background Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration. Methods Ranking and correlational analyses were conducted on African physician migration data adjusted for bilateral net flows, and supplemented with developmental, economic and health system data. The setting was the 53 African birth countries of African-born physicians working in nine wealthier destination countries. Three metrics of physician migration were used: total number of physician émigrés; emigration fraction defined as the proportion of the potential physician pool working in destination countries; and physician migration density defined as the number of physician émigrés per 1000 population of the African source country. Results Rankings based on any of the migration metrics differed substantially from those based on the other two metrics. Although the emigration fraction and physician migration density metrics gave proportionality to the migration crisis, only the latter was consistently associated with source countries' workforce capacity, health, health spending, economic and development characteristics. As such, higher physician migration density was seen among African countries with relatively higher health workforce capacity (0.401 ≤ r ≤ 0.694, p ≤ 0.011, health status, health spending, and development. Conclusion The perceived magnitude of physician migration is sensitive to the choice of metrics. Complementing the emigration fraction, the physician migration density is a metric

  19. Factors associated with physicians’ perception of physician-patient relationship

    Directory of Open Access Journals (Sweden)

    Johnny Francisco Casanova Saldarriaga

    2017-03-01

    Full Text Available Objective: To determine the factors associated in the perception of physician-patient relationship by physicians who work at the Hospital Nacional Edgardo Rebagliati Martins, 2015. Materials and methods: An observational, prospective, cross-sectional, analytic, non-experimental study. The study population consisted of all the physicians who work at the Head and Neck Surgery Department, which includes the Otolaryngology (15 physicians, Ophthalmology (25 physicians, and Head and Neck (14 physicians Specialty Areas. The research instrument was a self-administered survey based on three topics: 1 Influence of technology and specialization in dehumanizing physician-patient relationship. 2 Influence of judicialization of medicine. 3 Respect and confidence of patients. Eighteen questions based on the three main topics were asked, and physician’s sociodemographic, educational and cultural data were collected. The instrument was validated by a team of experts, at a confidence level of 0.92 (Cronbach’s Alpha score. Besides the survey, physicians underwent a personal interview, in order to find out their personal opinion about their physician-patient relationship. Data were analyzed using IBM SPSS Statistics statistical software. Statistical analysis was conducted using chi-square test, with a significance level of 5%. Results: The research assessed 30 specialty physicians with a mean age of 53.57 years: 83.3% of the interviewed physicians were male, 43% majored in ophthalmology, 36.7% were born in Lima, 43.3% finished high school at a public school, 66.7% studied medicine at a public university, 93.3% pursued major studies at a public university, 46.7% stated that their mother was born in the Peruvian highlands, 63.3% stated that their father was born in the Peruvian highlands, 87% were Catholics, 83% said that they chose to study medicine by vocation, 90% practiced medicine in the private sector, 43% volunteered in social support programs for low

  20. Physician Communication Techniques and Weight Loss in Adults

    Science.gov (United States)

    Pollak, Kathryn I.; Alexander, Stewart C.; Coffman, Cynthia J.; Tulsky, James A.; Lyna, Pauline; Dolor, Rowena J.; James, Iguehi E.; Namenek Brouwer, Rebecca J.; Manusov, Justin R.E.; Østbye, Truls

    2010-01-01

    Background Physicians are encouraged to counsel overweight and obese patients to lose weight. Purpose It was examined whether discussing weight and use of motivational-interviewing techniques (e.g., collaborating, reflective listening) while discussing weight predicted weight loss 3 months after the encounter. Methods 40 primary care physicians and 461 of their overweight or obese patient visits were audio recorded between December 2006 and June 2008. Patient actual weight at the encounter and 3 months after the encounter (n=426), whether weight was discussed, physicians’ use of Motivational-Interviewing techniques, and patient, physician and visit covariates (e.g., race, age, specialty) were assessed. This was an observational study and data were analyzed in April 2009. Results No differences in weight loss were found between patients whose physicians discussed weight or did not. Patients whose physicians used motivational interviewing–consistent techniques during weight-related discussions lost weight 3 months post-encounter; those whose physician used motivational interviewing–inconsistent techniques gained or maintained weight. The estimated difference in weight change between patients whose physician had a higher global “motivational interviewing–Spirit” score (e.g., collaborated with patient) and those whose physician had a lower score was 1.6 kg (95% CI=−2.9, −0.3, p=.02). The same was true for patients whose physician used reflective statements 0.9 kg (95% CI=−1.8, −0.1, p=.03). Similarly, patients whose physicians expressed only motivational interviewing–consistent behaviors had a difference in weight change of 1.1 kg (95% CI=−2.3, 0.1, p=.07) compared to those whose physician expressed only motivational interviewing–inconsistent behaviors (e.g., judging, confronting). Conclusions In this small observational study, use of motivational-interviewing techniques during weight loss discussions predicted patient weight loss. PMID

  1. Measurement and correlates of empathy among female Japanese physicians

    Directory of Open Access Journals (Sweden)

    Kataoka Hitomi U

    2012-06-01

    Full Text Available Abstract Background The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care. Methods The Jefferson Scale of Empathy (JSE was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians. Results The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach’s coefficient alpha was .81. Female physicians who were practicing in “people-oriented” specialties obtained a significantly higher mean empathy score than their counterparts in “procedure-” or “technology-oriented” specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family. Conclusions Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians’ empathy may help physicians to avoid career burnout.

  2. Norwegian physicians' knowledge of the prices of pharmaceuticals: a survey.

    Science.gov (United States)

    Eriksen, Ida Iren; Melberg, Hans Olav; Bringedal, Berit

    2013-01-01

    The objectives of this study are to measure physicians' knowledge of the prices of pharmaceuticals, and investigate whether there are differences in knowledge of prices between groups of physicians. This article reports on a survey study of physicians' knowledge of the prices of pharmaceuticals conducted on a representative sample of Norwegian physicians in the autumn of 2010. The importance of physicians' knowledge of costs derives from their influence on total spending and allocation of limited health-care resources. Physicians are important drivers in the effort to contain costs in health care, but only if they have the knowledge needed to choose the most cost-effective treatment options. A survey was sent to 1543 Norwegian physicians, asking them for price estimates and their opinions on the importance of considering the cost of treatment to society as a decision factor when treating their patients. This article deals with a subsection in which the physicians were asked to estimate the price of five pharmaceuticals: simvastatin, alendronate (Fosamax), infliximab (Remicade), natalizumab (Tysabri) and escitalopram (Cipralex). The response rate was 65%. For all the five pharmaceuticals, more than 50% and as many as 83% gave responses that differed more than 50% from the actual drug price. The price of more expensive pharmaceuticals was underestimated, while the opposite was the case for less expensive medicines. The data show that physicians in general have poor knowledge of the prices of the pharmaceuticals they offer their patients. However, the physicians who frequently deal with a drug have better knowledge of its price than those who do not handle a medication as often. The data also suggest that those physicians who agree that cost of care to society is an important decision factor have better knowledge of drug prices.

  3. Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives.

    Science.gov (United States)

    Snijdewind, Marianne C; van Tol, Donald G; Onwuteaka-Philipsen, Bregje D; Willems, Dick L

    2014-12-01

    The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known. To identify and categorize the characteristics of EAS requests that are more complex than others. We held in-depth interviews with 28 Dutch physicians about their perception of complex cases of EAS requests. We also interviewed 26 relatives of patients who had died by EAS. We used open coding and inductive analysis to identify various different aspects of the complexities described by the participants. Complexities can be categorized into relational difficulties-such as miscommunication, invisible suffering, and the absence of a process of growth toward EAS-and complexities that arise from unexpected situations, such as the capricious progress of a disease or the obligation to move the patient. The interviews showed that relatives of the patient influence the process toward EAS. First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Generation to generation: discrimination and harassment experiences of physician mothers and their physician daughters.

    Science.gov (United States)

    Shrier, Diane K; Zucker, Alyssa N; Mercurio, Andrea E; Landry, Laura J; Rich, Michael; Shrier, Lydia A

    2007-01-01

    To examine bias and sexual harassment experiences of physician mothers and their physician daughters; correlations of these experiences with career satisfaction, stress at work, stress at home, and percentage of women in specialty; and influences of the mother on her daughter's experiences. A convenience sample of 214 families with mother and daughter physicians was sent a 56-item survey that included questions on bias and sexual harassment experiences. Statistical comparisons were made within 136 dyads where both mother and daughter returned the questionnaire. Eighty-four percent of mothers and 87% of daughters responded. Mothers and daughters reported similarly high rates and severity of sexual harassment before medical school, while in residency/fellowship, while in practice/work setting, and by teachers and supervisors. Daughters reported higher rates of harassment during medical school and by patients, mothers by colleagues. Gender and racial/ethnic discrimination was lower for daughters compared with their mothers, but gender discrimination was still substantial. Compared with other daughters, daughters who experienced discrimination or sexual harassment reported lower career satisfaction and more stress at work and at home and worked in specialties with fewer women. Gender discrimination and sexual harassment remain entrenched in medical education and professional workplaces. Maternal role models and mentors were not as protective as anticipated. Leadership of medical institutions and professional associations must deal more effectively with persistent discrimination and harassment or risk the loss of future leaders.

  5. Physician Assistant | Center for Cancer Research

    Science.gov (United States)

    The Surgical Oncology section of the Thoracic & Gastrointestinal Oncology Branch is recruiting a Physician Assistant (PA) to support general surgery clinical activities of the Branch. Responsibilities: Complete in-depth documentation through written progress notes, dictation summaries, and communication with referring physicians according to medical record documentation requirements. Participate in clinical rounds and conferences. Administer and adjust trial medication under the guidance of a physician. Explain discharge instructions and medication regimens to patients and follow up with consulting service recommendations.  Order, perform and interpret basic laboratory diagnostic/treatment tests and procedures. Perform comprehensive health care assessments by obtaining health and family medical histories. Complete physical examinations. Perform clinical data recording and medical chart entries. Obtain informed consent. Perform minor surgeries (incisional and excisional biopsies). Maintain and complete medical records. Place orders for medications and tests. Perform retrievals from electronic medical information system. Distinguish between normal and abnormal findings and determine which findings need further evaluation and/or collaboration assessment. Develop and implement a plan for care, including appropriate patient/family counseling and education based on in-depth knowledge of the specific patient populations and/or protocols. Evaluate, modify and revise care plan at appropriate intervals. Assess acute and non-acute clinical problems and toxicities. Assess needs and/or problem areas and plan appropriate therapeutic measures. Assist in developing, implementing and evaluating medical services policies and practices. Ensure compliance with applicable licensure/certification requirements, healthcare standards, governmental laws and regulations, and policies, procedures, and philosophy in nature. Attend scheduled patient care rounds and didactic lecture sessions of

  6. Use of information sources by family physicians: a literature survey

    NARCIS (Netherlands)

    Verhoeven, A.A.H.; Boerma, E.J.; Meyboom-de Jong, B

    Analysis of the use of information sources by family physicians is important for both practical and theoretical reasons. First, analysis of the ways in which family physicians handle information may point to opportunities for improvement. Second, such efforts may lead to improvements in the

  7. To Assess Sleep Quality among Pakistani Junior Physicians (House ...

    African Journals Online (AJOL)

    Background: Sleep deprivation among junior physicians (house officers) is of growing concern. In developed countries, duty hours are now mandated, but in developing countries, junior physicians are highly susceptible to develop sleep impairment due to long working hours, on‑call duties and shift work schedule. Aim: We ...

