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BMJ (Clinical Research Ed.) Jul 2020To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices. (Observational Study)
Observational Study
OBJECTIVE
To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices.
DESIGN
Retrospective observational study.
SETTING
US national survey of physician salaries, 2014-18.
PARTICIPANTS
18 802 physicians from 9848 group practices (categorized according to proportion of male physicians ≤50%, >50-75%, >75-90%, and >90%).
MAIN OUTCOME MEASURES
Sex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography.
RESULTS
Among 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£29 663; €32 621) (95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P=0.03 for difference). Similar findings were observed among surgical specialists (n=3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P=0.06 for difference). Among primary care physicians (n=3829), sex differences in income were not related to the proportion of male physicians in a practice.
CONCLUSIONS
Among both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.
Topics: Female; Group Practice; Humans; Income; Male; Physicians; Physicians, Women; Primary Health Care; Retrospective Studies; Sex Distribution; Surgeons; United States
PubMed: 32732322
DOI: 10.1136/bmj.m2588 -
Journal of General Internal Medicine Oct 2008Few studies have clarified the mechanisms that contribute to racial and ethnic disparities in primary care quality among comparably-insured patients. (Comparative Study)
Comparative Study
BACKGROUND
Few studies have clarified the mechanisms that contribute to racial and ethnic disparities in primary care quality among comparably-insured patients.
OBJECTIVE
To examine relative contribution of "between-" and "within-" physician effects on disparities in patients' experiences of primary care.
DESIGN
Regression models using physician fixed effects to account for patient clustering were specified to assess "between-" and "within-"physician effects on observed racial and ethnic disparities in patients' experiences of primary care.
PARTICIPANTS
The Ambulatory Care Experiences Survey (ACES) was administered to patients visiting 1,588 primary care physicians (PCPs) from 27 California medical groups. The analytic sample included 49,861 patients (31.4 per PCP) who confirmed a PCP visit during the preceding 12 months.
MAIN RESULTS
Most racial and ethnic minority groups were significantly clustered within physician practices (p < 0.001). "Between-physician" effects were mostly negative and larger than "within-physician" effects for Latinos, Blacks, and American Indian/Alaskan Natives, indicating that disparities are mainly attributable to patient clustering within physician practices with lower performance on patient experience measures. By contrast, "within-physician" effects accounted for most disparities for Asians and Pacific Islanders, indicating these groups report worse experiences relative to Whites in the same practices. Practices with greater concentration of Blacks, Latinos and Asians had lower performance on patient experience measures (p < 0.05).
CONCLUSIONS
Targeting patient experience improvement efforts at low performing practices with high concentrations of racial and ethnic minorities might efficiently reduce disparities. Urgent study is needed to assess the contribution of "within-" and "between-" physician effects to racial and ethnic disparities in the technical quality of primary care.
Topics: Ethnicity; Female; Healthcare Disparities; Humans; Male; Middle Aged; Patient Satisfaction; Physician's Role; Physician-Patient Relations; Physicians; Primary Health Care; Race Relations
PubMed: 18651194
DOI: 10.1007/s11606-008-0732-8 -
The Western Journal of Medicine Jan 1991Although the supply of physicians in the United States has doubled during the past 20 years, there is still disagreement as to whether we currently have or should expect... (Review)
Review
Although the supply of physicians in the United States has doubled during the past 20 years, there is still disagreement as to whether we currently have or should expect a significant surplus of physicians. The evidence suggests that despite the rapid expansion in the pool of available physicians, serious physician shortages persist for certain rural populations, ethnic and occupational groups, and other medically disadvantaged segments of the population. Medical students' declining interest in rural practice and primary care specialties suggests that problems of geographic and specialty maldistribution may worsen despite a rising population of physicians. It is unlikely that a significant physician surplus will develop unless there is a conscious attempt to limit the proportion of national wealth expended on medical care. Pockets of shortage can be reduced by broadening the availability of health insurance, lessening large income disparities between different specialties, changing the way teaching institutions are reimbursed for their training costs, and supporting direct governmental service programs such as the National Health Service Corps.
Topics: Humans; Medically Underserved Area; Physicians; Physicians, Women; Rural Health; United States
PubMed: 2024510
DOI: No ID Found -
The Journal of the American Board of... 2003The number of physicians working as a locum tenens is increasing. Although most physicians who provide locum tenens coverage are often older and semiretired, an... (Review)
Review
BACKGROUND
The number of physicians working as a locum tenens is increasing. Although most physicians who provide locum tenens coverage are often older and semiretired, an increasing number of physicians are taking this route for limited periods early in their careers.
METHODS
The medical literature was searched through MEDLINE using the key words "career choice," "contract services," and "locum tenens." Information about locum tenens was gained by the author through research and a personal experience working as a locum tenens.
RESULTS AND CONCLUSION
Working as a locum tenens can be an opportunity to meet interesting patients, learn about local culture, see how practices are organized, learn adaptability, and broaden clinical skills. Opportunities are available through for-profit agencies, academic health centers, state agencies, federal sites such as the Indian Health Service, individual hospitals, and physicians or international staffing companies. Because the physician working as a locum tenens is an independent contractor, exercising some caution when choosing where to work by carefully checking workload and available resources is advised.
Topics: Career Choice; Employment; Humans; Personnel Staffing and Scheduling; Physicians; Practice Management, Medical
PubMed: 12755252
DOI: 10.3122/jabfm.16.3.242 -
Indian Journal of Medical Ethics 2015Trust in physicians is the patient's optimistic acceptance of vulnerability and the expectation that the physician will do what is best for his/her welfare. This study...
