Abstract
Background
Limited information exists regarding how medical students’ specialty interests evolve throughout medical school, particularly interest in surgical versus non-surgical specialties. ...Our objective was to identify medical students’ specialty interests before and after medical school and the most important curricular and non-curricular factors that shaped their specialty choice.
Methods
An online 22-question voluntary, anonymized survey was designed to assess specialty interests and factors impacting specialty choice at a single medical school in the United States. The study was pilot-tested with focus groups. The final questionnaire was distributed to final-year medical students from the Classes of 2020 and 2021. Responses were measured on a 5-point Likert scale (1 = strong negative impact to 5 = strong positive impact).
Results
102 of 184 students (55%) from Class of 2020 and 85 of 174 students (49%) from Class of 2021 participated. Of 187 respondents, the majority (60%) decided on their specialty during third year. 74 of 147 students (50%) pursued a specialty among their initial specialty interests. Students with initial surgical interests were significantly (p < 0.001) less likely to choose surgical specialties (42%) compared to students with initial non-surgical interests choosing non-surgical specialties (79%). Pre-clinical years (3.67 ± 0.96) were perceived to have a significantly (p < 0.001) less positive impact on specialty interests and choice compared to clinical years. Among pre-clinical factors, physician shadowing (3.80 ± 0.83) was perceived to have the significantly (p < 0.001) greatest positive impact. During clinicals, 34% of respondents indicated that order of clerkships impacted specialty choice. 112 of 171 respondents (65%) indicated that mentorship impacted specialty choice. Physicians in the chosen specialty were perceived to have the strongest impact (4.67 ± 0.49). 65 of 171 respondents (38%) indicated that peers impacted specialty choice with classmates (3.98 ± 0.87) and near-peers (3.83 ± 0.74) perceived to have a positive impact.
Conclusions
Specialty interests changed during medical school for a significant portion of students (50%). Those with initial surgical interests were more likely to change their specialty interests. Pre-clinicals were reported to have less impact on specialty choice compared to clinicals. Implementing factors such as shadowing and physician/peer mentorship, which may positively impact specialty choice, into pre-clinical curricula warrants further investigation.
Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited ...information is available for the economic burden of vertigo and dizziness across various health care settings.
Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities.
A retrospective analysis of data from the Medical Expenditures Panel Survey (2007-2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated.
Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007-2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion.
Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Elucidating the relationship between vestibular aqueduct size and hearing loss progression may inform the prognosis and counseling of patients who have an enlarged vestibular aqueduct (EVA).
To ...examine the association between vestibular aqueduct size and repeated measures of hearing loss.
For this retrospective medical record review, 52 patients with a diagnosis of hearing loss and radiologic diagnosis of EVA according to the Valvassori criterion were included. All available speech reception threshold and word recognition score data was retrieved; mixed-effects models were constructed where vestibular aqueduct size, age at diagnosis of hearing loss, and time since diagnosis of hearing loss were used to predict repeated measures of hearing ability. This study was performed at an academic tertiary care center.
Variable vestibular aqueduct size, age at first audiogram, length of time after first audiogram.
Speech reception threshold (dB) and word recognition score (%) during routine audiogram.
Overall, 52 patients were identified (29 females 56% and 23 males 44%; median age at all recorded audiograms, 7.8 years) with a total of 74 ears affected by EVA. Median (range) vestibular aqueduct size was 2.15 (1.5-5.9) mm, and a median (range) of 5 (1-18) tests were available for each patient. Each millimeter increase in vestibular aqueduct size above 1.5 mm was associated with an increase of 17.5 dB in speech reception threshold (95% CI, 7.2 to 27.9 dB) and a decrease of 21% in word recognition score (95% CI, -33.3 to -8.0 dB). For each extra year after a patient's first audiogram, there was an increase of 1.5 dB in speech recognition threshold (95% CI, 0.22 to 3.0 dB) and a decrease of 1.7% in word recognition score (95% CI, -3.08 to -0.22 dB).
Hearing loss in patients with an EVA is likely influenced by vestibular aqueduct midpoint width. When considering hearing loss prognosis, vestibular aqueduct midpoint width may be useful for the clinician who counsels patients affected by EVA.
The aim of this study was to evaluate the financial trends in Medicare reimbursement rates for the most billed procedures at a single institution from 2000 to 2020 within pediatric otolaryngology.
...Retrospective data analysis.
United States.
