Female Family Physicians Research Articles

Research to Improve Clinical Care in Family Medicine: Big Data, Telehealth, Artificial Intelligence, and More.

This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several articles report on the effectiveness of telehealth, including its use for hospital follow-up, medication abortion, management of diabetes, and as a potential tool for reducing health disparities. Other articles detail innovations in clinical practice, from the use of artificial intelligence and machine learning to a validated simple risk score that can support outpatient triage decisions for patients with COVID-19. Notably one article reports the impact of a voluntary program using scribes in a large health system on physician documentation behaviors and performance. One article addresses the wage gap between early-career female and male family physicians. Several articles report on inappropriate testing for common health problems; are you following recommendations for ordering Pulmonary Function Tests, mt-sDNA for colon cancer screening, and HIV testing?

Lack of Diversity in Female Family Physicians Performing Women's Health Procedures.

Lack of Diversity in Female Family Physicians Performing Women's Health Procedures.

Racial Inequities in Female Family Physicians Providing Women's Health Procedures.

Patient-physician race concordant dyads have been shown to improve patient outcomes; the race and ethnicity of family physicians providing women's health procedures has not been described. Using self-reported data, this analysis highlights the racial disparities in scope of practice; underrepresented in medicine (URiM) females are less likely to perform women's health procedures which may lead to disparities in care received by minority women.

Female Family Physicians Are More Racially Diverse Than Their Male Counterparts in Federal Sites.

Supporting a diverse family physician workforce is an integral component of achieving health equity. This study compared the racial/ethnic composition of Federal family physicians (Military, Veterans Administration/Department of Defense) to the entire cohort of family physicians and stratified by gender. Female family physicians serving at Federal sites were more diverse than the overall population of female family physicians and, also than their male Federal counterparts. This gendered trend among Federal physicians needs further exploration.

Family Physician Income Disparities by Race and Gender.

A race and gender salary gap has been well-documented throughout the U.S. economy, but little described in primary care. Using self-reported data on the most widely distributed primary care physician specialty, we reveal lower incomes and hourly wages among Black/African American and female family physicians. The clear gradient in family physician compensation by race and gender demands further study and action to better understand and address the underlying sources of these differences.

Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study.

Background:The proportion of women entering medicine has increased in recent years, and understanding the different practice patterns of female and male family physicians (FPs) will provide important information for health workforce planning. We sought to evaluate differences by sex in the supply, payments and clinical activity among FPs in Ontario.Methods:We conducted a cohort study using claims data from the Ontario Health Insurance Plan. We included all Ontario FPs who submitted claims from 1992 to 2018. We analyzed data using regression analyses for our outcomes of yearly number of FPs, payments, patient visits and distinct patients.Results:The number of practising FPs increased from 10 370 in 1992 to 14 329 in 2018, with an annual increase of 155 female FPs and 13 male FPs. In 2018, male FPs outnumbered female FPs by 1159. Among male FPs, 32.7% worked less than 1 full-time equivalent (FTE) position, 18.1% worked 1 FTE and 49.2% worked more than 1 FTE, with little change over the 27-year study period. Among female FPs, the percentage of those who worked less than 1 FTE position decreased over time (58.6% in 1998 to 48.3% in 2015), those who worked 1 FTE was stable (22.2%–24.3%) and those who worked more than 1 FTE increased (18.7% in 1998 to 28.0% in 2017). Yearly payments were higher for male FPs than female FPs by 40%–60% overall and by 10%–20% in FPs who worked more than 1 FTE. For FPs who worked 1 FTE or less than 1 FTE, both sexes had similar payment amounts (from 2005–2018). For FPs who worked 1 FTE, female FPs were less likely to receive payments from fee-for-service after 2004, and had 550 fewer visits and 121 fewer patients annually than male FPs.Interpretation:In Ontario, there are differences by sex in FP supply, payments, percentages of FTE groups, number of patient visits and number of distinct patients. Health administrators should be mindful of these differences when considering FP workforce plans to ensure a stronger primary health care system, with adequate health care delivery for the population.

Mental health impact of COVID-19 on family doctors in Canada: one year after.