  8. Physicians' and Pharmacists' Experience and Expectations of the ...

    African Journals Online (AJOL)

    Purpose: To investigate physicians' and pharmacists' experience and expectations of the roles of pharmacists in hospital setting in Macau for the development of physician-pharmacist collaborative working relationship (CWR). Methods: A survey was conducted to address the research questions. The study population ...

  9. Knowledge, attitude and practice of physicians and nurses toward ...

    African Journals Online (AJOL)

    Physicians tended to have higher knowledge score for steps of use, defining normal values, and concepts of ... Conclusion: Due to different patterns of knowledge and practice of nurses and physicians, training programs should be specifically tailored for each group to bridge the gap of knowledge and improve deficient ...

  10. Physician-patient discussions of controversial cancer screening tests.

    Science.gov (United States)

    Dunn, A S; Shridharani, K V; Lou, W; Bernstein, J; Horowitz, C R

    2001-02-01

    Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA screening is advantageous; house staff and attending physicians' intention to order a PSA test, and attending physicians' intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians' beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.

  11. Managing the negatives of experience in physician teams.

    Science.gov (United States)

    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.

  12. Patterns of Physician-Patient Communication Associated with Patient Satisfaction.

    Science.gov (United States)

    Williams, M. Lee; Clampitt, Phillip G.

    Using data drawn from ten initial physician/patient interviews, an original category system was employed to analyze patterns of physician/patient communication. Static analysis, interaction analysis, and Markov chain analysis were used to discover the underlying communication patterns associated with patient satisfaction. Results revealed that…

  13. Burnout among physicians | Romani | Libyan Journal of Medicine

    African Journals Online (AJOL)

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it ...

  14. Smoking habits of physicians in Enugu, Nigeria | Okeke | Journal of ...

    African Journals Online (AJOL)

    Background: Physicians are highly respected in their communities. They play a crucial role in issues related to health and people turn to them for advice and consultation. This study was therefore conducted to determine the prevalence of smoking among physicians in Enugu, Nigeria, a group of health professionals who ...

  15. Physician-assisted death in psychiatric practice in the Netherlands

    NARCIS (Netherlands)

    Groenewoud, JH; van der Maas, PJ; vanderWal, G; Hengeveld, MW; Tholen, AJ; Schudel, WJ; vanderHeide, A

    1997-01-01

    Background In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assist ed suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in psychiatric practice in the Netherlands.

  16. The Prevalence and Special Educational Requirements of Dyscompetent Physicians

    Science.gov (United States)

    Williams, Betsy W.

    2006-01-01

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

  17. Communication with the seriously ill: physicians' attitudes in Saudi Arabia.

    Science.gov (United States)

    Mobeireek, A F; al-Kassimi, F A; al-Majid, S A; al-Shimemry, A

    1996-10-01

    To study some ethical problems created by accession of a previously nomadic and traditional society to modern invasive medicine, by assessment of physicians' attitudes towards sharing information and decision-making with patients in the setting of a serious illness. Self-completion questionnaire administered in 1993. Riyadh, Jeddah, and Buraidah, three of the largest cities in Saudi Arabia. Senior and junior physicians from departments of internal medicine and critical care in six hospitals in the above cities. A total of 249 physicians participated in the study. Less than half (47%) indicated they provided information on diagnosis and prognosis of serious illnesses all the time. Physicians who were more senior and those who spoke Arabic fared better than other groups. The majority (75%) preferred to discuss information with close relatives rather than patients, even when the patients were mentally competent. Most of the physicians (72%) felt patients had the right to refuse a specific treatment modality, and 68% denied patients the right to demand such a treatment if considered futile. Further analysis showed that physicians' attitudes varied along a spectrum from passive (25%) to paternalistic (21%) with the largest group (47%) in a balanced position. In traditional societies where physicians are regarded as figures of authority and family ties are important, there is a considerable shift of access to information and decision-making from patients to their physicians and relatives in a manner that threatens patients' autonomy. Ethical principles, wider availability of invasive medical technology and a rise in public awareness dictate an attitude change.

  18. Physician job satisfaction related to actual and preferred job size

    NARCIS (Netherlands)

    Schmit Jongbloed, Lodewijk J.; Cohen-Schotanus, Janke; Borleffs, Jan C. C.; Stewart, Roy E.; Schonrock-Adema, Johanna

    2017-01-01

    Background: Job satisfaction is essential for physicians' well-being and patient care. The work ethic of long days and hard work that has been advocated for decades is acknowledged as a threat for physicians' job satisfaction, well-being, and patient safety. Our aim was to determine the actual and

  19. 46 CFR 5.67 - Physician-patient privilege.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Physician-patient privilege. 5.67 Section 5.67 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE INVESTIGATION REGULATIONS-PERSONNEL ACTION Statement of Policy and Interpretation § 5.67 Physician-patient privilege. For...

  20. Attitudes toward Suicide: Italian and United States Physicians.

    Science.gov (United States)

    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…

  1. A survey of disposition of physicians towards physical activity ...

    African Journals Online (AJOL)

    This study aimed to determine the knowledge of physical activity message, confidence, role perceptions, barriers and feasibility of physical activity promotion among physicians in two tertiary health institutions in North-Eastern Nigeria. Methods: A total of 153 (84.5% response) physicians at the University of Maiduguri ...

  2. Malawian impressions of expatriate physicians: A qualitative study ...

    African Journals Online (AJOL)

    Background: In many low-income countries, including Malawi, expatriate physicians serve diverse roles in clinical care, education, mentorship, and research. A significant proportion of physicians from high-income countries have global health experience. Despite the well-known benefits of global health experiences for ...

  3. Determinants of workplace violence against clinical physicians in hospitals.

    Science.gov (United States)

    Wu, Jeng-Cheng; Tung, Tao-Hsin; Chen, Peter Y; Chen, Ying-Lin; Lin, Yu-Wen; Chen, Fu-Li

    2015-01-01

    Workplace violence in the health sector is a worldwide concern. Physicians play an essential role in health-care teamwork; thus, understanding how organizational factors influence workplace violence against physicians is critical. A total of 189 physicians from three public hospitals and one private hospital in Northern Taiwan completed a survey, and the response rate was 47.1%. This study was approved by the institutional review board of each participating hospital. The 189 physicians were selected from the Taipei area, Taiwan. The results showed that 41.5% of the respondents had received at least one workplace-related physical or verbal violent threat, and that 9.8% of the respondents had experienced at least one episode of sexual harassment in the 3 months before the survey. Logistic regression analysis revealed that physicians in psychiatry or emergency medicine departments received more violent threats and sexual harassment than physicians in other departments. Furthermore, physicians with a lower workplace safety climate (OR=0.89; 95% CI=0.81-0.98) and more job demands (OR=1.15; 95% CI=1.02-1.30) were more likely to receive violent threats. This study found that workplace violence was associated with job demands and the workplace safety climate. Therefore, determining how to develop a workplace safety climate and ensure a safe job environment for physicians is a crucial management policy issue for health-care systems.

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

    Science.gov (United States)

    Zárate, Arturo

    2013-01-01

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

  5. Physician groups' use of data from patient experience surveys.

    NARCIS (Netherlands)

    Friedberg, M.W.; SteelFisher, G.K.; Karp, M.; Schneider, E.C.

    2011-01-01

    BACKGROUND: In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. OBJECTIVE: To

  6. Developing physician-leaders: a call to action.

    Science.gov (United States)

    Stoller, James K

    2009-07-01

    The many challenges in health care today create a special need for great leadership. However, traditional criteria for physicians' advancement to leadership positions often regard academic and/or clinical accomplishments rather than the distinctive competencies needed to lead. Furthermore, physicians' training can handicap their developing leadership skills. In this context, an emerging trend is for health-care institutions to offer physician-leadership programs. This paper reviews the rationale for developing physician-leaders. Factors that underscore this need include: (1) physicians may lack inclinations to collaborate and to follow, (2) health-care organizations pose challenging environments in which to lead (e.g., because of silo-based structures, etc.), (3) traditional criteria for advancement in medicine regard clinical and/or academic skills rather than leadership competencies, and (4) little attention is currently given to training physicians regarding leadership competencies. Definition of these competencies of ideal physician-leaders will inform the curricula and format of emerging physician leadership development programs.

  7. [Advanced online search techniques and dedicated search engines for physicians].

    Science.gov (United States)

    Nahum, Yoav

    2008-02-01

    In recent years search engines have become an essential tool in the work of physicians. This article will review advanced search techniques from the world of information specialists, as well as some advanced search engine operators that may help physicians improve their online search capabilities, and maximize the yield of their searches. This article also reviews popular dedicated scientific and biomedical literature search engines.

  8. Feedback data sources that inform physician self-assessment.

    Science.gov (United States)

    Lockyer, Jocelyn; Armson, Heather; Chesluk, Benjamin; Dornan, Timothy; Holmboe, Eric; Loney, Elaine; Mann, Karen; Sargeant, Joan

    2011-01-01

    Self-assessment is a process of interpreting data about one's performance and comparing it to explicit or implicit standards. To examine the external data sources physicians used to monitor themselves. Focus groups were conducted with physicians who participated in three practice improvement activities: a multisource feedback program; a program providing patient and chart audit data; and practice-based learning groups. We used grounded theory strategies to understand the external sources that stimulated self-assessment and how they worked. Data from seven focus groups (49 physicians) were analyzed. Physicians used information from structured programs, other educational activities, professional colleagues, and patients. Data were of varying quality, often from non-formal sources with implicit (not explicit) standards. Mandatory programs elicited variable responses, whereas data and activities the physicians selected themselves were more likely to be accepted. Physicians used the information to create a reference point against which they could weigh their performance using it variably depending on their personal interpretation of its accuracy, application, and utility. Physicians use and interpret data and standards of varying quality to inform self-assessment. Physicians may benefit from regular and routine feedback and guidance on how to seek out data for self-assessment.

  9. Stroke, tPA, and Physician Decision-Making

    Science.gov (United States)

    ... MD Steven Karceski, MD Stroke, tPA, and physician decision-making Dominic Hovsepian, BS Steven Karceski, MD WHAT DID ... has not been carefully studied is the physician ’ s decision-making process. It was because of this that Dr. ...

  10. Complementary Alternative Medicine for Children with Autism: A Physician Survey

    Science.gov (United States)

    Golnik, Allison E.; Ireland, Marjorie

    2009-01-01

    Previous studies suggest over half of children with autism are using complementary alternative medicine (CAM). In this study, physicians responded (n = 539, 19% response rate) to a survey regarding CAM use in children with autism. Physicians encouraged multi-vitamins (49%), essential fatty acids (25%), melatonin (25%) and probiotics (19%) and…

  11. Perceptions of physician leadership in Botswana | Sokol-Hessner ...

    African Journals Online (AJOL)

    Background. Physician leadership is essential for the strengthening of health systems, especially in underserved settings such as sub-Saharan Africa. To be effective, leaders must be perceived as such by their community. It is unknown how perceptions of physician leadership in Botswana compare with those of the ...