The most billed surgical and in-office procedures in pediatric otolaryngology at our institution were identified in the Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services to extract reimbursement data for each CPT code (Current Procedural Terminology). Monetary data were adjusted for inflation to 2020 US dollars per the changes to the consumer price index. Mean annual and total percentage changes in reimbursement were calculated by the adjusted values for all included procedures (N = 25).
From 2000 to 2020, without adjusting for inflation, reimbursement for the most billed procedures increased by 10.9%, while the allocated relative value unit per procedure increased by 15.4%. However, when adjusted for inflation, reimbursement for these procedures decreased by 27.5% over the study period.
The study findings identify a downward trend in reimbursement for the most billed procedures in pediatric otolaryngology at our institution. Given the low predominance of pediatric otolaryngology codes within Medicare reimbursement, these codes are rarely reviewed for accurate revaluation. It is imperative that our professional society remain active and engaged within this process to ensure quality delivery of care to our patients.
Objective
The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades.
Methods
This analysis used CMS' Physician Fee Schedule (PFS) ...Look‐Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office‐based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for “facilities” and global reimbursement for “non‐facilities”. The annual reimbursement rate for each procedure was averaged across all localities and adjusted for inflation. The compound annual growth rate (CAGR) of each procedure's reimbursement was determined, and a weighted average of the CAGR for each group of procedures was calculated using each procedure's 2020 Medicare Part B utilization.
Results
Reimbursement for laryngology procedure (CPT) codes has declined over the last two decades. In facilities, the weighted average CAGR for office‐based procedures was −2.0%, for airway procedures was −2.2%, for voice disorders procedures was −1.4%, and for dysphagia procedures was −1.7%. In non‐facilities, the weighted average CAGR for office‐based procedures was −0.9%. The procedures in the other procedure groups did not have a corresponding non‐facility reimbursement rate.
Conclusion
Like other otolaryngology subspecialties, inflation‐adjusted reimbursements for common laryngology procedures have decreased substantially over the past two decades. Because of the large number of physician participants and patient enrollees in the Medicare programs, increased awareness and further research into the implications of these trends on patient care is necessary to ensure quality in the delivery of laryngology care.
Level of Evidence
NA Laryngoscope, 134:247–256, 2024
Medicare reimbursement has decreased for commonly billed laryngology procedures over the last two decades. Decreasing reimbursement can impact the delivery of quality otolaryngology care, so there should be further research and advocacy among otolaryngologists to improve physician reimbursement and ensure sustainability and growth of the specialty.
Acute otitis media (AOM) is an acute infection of the middle ear and, depending on the age of the child, the certainty of diagnosis, and the severity of symptoms, should be either observed closely or ...treated (with high-dose amoxicillin, if not allergic). Host-related risk factors such as age, sex, cleft palate, or genetic predisposition or environmental risk factors such as seasonality, day care attendance, or tobacco smoke exposure may contribute to recurrent AOM (RAOM) episodes. Tympanostomy tubes are recommended in children with RAOM and an abnormal ear examination at the time of the clinic evaluation.
Objectives Individuals with angioedema (AE) are at high risk for airway compromise and often require endotracheal intubation. Patient factors predisposing one to airway compromise are not well ...described. The objective of this study is to examine whether substance use disorder (SUD) in patients with AE is associated with need for airway intervention. Methods This population‐based retrospective cohort study compared AE patients with SUD versus propensity‐matched control groups. Outcomes were hospitalization, intubation, and tracheotomy. Using the TriNetX National Database, this study included 28,931 patients with SUD and 117,509 patients without SUD who presented with AE. Results Among patients with AE, those with each subtype of SUD (alcohol, cannabis, cocaine, tobacco, and opioids) were found to have higher risk of severe AE compared to propensity‐matched non‐SUD cohorts. Rate of hospitalization after cohort matching ranged from 20.4% for tobacco use disorder to 30.4% for cocaine use disorder, all significantly higher than the 8.0% in a population without SUD. Each SUD subtype was associated with a higher rate of intubation compared with matched non‐SUD groups, with cannabis use disorder having the highest relative risk (RR) of 3.67 (95% CI: 2.69–5.02). Tobacco (RR = 2.45, 95% CI: 1.79–3.34) and alcohol (RR = 2.82, 95% CI: 1.73–4.58) use disorders were both associated with significantly higher risk of tracheotomy. Conclusion These data suggest that patients with SUD, regardless of subtype, and after propensity matching for demographics and comorbidities are at higher risk for adverse outcomes when presenting with AE. This study highlights clinically relevant predictors of airway compromise. Level of Evidence Level 3 Laryngoscope , 2024
To investigate interventions used in treating obstructive sleep apnea in neonates and infants and to report their efficacies.
