Demand For Physician Services Research Articles

Understanding Gender Biases and Differences in Web-Based Reviews of Sanctioned Physicians Through a Machine Learning Approach: Mixed Methods Study

BackgroundPrevious studies have highlighted gender differences in web-based physician reviews; however, so far, no study has linked web-based ratings with quality of care.ObjectiveWe compared a consumer-generated measure of physician quality (web-based ratings) with a clinical quality outcome (sanctions for malpractice or improper behavior) to understand how patients’ perceptions and evaluations of physicians differ based on the physician’s gender.MethodsWe used data from a large web-based physician review website and the Federation of State Medical Boards. We implemented paragraph vector methods to identify words that are specific to and indicative of separate groups of physicians. Then, we enriched these findings by using the National Research Council Canada word-emotion association lexicon to assign emotional scores to reviews for different subpopulations according to gender, gender and sanction, and gender and rating.ResultsWe found statistically significant differences in the sentiment and emotion of reviews between male and female physicians. Numerical ratings are lower and sentiment in text reviews is more negative for women who will be sanctioned than for men who will be sanctioned; sanctioned male physicians are still associated with positive reviews.ConclusionsGiven the growing impact of web-based reviews on demand for physician services, understanding the different dynamics of reviews for male and female physicians is important for consumers and platform architects who may revisit their platform design.

Moving Forward: 2022 Committee on Professional Diversity's 2nd Virtual Doctors Back to School Program

Committee News| September 2022 Moving Forward: 2022 Committee on Professional Diversity's 2nd Virtual Doctors Back to School Program Christine Vo, MD; Christine Vo, MD Search for other works by this author on: This Site PubMed Google Scholar Odmara L. Barreto Chang, MD, PhD Odmara L. Barreto Chang, MD, PhD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor September 2022, Vol. 86, 32–33. https://doi.org/10.1097/01.ASM.0000874272.69789.72 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Christine Vo, Odmara L. Barreto Chang; Moving Forward: 2022 Committee on Professional Diversity's 2nd Virtual Doctors Back to School Program. ASA Monitor 2022; 86:32–33 doi: https://doi.org/10.1097/01.ASM.0000874272.69789.72 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: continuing professional development, teachers June 7, 2022, marked the sixth time the ASA Committee on Professional Diversity (CPD) embarked on community outreach efforts inspired by the American Medical Association's (AMA's) Doctors Back to School™ Program (DBTS) (asamonitor.pub/3AFs5FH). Our primary goal was to reach out to kids from communities with minority populations who are underrepresented in medicine. By promoting interactions between students early in their academic pursuits and health care professionals with similar backgrounds, we hoped to bring to the forefront of their developing minds the message from our first virtual DBTS: “there is potential in you, and we are proof that you, too, can succeed and be part of our health profession” (ASA Monitor 2021;85:32). Why is it imperative for ASA to participate in health care pipeline efforts involving underrepresented minorities? AMA released data showing that “demand for physician services is projected to grow by 138,900 FTEs from 2019-2034... You do not currently have access to this content.

Online and offline health information seeking and the demand for physician services.

We examine the relationship between Internet-based health information seeking and the demand for physician services, using data collected from the 28 European Union states in 2014. Unlike previous research, our analysis distinguishes seekers of health information into those who use only non-Internet sources and those who use the Internet and possibly non-Internet sources. By comparing the frequencies of physician visits among the two groups of health information seekers and non-seekers, we infer the net association between online health information and the demand for physician services while partially controlling for the effects of concurrent seeking of offline health information. The following are the two key findings: (1) individuals’ health status and sociodemographic factors shape online and offline health information seeking patterns in similar ways; and (2) the demand for physician services is positively associated with offline health information seeking and not with online health information. The net association with online health information would be even smaller after controlling for the effect of concurrent offline health information seeking. These results suggest that extending the availability of online health information would potentially reinforce the unequal access to health information, which could create greater variation in individuals’ health management skills and benefits from health care in the long term. However, it would be associated with little or no increase in the demand for physician services, unlike the implications of previous research.

