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Becker B. Primary Care: Its Pokemon Moment. Am J Med 2024; 137:577-581. [PMID: 38556037 DOI: 10.1016/j.amjmed.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
Primary care in the United States is undergoing bursts of evolution in response to health system stresses, changing demographics, and expansion of risk and value-based reimbursement structures. The impact of primary care remains substantive and associated with improved population health. However, the spectrum of services, the nature of the physicians involved and new ways of including the patient in her, or his own care suggests that a new definition of primary care be considered, and patient expectations be heeded and understood. Evolutionary bursts yield new traits and in primary care, they are spawning new care models with significant implications for general internal medicine, internal medicine/pediatrics trained individuals and medicine subspecialties given the focus of these models on Medicare Advantage. Ultimately, changes in reimbursement and creative incentives will be two factors among many that will solidify the next stage of primary care in the United States.
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Affiliation(s)
- Bryan Becker
- Department of Medicine, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, Tex.
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2
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Cardinaal EMM, Truijens J, Jeurissen PPT, Berden H. Use of business model potential in Dutch academic medical centres-A case study. PLoS One 2024; 19:e0297966. [PMID: 38489295 PMCID: PMC10942033 DOI: 10.1371/journal.pone.0297966] [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: 05/09/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024] Open
Abstract
Academic Medical Centres (AMCs) are large organisations with a complex structure due to various intertwined missions and (public) roles that can be conflicting. This complexity makes it difficult to adapt to changing circumstances. The literature points to the use of business models to address such challenges. A business model describes the resources, processes, and cost assumptions that an organisation makes in order to the delivery of a unique value proposition to a customer/patient. Do AMC business operations managers actually use business models to address challenges and operate in a way that enables AMCs to adapt to changing circumstances? This study explored whether the use of a business model is a starting point for bringing about change in AMC operations. A case study design was considered appropriate to explore the knowledge and experience of business models among business operations managers of Dutch AMCs. Through purposive sampling, participants were invited to participate in a questionnaire to provide in-depth and detailed information about the use of business models in AMCs. Our research showed that a business model can support the complex organisation of an AMC, but the design and use of business models varies. In general, respondents attribute more potential to the use of a business model than they experience in daily practice. The majority consider a business model to be suitable for bringing about change, but see it only sparingly used in their own AMC. This is the first study to provide some initial insights into the use of business models in Dutch AMCs. We can assume that improvements are possible in order to optimise the change potential of business models in AMCs worldwide. In order to successfully implement an innovative business model, the interpretation of the concept of a business model and the creation of a framework of preconditions should be taken into account. Healthcare providers, policy makers or researchers should explicitly identify the environment in which the model will operate. In particular, by identifying the level of readiness for change readiness at all levels of the organisation.
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Affiliation(s)
- Ester M. M. Cardinaal
- Operating Rooms, Anesthesiology, Pain and Palliative Medicine, Radboud Universitair Medisch Centrum, Nijmegen, The Netherlands
| | - Joey Truijens
- Radboud Universitair Medisch Centrum, Nijmegen, The Netherlands
| | | | - Hubert Berden
- Radboud Institute of Health Sciences (RIHS), Nijmegen, The Netherlands
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3
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Weaver MD, Barger LK, Sullivan JP, Quan SF, Robbins R, Landrigan CP, Czeisler CA. Public opinion of resident physician work hours in 2022. Sleep Health 2024; 10:S194-S200. [PMID: 37940477 DOI: 10.1016/j.sleh.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize public awareness and opinion regarding resident physician work hours in the United States. METHODS We conducted a nationally representative cross-sectional survey among adults in the United States. Demographic quota-based sampling was conducted by Qualtrics to match 2020 United States Census estimates of age, sex, race, and ethnicity. Descriptive statistics are presented. Hypothesis testing was conducted to identify characteristics associated with agreement with current resident physician work-hour policies. RESULTS 4763 adults in the United States participated in the study. 97.1% of the public believes that resident physicians should not work 24-hour shifts and 95.6% believe the current 80 hours resident work week is too long. 66.4% of the participants reported that the maximum shift duration should be 12 consecutive hours or fewer, including 22.9% who recommended a maximum shift length of 8 hours. Similarly, 66.4% reported that maximum weekly work hours should be 59 or fewer, including 24.9% who recommended a maximum of 40 weekly work hours. CONCLUSIONS Nearly all US adults disagree with current work-hour policies for resident physicians. Public opinion supports limiting shifts to no more than 12 consecutive hours and weekly work to no more than 60 hours, which is in sharp contrast to current regulations that permit of 28 hours shifts and 80 hours of work per week.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Moparthi KP, Javed H, Kumari M, Pavani P, Paladini A, Saleem A, Ram R, Varrassi G. Acute Care Surgery: Navigating Recent Developments, Protocols, and Challenges in the Comprehensive Management of Surgical Emergencies. Cureus 2024; 16:e52269. [PMID: 38352101 PMCID: PMC10864012 DOI: 10.7759/cureus.52269] [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: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Acute care surgery (ACS) is a crucial medical field that specifically deals with the rapid treatment of surgical emergencies. This investigation encompasses the most recent progress, procedures, and obstacles in ACS, utilizing various sources such as scholarly articles, clinical trials, and expert statements. The development of ACS as a specialized field is a significant area of concentration, particularly emphasizing its contribution to improving patient care. An examination is conducted on the efficacy of contemporary triage systems and prompt response mechanisms, specifically in diminishing the incidence of illness and death rates associated with illnesses such as trauma, acute appendicitis, and obstructed viscera. The emphasis is placed on the surgical protocols and principles that form the basis of ACS. Examining regional and international approaches provides insight into the distinctions and commonalities in surgical techniques. An assessment is conducted to determine the effects of the transition to minimally invasive procedures on patient outcomes, recuperation periods, and healthcare expenses. The assessment also examines the logistical obstacles that ACS encounters, such as resource allocation and managing diverse teams. The examination focuses on the delicate equilibrium between prompt decision-making and care grounded in evidence. It also evaluates the possible contribution of technical breakthroughs such as telemedicine and AI to improving patient care and overcoming current obstacles. The topic of training and education for surgeons in ACS is of utmost importance and requires careful consideration. The evaluation evaluates the sufficiency of existing educational frameworks and the necessity of specific training to equip surgeons for the requirements of ACS. This analysis explores the current discourse surrounding the standardization of ACS training, considering its potential ramifications for the future of surgical procedures. Exploring ethical and legal problems in ACS also includes situations when prompt decision-making may clash with patient autonomy and informed consent. The significance of proficient communication with patients and their families during emergency surgical scenarios is underscored, emphasizing the necessity for ethical awareness and interpersonal aptitude. The investigation of ACS demonstrates its dynamic character, signifying notable advancements while recognizing enduring obstacles. Continual research, interdisciplinary collaboration, and policy adjustments are necessary to improve ACS procedures. This thorough investigation offers valuable insights for professionals and researchers, facilitating future progress in managing surgical crises.
