Factors associated with emergency physician income

Objective

Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income.

Methods

We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income.

Results

From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767.

Conclusions

This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.

Modeling relapse in unipolar depression: the effects of dysfunctional cognitions and personality disorders

Survival analytic models were used to determine the effects of Axis II pathology and dysfunctional cognitions on depressive relapse in a sample of 50 depressed inpatients followed 33 to 84 months (M = 49.9) postdischarge. In analyses based on follow-up interview measures, expected remission duration among patients without personality disorders was approximately 7.4 times longer than among patients with Axis II comorbidity. Attributional style also accounted for unique variance in the relapse model, with adaptive positive event attributions inversely related to relapse probability. Neither dysfunctional attitudes nor negative event attributions were significantly related to relapse. Dimensional Axis II Cluster B and C pathology ratings were associated with decreased survival time, whereas Cluster A pathology was associated with increased survival. Among measures obtained during index hospitalization, only the dimensional rating of Axis II pathology was significantly predictive, with a cumulative 8% decrease in expected survival for each Axis II criterion item met.

Factor analysis of the Montgomery-Asberg Depression Rating Scale

A maximum likelihood factor analysis with Promax rotation was performed on the Montgomery-Asberg Depression Rating Scale for 340 adult inpatients in an Affective Disorders Program. Four factors were identified and labeled cognitive-pessimism, affective, cognitive-anxiety, and vegetative. Recommendations were offered for the research and clinical use of the factor scores.

Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache

Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.

Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache

Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.

A controlled evaluation of thermal biofeedback and thermal biofeedback combined with cognitive therapy in the treatment of vascular headache

One-hundred-sixteen patients suffering from vascular headache (migraine or combined migraine and tension) were, after 4 weeks of pretreatment baseline headache monitoring, randomly assigned to one of four conditions: (a) thermal biofeedback with adjunctive relaxation training (TBF); (b) TBF plus cognitive therapy; (c) pseudomediation as an ostensible attention-placebo control; or (d) headache monitoring. The first three groups received 16 individual sessions over 8 weeks, while the fourth group continued to monitor headaches. All groups then monitored headaches for a 4-week posttreatment baseline. Analyses revealed that all treated groups improved significantly more than the headache monitoring group with no significant differences among the three treated groups. On a measure of clinically significant improvement, the two TBF groups had slightly higher (51%) degree of improvement than the meditation group (37.5%). It is argued that the attention-placebo control became an active relaxation condition.

Cardiovascular responses in the laboratory and in the natural environment: is blood pressure reactivity to laboratory-induced mental stress related to ambulatory blood pressure during everyday life?

Cardiovascular activity recorded at rest and during mental stress in the laboratory was studied in relation to ambulatory recorded cardiovascular activity at work and at home. Fifty-five Type A men (M = 42.4 years) underwent a standardized laboratory mental stress protocol in which systolic blood pressure, diastolic blood pressure, and heart rate were recorded at baseline and during a 15 min mental arithmetic task (MAT). On a subsequent day, ambulatory blood pressure and heart rate were recorded at 20 minute intervals for 12-14 hr during normal activities at home and at work. Subjects completed a behavioral diary concurrently with each cuff inflation. High and Low groups were identified based upon a median split of their cardiovascular response levels at baseline and during the MAT. Subjects with high systolic blood pressure levels during the MAT had high systolic blood pressure at home, at work, during physical activity, and when they reported being 'stressed'. Baseline systolic blood pressure in the laboratory was less consistently related to ambulatory systolic pressure across ambulatory conditions. Diastolic blood pressure at baseline was related to ambulatory diastolic blood pressure at work, at home, and when resting. Diastolic blood pressure during the MAT was associated with higher diastolic pressure at work and at home. Heart rate at baseline and during the MAT was related to heart rate at work and during physical activity. Change scores derived by subtracting mean values during the MAT from baseline resting levels were not associated with ambulatory blood pressures or heart rates under any daily conditions. In the best case, systolic blood pressure measured during the MAT was related to systolic blood pressure during physical activity, to systolic blood pressure and heart rate during mental stress, to systolic and diastolic blood pressure at rest, and to systolic blood pressure and heart rate at work but not at home. We conclude that levels of blood pressure and heart rate measured in the laboratory, but not reactivity (i.e, change scores) during the MAT, are related to blood pressure and heart rate levels recorded in the natural environment, especially in the work setting.

Tc-99m diphosphonate uptake in malignant fibrous histiocytoma: a possible iron-related effect

A man with malignant fibrous histiocytoma of the thigh had avid uptake of Tc-99m MDP in the lesion. Review of tissue sections showed considerable accumulation of iron in the tumor. Iron is known to be a potential nidus for deposition of the Tc-99m diphosphonates. A review was made of tissue sections from two other reported cases of malignant fibrous histiocytoma which also had significant accumulation of Tc-99m diphosphonates. Both revealed iron within the tumor. The origin of the iron is unknown (perhaps from necrosis and hemorrhage, from trauma, or from innate phagocytic activity of the histiocytes). However, this observation may serve as a stimulus to studies attempting to discern the underlying mechanisms of extraosseous deposition of the Tc-99m diphosphonates.