  12. A diagnosis of discrimination. Women physicians and the glass ceiling.

    Science.gov (United States)

    Sebastian, C

    1994-01-01

    Author Christy Sebastian writes about some of the limits facing women physicians, from the glass ceiling on down. She relates the limits faced by women physicians to the gender differences--both subtle and blatant--evident in society as a whole.

  13. Influences on physicians' adoption of electronic detailing (e-detailing).

    Science.gov (United States)

    Alkhateeb, Fadi M; Doucette, William R

    2009-01-01

    E-detailing means using digital technology: internet, video conferencing and interactive voice response. There are two types of e-detailing: interactive (virtual) and video. Currently, little is known about what factors influence physicians' adoption of e-detailing. The objectives of this study were to test a model of physicians' adoption of e-detailing and to describe physicians using e-detailing. A mail survey was sent to a random sample of 2000 physicians practicing in Iowa. Binomial logistic regression was used to test the model of influences on physician adoption of e-detailing. On the basis of Rogers' model of adoption, the independent variables included relative advantage, compatibility, complexity, peer influence, attitudes, years in practice, presence of restrictive access to traditional detailing, type of specialty, academic affiliation, type of practice setting and control variables. A total of 671 responses were received giving a response rate of 34.7%. A total of 141 physicians (21.0%) reported using of e-detailing. The overall adoption model for using either type of e-detailing was found to be significant. Relative advantage, peer influence, attitudes, type of specialty, presence of restrictive access and years of practice had significant influences on physician adoption of e-detailing. The model of adoption of innovation is useful to explain physicians' adoption of e-detailing.

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

    NARCIS (Netherlands)

    Keijser, Wouter Alexander; Smits, Jacco Gerardus Wilhelmus Leonardus; Penterman, Lisanne; Wilderom, Celeste P.M.

    2016-01-01

    Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective “physician e-leadership” (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and

  15. Physicians' professional performance: An occupational health psychology perspective

    NARCIS (Netherlands)

    Scheepers, R.A.

    2016-01-01

    In modern medical practice, multiple demands and high workloads challenge physician well-being. Physician well-being is considered a precondition for optimal health care. Physicians’ work-related well-being can be indicated by their work engagement, which is considered the opposite of burnout. We

  16. The effect of explicit financial incentives on physician behavior.

    Science.gov (United States)

    Armour, B S; Pitts, M M; Maclean, R; Cangialose, C; Kishel, M; Imai, H; Etchason, J

    2001-05-28

    Managed care organizations use explicit financial incentives to influence physicians' use of resources. This has contributed to concerns regarding conflicts of interest for physicians and adverse effects on the quality of patient care. In light of recent publicized legislative and legal battles about this issue, we reviewed the literature and analyzed studies that examine the effect of these explicit financial incentives on the behavior of physicians. The method used to undertake the literature review followed the approach set forth in the Cochrane Collaboration handbook. Our literature review revealed a paucity of data on the effect of explicit financial incentives. Based on this limited evidence, explicit incentives that place individual physicians at financial risk appear to be effective in reducing physician resource use. However, the empirical evidence regarding the effectiveness of bonus payments on physician resource use is mixed. Similarly, our review revealed mixed effects of the influence of explicit financial incentives on the quality of patient care. The effect of explicit financial incentives on physician behavior is complicated by a lack of understanding of the incentive structure by the managed care organization and the physician. The lack of a universally acceptable definition of quality renders it important that future researchers identify the term explicitly.

  17. Cancer Risk Assessment by Rural and Appalachian Family Medicine Physicians

    Science.gov (United States)

    Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael

    2009-01-01

    Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…

  18. Factors affecting cardiac rehabilitation referral by physician specialty.

    Science.gov (United States)

    Grace, Sherry L; Grewal, Keerat; Stewart, Donna E

    2008-01-01

    Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists. A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral. Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.

  19. The practice and earnings of preventive medicine physicians.

    Science.gov (United States)

    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.

  20. Poor physician performance in the Netherlands: characteristics, causes, and prevalence.

    NARCIS (Netherlands)

    Goor, M.M.P.G. van den; Wagner, C.; Lombarts, K.M.J.M.H.

    2015-01-01

    Introduction: Poor physician performance has a profound impact on patient safety and society's trust in the health care system. The attention that this topic has received in the media suggests that it is a large-scale issue. However, research about physician performance is still scant; there is

  1. Estate and business planning for the retiring physician.

    Science.gov (United States)

    Kingma, Kenneth W; Vaughn, Thomas D

    2012-01-01

    Retiring physicians have much to think about for estate planning purposes. The authors stand ready to help physicians sell or close their medical practice, navigate the 2010 Tax Act, take advantage of current planning opportunities, and prepare appropriate estate planning documents. Every estate is unique, so it is important to contact an estate planning advisor before taking any action.

  2. ACA Marketplace premiums and competition among hospitals and physician practices.

    Science.gov (United States)

    Polyakova, Maria; Bundorf, M Kate; Kessler, Daniel P; Baker, Laurence C

    2018-02-01

    To examine the association between annual premiums for health plans available in Federally Facilitated Marketplaces (FFMs) and the extent of competition and integration among physicians and hospitals, as well as the number of insurers. We used observational data from the Center for Consumer Information and Insurance Oversight on the annual premiums and other characteristics of plans, matched to measures of physician, hospital, and insurer market competitiveness and other characteristics of 411 rating areas in the 37 FFMs. We estimated multivariate models of the relationship between annual premiums and Herfindahl-Hirschman indices of hospitals and physician practices, controlling for the number of insurers, the extent of physician-hospital integration, and other plan and rating area characteristics. Premiums for Marketplace plans were higher in rating areas in which physician, hospital, and insurance markets were less competitive. An increase from the 10th to the 90th percentile of physician concentration and hospital concentration was associated with increases of $393 and $189, respectively, in annual premiums for the Silver plan with the second lowest cost. A similar increase in the number of insurers was associated with a $421 decrease in premiums. Physician-hospital integration was not significantly associated with premiums. Premiums for FFM plans were higher in markets with greater concentrations of hospitals and physicians but fewer insurers. Higher premiums make health insurance less affordable for people purchasing unsubsidized coverage and raise the cost of Marketplace premium tax credits to the government.

  3. Association Between Apple Consumption and Physician Visits

    Science.gov (United States)

    Davis, Matthew A.; Bynum, Julie P.W.; Sirovich, Brenda E.

    2015-01-01

    IMPORTANCE Fruit consumption is believed to have beneficial health effects, and some claim, “An apple a day keeps the doctor away.” OBJECTIVE To examine the relationship between eating an apple a day and keeping the doctor away. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of a nationally representative sample of the noninstitutionalized US adult population. A total of 8728 adults 18 years and older from the 2007–2008 and 2009–2010 National Health and Nutrition Examination Survey completed a 24-hour dietary recall questionnaire and reported that the quantity of food they ate was reflective of their usual daily diet. EXPOSURES Daily apple eaters (consuming the equivalent of at least 1 small apple daily, or 149 g of raw apple) vs non–apple eaters, based on the reported quantity of whole apple consumed during the 24-hour dietary recall period. MAIN OUTCOMES AND MEASURES The primary outcome measure was success at “keeping the doctor away,” measured as no more than 1 visit (self-reported) to a physician during the past year; secondary outcomes included successful avoidance of other health care services (ie, no overnight hospital stays, visits to a mental health professional, or prescription medications). RESULTS Of 8399 eligible study participants who completed the dietary recall questionnaire, we identified 753 adult apple eaters (9.0%)—those who typically consume at least 1 small apple per day. Compared with the 7646 non–apple eaters (91.0%), apple eaters had higher educational attainment, were more likely to be from a racial or ethnic minority, and were less likely to smoke (P Apple eaters were more likely, in the crude analysis, to keep the doctor (and prescription medications) away: 39.0% of apple eaters avoided physician visits vs 33.9%of non–apple eaters (P = .03). After adjusting for sociodemographic and health-related characteristics, however, the association was no longer statistically significant (OR, 1.19; 95%CI, 0.93–1

  4. Specialist physician knowledge of chronic kidney disease: A comparison of internists and family physicians in West Africa

    Directory of Open Access Journals (Sweden)

    Emmanuel I. Agaba

    2012-05-01

    Full Text Available Background: Postgraduate training is aimed at equipping the trainee with the necessary skills to practise as an expert. Non-nephrology specialist physicians render the bulk of pre-end-stage renal disease care for patients with chronic kidney disease (CKD. We sought to ascertain the knowledge of CKD amongst non-nephrology specialist physicians who serve as trainers and examiners for a training, accrediting and certifying body in postgraduate medicine in West Africa. We also compared the knowledge of family physicians and non-nephrology internists. Methods: Self-administered questionnaires were distributed to non-nephrology specialist physicians who serve as examiners for the West African College of Physicians. Results: Only 19 (27.5% of the respondents were aware of the Kidney Disease Outcomes Quality Initiatives guidelines for CKD management. Twenty five (36.2% of the respondents had adequate knowledge of CKD. There was no significant difference in the proportion of family physicians and non-nephrology internists who had adequate knowledge of CKD (27.3% vs. 40.4% respectively; p = 0.28. Hypertension and diabetes mellitus were identified by all of the physicians as risk factors for CKD. Non-nephrology internists more frequently identified systemic lupus erythematosus as a risk factor for CKD, urinalysis with microscopy as a laboratory test for CKD evaluation, and bone disease as a complication of CKD than family physicians. Conclusion: There is a lack of adequate CKD knowledge amongst non-nephrology specialist physicians, since many of them are unaware of the CKD management guidelines. Educational efforts are needed to improve the knowledge of CKD amongst non-nephrology specialist physicians. Guidelines on CKD need to be widely disseminated amongst these physicians.