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Affiliation(s)
- Kiran Prasad Moparthi
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Herra Javed
- Graduate, Shifa College of Medicine, Islamabad, PAK
| | - Monika Kumari
- Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Peddi Pavani
- General Surgery, Kurnool Medical College, Andhra Pradesh, IND
| | | | - Ayesha Saleem
- General Surgery, Hayatabad Medical Complex (HMC), Peshawar , PAK
| | - Raja Ram
- Medicine, MedStar Washington Hospital Center, Washington, USA
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5
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Yuan CM, Young BY, Watson MA, Sussman AN. Programmed to Fail: The Decline of Protected Time for Training Program Administration. J Grad Med Educ 2023; 15:532-535. [PMID: 37781435 PMCID: PMC10539136 DOI: 10.4300/jgme-d-23-00263.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Affiliation(s)
- Christina M. Yuan
- Christina M. Yuan, MD, is Associate Program Director, Nephrology SVC, Walter Reed National Military Medical Center
| | - Brian Y. Young
- Brian Y. Young, MD, is Program Director, Division of Nephrology, University of California at Davis
| | - Maura A. Watson
- Maura A. Watson, DO, MPH, is Program Director, Nephrology SVC, Walter Reed National Military Medical Center; and
| | - Amy N. Sussman
- Amy N. Sussman, MD, is Program Director, Division of Nephrology, Department of Medicine, University of Arizona Health Sciences Center
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Wertheimer SM, Harris JA, Collins JC, Spiegel NH, Chien GW. Internally versus externally trained residents and fellows hired as attendings at a large integrated healthcare system: a 20-year retrospective study. HUMAN RESOURCES FOR HEALTH 2023; 21:58. [PMID: 37501097 PMCID: PMC10373339 DOI: 10.1186/s12960-023-00846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND There remains a question of whether graduates trained internally are different than those trained elsewhere. We examine the difference between physicians trained within our Graduate Medical Education (GME) programs versus physicians trained elsewhere. Our large integrated healthcare system is unique in addressing this objective due to its large physician labor hiring needs across different specialties of GME graduates. METHODS A retrospective review was performed from Jan 2000 to August 2020 of Kaiser Permanente Southern California (KPSC) physicians hired: KPSC GME trained versus non-KPSC GME trained. We examined five variables: retention, leadership (current or historical), physician relations cases, member appraisal of physician and provider services survey (MAPPS) scores, and rate of board certification. Chi-square test of proportions was used for comparison, p < 0.05 was significant. RESULTS From Jan 2000 to August 2020, 2940 residents and fellows graduated from KPSC GME programs, of which 1127 (38%) were hired on at KPSC as full time attendings. Across all five metrics (Retention 82% vs 76% (p = < 0.01), Leadership [current 13% vs 10% (p = < 0.01)or historical 17% vs 14% (p = 0.01)], Physician Relations 23% vs 26% (p = 0.04), MAPPS 75% vs 69% (p = < 0.01), and Board Certification 81% vs 74% (p = < 0.01)), KPSC outperformed non-KPSC GME-trained physicians to a statistically significant degree. CONCLUSIONS We have shown that an internally sponsored GME program can represent an opportunity for recruitment of physicians that may have higher retention rates, higher probability of being physician leaders, decreased likelihood of physician relations issues, improved patient satisfaction, and increased rates of board certification.
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Affiliation(s)
| | - Jerad A Harris
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, United States of America
| | - J Craig Collins
- Department of Surgery, Kaiser Permanente, Southern California, Los Angeles, CA, United States of America
| | - Nancy H Spiegel
- Department of Clinical Science, Kaiser Permanente School of Medicine, Pasadena, CA, United States of America
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, United States of America.
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Tomei KL, Selby LV, Kirk LM, Bello JA, Nolan NS, Varma SK, Turner PL, Elliott VS, Brotherton SE. Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1592-1596. [PMID: 35731593 PMCID: PMC9592142 DOI: 10.1097/acm.0000000000004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians. When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.
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Affiliation(s)
- Krystal L. Tomei
- K.L. Tomei is associate professor of pediatric neurosurgery, Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luke V. Selby
- L.V. Selby is assistant professor of surgery, Department of Surgery, Division of Colorectal and Oncologic Surgery, University of Kansas Medical Center, Kansas City, Kansas; ORCID: https://orcid.org/0000-0002-0202-9646
| | - Lynne M. Kirk
- L.M. Kirk is chief of accreditation and recognition, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jacqueline A. Bello
- J.A. Bello is director of neuroradiology and professor of radiology and neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York
| | - Nathan S. Nolan
- N.S. Nolan is medical education fellow and infectious disease physician, Washington University Hospital, St. Louis, Missouri
| | - Surendra K. Varma
- S.K. Varma is executive associate dean for graduate medical education and resident affairs, university distinguished professor, and vice chair, Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Patricia L. Turner
- P.L. Turner is executive director, American College of Surgeons, and clinical associate professor of surgery, University of Chicago Medicine, Chicago, Illinois
| | - Victoria Stagg Elliott
- V.S. Elliott is a technical writer, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1223-0084
| | - Sarah E. Brotherton
- S.E. Brotherton is director, Data Acquisition Services, American Medical Association, Chicago, Illinois
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8
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Cardinaal E, Dubas-Jakóbczyk K, Behmane D, Bryndová L, Cascini F, Duighuisen H, Davidovitch N, Waitzberg R, Jeurissen P. Governance of academic medical centres in changing healthcare systems: An international comparison. Health Policy 2022; 126:613-618. [PMID: 35490139 DOI: 10.1016/j.healthpol.2022.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
We provide an explorative and international comparison of the governance models of academic medical centres (AMCs). These centres face significant challenges, including disruptive external pressures and enduring financial conflicts pertaining to patient treatment, research and education. Therefore, we covered 10 European countries (Cyprus, Czechia, Denmark, Germany, Italy, Latvia, the Netherlands, Norway, Poland and Spain) and one associated state (Israel) in our analysis. In addition, we developed an expert questionnaire to collect data on the governance of AMCs in these 11 countries. Our results revealed no standardised definition of AMCs, with countries combining patient care, education/teaching and research differently. However, the ownership of such institutions is significantly homogeneous and is limited to public or private, nonprofit ownership. Furthermore, significant differences are associated with the (functional) integration level between the hospital and medical school. Therefore, most experts believe that the governance of AMCs will evolve into a more functionally integrated model of patient care, research and education.
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Affiliation(s)
- Ester Cardinaal
- Radboud universitair medisch centrum, Nijmegen, The Netherlands.
| | - Katarzyna Dubas-Jakóbczyk
- Institute of Public Health, Chair of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Lucie Bryndová
- Center for Social and Economic Strategies, Faculty of Socials Sciences, Charles University, Prague, Czechia
| | - Fidelia Cascini
- Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel; Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany
| | - Patrick Jeurissen
- Radboud Institute of Health Sciences (RIHS), Nijmegen, The Netherlands
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Camison L, Brooker JE, Naran S, Potts JR, Losee JE. The History of Surgical Education in the United States: Past, Present, and Future. ANNALS OF SURGERY OPEN 2022; 3:e148. [PMID: 36935767 PMCID: PMC10013151 DOI: 10.1097/as9.0000000000000148] [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: 10/22/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022] Open
Abstract
In just over 100 years, surgical education in the United States has evolved from a disorganized practice to a refined system esteemed worldwide as one of the premier models for the training of physicians and surgeons. But in the changing environment of health care, new challenges have arisen that could warrant a reform. To design our future, we must understand our past. The present work is not intended to be a comprehensive account of the history of American surgery. Instead, it tells the abridged history of surgical education in our country: the evolution from apprenticeships to residencies; the birth of hospital-based teaching; the impact of key historical events on training; the marks left by some preeminent characters; the conception of regulatory entities that steer our education; and, finally, how our process of training surgeons might need to be refined for the continued progress of our profession. Told in chronological order in a manner that will be memorable to readers, this story weaves together the key events that explain how our current surgical training models came to be. We conclude with a timely invitation to draw from these past lessons to redesign the future of graduate medical education, making a case for the transition to time-variable, competency-based medical education for surgical residency programs in America.
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Affiliation(s)
- Liliana Camison
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center. Pittsburgh, PA
| | - Jack E. Brooker
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center. Pittsburgh, PA
| | - Sanjay Naran
- Division of Pediatric Plastic Surgery, Advocate Children’s Hospital. Park Ridge, IL
| | - John R. Potts
- Department of Surgery, John P. and Katherine G. McGovern Medical School at UT Health. Houston, TX
| | - Joseph E. Losee
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center. Pittsburgh, PA
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10
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Gao W, Li W, Zang Y, Zhong Y, Wu H. Stratification of Health Professional Education and Its Funding Disparities: Evidence From China During the Period of 1998–2017. Front Public Health 2022; 9:800163. [PMID: 35118045 PMCID: PMC8805589 DOI: 10.3389/fpubh.2021.800163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The finance of health professional education (HPE) is of immense importance for effective and sustainable health systems, yet relevant empirical research was scarce due to the lack of financial data. The study aimed to bridge the gap by presenting the scenario of finance for health professional institutions (HPIs) of different tiers in China and exploring how the stratification of institutions affected their funding disparities. Methods: The study employed data collected from the Ministry of Education in China, and selected the HPIs mainly based on the World Directory of Medical Schools. The funding levels and disparities of China's HPIs during the period (1998–2017) were analyzed with descriptive statistics, and the indicators of funding per institution and funding per student were both considered. The average funding in HPIs was presented by tiers, and the Gini coefficient and Theil index were employed to describe the differences in financing among HPIs over the span. Results: The study found that the number of HPIs has kept growing over the past two decades, with both the funding per institution and the funding per student increasing steadily. Specifically, the average funding per institution of the three tiers increased by 31.5 times, 13.4 times, and 10.5 times separately, with the first-tier universities having an absolute advantage compared to lower tiers. As for the financing disparities among HPIs, the Gini coefficient of the funding per institution maintained to be over 0.5, with the third-tier institutions scoring the highest, while the Gini coefficient of the funding per student all ranged approximately from 0.2 to 0.3. Through the decomposition of the inequalities measured by the Theil index, the share of the between-tier difference in per-institution funding grew from 29.7 in 1998 to 77.9% in 2017. Conclusions: The funding disparities between tiers of HPIs in China gradually became more accentuated, with the top-tier institutions taking up the largest share. Although the stratified development in HPE has posed a challenge to the unified quality assurance of medical personnel training, it may also be regarded as an effective pathway for developing countries like China to achieve stable development in health professional education.
