Suchergebnisse

Intro -- PHYSICIAN PRACTICES: CHANGES, TRENDS, AND IMPLICATIONS -- PHYSICIAN PRACTICES: CHANGES, TRENDS, AND IMPLICATIONS -- CONTENTS -- PREFACE -- Chapter 1 PHYSICIAN PRACTICES: BACKGROUND, ORGANIZATION, AND MARKET CONSOLIDATION -- SUMMARY -- INTRODUCTION -- PHYSICIAN SUPPLY -- Supporting Practitioners -- PRACTICE CONSOLIDATION -- Market Trends -- Larger Group Practices and Physician Organizations -- Hospital Affiliation and Employment -- Affiliation with Insurers and Other Payers -- Delivery Reforms -- Concierge Practices -- LEGAL ISSUES -- ISSUES FOR CONGRESS -- Medical Spending -- Access -- Coordinated Care/Quality -- APPENDIX. PHYSICIAN INCOME AND PRACTICE COSTS -- Federal Policies Affecting Compensation -- End Notes -- Chapter 2 PHYSICIAN SUPPLY AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT -- SUMMARY -- INTRODUCTION -- SIZE OF THE PHYSICIAN POPULATION -- Measuring the Physician Population -- Determining the Appropriate Size of the Physician Population -- PPACA and the Size of the Physician Population -- PPACA Provisions Targeting the Number of Physicians Trained -- PPACA Provisions Targeting Physician Productivity -- COMPOSITION OF THE PHYSICIAN POPULATION -- Primary Care Supply and Factors Influencing Primary Care Supply -- PPACA and the Composition of the Physician Population -- PPACA Provisions Targeting Primary Care Supply -- Primary Care Content in Physician Training -- Primary Care Physician Payment -- Care Coordination by Primary Care Physicians -- PPACA Provisions Targeting Shortages in Specialties -- GEOGRAPHIC DISTRIBUTION OF THE PHYSICIAN POPULATION -- Health Professional Shortage Areas and Medically Underserved Areas/Populations -- Why Geographic Shortages May Exist -- PPACA and the Geographic Distribution of the Physician Population -- PPACA Provisions Targeting the NHSC

Physician anthropologists have contributed extensively to the anthropology of biomedicine, as well as to other aspects of medical anthropology. Their use of detailed clinical case narratives allows elucidation of what is at stake for individuals and communities in the course of any given illness. Biomedically informed observations of bodies illustrate the connections between microscopic harm and macrosocial arrangements, while observations of clinical spaces and medical knowledge production contribute to current debates over evidence, metrics, migration, and humanitarianism. In moving away from culturalist explanations for illness, physician anthropologists have drawn attention to the manifold workings of structural violence—and have often sacrificed the possibility of deep epistemological challenges to biomedicine. While raising a note of caution about the moral authority of physician anthropologists, I recognize that much of this scholarship has laid the intellectual groundwork for a movement toward equity that refuses to justify poor-quality health care for poor people.

Although there has been significant interest from health services researchers and policy makers about recent trends in hospitals' ownership of physician practices, few studies have investigated the strengths and weaknesses of available data sources. In this article, we compare results from two national surveys that have been used to assess ownership patterns, one of hospitals (the American Hospital Association survey) and one of physicians (the SK&A survey). We find some areas of agreement, but also some disagreement, between the two surveys. We conclude that full understanding of the causes and consequences of hospital ownership of physicians requires data collected at the both the hospital and the physician level. The appropriate measure of integration depends on the research question being investigated.