Context: A year after the pandemic outbreak, primary care providers continue to face extreme psychological pressure. This study gauges the mental health and burnout levels of family physicians during the third wave of the COVID-19 pandemic in Canada. Objective: Assess the levels of personal, professional and patient-related burnout of family physicians (FPs) in the response to the pandemic and explore demographic and work-related factors that may influence burnout levels. Study Design: Online, self-report survey administered between April 7 and May 10, 2021. Setting or Dataset: The College of Family Physicians of Canada's (CFPC) list of all active members was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Family medicine trainees and members with primary addresses outside Canada were excluded. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: The study used the Copenhagen Burnout Inventory (CBI) which measures the level of personal, work-related and patient-related burnout. As well, question asking about FP's overall sense of well being and personal wellness which were asked in a previous survey, a year prior, were incorporated to allow for longitudinal comparison. Results: 15% of FPs reported feeling burned out and thinking of, or have taken, a break from work, three times more than last year. More than one-fifth of FPs currently experience high or severe personal (22%) and work-related (21%) burnout, while 13% report the same levels of patient-related burnout. Female FPs report higher levels of personal burnout (26%, 17%) and work-related burnout (23%, 16%) than male FPs. Generations Y (30%) and X (25%) are experiencing higher levels of personal burnout than Baby Boomers (14%) and Traditionalists (2%). Conclusions: Roughly 1-in-4 FPs in Canada are currently experiencing high or severe personal and work-related burnout. Compared with the survey results a year prior, the numbers are climbing rapidly, reflecting the serious challenges FPs facing during the pandemic. This study was designed to contribute to a better understanding of the extent of the problem, contributing factors and to assist in considering approaches to build effective support systems to improve the mental health of FPs.

Doctor-patient communication skills: a survey on knowledge and practice of Iranian family physicians

BackgroundCommunication skills are fundamental to successful medical practice and can greatly impact patient satisfaction, compliance and outcomes. This study evaluated knowledge and practice of doctor- patient communication among the urban family physicians based on main items of Calgary Cambridge Observation Guides.MethodThis cross-sectional study was conducted from July to September, 2019, in a 400 randomly selected sample of family physicians of Shiraz, Fars province. The data collection tool was a self-administered, second-part questionnaire developed by the researchers. Participants were asked about their age, gender, practice setting, and years of work experience and if they received any formal training in doctor- patient communication. Data were analyzed using SPSS (Version 16, SPSS Inc., Chicago, IL, USA). A p-value of less than 0.05 was considered statistically significant.ResultsThe study participants included 204 male and 196 female family physicians with a mean age of 46.7 ± 7.7 years. The mean communication skills knowledge score was 41.5 (SD: ± 2.8) indicating a high level of knowledge. The mean score for practices was 38.7 (SD: ± 3.4), implying a moderate level of practice. Based on Bloom’s scale, nearly 80% of family physicians had good knowledge about doctor-patient communication skills, however, 55% of participants reported moderate to poor level of practice in this regard. Results of multivariate regression analysis suggest that higher levels of related knowledge, having higher age or longer work experience, and working in the public sector can predict better practice scores (P < 0.005).ConclusionThere is a potential gap between knowledge and self-reported practices toward communication skills among a sample of Iranian family physicians. They have fundamental weakness in the most important evidence-based items of doctor- patient communication. Considering significant role of family physicians in prevention and control of non-communicable diseases (NCDs) as an emerging challenge of our country, the topic of communication skills should be inserted as a top educational priority of family physicians.

Aile Hekimlerinin Covıd-19 Pandemi Döneminde Kişisel Koruyucu Önlem Alma Davranışları

Objective The COVID-19 disease which emerged in Wuhan city of Hubei province of China in December 2019 has caused a pandemic worldwide. Family physicians who are the first point of contact in the primary health care system, have an important role in individual and social infection control. The aim of this study is to evaluate the behaviors of family physicians to take personal protective measures during the pandemic period. Materials and Methods 208 physicians (76 females; 142 males) included in the study. Physicians' use of personal protective equipment and their behaviors towards protective measures were questioned in our study. SPSS 22.0 statistical package program was used for data analysis. Results: 81% of family physicians stated that they felt sufficient to properly wear personal protective equipment and to take it off properly without contamination. It was found that female family physicians wash their hands more than male ones. (p<0.001) While the rate of family physicians who stated that they used less than 5 gloves a day was 66%, the rate of those who stated that they used less than 3 masks per day was 70.4% in their workplace. Conclusion: Our findings show that family physicians needed more education and adequate personal protective equipment support in personal protective measure applications. Providing adequate personal protective equipment support via health campaigns to family physicians during the pandemic period is protective for physicians and the society.