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Affiliation(s)
- Wenjuan Gao
- Institute of Higher Education, Beihang University, Beijing, China
| | - Wenzhuo Li
- Education Section, Aerospace Center Hospital/Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yue Zang
- Institute of Medical Education, Peking University, Beijing, China
- Graduate School of Education, Peking University, Beijing, China
| | - Yuxin Zhong
- Institute of Medical Education, Peking University, Beijing, China
- Graduate School of Education, Peking University, Beijing, China
| | - Hongbin Wu
- Institute of Medical Education, Peking University, Beijing, China
- National Center for Health Professions Education Development, Peking University, Beijing, China
- *Correspondence: Hongbin Wu
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11
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Asotibe JC, Shaka H, Akuna E, Shekar N, Shah H, Ramirez M, Sherazi SAA, Khoshbin K, Mutneja H, Attar B. Outcomes of Non-Variceal Upper Gastrointestinal Bleed Stratified by Hospital Teaching Status: Insights From the National Inpatient Sample. Gastroenterology Res 2021; 14:268-274. [PMID: 34804270 PMCID: PMC8577599 DOI: 10.14740/gr1437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022] Open
Abstract
Background Non-variceal upper gastrointestinal bleeding (NVUGIB) is a significant cause of mortality and morbidity in the USA. Currently, there are limited data on the inpatient outcomes of patients admitted with a diagnosis of NVUGIB stratified according to teaching hospital status. We analyzed data from the National Inpatient Sample (NIS) intending to evaluate these outcomes. Methods We queried the NIS 2016 and 2017 databases for NVUGIB hospitalizations by teaching hospital status. The primary outcome was inpatient mortality while secondary outcomes were rate of endoscopy for hemostasis, rate of early endoscopy (endoscopy in 1 day or less), mean time to endoscopy, rate of complications including acute kidney injury (AKI), acute respiratory failure (ARF), need for blood transfusion, development of sepsis, need for endotracheal intubation and mechanical ventilation as well as healthcare utilization. Results There were over 71 million weighted discharges in the combined 2016 and 2017 NIS database. A total of 94,900 NVUGIB cases were identified with 63.4% admitted in teaching hospitals. The in-hospital mortality for patients admitted with an NVUGIB in teaching hospitals was 1.98% compared to 1.5% in non-teaching hospitals (adjusted odds ratio (aOR): 1.38, 95% confidence interval (CI): 1.08 - 1.77, P = 0.010) when adjusted for biodemographic and hospital characteristics as well as comorbidities. Patients admitted with a diagnosis of NVUGIB in teaching hospitals had a 10% adjusted increased odds of getting endoscopy for hemostasis (27.0% vs. 24.5%, aOR: 1.10, 95% CI: 1.02 - 1.19, P = 0.016) compared to patients in non-teaching hospitals. There was, however, no difference in early endoscopy between the two groups. Conclusion Patients admitted at teaching hospitals for an NVUGIB had worse outcomes during hospitalizations including mortality, median length of stay, and total hospital charges when compared to NVUGIB patients managed at non-teaching hospitals.
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Affiliation(s)
- Jennifer C Asotibe
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Emmanuel Akuna
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Niveda Shekar
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Hassam Shah
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Marcelo Ramirez
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Syed Ali Amir Sherazi
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Katayoun Khoshbin
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Hemant Mutneja
- Department of Gastroenterology, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Bashar Attar
- Department of Gastroenterology, John H Stroger Hospital of Cook County, Chicago, IL, USA
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12
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Davis MJ, Luu BC, Cole SH, Abu-Ghname A, Winocour S, Reece EM. Employment as a Plastic Surgeon: A Review of Trends and Demand Across the Field. Ann Plast Surg 2021; 87:377-383. [PMID: 34117135 DOI: 10.1097/sap.0000000000002780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Intrinsic to the field of plastic surgery, constant changes in health care policy, consumer demands, and medical technology necessitate periodic evaluation of trends in employment over time. In this article, we review the existing literature to report the current state of plastic surgery employment in the United States with regards to compensation, practice patterns, subspecialty trends, contract negotiation, representation of women in the field of plastic surgery, burnout and job satisfaction, and retirement. Understanding how the plastic surgery job market is changing not only serves as a valuable tool for the individual plastic surgeon regarding the navigation of his or her own career but also offers insight into the future of the field as a whole.
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Affiliation(s)
| | - Bryan C Luu
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Samuel H Cole
- Section of Plastic and Reconstructive Surgery, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
| | | | - Sebastian Winocour
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Edward M Reece
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
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Greer DM, Moeller J, Torres DR, Soni M, Cruz S, Tornes L, Patwa H, Gutmann L, Sacco R, Galetta S. Funding the Educational Mission in Neurology. Neurology 2021; 96:574-582. [PMID: 33558302 DOI: 10.1212/wnl.0000000000011635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/14/2021] [Indexed: 11/15/2022] Open
Abstract
Although it is self-evident that education in neurology is important and necessary, how to fund the educational mission is a frequent challenge for neurology departments and clinicians. Department chairs often resort to a piecemeal approach, cobbling together funding for educators from various sources, but frequently falling short. Here, we review the various sources available to fund the educational mission in neurology, understanding that not every department will have access to every source. We describe the multiple different teaching models and formats used by the modern student and educator and their associated costs, some of which are exorbitant. We discuss possible nonfinancial incentives, including pathways to promotion, educational research, and other awards and recognition. Neurological education is commonly underfunded, and departments and institutions must be nimble and creative in finding ways to fund the time and effort of educators.
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Affiliation(s)
- David M Greer
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health.
| | - Jeremy Moeller
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Diego R Torres
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Madhu Soni
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Salvador Cruz
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Letitia Tornes
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Huned Patwa
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Laurie Gutmann
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Ralph Sacco
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
| | - Steven Galetta
- From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health
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Zinoviev R, Krumholz HM, Pirruccio K, Forman H. Association of Graduate Medical Education With Hospital Performance and Patient Outcomes. JAMA Netw Open 2021; 4:e2034196. [PMID: 33507257 PMCID: PMC7844596 DOI: 10.1001/jamanetworkopen.2020.34196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Graduate medical education (GME) funding consists of more than $10 billion annual subsidies awarded to academic hospitals to offset the cost of resident training. Critics have questioned the utility of these subsidies and accountability of recipient hospitals. OBJECTIVE To determine the association of GME funding with hospital performance by examining 3 domains of hospital operations: financial standing, clinical outcomes, and resident academic performance. DESIGN, SETTING, AND PARTICIPANTS This study is an economic evaluation of all academic centers that received GME funding in 2017. GME funding data were acquired from the Hospital Compare Database. Statistical analysis was performed from May 2016 to April 2020. EXPOSURES GME funding. MAIN OUTCOMES AND MEASURES This study assessed the association between GME funding and each aspect of hospital operations. Publicly available hospital financial data were used to calculate a financial performance score from 0 to 100 for each hospital. Clinical outcomes were defined as 30-day mortality, readmission, and complication rates for a set of predefined conditions. Resident academic performance was determined by Board Certification Examination (BCE) pass rates at 0, 2, and 5 years after GME funding was awarded. Confounder-adjusted linear regression models were used to test association between GME funding data and a hospital's financial standing, clinical outcomes, and resident academic performance. RESULTS The sample consisted of 1298 GME-funded hospitals, with a median (IQR) of 265 (168-415) beds and 32 (10-101) residents per training site. GME funding was negatively correlated with hospitals' financial scores (β = -7.9; 95% CI, -10.9 to -4.8, P = .001). Each additional $1 million in GME funding was associated with lower 30-day mortality from myocardial infarction (-2.34%; 95% CI, -3.59% to -1.08%, P < .001), heart failure (-2.59%; 95% CI, -3.93% to -1.24%, P < .001), pneumonia (-2.20%; 95% CI, -3.99% to -0.40%, P = .02), chronic obstructive pulmonary disease ( -1.20%; 95% CI, -2.35% to -0.05%, P = .04), and stroke (-3.40%; 95% CI, -5.46% to -1.33%, P = .001). There was no association between GME funding and readmission rates. There was an association between higher GME funding and higher internal medicine BCE pass rates (0.066% [95% CI, 0.033% to 0.099%] per $1 million in GME funding; P < .001). CONCLUSIONS AND RELEVANCE This study found a negative linear correlation between GME funding and patient mortality and a positive correlation between GME funding and resident BCE pass rates in adjusted regression models. The findings also suggest that hospitals that receive more GME funding are not more financially stable.