  5. Online Physician Reviews Do Not Reflect Patient Satisfaction Survey Responses.

    Science.gov (United States)

    Widmer, R Jay; Maurer, Matthew J; Nayar, Veena R; Aase, Lee A; Wald, John T; Kotsenas, Amy L; Timimi, Farris K; Harper, Charles M; Pruthi, Sandhya

    2018-04-01

    Online physician reviews have become increasingly prevalent and are a common means by which patients explore medical options online. Currently, there are no data comparing physicians with negative online reviews and those without negative reviews. We sought to compare industry-vetted patient satisfaction surveys (PSSs), such as Press Ganey (PG) PSSs, between those physicians with negative online reviews and those without negative reviews. Overall, there were 113 unique individuals with negative online reviews from September 1, 2014, to December 31, 2014, with 8 being nonphysicians. We matched 113 physicians in similar departments/divisions. We obtained PG PSS scores of both groups and compared the mean scores of the 2 groups. Press Ganey PSS scores were available for 98 physicians with negative online reviews compared with 82 matched physicians without negative online reviews. The mean raw PG PSS scores were not different between the 2 groups (4.05; 95% CI, 3.99-4.11 vs 4.04; 95% CI, 3.97-4.11; P=.92). We also noted no difference in mean scores on questions related to physician-patient communication and interaction skills between those with poor online reviews and those without (4.38; 95% CI, 4.32-4.43 vs 4.41; 95% CI, 4.35-4.47; P=.42). However, there was a significantly lower non-physician-specific mean in those with negative online reviews (3.91; 95% CI, 3.84-3.97) vs those without negative online reviews (4.01; 95% CI, 3.95-4.09) (P=.02). Here, we provide data indicating that online physician reviews do not correlate to formal institutional PG PSS. Furthermore, physicians with negative online reviews have lower scores on non-physician-specific variables included in the PG PSSs, emphasizing that these discrepancies can negatively affect overall patient experience, online physician reviews, and physician reputation. It is prudent that an improved mechanism for online ratings be implemented to better inform patients about a physician's online reputation. Copyright

  6. Exercise-induced bronchospasm: coding and billing for physician services.

    Science.gov (United States)

    Pohlig, Carol

    2009-01-01

    Physician reporting of the service to insurance companies for reimbursement is multifaceted and perplexing to those who do not understand the factors to consider. Test selection should be individualized based on the patient's history and/or needs. Federal regulations concerning physician supervision of diagnostic tests mandate different levels of physician supervision based on the type and complexity of the test. Many factors play a key role in physician claim submission. These include testing location, component services, coding edits, and additional visits. Medical necessity of the service(s) must also be demonstrated for payer consideration and reimbursement. The following article reviews various tests for exercise-induced bronchospasm and focuses on issues to assist the physician in reporting the services accurately and appropriately.

  7. Physician exposure to violence: a study performed in Turkey.

    Science.gov (United States)

    Baykan, Zeynep; Öktem, İbrahim Suat; Çetinkaya, Fevziye; Naçar, Melis

    2015-01-01

    Recently, in Turkey, there has been an increase in the number of violent acts against healthcare workers, towards doctors in particular. This study aimed to investigate the extent of violence, the causes of violence and to evaluate proposed solutions to violence. Out of 597 physicians, 86.4% indicated that they were exposed to at least one type of violence (physical, verbal, sexual) throughout their careers. Among the physicians participating in the study, 27.5% suffered physical threats and 68.6% suffered verbal violence in the past year. Only 40.4% reported the physical violence to their institution. Physicians indicated that the top three causes of violent behavior were excessive demands of patients, the expectation that the issue will be solved immediately and blaming physicians for their problems. To stop violence against themselves, physicians need to raise their voices, along with those of their personal or professional organizations, and should report and follow up incidents.

  8. Barriers to Medical Error Reporting for Physicians and Nurses.

    Science.gov (United States)

    Soydemir, Dilek; Seren Intepeler, Seyda; Mert, Hatice

    2017-10-01

    The purpose of the study was to determine what barriers to error reporting exist for physicians and nurses. The study, of descriptive qualitative design, was conducted with physicians and nurses working at a training and research hospital. In-depth interviews were held with eight physicians and 15 nurses, a total of 23 participants. Physicians and nurses do not choose to report medical errors that they experience or witness. When barriers to error reporting were examined, it was seen that there were four main themes involved: fear, the attitude of administration, barriers related to the system, and the employees' perceptions of error. It is important in terms of preventing medical errors to identify the barriers that keep physicians and nurses from reporting errors.

  9. Physician Competition in the Era of Accountable Care Organizations.

    Science.gov (United States)

    Richards, Michael R; Smith, Catherine T; Graves, Amy J; Buntin, Melinda B; Resnick, Matthew J

    2018-04-01

    To calculate physician concentration levels for all U.S. markets using detailed data on integration and accountable care organization (ACO) participation. 2015 SK&A office-based physician survey linked to all commercial and public payer ACOs. We construct three separate Herfindahl-Hirschman Index (HHI) measures and plot their distributions. We then investigate how prevailing levels of concentration change when incorporating more detailed organizational features into the HHI measure. Horizontal and vertical integration strongly influences measures of physician concentration; however, ACOs have limited impact overall. ACOs are often present in competitive markets, and only in a minority of these markets do ACOs substantively increase physician concentration. Monitoring ACO effects on physician competition will likely have to proceed on a case-by-case basis. © Health Research and Educational Trust.

  10. Physician Networks and Ambulatory Care-sensitive Admissions.

    Science.gov (United States)

    Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Nyweide, David J; Iwashyna, Theodore J; Sun, Xuming; Mendelsohn, Jayme; Moody, James

    2015-06-01

    Research on the quality and cost of care traditionally focuses on individual physicians or medical groups. Social network theory suggests that the care a patient receives also depends on the network of physicians with whom a patient's physician is connected. The objectives of the study are: (1) identify physician networks; (2) determine whether the rate of ambulatory care-sensitive hospital admissions (ACSAs) varies across networks--even different networks at the same hospital; and (3) determine the relationship between ACSA rates and network characteristics. We identified networks by applying network detection algorithms to Medicare 2008 claims for 987,000 beneficiaries in 5 states. We estimated a fixed-effects model to determine the relationship between networks and ACSAs and a multivariable model to determine the relationship between network characteristics and ACSAs. We identified 417 networks. Mean size: 129 physicians; range, 26-963. In the fixed-effects model, ACSA rates varied significantly across networks: there was a 46% difference in rates between networks at the 25th and 75th performance percentiles. At 95% of hospitals with admissions from 2 networks, the networks had significantly different ACSA rates; the mean difference was 36% of the mean ACSA rate. Networks with a higher percentage of primary-care physicians and networks in which patients received care from a larger number of physicians had higher ACSA rates. Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care.

  11. Physicians Experiencing Intense Emotions While Seeing Their Patients: What Happens?

    Science.gov (United States)

    Silva, Joana Vilela Da; Carvalho, Irene

    2016-01-01

    Physicians often deal with emotions arising from both patients and themselves; however, management of intense emotions when they arise in the presence of patients is overlooked in research. The aim of this study is to inspect physicians' intense emotions in this context, how these emotions are displayed, coping strategies used, adjustment behaviors, and the impact of the emotional reactions on the physician-patient relationship. A total of 127 physicians completed a self-report survey, built from a literature review. Participants were recruited in 3 different ways: through a snowball sampling procedure, via institutional e-mails, and in person during service meetings. Fifty-two physicians (43.0%) reported experiencing intense emotions frequently. Although most physicians (88.6%) tried to control their reactions, several reported not controlling themselves. Coping strategies to deal with the emotion at the moment included behavioral and cognitive approaches. Only the type of reaction (but not the emotion's valence, duration, relative control, or coping strategies used) seemed to affect the physician-patient relationship. Choking-up/crying, touching, smiling, and providing support were significantly associated with an immediate positive impact. Withdrawing from the situation, imposing, and defending oneself were associated with a negative impact. Some reactions also had an extended impact into future interactions. Experiencing intense emotions in the presence of patients was frequent among physicians, and the type of reaction affected the clinical relationship. Because many physicians reported experiencing long-lasting emotions, these may have important clinical implications for patients visiting physicians while these emotions last. Further studies are needed to clarify these results.

  12. Public reporting in Germany: the content of physician rating websites.

    Science.gov (United States)

    Emmert, M; Sander, U; Esslinger, A S; Maryschok, M; Schöffski, O

    2012-01-01

    Physician rating websites (PRWs) are gaining in popularity among patients seeking quality information about physicians. However, little knowledge is available about the quantity and type of information provided on the websites. To determine and structure the quantity and type of information about physicians in the outpatient sector provided on German-language physician rating websites. In a first step, we identified PRWs through a systematic internet search using German keywords from a patient´s perspective in the two search engines Google and Yahoo. Afterwards, information about physicians available on the websites was collected and categorised according to Donabedian´s structure/process/outcome model. Furthermore, we investigated whether the information was related to the physician himself/ herself or to the practice as a whole. In total, eight PRWs were detected. Our analysis turned up 139 different information items on eight websites; 67 are related to the structural quality, 4 to process quality, 5 to outcomes, and 63 to patient satisfaction/experience. In total, 37% of all items focus specifically on the physician and 63% on the physician's practice. In terms of the total amount of information provided on the PRWs, results range from 61 down to 13.5 items. A broad range of information is available on German PRWs. While structural information can give a detailed overview of the financial, technical and human resources of a practice, other outcome measures have to be interpreted with caution. Specifically, patient satisfaction results are not risk-adjusted, and thus, are not appropriate to represent a provider's quality of care. Consequently, neither patients nor physicians should yet use the information provided to make their final decision for or against an individual physician.

  13. Communication Skills Training for Physicians Improves Patient Satisfaction.

    Science.gov (United States)

    Boissy, Adrienne; Windover, Amy K; Bokar, Dan; Karafa, Matthew; Neuendorf, Katie; Frankel, Richard M; Merlino, James; Rothberg, Michael B

    2016-07-01

    Skilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted. We aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience. This was an observational study. The study was conducted at a large, multispecialty academic medical center. Participants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014. An 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction. Following the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.

  14. COLLABORATION PRACTICE BETWEEN NURSES AND PHYSICIAN AND THE AFFECTING FACTORS

    Directory of Open Access Journals (Sweden)

    Wiwin Martiningsih

    2017-04-01

    Full Text Available Introduction: Collaboration is basically discuss about togetherness, cooperation, sharing tasks, equality, responsibility, and accountability. Purpose of this research was to learn the collaboration practice beetwen nurses and physician and the factors affecting. Method: Design of this research was correlational and comparational study, and population were the physician who work in Ngudi Waluyo Blitar hospitals, intensive cooperation with the nurse in the room, not holding structural positions and not studying, there are 19 peoples taken by total population and nurses who work in Ngudi Waluyo hospitals, not holding structural positions (Head of Division or Head of Section, having relationship with the physician and the samples were 31 peoples taken by probability proportional to size (PPS. Methods of data collection by giving questionnaire about the characteristics of respondents (nurses and physician and practice of collaboration scale. Data characteristics and attitudes of nurses and physicians about the practice of collaboration is analyzed with descriptive statistics, to know the differences between nurses and physicians attitude using mann whitney u test. To know affecting characteristic with nurses and physician attitude by multivariate analysis. Result: Results of mann whitney test p value is 0.611, which means that there is no difference between nurses and physician attitude in practice collaboration, and result of multivariate analysis the influence of nurse characteristics (age, education, functional potition, length of working with attitude are 0.460 or 46%, while 54% influenced by other factors, and the influence of physician characteristics (age, education, length of working with attitude are 0.435 or 43.5%, while 56.5% influenced by other factors. Discussion: Further need to study other factors that influence and research by observation the impact of collaboration between the nurse with physician on the service quality.

