Doctors of empire Kim, Hoi-eun
Doctors of empire,
2014, 20140723, 2014, 2015-03-18
eBook
In Doctors of Empire, Hoi-eun Kim recounts the story of the almost 1,200 Japanese medical students who rushed to German universities to learn cutting-edge knowledge from the world leaders in ...medicine, and of the dozen German physicians who were invited to Japan to transform the country's medical institutions and education.
8 Questions with Dr. Puliafito Albini, Thomas A.; Puliafito, Carmen A.
Ophthalmic surgery, lasers & imaging,
04/2016, Letnik:
47, Številka:
4
Journal Article
Recenzirano
Physician Thomas A. Albini is interviewed. He discusses, among other things, his greatest influence.
ABSTRACT
BACKGROUND
General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable.
OBJECTIVE
We aimed to assess academic GIM worklife and determine remediable ...predictors of stress and burnout.
DESIGN
We conducted an email survey.
PARTICIPANTS
Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated.
MAIN MEASURES
A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses.
KEY RESULTS
Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10–56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders’ values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all
p
< 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %,
p
< 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both
p
< 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education.
CONCLUSIONS
While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.
For nearly thirty years, anthropologist and physician Paul Farmer has traveled to some of the most impoverished places on earth to bring comfort and the best possible medical care to the poorest of ...the poor. Driven by his stated intent to "make human rights substantial," Farmer has treated patients-and worked to address the root causes of their disease-in Haiti, Boston, Peru, Rwanda, and elsewhere in the developing world. In 1987, with several colleagues, he founded Partners In Health to provide a preferential option for the poor in health care. Throughout his career, Farmer has written eloquently and extensively on these efforts.Partner to the Poorcollects his writings from 1988 to 2009 on anthropology, epidemiology, health care for the global poor, and international public health policy, providing a broad overview of his work. It illuminates the depth and impact of Farmer's contributions and demonstrates how, over time, this unassuming and dedicated doctor has fundamentally changed the way we think about health, international aid, and social justice. A portion of the proceeds from the sale of this book will be donated to Partners In Health.
To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured ...compensation model incorporating national benchmarks and clear standardized pay steps and increments.
All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary.
Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties.
A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.
The United States does not have enough doctors. Every year since the 1950s, internationally trained and osteopathic medical graduates have been needed to fill residency positions because there are ...too few American-trained MDs. However, these international and osteopathic graduates have to significantly outperform their American MD counterparts to have the same likelihood of getting a residency position. And when they do, they often end up in lower-prestige training programs, while American-trained MDs tend to occupy elite training positions. Some programs are even fully segregated, accepting exclusively U.S. medical graduates or non-U.S. medical graduates, depending on the program's prestige. How do international and osteopathic medical graduates end up so marginalized, and what allows U.S.-trained MDs to remain elite? Doctors' Orders offers a groundbreaking examination of the construction and consequences of status distinctions between physicians before, during, and after residency training. Tania M. Jenkins spent years observing and interviewing American, international, and osteopathic medical residents in two hospitals to reveal the unspoken mechanisms that are taken for granted and that lead to hierarchies among supposed equals. She finds that the United States does not need formal policies to prioritize American-trained MDs. By relying on a system of informal beliefs and practices that equate status with merit and eclipse structural disadvantages, the profession convinces international and osteopathic graduates to participate in a system that subordinates them to American-trained MDs. Offering a rare ethnographic look at the inner workings of an elite profession, Doctors' Orders sheds new light on the formation of informal status hierarchies and their significance for both doctors and patients.
Nowadays, patients are seeking physician information more frequently via the internet. Physician-rating websites (PRWs) have been recognized as the most convenient way to gain insight and detailed ...information about specific physicians before receiving consultation. However, little is known about how the information provided on PRWs may affect patients' decisions to seek medical advice.
This study aimed to examine whether the physicians' online efforts and their reputation have a relationship with patients' choice of physician on PRWs.
A model, based on social exchange theory, was developed to analyze the factors associated with the number of online patients. A 3-wave data collection exercise, covering 4037 physicians on China's Good Doctor website, was conducted during the months of February, April, and June 2017. Increases in consultation in a 60-day period were used as the dependent variable, whereas 2 series of data were analyzed using linear regression modeling. The fixed-effect model was used to analyze the 3-wave data.
The adjusted R
value in the linear regression models were 0.28 and 0.27, whereas in the fixed-effect model, it was .30. Both the linear regression and fixed-effect models yielded a good fit. A positive effect of physicians' effort on the aggregated number of online patients was identified in all models (R
=0.30 and R
=0.37 in 2 regression models; R
=0.23 in fixed effect model; P<.001). The proxies of physicians' reputations indicated different results, with total number of page views of physicians' homepages (R
=0.43 and R
=0.46; R
=0.16; P<.001) and number of votes received (R
=0.33 and R
=0.27; R
=0.43; P<.001) being seen as positive. Virtual gifts were not significant in all models, whereas thank-you messages were only significant in the fixed-effect model (R
=0.11; P=.02). The effort made by physicians online is positively associated with their aggregated number of patients consulted, whereas the effect of a physician's reputation remains uncertain. The control effect of a physician's title and hospital's level was not significant in all linear regressions.
Both the effort and reputation of physicians online contribute to the increased number of online patients' consultation; however, the influence of a physician's reputation varies. This may imply that physicians' online effort and reputation are critical in attracting patients and that strategic manipulation of physician profiles is worthy of study. Practical insights are also discussed.
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