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Affiliation(s)
- Radoslav Zinoviev
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
- now with Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute Cleveland Clinic, Cleveland, Ohio
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Howard Forman
- Yale School of Management, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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He K, Whang E, Kristo G. Graduate medical education funding mechanisms, challenges, and solutions: A narrative review. Am J Surg 2021; 221:65-71. [PMID: 32680622 PMCID: PMC7308777 DOI: 10.1016/j.amjsurg.2020.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/30/2020] [Accepted: 06/06/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND With increased attention on the federal budget deficit, graduate medical education (GME) funding has in particular been targeted as a potential source of cost reduction. Reduced GME funding can further deteriorate the compensation of physicians during their residency training. METHODS In order to understand the GME funding mechanisms and current challenges, as well as the value of the work accomplished by residents, we searched peer-reviewed, English language studies published between 2000 and 2019. RESULTS Direct and indirect GME funding is intended to support resident reimbursement and the higher costs associated with supporting a teaching program. However, policy efforts have aimed to reduce federal funding for GME. Furthermore, evidence suggests that residents are inadequately compensated because their salaries do not reflect the number of hours worked and are not comparable to those of other medical staff. CONCLUSIONS Our review suggests that creative solutions are needed to diversify GME funding and improve resident compensation.
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Affiliation(s)
- Katherine He
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward Whang
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gentian Kristo
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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16
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Carney PA, Dickinson WP, Fetter J, Warm EJ, Zierler B, Patton J, Kirschner G, Crane SD, Shrader S, Eiff MP. An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice. J Prim Care Community Health 2021; 12:21501327211023716. [PMID: 34109864 PMCID: PMC8202267 DOI: 10.1177/21501327211023716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. METHODS This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. RESULTS The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach's alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach's expertise with the team's needs. CONCLUSIONS While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.
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Affiliation(s)
| | | | - Jay Fetter
- American Academy of Family Physicians, Leawood, KS, USA
| | - Eric J. Warm
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Brenda Zierler
- University of Washington, School of Nursing, Seattle, WA, USA
| | - Jill Patton
- Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | | | - Steven D. Crane
- University of North Carolina Health Science Center at Mountain Area Health Education Center, Asheville, NC, USA
| | - Sarah Shrader
- University of Missouri, School of Pharmacy, Kansas City, MO, USA
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Parikh KD, Smith DA, Kasprzak TP, Stovicek B, Pandya H, Ramaiya NH. A Foundational Guide to Understanding Radiology Department Business Operations for Trainees. J Am Coll Radiol 2020; 18:868-876. [PMID: 33326756 DOI: 10.1016/j.jacr.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
The financial success of a radiology department is crucial to the well-being of both the hospital and the community it serves. Radiology trainees should therefore be conscious of how the department maintains its value within the health system. The purpose of this review is to provide a concise foundational resource for contemporary radiology residents and fellows to understand the basic financial operations of a hospital-based radiology department and to demonstrate its importance in supporting clinical activities. The radiology report is at the heart of reimbursement. Coders use this tool to assign International Classification of Diseases and Current Procedural Terminology codes to file reimbursement claims. Medicare, commanding the highest market share for third-party payers, sets algorithmic standards for compensation practices. Private insurers contract with hospitals, and providers use these systems or create their own contractual framework. Radiology leaders strategically balance these revenue streams with various departmental costs utilizing tools such as budgets and forecasts to ensure long-term organizational viability. Notably, payment practices in the United States are transforming from fee-for-service to value-based care. The roles of the radiologist and the radiology report are evolving with it. Examples of value-based payment models are accountable care organizations and bundled payments. Radiologists participating in these models are increasingly expected to be stewards of imaging utilization and effectively manage health care resources. Within this context of a globally changing incentive structure, trainees must reconceptualize their educational experience to equip themselves for both current and future types of clinical practice.
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Affiliation(s)
- Keval D Parikh
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
| | - Daniel A Smith
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Timothy P Kasprzak
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Bart Stovicek
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Himanshu Pandya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
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Raus K, Mortier E, Eeckloo K. Past, present and future of university hospitals. Acta Clin Belg 2020; 75:177-184. [PMID: 30896377 DOI: 10.1080/17843286.2019.1590024] [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: 10/27/2022]
Abstract
Objectives: Health care systems worldwide are changing and taking new forms. The old, more hierarchically oriented, model with individual institutional and bilateral interactions between primary, secondary, tertiary and quaternary care is being replaced by an integrated and dynamic network model. We aim to look at what role university hospitals will play in this future organization of health care.Method: In this paper, we look at the relevant literature on the history of academic medicine and university hospitals. Subsequently, we look at the challenges university hospitals are facing according to contemporary literature on the topic.Results: Our current model of academic medicine with its university hospitals finds its origin in the institutionalization of the academic mission in the late 18th century. Currently, the sustainability of the model is under immense pressure. University hospitals are facing economic challenges, teaching challenges and research challenges. However, there is reason to believe that they can continue to play a role of importance in tomorrow's medicine. The organization of health care is undergoing two important changes. The first is the evolution towards a more dynamic and integrated network model. University hospitals can become an important hub within this network. The second change is an evolution towards evidence based medicine and translational research.Conclusion: Due to their unique tripartite mission, we argue that university hospitals can continue to play an important and critical role in promoting evidence-based medicine and speedy translation of new evidence.
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Affiliation(s)
- Kasper Raus
- Strategic policy cell, Ghent University Hospital, Ghent, Belgium
| | - Eric Mortier
- General management, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Kristof Eeckloo
- General management, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
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Dimon M, Ahmed B, Pieper P, Burns B, Tepas JJ. An Old Idea is a Novel Concept for Supplemental Funding of Surgical Residency Programs. Cureus 2020; 12:e7053. [PMID: 32219047 PMCID: PMC7086109 DOI: 10.7759/cureus.7053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background In July 2014, the Institute of Medicine released a review of the governance of Graduate Medical Education (GME), concluding that changes to GME financing were needed to reward desired performance and to reshape the workforce to meet the nation’s needs. In light of the rapid emergence of alternative payment systems, we evaluated the financial value of resident participation in operative surgical care. Methods The Department of Surgery provided Current Procedural Terminology (CPT) codes for procedures performed by the general surgical service at our institution for the 2011 academic year. For each code, the charge and total instances were provided. CPTs allowing an assistant fee were identified using the Searchable Medicare Physician Fee Schedule. This approach enabled calculation of the potential resident contribution to GME funding. Results A total of 515 unique CPTs were potentially billable for a total of 6,578 procedures, of which 2,552 (39%) were reimbursable. These CPTs would have generated $1,882,854 in assistant charges. The top 50 most frequent CPTs resulted in 4,247 procedures. Within the top 50, 1362 procedures (32% of the top 50, 21% of the total) were reimbursable. Of the total assistant charges, $963,227 (51%) occurred in the top 50 most frequent CPTs. Conclusions Credit for resident participation in operative care as co-surgeon would average $67,244 per resident, compared to our current funding of $142,635 per resident. This type of alternative funding could provide 47% of current educational support. The skew in distribution of procedures also suggests that such a system could provide guidance to a more balanced operative experience. Such performance-based credentialing could be used to ensure appropriate housestaff for a given case; these reimbursements could also be adjusted based on quality metrics to provide for transformational change in patient outcomes.