Perceptions of Gender and Race Equality in Leadership and Advancement Among Military Family Physicians.

There is increasing interest in assessing gender and race-based disparities in academic medicine and healthcare leadership in civilian medicine and the U.S. Military Health System. Approximately 15% of U.S. active duty service members are women, and racial minorities are 30% of the total active duty force. This study evaluates the following factors among uniformed services family physicians: gender and race representation in attaining early career leadership positions during training and 2 years postresidency; perceptions regarding leadership opportunities and career advancement. Registered attendees (n = 300) of the 2016 Uniformed Services Academy of Family Physicians Annual Meeting were given a voluntary and anonymous online questionnaire. The main outcomes measured were early leadership assignments and perceptions about command/leadership support, gender roles in leadership assignment, confidence to achieve leadership goals, and being passed over for leadership positions. Sixty-eight percent of registered attendees completed the study questionnaire. Statistically significant results, adjusting for service, grade, race, and gender, were that non-Caucasian family physicians were less likely to be chief residents (odds ratio 0.23, 95% CI 0.01-1.00) and less likely to have leadership positions within 2 years postresidency (odds ratio 0.30, 95% CI 0.10-0.91). Female family physicians were more likely to agree that gender has a role in assigning leadership positions (odds ratio 2.33, 95% CI 1.01-5.39). There were no differences in perceptions of command support for leadership; confidence in achieving desired leadership level; or in being passed over for leadership positions. This study provides important information about perceived gender and race equality among uniformed services family physicians. Key findings included that non-Caucasian military family physicians were less likely to attain junior leadership positions or be assigned to academic settings; and female respondents were more likely to agree that gender has a role in assignment of leadership positions. Evaluating composite personnel records of services' family physicians would provide invaluable information to complement this study.

Family Physician Burnout Does Not Differ With Rurality.

Burnout affects about half of family physicians (FPs). Minimal research exists which examines the impact of urban and rural practice settings on FP burnout. In this study, we examined whether rural practice is associated with FP burnout. Data from the 2017 and 2018 American Board of Family Medicine Family Medicine Certification examination registration questionnaire were used. We limited our sample to FPs in continuity care in the United States. The questionnaire is a mandatory component of registration, resulting in a 100% response rate. Burnout was measured via 2 questions validated against the Maslach Burnout Inventory. We used logistic regression to determine associations between burnout and rural location, controlling for practice and personal characteristics. Of the FPs surveyed, 2,740 met our inclusion criteria. Rural FPs were older, more likely to be male, and had a broader scope of practice than urban FPs. Rural FPs had a nonsignificantly higher burnout rate than urban FPs (45.1% vs 43.0%). Burnout was more common in younger and female FPs. We found no rural/urban differences between job satisfaction, practice environment, workload, and job stress; however, all of these characteristics were associated with burnout. In adjusted analyses, rural location was not associated with burnout (odds ratio = 1.15, 95% CI: 0.87-1.52). In a large national sample, we found no difference in burnout between rural and urban FPs. This suggests there is nothing unique about rural practice that predisposes to burnout and that a common pathway to reduce burnout may exist.

A human resources for health analysis of registered family medicine specialists in South Africa: 2002-19.