Trust in physicians is the patient's optimistic acceptance of vulnerability and the expectation that the physician will do what is best for his/her welfare. This study was undertaken to develop a conceptual understanding of the dimensions and determinants of trust in physicians in healthcare settings in resource-poor, developing countries. A cross-sectional household survey was conducted on a sample of 625 men and women from urban and rural areas in Tamil Nadu, India. The sample was selected using a multistage sampling method and a pre-tested structured questionnaire was utilised. The questionnaire covered the five dimensions of trust: perceived competence of the physician, assurance of treatment, confidence in the physician, loyalty towards him/her, and respect for him/her. Items covering four main factors that influence trust, ie shared identity, the physician's behaviour, personal involvement of the physician and level of comfort with him/her, were included in the questionnaire. A structural equation model was constructed with the dimensions of trust on one hand and the four factors influencing trust on the other. Trust in physicians is based more on notional constructs, such as assurance of treatment (b=0.714, p<0.001) and respect for the physician (b=0.763, p<0.001),than objective assessments, such as the physician's competence (b=0.607, p<0.001). Feeling comfortable with the physician (b=0.630, p<0.001) and the physician's communication skills (b=0.253, p<0.001) significantly influence the level of trust. The former is correlated with the personal involvement of the physician (r=0.124, p<0.001), and so is the latter (r=0.152, p<0.001). The overall model has a good statistical fit. The factors that give rise to trust in physicians vary with the sociocultural context.
Topics: Adolescent; Adult; Aged; Attitude to Health; Cross-Sectional Studies; Delivery of Health Care; Developing Countries; Family Characteristics; Female; Humans; India; Male; Middle Aged; Physician-Patient Relations; Physicians; Poverty; Surveys and Questionnaires; Trust; Young Adult
PubMed: 26228046
DOI: 10.20529/IJME.2015.043 -
Clinical Cardiology Nov 2005
Topics: Clinical Competence; Education, Medical, Continuing; Health Knowledge, Attitudes, Practice; Humans; Physician's Role; Physician-Patient Relations; Physicians; United States
PubMed: 16450791
DOI: 10.1002/clc.4960281102 -
Annals of Family Medicine May 2018Physicians and physician trainees are among the highest-risk groups for burnout and suicide, and those in primary care are among the hardest hit. Many health systems...
Physicians and physician trainees are among the highest-risk groups for burnout and suicide, and those in primary care are among the hardest hit. Many health systems have turned to resilience training as a solution, but there is an ongoing debate about whether that is the right approach. This article distinguishes between unavoidable occupational suffering (inherent in the physician's role) and avoidable occupational suffering (systems failures that can be prevented). Resilience training may be helpful in addressing unavoidable suffering, but it is the wrong treatment for the organizational pathologies that lead to avoidable suffering- and may even compound the harm doctors experience. To address avoidable suffering, health systems would be better served by engaging doctors in the co-design of work systems that promote better mental health outcomes.
Topics: Burnout, Professional; Humans; Physicians; Resilience, Psychological; Suicide Prevention
PubMed: 29760034
DOI: 10.1370/afm.2223 -
Journal of General Internal Medicine Nov 2019Physician online ratings are ubiquitous and influential, but they also have their detractors. Given the lack of scientific survey methodology used in online ratings,... (Comparative Study)
Comparative Study
BACKGROUND
Physician online ratings are ubiquitous and influential, but they also have their detractors. Given the lack of scientific survey methodology used in online ratings, some health systems have begun to publish their own internal patient-submitted ratings of physicians.
OBJECTIVE
The purpose of this study was to compare online physician ratings with internal ratings from a large healthcare system.
DESIGN
Retrospective cohort study comparing online ratings with internal ratings from a large healthcare system.
SETTING
Kaiser Permanente, a large integrated healthcare delivery system.
PARTICIPANTS
Physicians in the Southern California region of Kaiser Permanente, including all specialties with ambulatory clinic visits.
MAIN MEASURES
The primary outcome measure was correlation between online physician ratings and internal ratings from the integrated healthcare delivery system.
RESULTS
Of 5438 physicians who met inclusion and exclusion criteria, 4191 (77.1%) were rated both online and internally. The online ratings were based on a mean of 3.5 patient reviews, while the internal ratings were based on a mean of 119 survey returns. The overall correlation between the online and internal ratings was weak (Spearman's rho .23), but increased with the number of reviews used to formulate each online rating.
CONCLUSIONS
Physician online ratings did not correlate well with internal ratings from a large integrated healthcare delivery system, although the correlation increased with the number of reviews used to formulate each online rating. Given that many consumers are not aware of the statistical issues associated with small sample sizes, we would recommend that online rating websites refrain from displaying a physician's rating until the sample size is sufficiently large (for example, at least 15 patient reviews). However, hospitals and health systems may be able to provide better information for patients by publishing the internal ratings of their physicians.
Topics: Ambulatory Care Facilities; Delivery of Health Care, Integrated; Female; Humans; Internet; Male; Patient Satisfaction; Physicians; Retrospective Studies; Surveys and Questionnaires
PubMed: 31531811
DOI: 10.1007/s11606-019-05265-3 -
Annals of Internal Medicine Oct 2020
Topics: Academic Medical Centers; Black or African American; Humans; Personnel Selection; Physician's Role; Physicians; Police; Racism; United States; Violence
PubMed: 32551811
DOI: 10.7326/M20-4280 -
Family Medicine and Community Health 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Pandemics; Physician's Role; Physicians, Family; Pneumonia, Viral; Referral and Consultation; SARS-CoV-2
PubMed: 32148740
DOI: 10.1136/fmch-2020-000333