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Affiliation(s)
- Matthew Dimon
- Surgery, Coosa Valley Medical Center, Sylacauga, USA
| | - Bestoun Ahmed
- General Surgery, University Of Pittsburgh, Pittsburgh, USA
| | - Pam Pieper
- Pediatric Trauma, Wolfson Children's Hospital, Jacksonville, USA.,College of Nursing, University of Florida, Jacksonville, FL, USA
| | - Bracken Burns
- Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Joseph J Tepas
- Pediatric Surgery, University of Florida College of Medicine, Jacksonville, USA
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Schnapp LM, Steiner MJ, Davis SD. Basic Primer for Finances in Academic Adult and Pediatric Pulmonary Divisions. Chest 2020; 157:363-368. [PMID: 31593691 PMCID: PMC7005376 DOI: 10.1016/j.chest.2019.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/16/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022] Open
Abstract
The finances of academic medical centers (AMCs) are complex and rapidly evolving. This financial environment can have important effects on faculty expectations, compensation, and the work environment. This article describes the commonly used concepts and models related to financial decision-making in Pulmonology and Critical Care divisions across AMCs in the United States. Faculty clinical productivity is often measured by work relative value units, which are set nationally for a discrete piece of physician work and attempt to equilibrate aspects of care across specialties. The expected clinical productivity and salary for a given faculty member are often determined relative to one or more national benchmarks developed from data submitted by departments and schools across the country. The most commonly used benchmarks include those from the Association of American Medical Colleges and the Medical Group Management Association. Changes to the paradigm of fee for service reimbursement are beginning to change physician compensation and incentive structures. In addition, research and education are key academic missions for faculty. It is important to understand the limitations of extramural research funding and implications for the support of research infrastructure. Measurements of productivity within education have been less codified, but some centers are attempting to create educational relative value units similar to those used in clinical productivity. In summary, faculty should understand basic concepts of finances. This knowledge includes a common set of terms and concepts that can help all faculty understand basic financial considerations in their work and lead to success for their divisions.
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Affiliation(s)
- Lynn M Schnapp
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
| | | | - Stephanie D Davis
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Lauer CI, Shabahang MM, Restivo B, Lane S, Hayek S, Dove J, Ellison HB, Pica E, Ryer EJ. The Value of Surgical Graduate Medical Education (GME) Programs Within An Integrated Health Care System. JOURNAL OF SURGICAL EDUCATION 2019; 76:e173-e181. [PMID: 31466894 DOI: 10.1016/j.jsurg.2019.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/06/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Surgical graduate medical education (GME) programs add both significant cost and complexity to the mission of teaching hospitals. While expenses tied directly to surgical training programs are well tracked, overall cost-benefit accounting has not been performed. In this study, we attempt to better define the costs and benefits of maintaining surgical GME programs within a large integrated health system. DESIGN We examined the costs, in 2018 US dollars, associated with the surgical training programs within a single health system. Total health system expenses were calculated using actual and estimated direct GME expenses (salary, benefits, supplies, overhead, and teaching expenses) as well as indirect medical education (IME) expenses. IME expenses for each training program were estimated by using both Medicare percentages and the Medicare Payment Advisor Commission study. The projected cost to replace surgical trainees with advanced practitioners or hospitalists was obtained through interviews with program directors and administrators and was validated by our system's business office. SETTING A physician lead, integrated, rural health system consisting of 8 hospitals, a medical school and a health insurance company. PARTICIPANTS GME surgical training programs within a single health system's department of surgery. RESULTS Our health system's department of surgery supports 8 surgical GME programs (2 general surgery residencies along with residencies in otolaryngology, ophthalmology, oral-maxillofacial surgery, urology, pediatric dentistry, and vascular surgery), encompassing 89 trainees. Trainees work an average of 64.4 hours per week. Total health system cost per resident ranged from $249,657 to $516,783 based on specialty as well as method of calculating IME expenses. After averaging program costs and excluding IME and overhead expenses, we estimated the average annual cost per trainee to be $84,171. We projected that replacing our surgical trainees would require hiring 145 additional advanced practitioners at a cost of $166,500 each per year, or 97 hospitalists at a cost of $346,500 each per year. Excluding overhead, teaching and IME expenses, these replacements would cost the health system an estimated additional $16,651,281 or $26,119,281 per year, respectively. CONCLUSIONS Surgical education is an integral part of our health system and ending surgical GME programs would require large expansion of human resources and significant additional fiscal capital.
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Affiliation(s)
- Claire I Lauer
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Brian Restivo
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Samantha Lane
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Sarah Hayek
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - James Dove
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Halle B Ellison
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Erin Pica
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Evan J Ryer
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.
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Rao AR, Clarke D. Exploring relationships between medical college rankings and performance with big data. BIG DATA ANALYTICS 2019. [DOI: 10.1186/s41044-019-0040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Caverzagie KJ, Lane SW, Sharma N, Donnelly J, Jaeger JR, Laird-Fick H, Moriarty JP, Moyer DV, Wallach SL, Wardrop RM, Steinmann AF. Proposed Performance-Based Metrics for the Future Funding of Graduate Medical Education: Starting the Conversation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1002-1013. [PMID: 29239903 DOI: 10.1097/acm.0000000000002096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Graduate medical education (GME) in the United States is financed by contributions from both federal and state entities that total over $15 billion annually. Within institutions, these funds are distributed with limited transparency to achieve ill-defined outcomes. To address this, the Institute of Medicine convened a committee on the governance and financing of GME to recommend finance reform that would promote a physician training system that meets society's current and future needs. The resulting report provided several recommendations regarding the oversight and mechanisms of GME funding, including implementation of performance-based GME payments, but did not provide specific details about the content and development of metrics for these payments. To initiate a national conversation about performance-based GME funding, the authors asked: What should GME be held accountable for in exchange for public funding? In answer to this question, the authors propose 17 potential performance-based metrics for GME funding that could inform future funding decisions. Eight of the metrics are described as exemplars to add context and to help readers obtain a deeper understanding of the inherent complexities of performance-based GME funding. The authors also describe considerations and precautions for metric implementation.
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Affiliation(s)
- Kelly J Caverzagie
- K.J. Caverzagie is associate dean for educational strategy, University of Nebraska College of Medicine, and vice president for education, Nebraska Medicine, Omaha, Nebraska. S.W. Lane is associate professor of medicine, vice chair for education, Department of Medicine, and internal medicine residency program director, Stony Brook Medicine, Stony Brook, New York. N. Sharma is assistant professor of internal medicine and pediatrics, Harvard Medical School, and program director, Internal Medicine-Pediatrics Residency Program, Brigham and Women's Hospital and Boston Children's Hospital, Boston, Massachusetts. J. Donnelly is program director, Internal Medicine Residency Program, Christiana Care Health System, and clinical associate professor for internal medicine and pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. J.R. Jaeger is professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. H. Laird-Fick is associate professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan. J.P. Moriarty is associate professor of medicine and program director, Yale Primary Care Residency, Yale University, New Haven, Connecticut. D.V. Moyer, at the time this article was written, was professor of medicine, Lewis Katz School of Medicine (LKSOM), Temple University, and internal medicine program director, Temple University Hospital, Philadelphia, Pennsylvania. She is now adjunct professor of medicine, LKSOM, Temple University, and executive vice president/chief executive officer, American College of Physicians, Philadelphia, Pennsylvania. S.L. Wallach is associate professor of medicine, Seton Hall-Hackensack Meridian School of Medicine, and chair and program director of internal medicine, St. Francis Medical Center, Trenton, New Jersey. R.M. Wardrop III is associate professor of medicine and pediatrics and program director for the combined medicine and pediatrics residency training program, University of North Carolina School of Medicine, Chapel Hill, North Carolina. A.F. Steinmann is chief of academic medicine, Saint Joseph Hospital, and associate clinical professor of medicine, University of Colorado School of Medicine, Denver, Colorado
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Rosenkrantz AB, Wang W, Vijayasarathi A, Duszak R. Physician Specialty and Radiologist Characteristics Associated with Higher Medicare Patient Complexity. Acad Radiol 2018; 25:219-225. [PMID: 29103917 DOI: 10.1016/j.acra.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Meaningfully measuring physician outcomes and resource utilization requires appropriate patient risk adjustment. We aimed to assess Medicare patient complexity by physician specialty and to further identify radiologist characteristics associated with higher patient complexity. MATERIALS AND METHODS The average beneficiary Hierarchical Condition Category (HCC) risk scores (Medicare's preferred measure of clinical complexity) were identified for all physicians using 2014 Medicare claims data. HCC scores were compared among physician specialties and further stratified for radiologists based on a range of characteristics. Univariable and multivariable analyses were performed. RESULTS Of 549,194 physicians across 54 specialties, the mean HCC risk score was 1.62 ± 0.75. Of the 54 specialties, interventional radiology ranked 4th (2.60 ± 1.29), nuclear medicine ranked 16th (1.87 ± 0.45), and diagnostic radiology ranked 21st (1.75 ± 0.61). Among 31,175 radiologists, risk scores were higher (P < 0.001) for those with teaching (2.03 ± 0.74) vs nonteaching affiliations (1.72 ± 0.61), practice size ≥100 (1.94 ± 0.70) vs ≤9 (1.59 ± 0.79) members, urban (1.79 ± 0.69) vs rural (1.67 ± 0.59) practices, and subspecialized (1.85 ± 0.81) vs generalized (1.68 ± 0.42) practice patterns. Among noninterventional radiology subspecialties, patient complexity was highest for cardiothoracic (2.09 ± 0.57) and lowest for breast (1.08 ± 0.32) imagers. At multivariable analysis, a teaching affiliation was the strongest independent predictor of patient complexity for both interventional (β = +0.23, P = 0.005) and noninterventional radiologists (β = +0.21, P < 0.001). CONCLUSIONS Radiologists on average serve more clinically complex Medicare patients than most physicians nationally. However, patient complexity varies considerably among radiologists and is particularly high for those with teaching affiliations and interventional radiologists. With patient complexity increasingly recognized as a central predictor of clinical outcomes and resource utilization, ongoing insights into complexity measures may assist radiologists navigating emerging risk-based payment models.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, 660 First Avenue, 3rd Floor, New York, NY 10016.