Trajectories Matching for Characterizing Patient’s Behavior in Policy Evaluation

Background: Economic theory and earlier empirical evidence suggest that patients will use fewer health services when they have to pay more for them. However, that copayment had little or no effect on visits to physicians. Objectives: This study exploits a natural experiment in Taiwan to estimate the effect of an increase in copayment on the demand for physician services and prescription drugs across the different dimensions of age, illness severity and patient behavior. Methods: Data were taken from the National Health Research Institute (NHRI) in Taiwan for the period of 1998 to 2000 and contained enrollment and claims files from a randomly chosen 0.2% of Taiwan’s population. The deletion of observations with missing values for any of the dependent or independent variables resulted in a final sample size of 69 768 individuals. The basic empirical strategy is to pool the data over the two years in question and estimate the effects of the reform by comparing the expected number of visits before and after the reform. We explored several alternatives stratifying the treatment in order to improve the quality of the identification. Results: We found that the reduction in visits was rather conservative with the DD estimates ranging from -0.08 to -0.17 compared to the estimate of -0.38 without stratification. The reform effect will most likely be exaggerated if the unobserved heterogeneity of the individual, such as health status and behavior, is not considered in the model.

Effects of health insurance on patient demand for physician services

BackgroundIn recent years, policymakers have sought to reduce health disparities between the insured and uninsured through a federal health insurance expansion policy; however, disparities continue to persist among the insured population. One potential explanation is that the use of healthcare services varies by the type of health insurance coverage due to differences in the design of coverage. The aim of this study is to examine whether health insurance coverage type is associated with the structure and use of healthcare services.MethodsThe nationally representative Medical Expenditure Panel Survey and multinomial logistic regression are used to estimate the effects of different types of health coverage on the combinations of routine and emergency care sought and received.ResultsThe multinomial logistic regression analysis for the overall sample revealed privately insured respondents reported higher use of routine care only p < 0.01 and lower use of emergency room care only (− 2.13%; p < 0.01) than the uninsured. The publicly insured reported similar trends for use of routine care only (17.93%; p < 0.01) as the privately insured, as compared to the uninsured. Both the privately and publicly insured reported higher use of a mixture of care; however, publicly insured were more likely to use a mixture of care (8.57%, p < 0.01).ConclusionThe results show that health insurance is associated with higher use of the physician services, but does not promote the use of cost-effective schedules of care among the publicly insured.

Do Children on Medicaid Benefit from a Weak Labor Market? Evidence from the Great Recession

In this article, I estimate the association between weak labor market conditions and the quantity of office-based physician services received by children enrolled in Medicaid. I find that children use more services in areas with higher unemployment during the Great Recession, and the result is not influenced by changes in sample composition. The association could reflect either demand factors such as worsening health or supply factors such as changes in the number of physicians willing to accept Medicaid patients. I provide several pieces of evidence supporting a supply-side mechanism: higher unemployment reduces the demand for physician services by privately-insured patients. Physicians respond to the demand shock by serving more Medicaid enrollees.

Is there a doctor in the house? Availability of Israeli physicians to the workforce

BackgroundIsraeli policymakers have expressed serious concerns about being able to meet the growing demand for physician services. For this reason, the Israel Ministry of Health (MoH) undertook studies based on 2008 and then 2012 data to obtain an accurate assessment of the size, specialty mix, demographic and geographic composition of the physician workforce. This paper highlights the findings from these studies about the number and percentage of licensed physicians in Israel who were not available, were only partially available, or were about to leave the Israeli healthcare workforce.MethodsThe two studies cross-linked administrative files of the entire physician population in Israel. The two sources were the MoH registry of licensed physicians, which contains demographic, medical education and specialty information, and the Israel Tax Authority income file on employment data. A third source, used only for the study of 2008 data, was the CBS Population Census Data 2008 which was based on a large representative sample of the population (14%), along with the updated Population Registry, which provided data on physicians whose occupation was in medical care as well as the number of work-hours. By linking the files we could also assess the population of licensed Israeli physicians living abroad.ResultsOnly 74% of licensed physicians of all ages in 2012 were active in the Israeli workforce. Of physicians under the age of 70, 87% were living and working in Israel. Female physicians tended to retire from the workforce earlier than males and were more likely to work fewer hours during their working years. The rate of physicians who worked longer hours declined in both genders as age rose. About 10% of licensees had been living abroad for at least a year and the majority of these were older. Approximately 7% of licensed physicians, ages 30–44, were abroad and most are presumed to be doing additional clinical training or gaining research experience.In some specialty fields young physicians were not replacing retirees at a compensatory rate; anesthesiologists, a specialty in short supply in Israel were more likely to be living abroad than other specialists.ConclusionsAssessment of the medical workforce pool and personnel planning require not just the number of licensed physicians but also information about the employment mix of license holders and their level of professional activity in Israel.For planning future workforce needs, it is important to keep in mind that the average female vs. male physician has lower clinical productivity due to shorter hours and earlier retirement and that a group of young physicians will predictably be abroad at any point in time; however major “brain drain” is not evident. Furthermore, extrapolating from the findings in the current studies, we believe that a potential shortage of physicians within Israel can be mitigated by better administrative support of physicians, use of physician extenders, and careful attention to improving physician satisfaction in certain specialties.