In South Africa, there is a need to clarify the human resources for health policy on family physicians (FPs) and to ensure that the educational and health systems are well aligned in terms of the production and employment of FPs. To analyse the human resource situation with regard to family medicine in South Africa and evaluate the requirements for the future. A retrospective review of the Health Professions Council of South Africa's (HPCSA) database on registered family medicine practitioners from 2002 until 2019. Additional data were obtained from the South African Academy of Family Physicians and published research. A total of 1247 family medicine practitioners were registered with the HPCSA in 2019, including 969 specialist FPs and 278 medical practitioners on a discontinued register. Of the 969, 194 were new graduates and 775 from older programmes. The number of FPs increased from 0.04/10 000 population in 2009 to 0.16/10 000 in 2019, with only 29% in the public sector. On average, seven registrars entered each of nine training programmes per year and three graduated. New graduates and registrars reflect a growing diversity and more female FPs. The number of FPs differed significantly in terms of age, gender, provincial location and population groups. South Africa has an inadequate supply of FPs with substantial inequalities. Training programmes need to triple their output over the next 10 years. Human resources for health policy should substantially increase opportunities for training and employment of FPs.

The Gender Penalty: Reasons for Differences in Reported Weekly Work Hours Among Male and Female Family Physicians.

The JABFM policy brief by Wilkensen et al[1][1] highlights gender differences in work hours between male and female family physicians, with men reporting significantly more hours of total and direct patient care across age groups. This comes as no surprise to me as a female family physician with 3

Gender Differences in Reported Weekly Work Hours Among Family Physicians.

While women are entering family medicine at higher rates than men, little is known about the present differences in practice patterns between male and female family physicians (FPs). We used 2017 and 2018 American Board of Family Medicine Family Medicine Certification Examination practice demographic questionnaires to assess average weekly total hours and direct patient care hours by age and gender reported by FPs. We found a gender gap between both overall hours worked and direct patient care hours, with female FPs reporting fewer hours across age groups.

Specialist LINK and primary care network clinical pathways - a new approach to patient referral: a cross-sectional survey of awareness, utilization and usability among family physicians in Calgary

BackgroundSpecialist LINK is a real-time, non-urgent telephone collaboration line designed to link family doctors and specialists. The purpose was to reduce wait times, improve efficiency and enhance the coordination of patient care through enhanced communication between primary and specialty care. The aim of this study was to determine the awareness and utilization of Specialist LINK and Primary Care Network (PCN) Clinical Pathways among family physicians.MethodsA family physician experience cross-sectional survey was conducted from March to May 2018 in Calgary and Area. The survey was designed to assess family physicians’ awareness and utilization of Specialist LINK and PCN Clinical Pathways. We also used a 1–10 scale for respondents to rate the utility of Specialist LINK (1 was least useful and 10 represented highly useful). To obtain a true representative sample, family physicians were selected through a random sampling method. We applied multiple approaches to ensure a high response rate: paper survey, telephone reminders, and an on-site survey for non-responders.ResultsA total of 251 participants completed the survey of the 650 randomly selected family physicians (Response rate≈39%). Eighty-nine percent of the family physicians were aware of Specialist LINK [95% Confidence Interval (84–92%)]. The average rating was 8.1 (on a scale of 1–10) for the usefulness of Specialist LINK. We found that the odds of being aware of Specialist LINK were two times higher in female family physicians compared to male physicians. Also, those with less than 5 years of experience, the odds of being aware of Specialist LINK were around five times higher compared to those with 5 or more years of experience. Fifty-five percent of family physicians were aware of PCN Clinical Pathways (95% CI = 48–60%); of those, 82% were accessing and following PCN Clinical Pathways in their clinical practice. The average rating was 7.9 (on a scale of 1–10) for the usefulness of PCN Clinical Pathways.ConclusionMost of the respondents in Calgary and area were aware of Specialist LINK and a large proportion of them were using it to access advice for their patients.

Burnout Among Family Physicians by Gender and Age.

Using data from 2017 to 2018, we found that female family physicians, especially those younger than 40 years of age, experience burnout at higher rates than males. This has implications for the primary care workforce and suggests pathways for policy makers and health system administrators to more effectively tackle burnout in their organizations.