| | - Wenyi Wang
- Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Arvind Vijayasarathi
- Department of Neuroradiology, University of California Los Angeles, Los Angeles, California
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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State of the Plastic Surgery Workforce and the Impact of Graduate Medical Education Reform on Training of Plastic Surgeons. Plast Reconstr Surg 2017; 140:412-420. [PMID: 28746291 DOI: 10.1097/prs.0000000000003512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although recent estimates predict a large impending shortage of plastic surgeons, graduate medical education funding through the Centers for Medicare and Medicaid Services remains capped by the 1997 Balanced Budget Act. The authors' aim was to develop a plan to stimulate legislative action. METHODS The authors reviewed responses of the American Society of Plastic Surgeons, American College of Surgeons, and American Medical Association from January of 2015 to a House Energy & Commerce Committee request for input on graduate medical education funding. In addition, all program directors in plastic surgery were surveyed through the American Council of Academic Plastic Surgeons to determine their graduate medical education funding sources. RESULTS All three organizations agree that current graduate medical education funding is inadequate to meet workforce needs, and this has a significant impact on specialty selection and distribution for residency training. All agreed that funding should be tied to the resident rather than to the institution, but disagreed on whether funds should be divided between direct (allocated to residency training) and indirect (allocated to patient care) pools, as is currently practiced. Program directors' survey responses indicated that only 38 percent of graduate medical education funds comes from the Centers for Medicare and Medicaid Services. CONCLUSIONS Organized medicine is at risk of losing critically needed graduate medical education funding. Specific legislation to support additional graduate medical education positions and funding (House Resolutions 1180 and 4282) has been proposed but has not been universally endorsed, in part because of a lack of collaboration in organized medicine. Collaboration among major organizations can reinvigorate these measures and implement real change in funding.
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Discussion: State of the Plastic Surgery Workforce and the Impact of Graduate Medical Education Reform on Training of Plastic Surgeons. Plast Reconstr Surg 2017; 140:421-423. [PMID: 28746292 DOI: 10.1097/prs.0000000000003513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Drolet BC, Tandon VJ, Sargent R, Loor K, Schmidt ST, Liu PY. Revenue Generation and Plastic Surgery Training Programs. Plast Reconstr Surg 2016; 138:539e-542e. [DOI: 10.1097/prs.0000000000002485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosenkrantz AB, Wang W, Duszak R. The Ongoing Gap in Availability of Imaging Services at Teaching Versus Nonteaching Hospitals. Acad Radiol 2016; 23:1057-63. [PMID: 27095314 DOI: 10.1016/j.acra.2015.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to characterize associations between availability of imaging services and intensity of teaching among US hospitals. MATERIALS AND METHODS Using the American Hospital Association Annual Survey Database, we studied information regarding the availability of imaging services at general hospitals nationwide in 2007 (4102 hospitals) and in 2012 (3876). Teaching intensity was categorized as Council of Teaching Hospitals (COTH) member, non-COTH teaching hospital (non-COTH member with affiliated medical school and/or residency), and nonteaching hospital. Availability in hospitals of reported basic and advanced imaging modalities, as well as beds, number of employed physicians, and case mix index, was analyzed. Univariable and multivariable trends were assessed. RESULTS All 15 assessed modalities showed significant increases in availability with increasing hospital teaching intensity (P < 0.001). Modalities showing the largest differences between COTH and nonteaching hospitals in 2012 were image-guided radiation therapy (78% vs. 14%), positron emission tomography/computed tomography (74% vs. 17%), and single-photon emission computed tomography (88% vs. 35%). The gap between COTH and nonteaching hospitals increased from 43% in 2007 to 57% in 2012 for positron emission tomography/computed tomography, and from 34% to 48% for virtual colonoscopy. COTH status was a significant predictor, independent of beds and employed physicians, for 10 modalities (P < 0.001-0.038). Greater case mix index was significantly associated with availability of advanced, although not basic, modalities. CONCLUSIONS Availability of imaging services increased with greater hospital teaching intensity. Differences were most pronounced and sustained over time for advanced modalities. Our findings reflect the greater advanced imaging resources necessary to support the complexity of care rendered at teaching hospitals. This differential must be considered when exploring adjustments to teaching hospitals' funding levels.
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Davis CS, Carr D. Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug Alcohol Depend 2016; 163:100-7. [PMID: 27137406 DOI: 10.1016/j.drugalcdep.2016.04.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The opioid overdose epidemic in the United States is driven in large part by inappropriate opioid prescribing. Although most American physicians receive little or no training during medical school regarding evidence-based prescribing, substance use disorders, and pain management, some states require continuing medical education (CME) on these topics. We report the results of a systematic legal analysis of such requirements, together with recommendations for improved physician training. METHODS To determine the presence and characteristics of CME requirements in the United States, we systematically collected, reviewed, and coded all laws that require such education as a condition of obtaining or renewing a license to practice medicine. Laws or regulations that mandate one-time or ongoing training in topics designed to reduce overdose risk were further characterized using an iterative protocol RESULTS Only five states require all or nearly all physicians to obtain CME on topics such as pain management and controlled substance prescribing, and fewer than half require any physicians to obtain such training. CONCLUSIONS While not a replacement for improved education in medical school and post-graduate clinical training, evidence-based CME can help improve provider knowledge and practice. Requiring physicians to obtain CME that accurately presents evidence regarding opioid prescribing and related topics may help reduce opioid-related morbidity and mortality. States and the federal government should also strongly consider requiring such training in medical school and residency.
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Affiliation(s)
- Corey S Davis
- Network for Public Health Law-Southeastern Region, 101 E. Weaver St. #G-7, Carrboro, NC 27510, United States.
| | - Derek Carr
- Network for Public Health Law-Southeastern Region, 101 E. Weaver St. #G-7, Carrboro, NC 27510, United States.
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LANDEFELD CSETH. THE STRUCTURE AND FUNCTION OF DEPARTMENTS OF MEDICINE. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2016; 127:196-211. [PMID: 28066053 PMCID: PMC5216493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The structure and function of departments of medicine are important for several reasons. First, departments of medicine are the biggest departments in virtually every medical school and in most universities with a medical school, and they are the largest professional units in most academic medical centers. In fact, Petersdorf described them as "the linchpins of medical schools" (1). Departments of medicine account for one-fourth or more of the academic medical enterprise: they include about one-fourth of the faculty of medical school, account for roughly one-fourth of the patient care and clinical revenue of academic medical centers, and their faculty perform a disproportionate share of teaching and research, accounting for up to 45% of National Institutes of Health (NIH) - funded research in some medical schools. Second, the department's ability to fulfill its role and advance its mission depends on its structure and function. Finally, lessons learned from examining the structure and function of departments of medicine may guide other departments and schools of medicine themselves in improving their structure and function. This paper describes the issues that face departments of medicine in 2016. I begin by providing the context for these issues with a definition of a department of medicine, describing briefly the history of departments, and stating their mission.