Obesity and the Demand for Canadian Physician Services

The objective of this study is to determine the role that obesity plays in how often Canadians visit their family doctors or general practitioners. Doctor visits are analyzed using mixtures of ordered probability models applied to sample survey data from the 2010 Canadian Community Health Survey. This procedure is shown to be superior in terms of likelihood criteria to the more usual one involving count models of doctor visits. The main result is that obesity is one of the leading causes of doctor visits. Obesity has become more important in the demand for physician services than smoking for all Canadians. Other factors including diabetes, the individual’s level of education, position in the income distribution, and drinking behavior are also important. The application of latent class’s ordered probability models by age-group and gender leads to results which are different from what others have found. While obesity is shown to be a serious problem in Canada, it has not yet reached the stage which some researchers have described as critical.

Commentaries on health services research

Commentaries on health services research

Primary Care Physician Shortages Could Be Eliminated Through Use Of Teams, Nonphysicians, And Electronic Communication

Most existing estimates of the shortage of primary care physicians are based on simple ratios, such as one physician for every 2,500 patients. These estimates do not consider the impact of such ratios on patients' ability to get timely access to care. They also do not quantify the impact of changing patient demographics on the demand side and alternative methods of delivering care on the supply side. We used simulation methods to provide estimates of the number of primary care physicians needed, based on a comprehensive analysis considering access, demographics, and changing practice patterns. We show that the implementation of some increasingly popular operational changes in the ways clinicians deliver care-including the use of teams or "pods," better information technology and sharing of data, and the use of nonphysicians-have the potential to offset completely the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage.

Medical physics graduate programs should adjust enrollment to achieve equilibrium between graduates and residents

Medical physics graduate programs should adjust enrollment to achieve equilibrium between graduates and residents

Effects of cost sharing on the demand for physician services in Japan: Evidence from a natural experiment

In this paper, we investigate the effects of cost sharing on the demand for physician services in Japan by using a natural experiment, namely, the increase in the coinsurance rate for household heads in 1997. Our primary finding from the two-year data, which includes the transitory effects of the reform, is that the effects of the reform on the frequency of physician visits were negative and statistically significant, and that the effects of the reform on expenditures per visit were also negative. Based on these results, the arc elasticity of demand for physician services is −0.055. When we exclude the transitory period using the three-year data, the effects of the reform on the frequency of physician visits turn to be positive. It seems that the patients marginally curtailed the number of physician visits immediately after the reform; however, this effect was not sustained in the six months after the reform. We conclude that Japanese patients are not very price sensitive within the 10–20 percent range of coinsurance rate. Another important finding in our study is that the decrease in expenditure per visit retained even after the transitory period. This result suggests that the existence of a possible moral hazard in the treatment intensity although the decision-making process on the treatment intensity needs to be examined more carefully.

The demand for physician services: Evidence from a natural experiment

This study exploits a natural experiment in Belgium to estimate the effect of copayment increases on the demand for physician services. It shows how a differences-in-differences (DD) estimator of the price effects can be decomposed into effects induced by the common average proportional price increase (income effects) and by the change in relative prices (substitution effects). The price elasticity of a uniform proportional price increase is relatively small (−0.13 for men and −0.03 for women). Substitution effects are large, especially for women, but imprecisely estimated. Despite the substantial price increases, the efficiency gain of the reform, if any, is modest.

