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Yılmaz S, Koyuncu Aydın S. Why is Turkey losing its doctors? A cross-sectional study on the primary complaints of Turkish doctors. Heliyon 2023; 9:e19882. [PMID: 37809803 PMCID: PMC10559269 DOI: 10.1016/j.heliyon.2023.e19882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
In 2022, Turkey encountered the formidable task of addressing an unprecedented loss of medical doctors and seeking remedies for potential issues within the healthcare system. This study set out to explore the inclination of 402 actively practicing Turkish doctors to depart from Turkey, assess the socio-demographic and socio-economic factors influencing this trend, and establish the hierarchy of raised concerns among doctors. Employing a cross-sectional and analytical approach, the study drew comparisons between doctors' demographic characteristics and the significance of their grievances, while also examining the correlation between the importance of complaints and the desire to remain in Turkey. The doctors' primary complaints encompassed financial challenges, instances of violence in the healthcare sector, and insufficient examination durations. The migration of doctors poses a substantial risk to healthcare accessibility, public health, and the sustainability of Turkey's healthcare delivery capacity. To mitigate this risk and curb doctor migration, corrective measures must be implemented to improve working conditions. Additionally, there is a need for further scientific research focusing on doctors' concerns, particularly in developing countries like Turkey, to expand the current body of literature on this subject.
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Affiliation(s)
- Salim Yılmaz
- Istanbul Arel University, Faculty of Health Sciences, Assistant Professor at Health Management Department, Istanbul, Turkiye
| | - Seher Koyuncu Aydın
- Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital, Research Assistant at Gynecology and Obstetrics, Istanbul, Turkiye
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Jayroe H, Weaver L, Velazquez G, Nelson P, Jennings W, Henning N, Edmonds J, Nsa W, Zamor K, Kempe K. Vascular Surgery Training Positions and Applicant 10-Year Trends with Consideration for Further Expansion. Ann Vasc Surg 2023; 95:291-296. [PMID: 37247836 DOI: 10.1016/j.avsg.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND There is a significant shortage of vascular surgeons in the United States and projections for these practicing surgical specialists continue to worsen. Annual appraisal of our workforce recruitment and growth is imperative. MATERIALS AND METHODS Retrospective data were analyzed using the National Resident Matching Program from 2012-2022 applicant appointment years (specialty code for vascular surgery 450). Simple linear trend analysis was performed for the number of positions available and the number of applicants, stratified by fellowship or residency. RESULTS Over the 10-year study period, the total vascular surgery trainee positions expanded from 161 to 202. Integrated residency positions increased (41 positions in 2012 vs. 84 in 2022) while available fellowship positions remained stagnant (120 in 2012 vs. 118 in 2022). Total applicants rose as well, from 213 to 311. In 2022, unmatched applicants have increased for both paradigms (25 fellowship and 84 residency applicants) and 100% of programs filled. On average, the number of residency positions offered increased by 4 each year (P < 0.0001) and the number of fellowship positions increased by 0.5 each year (P = 0.1617). The number of integrated residency applicants increased by approximately 9 per year (P = 0.001), while the number of fellowships applicants increased by approximately 1.5 per year (P = 0.121). CONCLUSIONS Applicants for both vascular tracks have increased since 2012 indicating successful recruitment; however, all 2022 programs filled, leaving many applicants unmatched. Residency positions have continued to expand while fellowship positions have not. With the demonstrated surge among applicants, the disproportionate lack of increasing training positions, and the existing shortage of vascular surgeons, there is an urgency to meet the increasing demand. A concerted effort should be made toward adding additional residency and fellowship positions where feasible.
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Affiliation(s)
- Hannah Jayroe
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Libby Weaver
- Division of Vascular and Endovascular Surgery, School of Medicine, University of Virginia, Charlottesville, VA
| | - Gabriela Velazquez
- Department of Vascular and Endovascular Surgery, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Peter Nelson
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - William Jennings
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Nolan Henning
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Joseph Edmonds
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Wato Nsa
- Department of Medical Informatics Tulsa, The University of Oklahoma Health Sciences Center, School of Community Medicine, Tulsa, OK
| | - Kimberly Zamor
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Kelly Kempe
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.