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Affiliation(s)
- C. SETH LANDEFELD
- Correspondence and reprint requests: C. Seth Landefeld, MD,
BDB 420, 1808 Seventh Avenue South, Birmingham, AL 35233-1912
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Love JN, Ander DS. Growing a Specialty-Specific Community of Practice in Education Scholarship. West J Emerg Med 2015; 16:799-800. [PMID: 26594268 PMCID: PMC4651572 DOI: 10.5811/westjem.2015.9.28644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jeffrey N. Love
- Georgetown University School of Medicine, Department of Emergency Medicine, Washington, D.C
| | - Douglas S. Ander
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
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Patel MS, Reed DA, Smith C, Arora VM. Role-Modeling Cost-Conscious Care--A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States. J Gen Intern Med 2015; 30:1294-8. [PMID: 26173514 PMCID: PMC4539317 DOI: 10.1007/s11606-015-3242-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care. OBJECTIVE We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in cost-conscious care impacted responses. DESIGN Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently role-model cost-conscious care from residency program, resident, and program director characteristics. PARTICIPANTS Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included. MAIN MEASURES The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care. KEY RESULTS Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently role-modeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in cost-conscious care did not have a significant impact on survey responses (odds ratio [OR], 1.04; 95 % Confidence Interval [CI], 0.52-2.06; p value [p] = 0.91). CONCLUSIONS Responses from residents and program directors indicate that faculty at US teaching hospitals were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in cost-conscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.
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Affiliation(s)
- Mitesh S Patel
- Center for Health Equity Research and Promotion, Veterans Affairs Medical Center, Philadelphia, PA, USA,
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Nuss MA, Robinson B, Buckley PF. A Statewide Strategy for Expanding Graduate Medical Education by Establishing New Teaching Hospitals and Residency Programs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1264-1268. [PMID: 26312605 DOI: 10.1097/acm.0000000000000803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The graduate medical education (GME) system in the United States is in need of reform to ensure that the physician workforce being trained is able to meet the current and future health care needs of the population. However, GME funding to existing teaching hospitals and programs relies heavily on support from Medicare, which was capped in 1997. Thus, new, innovative models to expand GME are needed. To address physician shortages, especially in primary care and general surgery and in rural areas, the state of Georgia implemented a statewide initiative. They increased medical school enrollment by 600 students from 2000 to 2010 and committed to establishing new GME programs at new teaching hospitals to train 400 additional residents by 2018. As increasing the capacity of GME programs likely increases the number of physicians practicing in the state, these efforts aim to encourage trainees to practice in Georgia. Although new teaching hospitals, like these, are eligible for new Medicare funding, this approach to expanding GME also incorporates state funding to cover the start-up costs associated with establishing a new teaching hospital and GME program.In this article, the authors provide background on the current state of GME funding in the United States and on the physician workforce and medical education system in Georgia. They then outline the steps taken to expand GME by establishing new teaching hospitals and programs. They conclude by sharing outcomes to date as well as challenges faced and lessons learned so that others can follow this novel model.
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Affiliation(s)
- Michelle A Nuss
- M.A. Nuss is campus associate dean for graduate medical education, Georgia Regents University/University of Georgia Medical Partnership, Medical College of Georgia at Georgia Regents University, Athens, Georgia. B. Robinson is executive director, Center for Health Workforce Planning and Analysis, University System of Georgia, Atlanta, Georgia. P.F. Buckley is dean, Medical College of Georgia at Georgia Regents University, interim executive vice president for health affairs, Georgia Regents University, and interim CEO, Georgia Regents Medical Center & Medical Associates, Augusta, Georgia
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A survey of the pediatric surgery program directors: optimizing resident research to make pediatric surgery training more efficient. J Pediatr Surg 2015; 50:1053-7. [PMID: 25805008 DOI: 10.1016/j.jpedsurg.2015.03.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 03/10/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Resident Research (RR) has been a presumed requirement for pediatric surgery fellowship candidates. We hypothesized that: 1) pediatric surgery leaders would no longer feel that RR was necessary for fellowship candidates, 2) the type of study performed would not impact a program's opinion of candidates, and 3) the timing of RR could be altered for those interested in a research career. METHODS An anonymous survey was sent to pediatric surgery fellowship program directors (PDs). Sixty-three percent responded, and answers were compared via Chi square analysis with p<0.05 being significant. RESULTS Respondents did not agree that RR was critical for pediatric surgery fellowship candidates. Seventy-five percent had no preference between one or two years of research (p=0.0005), 79% placed no heavier weight on basic or clinical research (p<0.0001), and 76% had no preference between scientific research or humanitarian efforts (p=0.0003). Sixty-three percent felt that surgeon scientists would be better prepared for extramural funding if RR was performed at the end of training (p=0.04). CONCLUSION Dedicated research time during general surgery may not be necessary. Pediatric surgery candidates who partake in RR are not penalized for their choice of study. Increasing efficiency of training is important in today's era of medical training.
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Medical Education Research for Radiologists: A Road Map for Developing a Project. AJR Am J Roentgenol 2015; 204:692-7. [DOI: 10.2214/ajr.14.13675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jackson A, Baron RB, Jaeger J, Liebow M, Plews-Ogan M, Schwartz MD. Addressing the nation's physician workforce needs: The Society of General Internal Medicine (SGIM) recommendations on graduate medical education reform. J Gen Intern Med 2014; 29:1546-51. [PMID: 24733299 PMCID: PMC4238189 DOI: 10.1007/s11606-014-2847-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/28/2014] [Accepted: 03/09/2014] [Indexed: 12/01/2022]
Abstract
The Graduate Medical Education (GME) system in the United States (US) has garnered worldwide respect, graduating over 25,000 new physicians from over 8,000 residency and fellowship programs annually. GME is the portal of entry to medical practice and licensure in the US, and the pathway through which resident physicians develop the competence to practice independently and further develop their career plans. The number and specialty distribution of available GME positions shapes the overall composition of our national workforce; however, GME is failing to provide appropriate programs that support the delivery of our society's system of healthcare. This paper, prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM) and unanimously endorsed by SGIM's Council, outlines a set of recommendations on how to reform the GME system to best prepare a physician workforce that can provide high quality, high value, population-based, and patient-centered health care, aligned with the dynamic needs of our nation's healthcare delivery system. These recommendations include: accurate workforce needs assessment, broadened GME funding sources, increased transparency of the use of GME dollars, and implementation of incentives to increase the accountability of GME-funded programs for the preparation and specialty selection of their program graduates.
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Affiliation(s)
- Angela Jackson
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, A-208, Boston, MA, USA,
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Dow A, Li STT, Srinivasan M. Training residents for a new system of primary care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1442-1443. [PMID: 25350337 DOI: 10.1097/acm.0000000000000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Alan Dow
- Dr. Dow is associate professor of medicine and assistant vice president of health sciences for interprofessional education and collaborative care, Virginia Commonwealth University, Richmond, Virginia. Dr. Li is associate professor, program director, and vice chair of pediatrics, University of California Davis School of Medicine, Sacramento, California. Dr. Srinivasan is associate professor of medicine and director of practice based learning and improvement, University of California Davis School of Medicine, Sacramento, California
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Bruns SD, Davis BR, Demirjian AN, Ganai S, House MG, Saidi RF, Shah BC, Tan SA, Murayama KM. The subspecialization of surgery: a paradigm shift. J Gastrointest Surg 2014; 18:1523-31. [PMID: 24756925 DOI: 10.1007/s11605-014-2514-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/24/2014] [Indexed: 01/31/2023]
Abstract
General surgery has become increasingly fragmented into subspecialties and diseases previously treated by general surgeons are now managed by "specialists". The Resident Education Committee of the Society for Surgery of the Alimentary Tract (SSAT) has reviewed the history of surgical training and factors that have contributed to this evolution to subsepcialization. As it is unlikely that this paradigm shift is reversible, a clear understanding of the contributing factors is essential. Herein, we present a timeline and taxonomy of forces in this evolution to subspecialization.