  15. Attitudes of pharmacists and physicians to antibiotic policies in hospitals.

    Science.gov (United States)

    Adu, A; Simpson, J M; Armour, C L

    1999-06-01

    Antibiotic therapy in hospitals has substantial impact on patient outcome and the pharmacy drug budget. Antibiotic policies have been implemented by some hospitals to improve the quality of patient outcome and cost of antibiotic therapy. Antibiotic policies impose certain requirements on pharmacists and physicians. Pharmacists' and physicians' attitudes to and opinions about antibiotic policies are likely to affect the usefulness of such policies. To determine the attitudes of pharmacists and physicians to antibiotic policies in New South Wales (NSW) hospitals. Pharmacists and physicians in NSW public hospitals were surveyed to determine their attitudes to and opinions on antibiotic policies. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the attitudinal dimensions. General linear modelling was used to investigate the effects of predictor variables on outcome variables. The response rates were 91% and 77% for pharmacists and physicians, respectively. Factor analysis identified three dimensions of attitude to antibiotic policies: that they encourage rational antibiotic use; that they improve the quality of antibiotic prescribing and that they are associated with some problems. The reliability of these factors (Cronbach's alpha) ranged from 0.71 to 0.74, and was 0.90 for the overall attitude scale. Pharmacists and physicians had a positive overall attitude to antibiotic policies. Whereas physicians recognize that antibiotic policies improve the quality of prescribing, this was highly correlated with identification of problems (alpha = 0.71). In urban hospitals, pharmacists were more likely than physicians to associate antibiotics with problems. There was a positive overall attitude to hospital antibiotic policies expressed by pharmacists and physicians.

  16. Physician Knowledge and Attitudes around Confidential Care for Minor Patients.

    Science.gov (United States)

    Riley, Margaret; Ahmed, Sana; Reed, Barbara D; Quint, Elisabeth H

    2015-08-01

    Minor adolescent patients have a legal right to access certain medical services confidentially without parental consent or notification. We sought to assess physicians' knowledge of these laws, attitudes around the provision of confidential care to minors, and barriers to providing confidential care. An anonymous online survey was sent to physicians in the Departments of Family Medicine, Internal Medicine-Pediatrics, Obstetrics/Gynecology, and Pediatrics at the University of Michigan. Response rate was 40% (259/650). The majority of physicians felt comfortable addressing sexual health, mental health, and substance use with adolescent patients. On average, physicians answered just over half of the legal knowledge questions correctly (mean 56.6% ± 16.7%). The majority of physicians approved of laws allowing minors to consent for confidential care (90.8% ± 1.7% approval), while substantially fewer (45.1% ± 4.5%) approved of laws allowing parental notification of this care at the physician's discretion. Most physicians agreed that assured access to confidential care should be a right for adolescents. After taking the survey most physicians (76.6%) felt they needed additional training on confidentiality laws. The provision of confidential care to minors was perceived to be most inhibited by insurance issues, parental concerns/relationships with the family, and issues with the electronic medical record. Physicians are comfortable discussing sensitive issues with adolescents and generally approve of minor consent laws, but lack knowledge about what services a minor can access confidentially. Further research is needed to assess best methods to educate physicians about minors' legal rights to confidential healthcare services. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Manager-physician relationships: an organizational theory perspective.

    Science.gov (United States)

    Kaissi, Amer

    2005-01-01

    Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of

  18. Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say.

    Science.gov (United States)

    Hebert, Lauren M; Watson, Anne C; Madrigal, Vanessa; October, Tessie W

    2017-12-01

    When contemplating tracheostomy placement in a pediatric patient, a family-physician conference is often the setting for the disclosure of risks and benefits of the procedure. Our objective was to compare benefits and risks of tracheostomy presented during family-physician conferences to an expert panel's recommendations for what should be presented. We conducted a retrospective review of 19 transcripts of audio-recorded family-physician conferences regarding tracheostomy placement in children. A multicenter, multidisciplinary expert panel of clinicians was surveyed to generate a list of recommended benefits and risks for comparison. Primary analysis of statements by clinicians was qualitative. Single-center PICU of a tertiary medical center. Family members who participated in family-physician conferences regarding tracheostomy placement for a critically ill child from April 2012 to August 2014. We identified 300 physician statements describing benefits and risks of tracheostomy. Physicians were more likely to discuss benefits than risks (72% vs 28%). Three broad categories of benefits were identified: 1) tracheostomy would limit the impact of being in the PICU (46%); 2) perceived obstacles of tracheostomy can be overcome (34%); and 3) tracheostomy optimizes respiratory health (20%). Risks fell into two categories: tracheostomy involves a big commitment (71%), and it has complications (29%). The expert panel's recommendations were similar to risks and benefits discussed during family conferences; however, they suggested physicians present an equal balance of discussion of risks and benefits. When discussing tracheostomy placement, physicians emphasized benefits that are shared by physicians and families while minimizing the risks. The expert panel recommended a balanced approach by equally weighing risks and benefits. To facilitate educated decision making, physicians should present a more extensive range of risks and benefits to families making this critical

  19. PHYSICIAN FRIDERIK PREGL, NOBELIST OF SLOVENIAN DESCENT

    Directory of Open Access Journals (Sweden)

    Zvonka Zupanič Slavec

    2001-07-01

    Full Text Available With his Nobel Prize for chemistry in 1923, Friderik (Fritz Pregl (1869–1930, a physician and a university professor for medical chemistry became a famous person both among Slovenians and world’s most eminent scientists. He did not win the Nobel Prize only for his work on the field of microanalysis of organic substances because he would have invented something very new but because he made a significant contribution to the improvement of the methodology in the quantitative organic microanalysis of that time. In his scientific work he focused on reducing the amount of substance designed for the analysis and on the improvement of the analytical scales. He improved the scales’ accuracy to a thousandth of a gram, decreased the amount of testing substance and reduced working time and the energy spared for the work considerably. Consequently, the study of substance was possible also in cases where only 3–5mg of the substance or even less were available. The same amount of substance, which had been sufficient only for one analyse, was now enough to carry out more than 50 analyses. Therefore, his improvements made the work of physiological and pathological chemists more exact and quicker. Scientific success and many publications made Pregl’s name; he became an honorary doctor of the wellknown university in Göttingen, a member of the academy of sciences and arts in Vienna and an honorary citizen of Graz

  20. Physicians should prepare for nuclear disaster

    International Nuclear Information System (INIS)

    Maccabee, H.D.

    1985-01-01

    In this paper, the author insists that physicians must take an active role in the civil defense of the United States. They must prepare to save lives and prevent suffering in any type of disaster including nuclear war. The author makes comparisons of America's civil defense programs and those of other nations. The United States is way behind other nations in civil defense. The author gives five advantages of civil defense. He says civil defense, unlike offensive weapons systems, cannot directly threaten the lives of Russians or any other nation. Properly designed shelter systems can serve multiple purposes, including storage and parking. Construction of shelters is likely to be labor-intensive by comparison with weapons systems and would probably result in more jobs in portions of the economy that have been distressed. If arms control and reduction negotiations are successful, there may be a transition period of fear and instability while methods of verification are checked. An adequate civil defense system could help to bridge these gaps of insecurity. The extension of the above argument would be to replace the doctrine of mutually assured destruction (MAD) with mutually assured survival

  1. A public health physician named Walter Leser.

    Science.gov (United States)

    Mello, Guilherme Arantes; Bonfim, José Ruben de Alcântara

    2015-09-01

    A brief review of the career of the public health physician Walter Sidney Pereira Leser, who died in 2004 aged 94. Self-taught, from his 1933 doctoral thesis he became a country reference in the field of statistics and epidemiology, with dozens of studies and supervisions. In the clinical field he is one of the founders of Fleury Laboratory, and participates in the creation of CREMESP. As an academic, Leser was a professor at the Escola de Sociologia e Política de São Paulo, Escola Paulista de Medicina e Faculdade de Farmácia e Odontologia da USP. Also, Leser introduced objective tests in the college entrance examination, and led the creation of CESCEM and Carlos Chagas Foundation. In the Escola Paulista de Medicina he created the first Preventive Medicine Department of the country. As a public official, he was secretary of the State Department of Health of São Paulo between 1967 and 1971 and between 1975 and 1979, responsible for extensive reforms and innovations. Among the most remembered, the creation of sanitary medical career. Throughout this legacy, he lent his name to the "Medal of Honor and Merit Public Health Management" of the State of São Paulo.

  2. How Digital Health Technology Aids Physicians

    Directory of Open Access Journals (Sweden)

    Nik Tehrani

    2015-06-01

    Full Text Available There is so much health and medical information available today that physicians cannot be expected to know it all. Thus, advances in technology have become a necessity for doctors to track patient information and care, and add to patient databases for reference and to conduct research. It is important to understand the new language of digital health, such as Personal Health Record (PHR, Electronic Medical Record (EMR and Electronic Health Record (EHR, all of which sound similar, but are not interchangeable. The ideal comprehensive IT system would empower patients, advance healthcare delivery and transform patient data into life-saving research (Kaiser, 2015. OmniFluent Health is language translation software that will allow for better patient/practitioner communication and avoid errors. Digital technology employs the use of big data that is shared, accessed, compiled and applied using analytics. However, information transfer, especially as mandated by current ethics of use of technology, has resulted into breach of patient privacy. Improved digital technology is providing the health care field with upgrades that are necessary, electronic files and health records, from mobile apps, and remote monitoring devices.

  3. Physician Assistants Contribution to Emergency Department Productivity

    Directory of Open Access Journals (Sweden)

    Christopher Brook, MD

    2012-05-01

    Full Text Available Introduction: The objective of this report is to determine physician assistant (PA productivity in anacademic emergency department (ED and to determine whether shift length or department censusimpact productivity.Methods: A retrospective chart review was conducted at a tertiary ED during June and July of 2007.Productivity was calculated as the mean number of patients seen each hour. Analysis of variance wasused to compare the productivity of different length shifts, and linear regression analysis was used toassess the relationship between productivity and department volume.Results: One hundred sixty PA shifts were included. Shifts ranged from 4 to 13 hours. Meanproductivity was 1.16 patients per hour (95% confidence interval [CI] ¼ 1.12–1.20. Physicianassistants generated a mean of 2.35 relative value units (RVU per hour (95% CI¼1.98–2.72. Therewas no difference in productivity on different shift lengths (P¼0.73. There was no correlation betweendepartmental census and productivity, with an R2 (statistical term for the coefficient of determination of0.01.Conclusion: In the ED, PAs saw 1.16 patients and generated 2.35 RVUs per hour. The length of theshift did not affect productivity. Productivity did not fluctuate significantly with changing departmentalvolume.

  4. Physician aid-in-dying: cautionary words.

    Science.gov (United States)

    Van Norman, Gail A

    2014-04-01

    Physician-assisted suicide (PAS) and euthanasia have been increasingly discussed in end-of-life care, as PAS and euthanasia have now been legalized in three European countries and PAS has been legalized in Washington, Oregon, and Montana in the USA. This review focuses on some aspects of PAS and euthanasia and discusses deep terminal sedation (DTS), which is increasingly used to treat intractable symptoms at the end of life. PAS and euthanasia present potential risks for vulnerable populations, such as the depressed and disabled. The Oregon experience does not allow specific analysis regarding disabled patients, but fewer psychiatric consultations are being done to evaluate patients for depression. In the Netherlands, a small number of patients undergo euthanasia without an explicit request. Twenty percent of cases go unreported, raising questions of whether they met legal standards. The use of DTS in all countries has increased, but in a significant number of cases, DTS is used with an explicit intent to hasten death. Double-effect arguments to justify DTS may not actually apply. Caution is warranted regarding PAS and euthanasia, as vulnerable patients may still be at risk. More research is needed to characterize the use (and misuse) of DTS.