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Kirshteyn G, Golan R, Gilchrist IC, Cohen MG. Medical Malpractice Lawsuits Involving Percutaneous Coronary and Peripheral Intervention. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100975. [PMID: 39132393 PMCID: PMC11307492 DOI: 10.1016/j.jscai.2023.100975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 08/13/2024]
Abstract
Background Malpractice lawsuits following percutaneous coronary and peripheral interventions are not uncommon. Understanding the most common causes of medical legal action can inform clinicians and prevent future injury and litigation. Methods LexisNexis is a legal database that compiles all publicly available court records for state and federal jury verdicts and settlements in the United States. We analyzed LexisNexis for malpractice cases involving percutaneous coronary and peripheral interventions between January 1, 2005 and December 31, 2020. Results We found a total of 89 cases over the studied period, of which 55 cases were coronary interventions, 18 cases were peripheral interventions, and 16 cases did not specify the vessel location. Procedural error was alleged in 44 (49.4%) cases, complications in 42 (47.2%) cases, failure to monitor in 22 (24.7%) cases, failure to properly treat in 15 (16.9%) cases, incorrect treatment in 15 (16.9%) cases, failure to refer in 10 (11.2%) cases, lack of informed consent in 9 (10.1%) cases, and delay of intervention in 3 (3.4%) cases. The most common procedural error was vessel perforation (34.1%). Death was the most prevalent precipitating medical outcome of the cases (n = 41, 46.1%). Litigation resolution favored the defendant in 43 (48.3%) cases, the plaintiff in 13 (14.6%) cases, and a settlement was reached in 33 (37.1%) cases. Conclusions Awareness of the most common causes of litigations among interventional cardiologists and vascular specialists may prevent future legal actions and promote implementations of processes to improve patient care. Our results suggest the importance of attentive patient care before, during, and after percutaneous coronary and peripheral interventions. Procedural expectations and risks should be meticulously discussed with patients and families.
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Affiliation(s)
| | - Roei Golan
- Florida State University College of Medicine, Tallahassee, Florida
| | - Ian C. Gilchrist
- Cardiology Division, Department of Medicine, Pennsylvania State Heart and Vascular Institute, Hershey, Pennsylvania
| | - Mauricio G. Cohen
- Heart and Vascular Institute, Cleveland Clinic Florida, Weston, Florida
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Sen I, Choudhry A, Cherukuri SK, Mendes BC, Colglazier JJ, Shuja F, DeMartino RR, Rasmussen TE, Kalra M. An Analysis of Malpractice Litigation of Vascular Surgeons in Cases Involving Aortic Pathologies. Vasc Endovascular Surg 2023; 57:350-356. [PMID: 36537051 DOI: 10.1177/15385744221146389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The aim of this study was to analyze malpractice claims for aortic pathologies and to assess if there has been a change in rate of malpractice lawsuits with evolution of endovascular therapy. METHODS Malpractice lawsuits were individually screened and compiled from the Westlaw database from 2000 to 2017 through use of relevant search terms. Data were collected of allegations, diagnoses, and outcomes of each case and compared. RESULTS 268 unique cases were included in this study, with aneurysms (54%, n = 145) and dissection (35%, n = 94) making up the majority. There was a defendant verdict in 53% (n = 141), plaintiff verdict in 24% (n = 65), and settlements in 23% (n = 62) of lawsuits. Litigation was higher in the Midwest and Northeast. There was a gradual decline in litigation overall, however endovascular case numbers remained constant. There was negligible difference in the primary allegation underlying the litigation for various aortic pathologies, time to litigation and award between open and endovascular procedures. CONCLUSION The proportion of litigation for clinical negligence in endovascular cases amongst all vascular surgical lawsuits is increasing. As novel methods of endovascular therapy emerge, it is imperative that physicians remain vigilant to legal considerations to minimize malpractice risk.
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Affiliation(s)
- Indrani Sen
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Asad Choudhry
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sai Kiran Cherukuri
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bernardo C Mendes
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jill J Colglazier
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Fahad Shuja
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Randall R DeMartino
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Todd E Rasmussen
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Suresh NV, Shah VN, Fritz CG, Griff JR, Shah S, Watane A, Parikh RS, Nicolli EA. Medical malpractice litigation involving otolaryngology residents and fellows: A case-based 30-year review. World J Otorhinolaryngol 2022; 9:1-11. [DOI: 10.5319/wjo.v9.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 08/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Errors, misdiagnoses, and complications can occur while trainees are involved in patient care. Analysis of such events could reveal areas for improvement by residency and fellowship programs.
AIM To examine lawsuits tried at the state and federal level involving otolaryngology trainees.
METHODS The LexisNexis database, an online legal research database containing state and federal case records from across the United States, was retrospectively reviewed for malpractice cases involving otolaryngology residents or fellows from January 1, 1990 to December 31, 2020. Case data collected: Plaintiff/trainee/defendant characteristics, allegations, medical outcomes, and legal outcomes.