"Physician-assisted suicide (PAS) is legal in nine US states and the District of Columbia. It is not without controversy, even in those states in which PAS laws have been passed. Proponents believe that it's a matter of liberty, that the terminally ill have the right to choose how their lives will end. Opponents argue that such laws make the terminally ill vulnerable to medical errors and abuse, and that in effect they devalue life. The viewpoints in this volume examine physician-assisted suicide from many angles, providing readers with a comprehensive approach to a challenging topic"--

Intro -- PHYSICIAN SUPPLY AND DEMAND -- PHYSICIAN SUPPLY AND DEMAND -- CONTENTS -- PREFACE -- Chapter 1 GRADUATE MEDICAL EDUCATION: TRENDS IN TRAINING AND STUDENT DEBT -- ENCLOSURE I -- Graduate Medical Education: Trends in Training and Student Debt -- Overview -- Introduction -- Objectives -- Scope and Methodology -- Background -- Medical education -- Key Policy Changes in Postgraduate Medical Training -- Federal student loans -- Most specialties can fall into three categories -- Summary of Findings -- 1. Surgical and Procedural Specialties Preferred, and Subspecialization Increasing -- Surgical and Procedural Specialties Have Been More Competitive -- U.S. MD students fill higher proportions of available surgical and procedural positions -- More doctors are pursuing training to become subspecialists -- 2. Multiple Factors, Demographic Characteristics Influence Specialty Choice -- Students consider multiple factors -- Factors lead students to pursue or avoid certain specialties -- Demographics and personality traits are important -- 3. Debt Is Rising but Federal Assistance Is Available and Physicians Can Earn High Incomes -- Debt, Federal Assistance, Physician Income -- Nearly half of graduating medical students are at least 150,000 in debt -- Medical school tuition is also increasing -- Federal loans are available to cover the full cost of medical education -- Options for reducing repayment burdens until after training -- Physicians incur more debt but can earn high incomes to repay it -- ENCLOSURE II -- Trends in Postgraduate Dental Education and Student Debt -- ENCLOSURE III -- Trends in Thoracic Surgery Fellowships -- ENCLOSURE IV -- Scope and Methodology -- Data Analysis -- Literature and Document Review -- Interviews with Government Officials and Professional Groups -- ENCLOSURE V.

Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military's health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.

Professionalism and Ethics in Medicine: A Study Guide for Physicians and Physicians-in-Training is a unique self-study guide for practitioners and trainees covering the core competency areas of professionalism, ethics, and cultural sensitivity. This novel title presents real-world dilemmas encountered across the specialties of medicine, offering guidance and relevant information to assist physicians, residents, and medical students in their decision-making. The text is divided into two parts: Foundations and Questions with Answers. The first part provides a substantive foundation of knowledge in the principles, scholarship, policy guidelines, and decision-making strategies of the modern health professions. The second part assists practitioners and trainees in preparing for the complex issues that arise each day in the settings where health professionals work and train - clinics, research centers, educational contexts, and communities. Developed by renowned leaders in a broad range of clinical fields, Professionalism and Ethics in Medicine: A Study Guide for Physicians and Physicians-in-Training is a major, invaluable contribution to the literature and an indispensable reference for clinicians at all levels.

"Patient sorting can confound estimates of the returns to physician human capital. This paper compares nearly 30,000 patients who were randomly assigned to clinical teams from one of two academic institutions. One institution is among the top medical schools in the country, while the other institution is ranked lower in the quality distribution. Patients treated by the two teams have identical observable characteristics and have access to a single set of facilities and ancillary staff. Those treated by physicians from the higher-ranked institution have 10-25% shorter and less expensive stays than patients assigned to the lower-ranked institution. Health outcomes are not related to the physician team assignment, and the estimates are precise. Procedure differences across the teams are consistent with the ability of physicians in the lower-ranked institution to substitute time and diagnostic tests for the faster judgments of physicians from the top-ranked institution"--National Bureau of Economic Research web site

Physician motivation and related incentive compensations plans are central to the design and delivery of safe, high-quality, satisfying medical care as well as advancing physician satisfaction and engagement. The underlying premise of this article is that the interests of physicians and patients as well as the community ought to be better aligned to improve clinical and population health outcomes. The Triangle of Patient Centered Compensation is presented as a model to design or redesign compensation programs that seek to achieve better alignment between physicians, patients and the community. After reading this article, practitioners will be able to adopt and adapt the model to fit with the vision, mission and strategies of their organization and academics will be able to empirically test this model and revise this model.