  5. Ethics and responsibility of the physics physician

    International Nuclear Information System (INIS)

    Villasenor N, L. F.

    2008-12-01

    Professional ethics in radiation protection is characterized by high set of standards governing the conduct of any professional who is responsible for enforcing o accomplish with a set of laws and rules aimed at protecting the individuals health and the physical security of radiation sources. Without losing sight of the fulfillment of these obligations are not limited to such minimum standards and expressed as active all have a right to recognize and accept the consequences of an act done freely. There are a number of institutions that function as moral and ethics authorities in radiation protection, such as the IAEA, the Committee on Radiation Protection and Public Health at the NEA, the UNSCEAR, in addition to national authorities in each country. There are also a reference regulatory framework which includes the Regulatory Law to Article 27 of the Constitution in the Nuclear Matter, the General Regulation of Radiation Safety and the Mexican Official Standards. The use of radiation sources representing a wide range of charitable purposes but their use involves risks due to possible radiations exposure. Hence arises the need to protect individuals, society and environment against the adverse effects of possible accidents and malicious acts involving radioactive sources. In the case of the physics physician, there is a matrix of responsibilities under obligations not only in terms of treatment planing, but also equipment, dosimetry, radiation protection and even some kinds of academic and administrative. (Author)

  6. Physicians' opinions of a health information exchange.

    Science.gov (United States)

    Hincapie, Ana Lucia; Warholak, Terri L; Murcko, Anita C; Slack, Marion; Malone, Daniel C

    2011-01-01

    Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE). To evaluate physicians' perceptions regarding AMIE's impact on health outcomes and healthcare costs. A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding. A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of "doctor shopping"; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system. Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.

  7. Physician-Patient Communication about Dietary Supplements

    Science.gov (United States)

    Tarn, Derjung M.; Paterniti, Debora A.; Good, Jeffrey S.; Coulter, Ian D.; Galliher, James M.; Kravitz, Richard L.; Karlamangla, Arun; Wenger, Neil S.

    2013-01-01

    Objective Describe the content and frequency of provider-patient dietary supplement discussions during primary care office visits. Methods Inductive content analysis of 1477 transcribed audio-recorded office visits to 102 primary care providers was combined with patient and provider surveys. Encounters were collected in Los Angeles, California (2009–2010), geographically-diverse practice settings across the United States (2004–2005), and Sacramento, CA (1998–1999). Results Providers discussed 738 dietary supplements during encounters with 357 patients (24.2% of all encounters in the data). They mentioned: 1) reason for taking the supplement for 46.5% of dietary supplements; 2) how to take the supplement for 28.2%; 3) potential risks for 17.3%; 4) supplement effectiveness for 16.7%; and 5) supplement cost or affordability for 4.2%. Of these five topics, a mean of 1.13 (SD=1.2) topics were discussed for each supplement. More topics were reviewed for non-vitamin non-mineral supplements (mean 1.47 (SD=1.2)) than for vitamin/mineral supplements (mean 0.99 (SD=1.1); psupplements are occurring, it is clear that more discussion might be needed to inform patient decisions about supplement use. Practice Implication Physicians could more frequently address topics that may influence patient dietary supplement use, such as the risks, effectiveness, and costs of supplements. PMID:23466249

  8. Euthanasia and physician-assisted suicide.

    Science.gov (United States)

    Swarte, N B; Heintz, A P

    1999-12-01

    In the Netherlands there are about 9700 explicit requests for euthanasia or physician-assisted suicide (EAS) each year, of which approximately 3600 are granted. Other countries have criticized the Dutch policy concerning EAS. It has been suggested that palliative care in the Netherlands is not adequate and that euthanasia is often requested by patients with depression. In addition, this criticism is partly based on the firm stance that 'human life has an absolute value and a human being has under no circumstances the right of self-determination over his or her own life'. Many aspects of EAS are currently the focus of attention in the literature. In this review the following aspects of EAS are discussed: ethics, judicial questions, the relationship between depression and euthanasia, and the impact of EAS on members of the family. Also, the current situation concerning EAS in the Netherlands is summarized and described. Despite the fact that EAS have been widely discussed in the literature, the association between depression and the number of requests for EAS remains to be discovered. It is also not yet known what the effects of EAS are on members of the family, and whether unnatural death causes a higher incidence of complicated grief.

  9. Patients' trust in their physician-Psychometric properties of the Dutch version of the "Wake Forest Physician Trust Scale"

    NARCIS (Netherlands)

    Bachinger, Suse Maria; Kolk, Annemarie M.; Smets, Ellen M. A.

    2009-01-01

    Objective: Aim was to investigate the psychometric properties of a Dutch version of the "Wake Forest Physician Trust Scale", which intends to measure patients' trust in their physician. Methods: A random sample of internal medicine patients visiting the outpatient clinic completed the questionnaire

  10. Patients’ trust in their physician - Psychometric properties of the Dutch version of the "Wake Forest Physician Trust Scale"

    NARCIS (Netherlands)

    Bachinger, S.M.; Kolk, A.M.; Smets, E.M.A.

    2009-01-01

    Objective: Aim was to investigate the psychometric properties of a Dutch version of the "Wake Forest Physician Trust Scale", which intends to measure patients’ trust in their physician. Methods: A random sample of internal medicine patients visiting the outpatient clinic completed the questionnaire

  11. African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

    Science.gov (United States)

    McLaughlin, Megan M; Simonson, Louis; Zou, Xia; Ling, Li; Tucker, Joseph D

    2015-01-01

    Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust. We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians. These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

  12. African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

    Directory of Open Access Journals (Sweden)

    Megan M McLaughlin

    Full Text Available Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust.We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians.These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

  13. Physicians' Perceptions on the usefulness of contextual information for prioritizing and presenting alerts in computerized physician order entry systems

    NARCIS (Netherlands)

    Jung, Martin; Riedmann, Daniel; Hackl, Werner O.; Hoerbst, Alexander; Jaspers, Monique W.; Ferret, Laurie; Lawton, Kitta; Ammenwerth, Elske

    2012-01-01

    Background: One possible approach towards avoiding alert overload and alert fatigue in Computerized Physician Order Entry (CPOE) systems is to tailor their drug safety alerts to the context of the clinical situation. Our objective was to identify the perceptions of physicians on the usefulness of

  14. Effects of compensation methods and physician group structure on physicians' perceived incentives to alter services to patients.

    Science.gov (United States)

    Reschovsky, James D; Hadley, Jack; Landon, Bruce E

    2006-08-01

    To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. Nationally representative data on physicians are from the 2000-2001 Community Tracking Study Physician Survey (N=12,406). Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage.

  15. Breast cancer patients' trust in physicians: the impact of patients' perception of physicians' communication behaviors and hospital organizational climate.

    Science.gov (United States)

    Kowalski, Christoph; Nitzsche, Anika; Scheibler, Fueloep; Steffen, Petra; Albert, Ute-Susann; Pfaff, Holger

    2009-12-01

    To examine whether patients' perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians' communication behaviors as perceived by the patients and patient characteristics. Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed. 80.5% of the patients responded to the survey. 37% of the variance in patients' trust in physicians can be explained by the variables included in our final model (N=2226; R(2) adj.=0.372; porganizational climate. The impact of their perception of physicians' communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust. A trusting physician-patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians' communication behaviors. With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.

  16. Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness.

    Science.gov (United States)

    Frush, Benjamin W; Brauer, Simon G; Yoon, John D; Curlin, Farr A

    2018-03-01

    Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness. This study sought to determine how patient age, patient disposition, and physician religiousness affect physician recommendations in the context of advanced illness. A survey was mailed to a stratified random sample of U.S. physicians, which included three vignettes depicting advanced illness scenarios: 1) cancer, 2) heart failure, and 3) dementia with acute infection. One vignette included experimental variables to test how patient age and patient disposition affected physician recommendations. After each vignette, physicians indicated their likelihood to recommend disease-directed medical care vs. hospice care. Among eligible physicians (n = 1878), 62% (n = 1156) responded. Patient age and stated patient disposition toward treatment did not significantly affect physician recommendations. Compared with religious physicians, physicians who reported that religious importance was "not applicable" were less likely to recommend chemotherapy (adjusted odds ratio [OR] 0.39, 95% CI 0.23-0.66) and more likely to recommend hospice (OR 1.90, 95% CI 1.15-3.16) for a patient with cancer. Compared with physicians who ever attended religious services, physicians who never attended were less likely to recommend left ventricular assist device placement for a patient with congestive heart failure (OR 0.57, 95% CI 0.35-0.92). In addition, Asian ethnicity was independently associated with recommending chemotherapy (OR 1.72, 95% CI 1.13-2.61) and being less likely to recommend hospice (OR 0.59, 95% CI 0.40-0.91) for the patient with cancer; and it was associated with recommending antibiotics for the patient with dementia and pneumonia (OR 1.64, 95% CI 1.08-2.50). This study provides preliminary evidence that patient disposition toward more and less aggressive treatment in advanced illness does not substantially factor

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

    Science.gov (United States)

    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

  18. Physician attitudes toward advanced directives: a literature review of variables impacting on physicians attitude toward advance directives.

    Science.gov (United States)

    Coleman, Albert M E

    2013-11-01

    To review physician's attitudes as well as the variables that may impact on physicians' attitude toward advance directives (ADs). Literature review of 17 published articles, covering the period 1989 to 2011. Physicians overall have a positive attitude toward patients' AD. However, other factors affect this "general positive attitude." These factors influence the attitude-behavior relationship of physicians, and hence their actual practice in relation to patients' AD. The findings from this review are of importance in explaining the differences in the attitude of physicians toward AD and their compliance. This raises the issue of consideration of other ethical paradigms/theories in the clinical context other than the framework of "principlism-"based autonomy, on which AD leans on. This is important in light of the pluralism of ethical theories.

  19. Prevalence of Horizontal Violence Among Emergency Attending Physicians, Residents, and Physician Assistants

    Directory of Open Access Journals (Sweden)

    Nico B. Volz

    2017-02-01

    Full Text Available Introduction: Horizontal violence (HV is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among emergency department (ED attending physicians, residents, and mid-level providers (MLPs. Methods: We sent an electronic survey to emergency medicine attending physicians (n=67, residents (n=25, and MLPs (n=24 in three unique EDs within a single multi-hospital medical system. The survey consisted of 18 questions that asked participants to indicate with what frequency (never, once, a few times, monthly, weekly, or daily they have witnessed or experienced a particular behavior in the previous 12 months. Seven additional questions aimed to elicit the impact of HV on the participant, the work environment, or the patient care. Results: Of the 122 survey invitations 91 were completed, yielding a response rate of 74.6%. Of the respondents 64.8% were male and 35.2% were female. Attending physicians represented 41.8%, residents 37.4%, and MLPs 19.8% of respondents. Prevalence of reported behaviors ranged from 1.1% (Q18: physical assault to 34.1% (Q4: been shouted at. Fourteen of these behaviors were most prevalent in the attending cohort, six were most prevalent in the MLP cohort, and three of the behaviors were most prevalent in the resident cohort. Conclusion: The HV behaviors investigated in this pilot study were similar to data previously published in nursing cohorts. Furthermore, nearly a quarter of participants (22.2% indicated that HV has affected care for their patients, suggesting further studies are warranted to assess prevalence and the impact HV has on staff and patients. [West J Emerg Med. 2017;18(2213-218.