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Oates RK, Goulston KJ, Bingham CM, Dent OF. The cost of teaching an intern in New South Wales. Med J Aust 2014; 200:100-3. [DOI: 10.5694/mja13.10213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
Affiliation(s)
- R Kim Oates
- Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Craig M Bingham
- General Medical Education and Training Unit, Health Education and Training Institute, Gladesville Hospital, Sydney, NSW
| | - Owen F Dent
- School of Medicine, University of Western Sydney, Sydney, NSW
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Pittman P, Horton K, Terry M, Bass E. Residency Programs for Home Health and Hospice Nurses. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2014. [DOI: 10.1177/1084822313511457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” calls for “transition-to-practice” residencies for new nurses and nurses transferring to new types of settings. In this study, we examine the current residency landscape for home health and hospice nurses and compare it with responses from their peers in hospitals and nurse-led primary care clinics. We find that just 2% of surveyed home health and hospice settings offer residencies, while almost 49% of hospitals and 11% of nurse-led primary care clinics provide them. Major barriers cited include lack of available preceptors and financial costs. We discuss ways in which the federal government could help spur the development of residencies in this sector.
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Affiliation(s)
| | | | - Margaret Terry
- Visiting Nurse Associations of America, Washington, DC, USA
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Variations in procedure time based on surgery resident postgraduate year level. J Surg Res 2013; 185:570-4. [DOI: 10.1016/j.jss.2013.06.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/07/2013] [Accepted: 06/26/2013] [Indexed: 11/24/2022]
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Mitchell CH, Spinelli RJ. Medicare Reform and Primary Care Concerns for Future Physicians. J Osteopath Med 2013; 113:776-87. [DOI: 10.7556/jaoa.2013.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
The widening income gap between specialists and primary care physicians (PCPs) has spurred many physician associations to reform the current Resource-Based Relative Value Scale fee schedule and sustainable growth rate expenditure target system. Hoping to better represent primary care, the American Association of Family Physicians formed a task force in 2011 to suggest supplements to the Relative Value Update Committee's procedural code recommendations to the Centers for Medicare and Medicaid Services. In addition, the predicted shortage of PCPs has caused many medical schools to increase class sizes; the scarcity of PCPs has also spurred the founding of new medical schools. Such measures, however, have not been met with more residency program sites or graduate medical education funding. The present article highlights major Medicare reform strategies and explores several issues affecting the field of primary care, including reimbursement, representation, and residency training.
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Ward RC, Mainiero MB. Graduate Medical Education in the Era of Health Care Reform. J Am Coll Radiol 2013; 10:708-12. [DOI: 10.1016/j.jacr.2013.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 03/05/2013] [Indexed: 11/30/2022]
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Turner J, Kim K, Mehrotra S, DaRosa DA, Daskin MS, Rodriguez HE. Using optimization models to demonstrate the need for structural changes in training programs for surgical medical residents. Health Care Manag Sci 2013; 16:217-27. [DOI: 10.1007/s10729-013-9230-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
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Deloney LA, Rozenshtein A, Deitte LA, Mullins ME, Robbin MR. What program directors think: results of the 2011 annual survey of the Association of Program Directors in Radiology. Acad Radiol 2012; 19:1583-8. [PMID: 23122573 DOI: 10.1016/j.acra.2012.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 08/21/2012] [Accepted: 08/27/2012] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The Association of Program Directors in Radiology (APDR) conducts an annual survey to monitor and evaluate issues pertaining to radiology residents' educational experiences, work responsibilities, and benefits. Data are used to identify emerging trends and patterns of change to plan and provide resources that support radiology residency programs and their directors. MATERIALS AND METHODS The APDR Annual Survey Committee selected 59 items for an observational, cross-sectional study using a Web-based survey. Topics of interest included program director satisfaction, resident recruitment, social media, program requirements, curriculum, the new American Board of Radiology exam process, call, and residents-as-teachers programs. All active APDR members (n = 296) were invited to participate in survey between February 20 and March 11, 2011. RESULTS The response rate was 47% (140 of 296). Descriptive results were tallied using SurveyMonkey software, and qualitative responses were tabulated or summarized as comments. Findings were reported during the 59th annual meeting of the Association of University Radiologists. CONCLUSIONS Data generated by the annual survey enable the APDR to accrue data pertaining to residents' real-time educational experiences. In 2011, program directors were satisfied with their jobs but not convinced that competency-based program requirements had positive effect on residency training. Programs plan to use the Radiological Society of North America and American Association of Physicists in Medicine Web-based physics training modules. Most radiology programs do not have residents-as-teachers programs, nor do they plan to initiate them. During recruitment, programs use an applicant's location as a proxy for true interest in the program, and interest in the program is important for granting interviews and final ranking. Qualified international medical graduate applicants have access to radiology training in the United States and Canada. Almost half of radiology programs have in-house reading by attending radiologists with residents on call. Residency programs have been slow to embrace social media.
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Girard DE, Brunett P, Cedfeldt A, Bower EA, Flores C, Rajhbeharrysingh U, Choi D. Plug the leak: align public spending with public need. J Grad Med Educ 2012; 4:293-5. [PMID: 23997870 PMCID: PMC3444179 DOI: 10.4300/jgme-d-11-00199.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We explore the history behind the current structure of graduate medical education funding and the problems with continuing along the current funding path. We then offer suggestions for change that could potentially manage this health care spill. Some of these changes include attracting more students into primary care, aligning federal graduate medical education spending with future workforce needs, and training physicians with skills they will require to practice in systems of the future.
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Rahman M, Hoh BL. Impending Federal Cuts in Graduate Medical Education Funding: An Urgent Threat to Neurosurgery Training and Manpower. World Neurosurg 2012; 77:597-9. [DOI: 10.1016/j.wneu.2012.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Guss D, Prestipino AL, Rubash HE. Graduate medical education funding: a Massachusetts General Hospital case study and review. J Bone Joint Surg Am 2012; 94:e24. [PMID: 22336983 DOI: 10.2106/jbjs.k.00425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
During the past century, graduate medical education funding has evolved in response to the increasing specialization of modern medicine as well as the need for federal funding to effectively sustain specialty training. This article reviews historical and current funding methods for graduate medical education and examines current funding using Massachusetts General Hospital (MGH) as a case example. Notably, it also explores whether graduate medical education funding at a large academic center such as MGH is commensurate with expenditures.
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Affiliation(s)
- Daniel Guss
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, WHT-5-535, Boston, MA 02114, USA.
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Cheng G. The national residency exchange: a proposal to restore primary care in an age of microspecialization. AMERICAN JOURNAL OF LAW & MEDICINE 2012; 38:158-195. [PMID: 22497096 DOI: 10.1177/009885881203800103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Healthcare deficiencies in the United States have long been perpetuated by a shortage of primary care providers. A core purpose of the Patient Protection and Affordable Care Act (PPACA) is to provide health insurance for America's approximately fifty million uninsured. Implementation of universal health insurance, however, does not mean sufficient healthcare access for all, since the supply of physicians does not and will not meet demand. For reasons reviewed in this Article, the current physician shortage mainly impacts primary care providers. This shortage is particularly troubling because increased provision of primary care relative to specialty care has been associated with improvement in health outcomes, disease prevention, cost effectiveness, and coordination of care. This Article highlights provisions in the PPACA that impact primary care physicians. Finally, this Article proposes the creation of a universal primary care loan repayment program and a national residency exchange designed to alleviate the U.S. primary care crisis by facilitating optimal distribution of resident physicians in each medical specialty based on community need.
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Affiliation(s)
- Glen Cheng
- United States District Court for the District of New Jersey, USA
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Sandy LG, Bodenheimer T, Pawlson LG, Starfield B. The political economy of U.S. primary care. Health Aff (Millwood) 2011; 28:1136-45. [PMID: 19597213 DOI: 10.1377/hlthaff.28.4.1136] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Compelling evidence suggests that the United States lags behind other developed nations in the health of its population and the performance of its health care system, partly as a result of a decades-long decline in primary care. This paper outlines the political, economic, policy, and institutional factors behind this decline. A large-scale, multifaceted effort--a new Charter for Primary Care--is required to overcome these forces. There are grounds for optimism for the success of this effort, which is essential to achieving health outcomes and health system performance comparable to those of other industrialized nations.
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