There is only limited evidence on whether certified and uncertified health care providers in India support reforming the Medical Termination of Pregnancy (MTP) Act to expand the abortion provider base to allow trained nurses and AYUSH physicians (who are trained in Indian systems of medicine) to provide medical abortion. To explore their views, we conducted a survey of 1,200 physicians and other health care providers in Maharashtra and Bihar states and in-depth interviews with 34 of them who had used medical abortion in their practices. Findings indicate that obstetrician-gynaecologists and other allopathic physicians were less supportive than non-physicians of nurses and AYUSH physicians providing early medical abortion. The physicians did not think that these providers would be able to assess women's eligibility for medical abortion correctly. In contrast, the majority of non-physicians found task shifting of medical abortion provision to trained nurses and AYUSH physicians acceptable, and they were confident that these providers would be able to provide medical abortion as safely and effectively as trained physicians. Assuming the reforms are passed, efforts will need to be made by government and medical professional bodies to train these new providers to undertake this role, prepare the health infrastructure to include them, and create an environment, including among physicians, that is conducive to enabling non-physicians to provide medical abortion.

A brief review of the Physician Quality Reporting System (PQRS) is presented highlighting the program's legislative history, eligibility requirements and incentive payment plan. Specifically, PQRS measures applicable to neuroradiology practice are discussed. Several steps are suggested for individual physicians or group practices to start participation in the program. Resources are also provided for further information on the program requirements and PQRS measures.

Physician reimbursement and the coding to support it are critically important to the sustained health of any physician's practice. This article reviews the recent history of physician reimbursement from the government and third-party payers and physician coding to support reimbursement. Explanations of terminology and documentation requirements are included.

Intro -- Preface -- Contents -- Contributors -- Part I: Advancing Professional Calling and the Culture of Wellbeing in Medicine -- Chapter 1: Calling, Compassionate Self, and Cultural Norms in Medicine -- Medical Cultural Norms -- Deferring Personal Needs to Serve Others -- Shaming Intolerance of Error -- Compassion in Addressing Personal Well-Being and Health-Care Quality Improvement -- Compassion in Addressing Personal Wellbeing -- Compassion in Health-Care Quality Improvement -- References -- Chapter 2: Creating a Culture of Wellness -- Barriers to a Culture of Wellness Common in Medical Training and Practice -- Belief that Deferring Self-Care Equals Dedication to Patients -- Belief that Shaming and Punishment in Response to Errors Promote Safety in Health Care -- Stigma Suggesting that Physicians Who Seek Mental Health Help Are Less Fit for Duty -- Promoting Specific Culture of Wellness Factors for Physician WellBeing -- Psychological Safety -- Inclusive Leadership Style -- Leadership Support -- Values Alignment -- Appreciation and Gratitude -- Fairness/Equity -- Flexibility and Work-Life Integration -- Peer Support -- Community/Collegiality -- Conclusion -- A Culture of Wellness Is Achievable -- References -- Chapter 3: Compassion Cultivation -- Introduction -- How Is Compassion Cultivated -- Compassion Training Programs -- Cognitively-Based Compassion Training -- Compassion Cultivation Training -- Mindful Self-Compassion (MSC) -- Being with Dying (BWD) -- Brief Compassion Training for Physician Well-Being: A Case Study in Program Design -- Conclusion -- References -- Part II: Recognizing Threats to Physician Wellbeing -- Chapter 4: Mistreatment -- Introduction -- History and Prevalence -- Types of Mistreatment -- Sources of Mistreatment -- The Interplay of Wellness and Mistreatment -- Impact on Learners -- Impact on Mistreater -- Solutions.