The Shortage of Anesthesiologists—and Other Medical Specialists

To the Editor: The article on the shortfall in anesthesia care providers raised many unanswered questions for other specialists, including internists and surgeons, most importantly how to implement an effective national system that addresses the number of specialists required to provide optimal health care.1Schubert A Eckhout G Cooperider T Kuhel A Evidence of a current and lasting national anesthesia personnel shortfall: scope and implications.Mayo Clin Proc. 2001; 76: 995-1010Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In contrast to the oversimplified approach highlighted by Schubert et al,1Schubert A Eckhout G Cooperider T Kuhel A Evidence of a current and lasting national anesthesia personnel shortfall: scope and implications.Mayo Clin Proc. 2001; 76: 995-1010Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar which was based on a single snapshot analysis of data driven by incomplete economic analysis, we propose the establishment of a series of standing interdisciplinary committees to reevaluate specialty training needs on an ongoing basis. Specifically, we recommend a core group of statisticians, health economists, legislators, regulators, and insurers be established and funded to serve as a permanent oversight committee. This committee would convene on a regular basis with academic and community physician representatives from individual specialties (eg, internal medicine, anesthesiology, or surgery) and subspecialty groups (eg, gastroenterology, critical care, or urology). Together, they would be charged with identifying supply/demand economic factors that have an impact on specialty personnel needs such as reimbursement, cost of training, and insurer and governmental expenditures. The group would establish criteria to address manpower requirements from a broader, more rational, and more realistic perspective. These experts would meet to reevaluate and redefine their recommendations based on the rapid and continuous changes taking place in our health systems environment. Demand for physician services is ever increasing with our growing and aging population. The need is not specialty specific. With ever-expanding pharmaceutical and technologic innovation and expenses, the delivery of care by a specific specialty becomes a dynamic process, such as the shift in demand for a specific specialty created by interventional cardiology vs cardiac surgery. The supply side of physician manpower availability necessitates a preemptive and ongoing perspective to allow compensation for the time required to train additional specialists to meet a specific patient demand.2Pingleton SK Committee on Manpower of Pulmonary and Critical Care Societies: a report to membership.Chest. 2001; 120: 327-328Crossref PubMed Scopus (6) Google Scholar, 3The Leapfrog Group Available at: www.leapfroggroup.org/purchase1.htmGoogle Scholar In addition, if reimbursement issues are not addressed, specific care providers will not be available. Various specialties, most recently critical care medicine, have been directly affected by the absence of comprehensive reimbursement despite a demonstrated need and benefit. Meanwhile, the fear of inadequate reimbursement by Medicare for physician services has altered generalist and specialist physician training and may continue to impact this dramatically in the future. We need to look no further than the current Medicare reimbursement proposals that call for an overall 5.4% cut in physician payments to see hard evidence of factors that will directly affect physician numbers, specialization, and training.4Grassroots Action Center Congress fails to fix Medicare physician cut.Available at: capwiz.com/ama/issues/alert/?alertid=26171&type=COGoogle Scholar If we fail to address physician manpower needs, do not provide appropriate and attractive training and practice opportunities, and allow reimbursement to be inequitable or inadequate, future quality American practitioners may follow more appealing paths into nonmedical fields. Such a scenario presents a lose-lose situation for clinicians, patients, and society. The Shortage of Anesthesiologists—and Other Medical Specialists: In ResponseMayo Clinic ProceedingsVol. 77Issue 2PreviewWe appreciate the thoughtful letter by Drs Coursin and Vender regarding our article. We agree that personnel fluctuations need to be minimized. The issue is how to accomplish such a complex and never-ending objective. A comprehensive approach across all medical specialties may be too cumbersome to establish and fund de novo. As Coursin and Vender point out, changes in the health care sector occur rapidly. In addition, personnel supply considerations differ across specialties. For example, surgical specialties control training positions more tightly than does anesthesiology. Full-Text PDF The Shortage of Anesthesiologists—and Other Medical SpecialistsMayo Clinic ProceedingsVol. 77Issue 2PreviewIn reply: The recommendations to form an interdisciplinary group to provide advice and/or oversight regarding physician manpower requirements and availability are logical at first glance. The concept that physician availability is not just a “medical profession” problem but clearly a major societal issue is obviously appropriate. Therefore, a committee to represent the intellectual and pragmatic framework of physician availability is an excellent recommendation. Full-Text PDF