Retrospective medical record review.
Tertiary care children's hospital.
...Neonates and infants aged 0 to 12 months at the time of obstructive sleep apnea diagnosis by polysomnography.
Demographic data, comorbidities, polysomnography data, and intervention data.
In total, 126 patients (86 68.3% male and 40 31.7% female) were included in the study. The most common interventions (and the mean age at the time of intervention) were anti-gastroesophageal reflux disease treatment (88 patients 69.8% at age 7 months), observation (33 patients 26.2% at age 6 months), supplemental oxygen (31 patients 24.6% at age 4 months), adenoidectomy (30 patients 23.8% at age 15 months), other surgical (25 patients 19.8% at age 7 months), continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP) (18 patients 14.3% at age 16 months), supraglottoplasty (11 patients 8.7% at age 6 months), tonsillectomy and adenoidectomy (9 patients 7.1% at age 24 months), tracheostomy (7 patients 5.6% at age 10 months), and other nonsurgical (7 patients 5.6% at age 15 months). Among neonates and infants, nonsurgical interventions were performed in most cases, although those aged 0 to 3 months underwent more surgical interventions (19.7%) than those aged older than 3 to 9 months (11.7%). The mean objective improvement, measured as a percentage decrease in preintervention to postintervention apnea-hypopnea index, was greatest in neonates and infants receiving CPAP/BiPAP, followed by those undergoing tracheostomy.
Anti-gastroesophageal reflux disease treatment is the most common intervention in each age group. Although adenoidectomy is the most common surgical intervention overall, the prevalence increases with age. Supraglottoplasty is the most common surgical intervention in neonates and infants aged 0 to 3 months and offers the greatest objective improvement in this age group. Overall, the use of CPAP/BiPAP is associated with the greatest objective improvement.
The 2019 novel coronavirus (COVID-19) is disproportionately impacting older individuals and healthcare workers. Otolaryngologists are especially susceptible with the elevated risk of aerosolization ...and corresponding high viral loads. This study utilizes a geospatial analysis to illustrate the comparative risks of older otolaryngologists across the United States during the COVID-19 pandemic.
Demographic and state population data were extracted from the State Physician Workforce Reports published by the AAMC for the year 2018. A geospatial heat map of the United States was then constructed to illustrate the location of COVID-19 confirmed case counts and the distributions of ENTs over 60 years for each state.
In 2018, out of a total of 9578 practicing U.S. ENT surgeons, 3081 were older than 60 years (32.2%). The states with the highest proportion of ENTs over 60 were Maine, Delaware, Hawaii, and Louisiana. The states with the highest ratios of confirmed COVID-19 cases to the number of total ENTs over 60 were New York, New Jersey, Massachusetts, and Michigan.
Based on our models, New York, New Jersey, Massachusetts, and Michigan represent states where older ENTs may be the most susceptible to developing severe complications from nosocomial transmission of COVID-19 due to a combination of high COVID-19 case volumes and a high proportion of ENTs over 60 years.
Objective
To observe trends in practice consolidation within otolaryngology by analyzing changes in size and geographic distribution of practices within the United States from 2014 to 2021.
Study ...Design
Retrospective analysis based on the Physician Compare National Database from the US Centers for Medicare and Medicaid Services.
Setting
United States.
Methods
Annual files from the Physician Compare National Database between 2014 and 2021 were filtered for all providers that listed “otolaryngology” as their primary specialty. Organization affiliations were sorted by size of practice and categorized into quantiles (1 or 2 providers, 3-9, 10-24, 25-49, and ≥50). Both the number of practices and the number of surgeons within a practice were collected annually for each quantile. Providers were also stratified geographically within the 9 US Census Bureau divisions. Chi-square analysis was conducted to test significance for the change in surgeon and practice distributions between 2014 and 2021.
Results
Over the study period, the number of active otolaryngology providers increased from 7763 to 9150, while the number of practices fell from 3584 to 3152 in that time span. Practices with just 1 or 2 otolaryngology providers accounted for 80.2% of all practices in 2014 and fell to 73.1% in 2021. Similar trends were observed at the individual provider level. Regional analysis revealed that New England had the largest percentage decrease in otolaryngologists employed by practices of 1 or 2 active providers at 45.7% and the Mountain region had the lowest percentage decrease at 17.4%.
Conclusion
The otolaryngology practice marketplace has demonstrated a global trend toward practice consolidation.
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