  20. Coronary CT angiography: How should physicians use it wisely and when do physicians request it appropriately?

    International Nuclear Information System (INIS)

    Sun Zhonghua; Aziz, Yang Faridah Abdul; Ng, Kwan-Hoong

    2012-01-01

    Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease due to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with 64- and more slice CT scanners and in selected patients, coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. Although the tremendous contributions of coronary CT angiography to cardiac imaging are acknowledged, appropriate use of cardiac CT as the first line technique by physicians has not been well established. Optimal selection of cardiac CT is essential to ensure acquisition of valuable diagnostic information and avoid unnecessary invasive procedures. This is of paramount importance since cardiac CT not only involves patient risk assessment, prediction of major cardiac events, but also impacts physician decision-making on patient management. Applications of CT in cardiac imaging include coronary artery calcium scoring for predicting the patient risk of developing major cardiac events, followed by coronary CT angiography which is commonly used to determine the diagnostic and prognostic accuracy in the coronary artery disease. This review presents an overview of the applications of CT in cardiac imaging in terms of coronary calcium scoring and coronary CT angiography. Judicious use of both cardiac CT tools will be discussed with regard to their value in different patient risk groups with the aim of identifying the appropriate criteria for choosing a cardiac CT modality. An effective diagnostic pathway is finally recommended to physicians for appropriate selection of cardiac CT in clinical practice.

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

    Science.gov (United States)

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

    2014-02-01

    Talent management and leadership development is becoming a necessity for health care organizations. These leaders will be needed to manage the change in the delivery of health care and payment systems. Appointment of clinically skilled physicians as leaders without specific training in the areas described in our program could lead to failure. A comprehensive program such as the one described is also needed for succession planning and retaining high-potential individuals in an era of shortage of surgeons. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  2. An Ethical Review of Euthanasia and Physician-assisted Suicide.

    Science.gov (United States)

    Banović, Božidar; Turanjanin, Veljko; Miloradović, Anđela

    2017-02-01

    In the majority of countries, active direct euthanasia is a forbidden way of the deprivation of the patients' life, while its passive form is commonly accepted. This distinction between active and passive euthanasia has no justification, viewed through the prism of morality and ethics. Therefore, we focused on attention on the moral and ethical implications of the aforementioned medical procedures. Data were obtained from the Clinical Hospital Center in Kragujevac, collected during the first half of the 2015. The research included 88 physicians: 57 male physicians (representing 77% of the sample) and 31 female physicians (23% of the sample). Due to the nature, subject and hypothesis of the research, the authors used descriptive method and the method of the theoretical content analysis. A slight majority of the physicians (56, 8%) believe that active euthanasia is ethically unacceptable, while 43, 2% is for another solution (35, 2% took a viewpoint that it is completely ethically acceptable, while the remaining 8% considered it ethically acceptable in certain cases). From the other side, 56, 8% of respondents answered negatively on the ethical acceptability of the physician-assisted suicide, while 33% of them opted for a completely ethic viewpoint of this procedure. Out of the remaining 10, 2% opted for the ethical acceptability in certain cases. Physicians in Serbia are divided on this issue, but a group that considers active euthanasia and physician-assisted suicide as ethically unacceptable is a bit more numerous.

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

    Science.gov (United States)

    Domenighetti, G; Casabianca, A

    1995-10-21

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

  4. Determinants of Indian physicians' satisfaction & dissatisfaction from their job.

    Science.gov (United States)

    Sharma, Meenakshi; Goel, Sonu; Singh, Sharad Kumar; Sharma, Raman; Gupta, Pramod K

    2014-03-01

    Physicians' satisfaction/dissatisfaction from their job is an important factor associated with health service that deals with human life. This study was conducted to ascertain overall level and proportion of physicians' satisfaction from their job as well as to identify those components that influenced it. A comprehensive customized questionnaire was used with Section A to assess demographic profile of physicians and Section B to assess satisfaction. Response to each question was devised using Likert scale. Likert scale responses were converted to normal scale so that statistical procedures could be naturally developed. A total of 170 physicians were selected using multistage sampling. Questionnaire was administered on one to one basis to avoid non-response. Precise and contextualized descriptive and inferential statistical procedures were used for analysis. Of the 140 physicians, 103 (74%) were satisfied from their job with average score of 19.15 ± 11.46 while 37 (26%) were dissatisfied with average score -09.27 ± 06.30. Nine out of 15 components were found significant (P<0.05). Comparative assessment of the present results with those of other studies revealed that satisfaction percentage of Indian physicians and those of the developed countries were almost the same. Perhaps, magnitude of satisfaction level (average score) of the Indian physicians were towards the lower side. Nine determinants, identified in this study can be used safely to assess any professionals' satisfaction.

  5. Review on Factors Influencing Physician Guideline Adherence in Cardiology.

    Science.gov (United States)

    Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

    2018-04-09

    Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

  6. Pain and symptom control. Patient rights and physician responsibilities.

    Science.gov (United States)

    Emanuel, E J

    1996-02-01

    In considering the care of patients with incurable and terminal diseases, there are three types of interventions: (1) palliative care and symptom management; (2) experimental therapies; and (3) active life-ending interventions. Relief of pain, other symptoms, and suffering should be the basic and standard treatment; the other interventions are meant to supplement, not replace, this intervention. This means the physician's primary obligation is to inform patients about the options for palliative care and to provide quality palliative care. Thus, physicians who care for terminally ill patients have an obligation to keep their knowledge base and skills in palliative care current. In those circumstances in which a patient's needs exceeds the physician's knowledge and skills, physicians have a responsibility to refer the patient to a palliative care specialist. With regard to experimental therapies, physicians must obtain full informed consent, provide especially accurate data on the risks and benefits of experimental therapies, and ensure that the patient understands the aims of the proposed therapy. Regarding active life-ending therapies, physicians have the obligation to withhold or withdraw life-sustaining treatment if the patient so desires and to provide adequate pain medication even if this hastens death. Even if euthanasia or physician-assisted suicide are legalized, there is unlikely to be an obligation to provide this intervention.

  7. Estimated time spent on preventive services by primary care physicians

    Directory of Open Access Journals (Sweden)

    Gradison Margaret

    2008-12-01

    Full Text Available Abstract Background Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. Methods We analyzed a large dataset of primary care (family and internal medicine visits using the National Ambulatory Medical Care Survey (2001–4; analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. Results Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively. New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA, cholesterol, Papanicolaou (Pap smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence" services, tobacco cessation and Pap smear (in preventive visits, and one "B" rated ("at least fair evidence" service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness", PSA and exercise counseling. Conclusion Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

  8. Colorectal cancer screening awareness among physicians in Greece

    Directory of Open Access Journals (Sweden)

    Chatzimichalis Georgios

    2006-06-01

    Full Text Available Abstract Background Data comparison between SEER and EUROCARE database provided evidence that colorectal cancer survival in USA is higher than in European countries. Since adjustment for stage at diagnosis markedly reduces the survival differences, a screening bias was hypothesized. Considering the important role of primary care in screening activities, the purpose of the study was to investigate the colorectal cancer screening awareness among Hellenic physicians. Methods 211 primary care physicians were surveyed by mean of a self-reported prescription-habits questionnaire. Both physicians' colorectal cancer screening behaviors and colorectal cancer screening recommendations during usual check-up visits were analyzed. Results Only 50% of physicians were found to recommend screening for colorectal cancer during usual check-up visits, and only 25% prescribed cost-effective procedures. The percentage of physicians recommending stool occult blood test and sigmoidoscopy was 24% and 4% respectively. Only 48% and 23% of physicians recognized a cancer screening value for stool occult blood test and sigmoidoscopy. Colorectal screening recommendations were statistically lower among physicians aged 30 or less (p = 0.012. No differences were found when gender, level and type of specialization were analyzed, even though specialists in general practice showed a trend for better prescription (p = 0.054. Conclusion Contemporary recommendations for colorectal cancer screening are not followed by implementation in primary care setting. Education on presymptomatic control and screening practice monitoring are required if primary care is to make a major impact on colorectal cancer mortality.

  9. Physician capability to electronically exchange clinical information, 2011.

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    Patel, Vaishali; Swain, Matthew J; King, Jennifer; Furukawa, Michael F

    2013-10-01

    To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement. Survey of a nationally representative sample of nonfederal office-based physicians who provide direct patient care. The survey was administered by mail with telephone follow-up and had a 61% weighted response rate. The overall sample consisted of 4326 respondents. We calculated estimates of electronic exchange capability at the national and state levels, and applied multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics. In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries. In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians' capability to exchange varies by vendor and by state.

  10. Physician attitudes toward industry: a view across the specialties

    Science.gov (United States)

    Korenstein, Deborah; Keyhani, Salomeh; Ross, Joseph S.

    2010-01-01

    Objectives Physician relationships with industry are receiving attention as government and professional organizations move toward restrictive policies and financial transparency. Our objective was to explore attitudes of physicians from all specialties toward gifts from and interactions with the pharmaceutical and device industries. Design Anonymous cross sectional survey. Setting Hospitals in the Mount Sinai School of Medicine consortium, in the New York City metro area Participants Faculty and trainee physicians from all clinical departments Main Outcome Measures Attitudes toward industry interactions and gifts and their appropriateness, measured on 4-point Likert scales. Results Five hundred ninety physicians and medical students completed the survey (response rate=67%); 59% were male, 39% were attendings, and 24% were from surgical specialties. Attitudes toward industry and gifts were generally positive. More than 65% found educational materials and sponsored lunches appropriate, whereas fewer than 25% considered vacations or large gifts appropriate. Surgeons, trainees, and those unfamiliar with institutional policies on industry interactions held more positive attitudes than others and were more likely to deem some gifts appropriate, including industry funding of residency programs and, among surgeons, receiving meals, travel expenses, and payments for attending lectures. Non-attendings held more positive attitudes toward meals in clinical settings, textbooks and samples. Conclusions Physicians continue to hold positive attitudes toward marketing-oriented activities of the pharmaceutical and device industries. Changes in medical culture and physician education focused on surgeons and trainees may align physician attitudes with current policy trends. PMID:20566978

  11. A Systematic Review of Physician Leadership and Emotional Intelligence

    Science.gov (United States)

    Mintz, Laura Janine; Stoller, James K.