Issues of intervention aimed at preventing prospective surplus of physicians in Japan

In Japan, regulatory intervention aimed at preventing a prospective surplus of physicians is an important medical issue. The study committees organized by the Ministry of Health and Welfare (MHW) in 1986, 1993 and 1998, concluded that the number of physicians would exceed demand for their services in the future. As a result, the government planned to reduce the number of medical students. However, MHW has not been successful in the intervention so far, as shown by the fact that their initial plan for a 10% reduction in the number of students enrolled in medical school has not been attained. In this paper, we examine why the MHW policy failed. We reviewed those forecasts performed by past MHW study committees and examined whether the government policy of controlling physician training was appropriate. Additionally, we did a preliminary projection of specialty-specific demand for physician services as a reference for future physician manpower policies in Japan. We found that both conflicts among various interest groups and a lack of precise projections of physician services hampered the proper formation and implementation of a physician manpower policy in Japan. It might be necessary to examine the appropriateness of the MHW policy in reducing the overall number of students enrolled in medical schools. As a first step in formulating and implementing a physician manpower policy, we should begin to consolidate the necessary data to conduct precise and proper projections of future physician demand.

Moral hazard and the demand for physician services: First lessons from a French natural experiment

This paper presents empirical results on moral hazard in demand for medical care, using a longitudinal dataset on 4578 individuals followed during two years. The dataset contains two subgroups, one for which a copayment rate of 10% for physician visits was introduced in 1994, and an other for which no change occurred during the period of the study. This enables us to use these data as coming from a controlled natural experiment. We test if the number of visits per agent was modified by this copayment rate. The data reject the hypothesis for office visits, but do not for home visits. This suggests that there is moral hazard in demand for some physician services, but also that when non-monetary costs are important, small changes in monetary price may not induce any major change in behavior

The demand for physician services in a changing health care system: a synthesis.

The demand for physician services in a changing health care system: a synthesis.

Medicine as a career: choices and consequences.

Medicine has traditionally been regarded as a rewarding career both financially and socially. How true, however, is that tradition in today's world of rising costs and decreasing revenues? The educational debt of the physician-in-training is steadily increasing, and currently does not affect specialty choice. As the cost of medical education continues to rise, the applicant pool begins to shrink, thereby possibly affecting the quality of future physicians. Once the physician has completed training however, the majority enjoy a positive return on investment. Their incomes generally fail to remain ahead of inflation, and therefore, have remained within a narrow band of $40,000 in 1970 dollars. Finally, the demand for physician services cannot be attributed solely to either the consumer (patient) or to the supplier (physician). Rather, the demand for medical services appears to be a unique combination of the two. In conclusion, medicine still is an attractive career path, but the choices and consequences are becoming much more demanding.

Supply and demand elasticities of physician services: disequilibrium analysis.

Numerous empirical works have examined the demand for and supply of physician services during the past 15 years. Almost all simultaneous equation models have used the assumption of an equilibrium condition in the physician services market. The assumption of an equilibrium market for physician services may not be realistic, at least not in the short term, because the cost of physician services is insufficiently flexible or because of the induced demand on the part of physicians. Different market assumptions will result in different model formulations and model estimations, and with different empirical implications of the estimated results. The paper has used the US aggregate time-series data, 1950 to 1980, to estimate the demand and supply relationship of physician services, similar to the model specified in the Martin Feldstein article, 1 under a disequilibrium physician services market assumption. The maximum likelihood method is used for the empirical estimation. Contrary to Feldstein's earlier findings, the price elasticity of the demand for physicians is statistically significant with expected signs under a disequilibrium condition. The elasticity of supply of physician services is also, as expected, positive and statistically significant. Economic and policy implications are discussed based on these findings. This paper should fill empirically the gap that has been noted by previous researchers on the demand for physician services.

The Demographics Of Physician Supply

The Demographics Of Physician Supply