Prediction of early termination from the self-regulatory treatment of chronic headache

The ability of demographic, psychological testing and history information to predict which patients will terminate early from nonpharmacological treatment of headache (relaxation and biofeedback) was tested. Information from each of these areas was initially examined for differences between dropouts and treatment completers using univariate analyses. These analyses were followed by a canonical discriminate function analysis that predicted whether patients would complete treatment or drop out. Information from the three predictor sets combined resulted in 77.4% of the patients being correctly classified.

Psychological comparisons of irritable bowel syndrome to chronic tension and migraine headache and nonpatient controls

Comparisons were made among patients with IBS (n = 55), tension headache (n = 69), or migraine headache (n = 68) and nonpatient controls (n = 64) on the MMPI and several other psychological tests, including BDI, STAI, Life Events, and Psychosomatic Symptom Checklist. With two nonsignificant exceptions (MMPI scale F and Life Events) the groups were consistently ordered, in terms of increasing psychological distress: Normals less than Migraine Headache less than Tension Headache less than IBS. The IBS patients were more like the tension headache patients than any other group. Subgroups of IBS patients, on the basis of presence or absence of diarrhea or constipation in addition to abdominal pain, were generally not significantly different on the psychological tests.

Three studies of the psychologic changes in chronic headache patients associated with biofeedback and relaxation therapies

Three separate, but similar, studies are described in which the psychologic effects (depression, anxiety, and overall degree of psychosomatic distress) of nonpharmacologic treatment (relaxation and/or biofeedback training) for three kinds of chronic headache (tension, migraine, and mixed migraine and tension) were evaluated. Results showed consistently (across all three studies) significant reductions in depression and trait-anxiety associated with receiving treatment, regardless of headache type or treatment outcome. The significant reduction for overall degree of psychosomatic distress was not differentially related to receiving treatment and thus could have been due to prolonged monitoring of headaches or test-retest regression effects.

Biofeedback and relaxation treatments for headache in the elderly: a caution and a challenge

Results for 11 older (60 years or greater) headache patients treated with combinations of biofeedback and relaxation are presented. Overall, only 18.2% were clinically improved after treatment. None of the 5 tension headache patients were improved. Suggestions for future work with the older headache patient are offered.

Multicystic renal cell carcinoma

This is a case report of a patient with cystic renal cell carcinoma that had all of the ultrasound and computed tomographic features of benign multicystic renal disease. Although this benign entity is a possibility in some patients, thick-wall cystic lesions of the kidney must be considered malignant until proven otherwise and surgery cannot be avoided.

Renal cyst wall thickening following percutaneous aspiration

Computed tomography (CT) is an accurate and efficient means for evaluating and characterizing renal masses. Using established criteria, benign cortical cysts may be accurately differentiated from complex cysts or solid renal lesions. We report a case of cyst wall thickening simulating a cystic tumor that occurred after percutaneous aspiration of a simple renal cyst.

Synthesis and some reactions of the N-Tosyl derivative of indoles and 2,3-Dihydrocarbazol-4(1H)-one

The preparation and some reactions of the N-tosyl derivative of 3-(2?- nitropropenyl)indole (1), indole-3-carbaldehyde (2), indole-3- glyoxylamide (3), and 2,3-di-hydrocarbazol-4(1H)-one (7) are described. The N-tosylnitropropenyl derivative (1) was converted into α-methyl-1- tosyltryptamine, and the reaction of 2,3-dihydro-9-tosyl-carbazol-4(1H)-one (7) with ethoxyethynylmagnesium bromide and in the Mannich and Cope-Knoevenagel reactions are described.

Synthesis of some tricyclic amines - Hexahydro-1H-indenoazepines and a Hexahydro-1H-benzo-quinoline and -isoquinoline

2,3,4,4a,5,6-Hexahydro-1H-indeno[7,1-cd]azepine (6), 2,3,3a,4,5,6- hexahydro-1H-benzo[de]quinoline (10), 2,3,3a,4,5,6-hexahydro-1H- benz[de]isoquinoline (12), isolated as their hydrochlorides, and 2,3,4,4a,5,6-hexahydro-1H-indeno[7,1-bc]azepine (8) have been prepared by lithium aluminium hydride reduction of the corresponding lactams which were synthesized from the appropriate tricyclic ketones by Beckmann rearrangement or Schmidt reaction. The base (8) was also synthesized from 1,2,3,4-tetrahydronaphthalene-1,8-dimethanol (15).