RESULTS Over the study period, 20 malpractice lawsuits involving otolaryngology trainees were identified. Plaintiffs raised numerous allegations including procedural error (n = 12, 25.5%), incorrect diagnosis and/or treatment (n = 8, 17.0%), and lack of knowledge of trainee involvement (n = 6, 12.8%). Nine cases (45%) had verdicts in favor of the plaintiff, whereas 5 cases (25%) had verdicts in favor of the defense. Six cases (30%) ended in a settlement. Awards to plaintiffs were heterogenous, with a median of $617,500 (range $32K-17M) for settled cases and verdicts favoring plaintiffs.
CONCLUSION The findings enclosed herein represent the first published analysis of trainee involvement in otolaryngology malpractice cases held at the state/federal level. Otolaryngology trainees can be involved in lawsuits for both procedural and nonprocedural events. This study highlights the importance of education specifically in the domains of procedural errors, informed consent, proper diagnosis/management, and clear communication within patient care teams. Training programs should incorporate these study findings into effective simulation courses and didactic sessions. Educating trainees about common pitfalls holds the promise of decreasing healthcare systems costs, reducing trainee burnout, and, most importantly, benefiting patients.
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Affiliation(s)
- Neeraj V Suresh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19107, United States
| | - Viraj N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Christian G Fritz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19107, United States
| | - Jessica R Griff
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Shreni Shah
- Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
| | - Arjun Watane
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT 06510, United States
| | - Ravi S Parikh
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Elizabeth A Nicolli
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, United States
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Impact of "Defensive Medicine" On the Costs of Diabetes and Associated Conditions. Ann Vasc Surg 2022; 87:231-236. [PMID: 35595208 DOI: 10.1016/j.avsg.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Geographic variation in healthcare spending is typically attributed to differences in patient health status and provider practice patterns. While medicolegal considerations (i.e., "defensive medicine") anecdotally impact healthcare spending, this phenomenon is difficult to measure. The purpose of this study was to explore the association between the medicolegal environment and Medicare costs for diabetes and associated conditions of interest to vascular surgeons. Specifically, we hypothesized that an adverse medicolegal environment is associated with higher per-capita Medicare costs for diabetic patients. METHODS Medicare data including the most recent (2018) Medicare Geographic Variation Public Use Files and Chronic Conditions Data Files were linked to National Practitioner Database (NPDB) files from the preceding 5 years (2013-2017), in addition to US Census data and AMA workforce statistics. State-level medicolegal environment was characterized by K-means clustering across a panel of metrics related to malpractice payment magnitude and prevalence. Per-capita Medicare spending for diabetes was compared across 5 distinct medicolegal environments. Costs were standardized and risk-adjusted to account for known geographic variation in healthcare costs and patient population. Analysis of variance (ANOVA) was applied to unadjusted data, followed by multivariate regression modeling. Readmissions rates, per-capita imaging studies, per-capita tests, per-capita procedures, and lower extremity amputation rates were compared between the least litigious quintile from the K-means clustering and the two most litigious quintiles. RESULTS Median (IQR) unadjusted Medicare per-capita expenditure on diabetic patients was $15,963 ($14,885 to $17,673), ranging from $13,762 (Iowa) to $21,865 (D.C.). 1.6-fold variation persisted after payment standardization. Cluster analysis based on malpractice-related variables yields 5 distinct medicolegal environments, based on litigation frequency and malpractice payment amounts. Per-capita spending on diabetes varied, ranging from $15,799 in states with low payments and infrequent litigation to $18,838 in states with the most adverse medicolegal environment (P<.05). After cost standardization and risk adjustment with multiple linear regression, malpractice claim prevalence (per 100 physicians) remained an independent predictor of states with the highest DM spending (p=0.022)[Table1]. Moreover, diabetic patients in states with adverse medicolegal environments had more procedures, imaging studies, and readmissions (p<.05 for all) but did not have significant differences in amputation rates compared to less litigious states. CONCLUSION An adverse medicolegal environment is independently associated with higher healthcare costs but does not result in improved outcome (i.e. amputation rate) for diabetic Medicare beneficiaries. Across states, a 1% increase in lawsuits/100 physicians was associated with a >10% increase in risk-adjusted standardized per-capita costs. These findings demonstrate the potential contribution of "defensive medicine" to variation in healthcare utilization and spending in a population of interest to vascular surgeons.
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Abstract
The possibility of a medical negligence claim lies at the back of many doctors' minds. But which specialties see the greatest and fewest claims, and what are the potential costs to the NHS of a successful claim? In their article, Dr Lane et al. analyse 10 years' NHS litigation data, broken down by specialty, number of claims, and the attendant cost of those claims which were successful. Litigation in the 'post Montgomery' era is considered along with some of the common factors which may lead to a patient or their family taking legal action.
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