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Esposito AC, Coppersmith NA, White EM, Papageorge MV, DiSiena M, Hess D, LaFemina J, Larkin AC, Miner TJ, Nepomnayshy D, Palesty J, Rosenkranz KM, Seymour NE, Trevisani G, Whiting J, Oliveira KD, Longo WE, Yoo PS. Update on the Financial Well-Being of Surgical Residents in New England. J Am Coll Surg 2023; 236:953-960. [PMID: 36622076 DOI: 10.1097/xcs.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Poor personal financial health has been linked to key components of health including burnout, substance abuse, and worsening personal relationships. Understanding the state of resident financial health is key to improving their overall well-being. STUDY DESIGN A secondary analysis of a survey of New England general surgery residents was performed to understand their financial well-being. Questions from the National Financial Capability Study were used to compare to an age-matched and regionally matched cohort. RESULTS Overall, 44% (250 of 570) of surveyed residents responded. Residents more frequently reported spending less than their income each year compared to the control cohort (54% vs 34%, p < 0.01). However, 17% (39 of 234) of residents reported spending more than their income each year. A total of 65% of residents (152 of 234), found it "not at all difficult" to pay monthly bills vs 17% (76 of 445) of the control cohort (p < 0.01). However, 32% (75 of 234) of residents reported it was "somewhat" or "very" difficult to pay monthly bills. Residents more frequently reported they "certainly" or "probably" could "come up with" $2,000 in a month compared to the control cohort (85% vs 62% p < 0.01), but 16% (37 of 234) of residents reported they could not. In this survey, 21% (50 of 234) of residents reported having a personal life insurance policy, 25% (59 of 234) had disability insurance, 6% (15 of 234) had a will, and 27% (63 of 234) had >$300,000 worth of student loans. CONCLUSIONS Surgical residents have better financial well-being than an age-matched and regionally matched cohort, but there is still a large proportion who suffer from financial difficulties.
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Affiliation(s)
- Andrew C Esposito
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Nathan A Coppersmith
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Erin M White
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Marianna V Papageorge
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Michael DiSiena
- Berkshire Medical Center, Department of Surgery, Pittsfield, MA (DiSiena)
| | - Donald Hess
- Boston Medical Center, Department of Surgery, Boston, MA (Hess)
| | - Jennifer LaFemina
- the University of Massachusetts Chan Medical School, Department of Surgery, Worcester, MA (LaFemina, Larkin)
| | - Anne C Larkin
- the University of Massachusetts Chan Medical School, Department of Surgery, Worcester, MA (LaFemina, Larkin)
| | - Thomas J Miner
- Rhode Island Hospital, Warren Alpert Medical School, Department of Surgery, Providence, RI (Miner)
| | - Dmitry Nepomnayshy
- Lahey Hospital and Medical Center, Department of Surgery, Burlington, MA (Nepomnayshy)
| | - John Palesty
- Saint Mary's Hospital, Department of Surgery, Waterbury, CT (Palesty)
| | - Kari M Rosenkranz
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Lebanon, NH (Rosenkranz)
| | - Neal E Seymour
- Baystate Health, Department of Surgery, Springfield, MA (Seymour)
| | - Gino Trevisani
- the University of Vermont Medical Center, Department of Surgery, Burlington, VT (Trevisani)
| | - James Whiting
- Maine Medical Center, Department of Surgery, Portland, ME (Whiting)
| | - Kristin D Oliveira
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Walter E Longo
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
| | - Peter S Yoo
- From the Yale School of Medicine, Department of Surgery, New Haven, CT (Esposito, Coppersmith, White, Papageorge, Oliveira, Longo, Yoo)
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Hyman N, Borrazzo E, Trevisani G, Osler T, Shackford S. Credentialing for Laparoscopic Bowel Operation: There Is No Substitute for Knowing the Outcomes. J Am Coll Surg 2007; 205:576-80. [PMID: 17903732 DOI: 10.1016/j.jamcollsurg.2007.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/16/2007] [Accepted: 05/21/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Case volume and training have been considered as reasonable surrogates for competency that can be used as a basis to grant privileges for performing laparoscopic operations. To determine the validity of this practice, we assessed the relationship of surgical volume and training to provider-related complications after laparoscopic bowel resection. STUDY DESIGN All patients undergoing open or laparoscopic resection at a university hospital from July 2003 to June 2006 were entered into a prospectively maintained database. Complications were recorded by a specially trained nurse practitioner and adjudicated monthly by a team of gastrointestinal surgeons. Surgeon case volume, training, and operative indication were assessed for their ability to predict technical complications after laparoscopic resection using a logistic regression model. RESULTS Six hundred twenty-four bowel resections were performed during the study period, of which 112 were performed laparoscopically. Of the four study surgeons, the percentage of laparoscopic versus open cases ranged from 8% to 56%. Individual surgeon complication rates varied from 9% to 47%. Surgical volume and training had no notable relationship to incidence of complications (19% high volume/fellowship training versus 10% low volume/no fellowship, p = 0.25). An inflammatory indication was a strong predictor of technical complications on univariate (p = 0.02) and multivariate (p = 0.01) analysis. CONCLUSIONS Surgeon case volume and training had no relationship to the complication rate after laparoscopic bowel operation. Case selection is a critical confounding variable because surgeons vary so greatly in their indications for using laparoscopic technique. Although documentation of training is appropriately considered in granting privileges, actually tracking outcomes is likely the only reliable way to assess competency.
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Affiliation(s)
- Neil Hyman
- Department of Surgery, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT 05401, USA.
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Laditka SB, Jenkins CL, Trevisani G, Mathews K. The doctor on the patient's turf: assessing patient satisfaction with physician home visit programs. Home Health Care Serv Q 2002; 19:1-16. [PMID: 11727286 DOI: 10.1300/j027v19n04_01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated a physician home visit program (n = 23 patients) focusing on program implementation and quality. Quality was measured by evaluating patient satisfaction with services using a patient satisfaction scale and interviews with patients, caregivers, and providers. Scale results showed patients expressed the highest satisfaction with access to routine care and physician consideration. Patients expressed less satisfaction with access to emergency care and continuity of care. Physician communication and integration with home- and community-based service providers were other areas of concern. Recommendations include enhancing physician communication skills in the home, providing care for urgent medical conditions, improving chart documentation, and incorporating community-based chronic care experts into the program.
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Affiliation(s)
- S B Laditka
- Center for Health and Aging, State University of New York Institute of Technology at Utica/Rome, USA
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