The ethical context of healthcare reform

The purpose of this article is to provide a summary discussion of healthcare reform, frame it in an ethical context, and present the necessity for oncology nurses to consider the important ethical considerations that accompany any decisions for change. The resulting implications for oncology nursing are presented with recommendations that the issues of healthcare reform be incorporated into oncology nursing research, clinical practice, administration, and education. All components of the profession have a contribution to make as proposals for change move from public debate to the enactment of national initiatives.

Practice satisfaction and dissatisfaction in general internal medicine departments of large multispecialty clinics

General internal medicine (GIM) physician practice satisfaction and dissatisfaction in large multispecialty clinics were assessed utilizing a survey designed to elicit physician perceptions of practice. 420 GIM physicians in 22 multispecialty clinics were contacted, and 168 participated in the survey. The most significant positive components of practice satisfaction were patient interactions and favorable physician colleague interactions. The prominent negative components were paperwork hassles and perceived "second-class" physician status. Coping strategies were varied and included increased political involvement, career change, and withdrawal via depression.

Current and future perspectives regarding the framework for nurse anesthesia education as a freestanding school

Nurse anesthesia educational programs can be conducted in a variety of frameworks. The program of the Minneapolis School of Anesthesia is an example of a freestanding program. The advantages and disadvantages of such a program are explored, as is the funding for such a program.

New Oslerians and real Flexnerians: the response to threatened professional autonomy

As federal governmental involvement in U.S. health care had become a fact in the mid-1960s, a significant number of contributors to The Journal of the American Medical Association (JAMA) had recommended educational reforms to save an autonomous profession. In the late 1970s, demands for additional professional reforms began to appear in JAMA and The Journal of Medical Education (JME), particularly from contributors who perceived threats to professional autonomy from corporate medicine. The New Oslerian reform agenda is an application of the "humanizing" movement to the clinical phase of medical education. In its most restricted formulation (the inherent ethic argument), proponents simply urged clinicians to permit every student's inborn sense of moral duty to blossom on the wards. Others argued that Sir William Osler's legacy was more complex and involved systematic instruction, especially in ethics, at the bedside (the service ethic argument). Real Flexnerian reforms were based on an assumption that unintended distortions in Abraham Flexner's reform measures had eventuated in stultifying and counterproductive teaching of the biomedical model. Consequently, medical education should be altered to train future physicians in what Flexner had really intended--the capacity to think and problem-solve in a scientific manner. In time, many reformers emphasized the complementarity of Real Flexnerian and New Oslerian curricular proposals. The most comprehensive proposal to date, GPEP (General Professional Education of the Physician), makes a strong case that implementation of these old, turn-of-the-century reform proposals would make physicians in the 21st century well-rounded and competent. But GPEP's proposed changes in medical education are inadequate because the recommendations do little to prepare future physicians to contend with the corporate context in which most of them will be practicing.

A consolidated approach to physician/hospital bonding--Ramsey Clinic style

This article describes the results made by Ramsey Clinic during the second year following consolidation of the Clinic with a Hospital (St. Paul-Ramsey Medical Center); a medical education/research Foundation (Ramsey Foundation) into a public benefit corporation (Ramsey HealthCare, Inc.). Many issues inspired Ramsey Clinic to examine ways and means to stabilize its growth and development as a multi-specialty physician and dentist group practice in the highly competitive health care environment of Minneapolis-St. Paul, MN. Influencing the need to change were such elements as shrinking reimbursement for physicians from government and other third party payers; increasing malpractice and general liability premiums; as well as, escalating competition among area health care providers reflected by significant variations in charges for similar services and exclusivity agreements with HMO's and PPO's for select services. In the fall of 1987, Ramsey Clinic consummated its consolidation as a subsidiary member of Ramsey HealthCare, Inc., a public benefit corporation established by an Act of the Legislature of the State of Minnesota, 1986 Laws of Minnesota, Chapter 462. As a public benefit corporation, Ramsey HealthCare, Inc. was chartered to "engage in the provision and delivery of health care and related services." Ramsey Clinic serves as the physician organization for the corporation. An article appeared in the March/April 1989 issue of the Group Practice Journal titled "A Natural Partnership" which described the Ramsey approach and illustrated 1988 results following consolidation. Continued change has resulted in further integration of services among the subsidiaries with a focus on expense reduction, revenue enhancement and increased operating efficiencies. This article provides a longitudinal follow-up on operational amalgamations and 1989 results.