    2014-01-01

    Objective This review evaluates the current understanding of emotional intelligence (EI) and physician leadership, exploring key themes and areas for future research. Literature Search We searched the literature using PubMed, Google Scholar, and Business Source Complete for articles published between 1990 and 2012. Search terms included physician and leadership, emotional intelligence, organizational behavior, and organizational development. All abstracts were reviewed. Full articles were evaluated if they addressed the connection between EI and physician leadership. Articles were included if they focused on physicians or physicians-in-training and discussed interventions or recommendations. Appraisal and Synthesis We assessed articles for conceptual rigor, study design, and measurement quality. A thematic analysis categorized the main themes and findings of the articles. Results The search produced 3713 abstracts, of which 437 full articles were read and 144 were included in this review. Three themes were identified: (1) EI is broadly endorsed as a leadership development strategy across providers and settings; (2) models of EI and leadership development practices vary widely; and (3) EI is considered relevant throughout medical education and practice. Limitations of the literature were that most reports were expert opinion or observational and studies used several different tools for measuring EI. Conclusions EI is widely endorsed as a component of curricula for developing physician leaders. Research comparing practice models and measurement tools will critically advance understanding about how to develop and nurture EI to enhance leadership skills in physicians throughout their careers. PMID:24701306

  12. Social media and physicians: Exploring the benefits and challenges.

    Science.gov (United States)

    Panahi, Sirous; Watson, Jason; Partridge, Helen

    2016-06-01

    Healthcare professionals' use of social media platforms, such as blogs, wikis, and social networking web sites has grown considerably in recent years. However, few studies have explored the perspectives and experiences of physicians in adopting social media in healthcare. This article aims to identify the potential benefits and challenges of adopting social media by physicians and demonstrates this by presenting findings from a survey conducted with physicians. A qualitative survey design was employed to achieve the research goal. Semi-structured interviews were conducted with 24 physicians from around the world who were active users of social media. The data were analyzed using the thematic analysis approach. The study revealed six main reasons and six major challenges for physicians adopting social media. The main reasons to join social media were as follows: staying connected with colleagues, reaching out and networking with the wider community, sharing knowledge, engaging in continued medical education, benchmarking, and branding. The main challenges of adopting social media by physicians were also as follows: maintaining confidentiality, lack of active participation, finding time, lack of trust, workplace acceptance and support, and information anarchy. By revealing the main benefits as well as the challenges of adopting social media by physicians, the study provides an opportunity for healthcare professionals to better understand the scope and impact of social media in healthcare, and assists them to adopt and harness social media effectively, and maximize the benefits for the specific needs of the clinical community. © The Author(s) 2014.

  13. Determining Childhood Blood Lead Level Screening Compliance Among Physicians.

    Science.gov (United States)

    Haboush-Deloye, Amanda; Marquez, Erika R; Gerstenberger, Shawn L

    2017-08-01

    Childhood Lead Poisoning Prevention Programs throughout the U.S. have addressed childhood lead poisoning by implementing primary and secondary prevention efforts. While many programs have helped increase screening rates, in some states children under the age of six still have not been tested for lead. This study aims to identify the barriers to childhood blood lead testing and develop a strategy to increase the number of children tested. Clark County physicians who work with children six and under were surveyed about blood lead level (BLL) testing practices, particularly, adherence to Centers for Disease Control and Prevention (CDC) guidelines, and parental compliance with orders to have their children tested to determine their blood lead levels. In addition, select in-person interviews were conducted with physicians who reported high parental compliance to identify best practices and barriers. Of the 77 physicians that provided data, 48% indicated they did not follow CDC guideline compared to 52% who follow guidelines. 18 of the 30 (or 60%) physicians reported more than 80% of parents complied with doctor recommended BLL testing. Twelve physicians identified cost, lack of insurance, and absence of symptomology as persistent barriers to lead screening. This study identified barriers to childhood lead screening including inadequate parental adherence to physician-ordered screenings and physician non-compliance with screening recommendations are two primary contributors. Addressing these issues could increase screening in children and reduce the risk of lead poisoning.

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

    Science.gov (United States)

    Harter, Thomas D

    2015-03-01

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

  15. Defenses to malpractice: what every emergency physician should know.

    Science.gov (United States)

    Hudson, Michael Jason; Moore, Gregory P

    2011-12-01

    Emergency medicine is a high-risk specialty that carries a constant risk of malpractice litigation. Fear of malpractice litigation can lead to less-than-optimal patient care as well as impairments in physician quality of life. Although malpractice fear can be ubiquitous among emergency physicians, most receive little to no education on malpractice. Medical malpractice requires that 1) The physician had a duty, 2) The physician breached the duty, 3) There was harm to the patient, and 4) The harm was caused by the physician's breach of duty. Even if all four medical malpractice conditions are met, there are still special legal defenses that have been and can be used in court to exonerate the physician. These defenses include assumption of the risk, Good Samaritan, contributory negligence, comparative fault, sudden emergency, respectable minority, two schools of thought, and clinical innovation. These legal defenses are illustrated and explained using defining precedent cases as well as hypothetical examples that are directly applicable to emergency medical practice. Knowledge of these special legal defenses can help emergency physicians minimize their risk of litigation when caring for patients. Published by Elsevier Inc.

  16. Recognition of depressive symptoms by physicians

    Directory of Open Access Journals (Sweden)

    Sergio Gonçalves Henriques

    2009-01-01

    Full Text Available OBJECTIVE: To investigate the recognition of depressive symptoms of major depressive disorder (MDD by general practitioners. INTRODUCTION: MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. METHODS: A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P. We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. RESULTS: The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6 and fatigue (1.7, mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5. The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4-76.9%, which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2-99.4%. DISCUSSION: Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. CONCLUSIONS: Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.

  17. Physician assistants and their intent to retire.

    Science.gov (United States)

    Coombs, Jennifer; Hooker, Roderick S; Brunisholz, Kim

    2013-07-01

    To determine predictors of physician assistants (PAs) to retire or to permanently leave clinical practice. The intent was to create a measure of retention and attrition for purposes of forecasting PA supply. All PAs 55 years or older who were nationally certified in 2011 were surveyed. Statistical analysis included descriptive measures utilizing means, standard deviations, range, and proportions for all survey questions. Univariable analysis using χ² test for the categorical variables determined gender differences in participants' intent to retire. A studentized t test analysis for continuous variables was used to compare differences across genders. The estimated time interval until retirement was calculated using reported values from participants and then subtracting their projected retirement age from current age. The same calculation was used for estimating PA career length from date of graduation to retirement. For all analyses, a P value surveyed online; 4767 responded (38%). The mean age was 60 years and the years in clinical practice was 25. When asked to predict a retirement date or age, the mean duration of working beyond age 55 years was 12 years (range 5 to 21). Most respondents reported being confident they were on track to retire with an adequate income. The significant differences that emerged were that men were more confident than women in preparing to retire, having enough money for medical expenses, and being able to live comfortably in retirement. Men more than women stated that, if forced to retire, they were more confident in the preparation to do so. PAs 55 years and older report they are likely to delay retirement from practice until age 67 years, on average. Women were less confident than men in retirement preparation. This age prediction expands career projections and refines forecasting models for the profession. Correlations based on expectation-action chain of events should be developed by periodically measuring how often intent and

  18. Radiologic reports : attitudes, preferred type, and opinion of referring physicians

    International Nuclear Information System (INIS)

    Kim, Won Young; Hwang, Seong Su; Ahn, Myeong Im and others

    2001-01-01

    To determine referring physicians' general attitudes, preferred reporting types, and opinions on radiologic reports. A survey questionnaire was distributed to the 315 staff and residents of four university hospitals with 400 to 800 beds, and a total of 228 physicians responded. The questionnaire aimed to determine of the general attitude of referring physicians to radiologic reports, the type of report they preferred, and other opinions and suggestions. The responses elicited, as well as discrepancies among residents, staff, internist, and surgeons, were analyzed. Most referring physicians replied that they read an entire report regardless of its length, and the second majority read the conclusion first and then the remainder of the report only if clarification was required. With regard to report length, physicians answered that reports describing the findings of conventional radiography were often too short, while those dealing with MRI were verbose. The majority experienced occasional confusion when reading a report, the major cause being grammatical errors and incomprehensible sentence structure. When confused, most physicians consulted the radiologist ; staff showed a greater inclination than residents to pursue this option. Most physicians preferred brief phrases or telegraphic-style sentences to a style which stressed completeness and detail, a preference which was statistically higher among residents than staff. Whereas physicians favored a brief radiologic report in cases of normal radiologic findings, conventional radiologic studies or no clinical findings, they wished to see a more detailed report in cases of abnormal radiologic findings, specific radiologic studies (special radiographs, US, CT, or MRI), or positive clinical findings. This need for more detail was expressed more frequently by internists than by surgeons. If implemented, the results of this study can be expected to enhance the quality and comprehensibility of radiologic reports, and may

  19. Environmental factors associated with physician's engagement in communication activities.

    Science.gov (United States)

    Mazurenko, Olena; Hearld, Larry R

    2015-01-01

    Communication between patients and providers is a crucial component of effective care coordination and is associated with a number of desired patient and provider outcomes. Despite these benefits, physician-patient and physician-physician communication occurs infrequently. The purpose of this study was to examine the relationship between a medical practice's external environment and physician engagement in communication activities. This was a cross-sectional examination of 4,299 U.S. physicians' self-reported engagement in communication activities. Communication was operationalized as physician's time spent on communication with patients and other providers during a typical work day. The explanatory variables were measures of environmental complexity, dynamism, and munificence. Data sources were the Health Tracking Physician Survey, the Area Resource File database, and the Dartmouth Atlas. Binary logistic regression was used to estimate the association between the environmental factors and physician engagement in communication activities. Several environmental factors, including per capita income (odds ratio range, 1.17-1.38), urban location (odds ratio range, 1.08-1.45), fluctuations in Health Maintenance Organization penetration (odds ratio range, 3.47-13.22), poverty (odds ratio range, 0.80-0.97) and population rates (odds ratio range, 1.01-1.02), and the presence of a malpractice crisis (odds ratio range, 0.22-0.43), were significantly associated with communication. Certain aspects of a physician's external environment are associated with different modes of communication with different recipients (patients and providers). This knowledge can be used by health care managers and policy makers who strive to improve communication between different stakeholders within the health care system (e.g., patient and providers).

  20. Professional Satisfaction and the Career Plans of US Physicians.

    Science.gov (United States)

    Sinsky, Christine A; Dyrbye, Lotte N; West, Colin P; Satele, Daniel; Tutty, Michael; Shanafelt, Tait D

    2017-11-01

    To evaluate the relationship between burnout, satisfaction with electronic health records and work-life integration, and the career plans of US physicians. Physicians across all specialties in the United States were surveyed between August 28, 2014, and October 6, 2014. Physicians provided information regarding the likelihood of reducing clinical hours in the next 12 months and the likelihood of leaving current practice within the next 24 months. Of 35,922 physicians contacted, 6880 (19.2%) returned surveys. Of the 6695 physicians in clinical practice at the time of the survey (97.3%), 1275 of the 6452 who responded (19.8%) reported it was likely or definite that they would reduce clinical work hours in the next 12 months, and 1726 of the 6496 who responded (26.6%) indicated it was likely or definite that they would leave their current practice in the next 2 years. Of the latter group, 126 (1.9% of the 6695 physicians in clinical practice at the time of the survey) indicated that they planned to leave practice altogether and pursue a different career. Burnout (odds ratio [OR], 1.81; 95% CI, 1.49-2.19; Pwork-life integration (OR, 1.65; 95% CI, 1.27-2.14; Pwork hours and leave current practice. Nearly 1 in 5 US physicians intend to reduce clinical work hours in the next year, and roughly 1 in 50 intend to leave medicine altogether in the next 2 years to pursue a different career. If physicians follow through on these intentions, it could profoundly worsen the projected shortage of US physicians. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.