The Management of Patients with Pneumonia in Family Medicine in Slovenia

Background: Pneumonia is among the most common infections treated in family practice. In Slovenia, a comprehensive management of pneumonia at the primary level has not yet been researched, which results in the lack of data regarding guideline adherence. Our aim was to describe the management of patients with pneumonia in family practices and to analyse characteristics of family physicians (FPs) and their practices which influence guideline adherence.Methods: The study was conducted as a cross-sectional research with clinical vignette and questions about characteristics of FPs and their practices, in the form of an online questionnaire; 892 specialists and FPs without specialty, and 320 residents were contacted. Using the guidelines, a proper management protocol for patients with pneumonia was designed and used for the evaluation of respondents’ answers. The collected data were analyzed using logistic regression.Results: The response rate was 475/1212 (39.2 %). When managing patients with pneumonia, 66.7 % of FPs performed a complete blood count with differential, 92.6 % CRP, 54.5 % chest X-ray, 62.6 % prescribed amoxicillin and 29.7 % amoxicillin with clavulanic acid. The correct preliminary diagnosis was provided by 93.7 % of FPs, correct diagnostics by 13.5 %, no referral by 90.3 %, proper treatment by 53.1 % and checkup by 48.8 % of FPs. 3.2 % of FPs exhibited an altogether adequate patient management. Negative association between female FPs and adequate diagnostics, and between FPs older than 45 years and adequate treatment and checkup was noticed.Conclusion: The research indicated many differences in managing pneumonia. Only a small share of FPs completely adhered to the set guidelines.

Impact of family physicians on cervical cancer screening: cross-sectional questionnaire-based survey in a region of southern Poland

BackgroundDespite worldwide efforts in encouraging routine pap smears for early detection of cervical cancer, Poland’s screening rate lags behind the rest of the European Union at 20.2%. Family physicians (FPs)...

Does the family physicians’ characteristics affect Cervical Cancer Screening rates?

IntroductionWhile the effectiveness of cervical cancer-screening (CCS) programs is well accepted, concern is growing regarding Family physicians (FP) poor adherence to CCS guidelines resulting in over and under screening. In Canada, it is a FP responsibility to ensure that the CCS is done as per guidelines and with appropriate follow-up.&#x0D; Objectives and ApproachTo identify primary care physicians’ characteristics that are associated with over and under CCS for eligible women in Calgary, Alberta.&#x0D; We accessed the Calgary Laboratory Services data for 1475 FPs practicing in Calgary and linked it with the Physicians database of College of Physicians and Surgeons Alberta database. We then matched FP’s gender, country and year of medical school graduation, years since medical school graduation, certification in family medicine and their clinic address with their CCS testing patterns. Using doctors as their own controls, we compared data from 2010-2016 to determine practice variations in CCS patterns subsequent to guideline changes.&#x0D; ResultsWe analyzed approximately 2,400,000 Pap test requisitions (approx. 300,000 per year) to identify screening patterns from 2010-2016 of 1475 family practitioners practicing in Calgary. Our preliminary results identified significant variations in the test ordering patterns of FPs. Approx. half of the male FPs were not performing CCS tests on their eligible female patients. Female FPs ordered more CCS tests than their male counterparts. FP trained in North America, were ordering more pap tests than FPS trained elsewhere. Decreased CSS was also observed among FPs practicing in Northeast Calgary.&#x0D; Conclusion/ImplicationsWe detected three CCS patterns: FPs who never perform CSS on eligible female patients; FPs who followed recommended guidelines for performing CCS tests and FPs who performed CCS tests, not following the guidelines. To ensure appropriate use of CSS, identifying intention-behavior relationships and innovative educational interventions for FPs are required.

Evaluation of the attitudes of specialist and family physicians regarding rational drug selection.

OBJECTIVE:Physicians’ personal (P) drugs, which were ranked by priority, may show variations even for the same indication. We aimed to evaluate physicians’ knowledge and attitudes regarding P-drug list preparation with respect to the rational use of medicine context.METHODS:A total of 1062 family physicians (FPs) and 562 specialist physicians (SPs) were interviewed and questioned about their knowledge and attitude regarding P-drug list preparation.RESULTS:Compared with SPs (64.9%), significantly more number of FPs (72.8%) prepared a P-drug list. Women were more likely to prepare the P-drug list in both groups; gender comparison showed that significantly more number of female FPs (75.9%) exhibited this attitude than female SPs (67.8%) (p=0.002). Among SPs, the trend for P-drug list preparation attitude decreased with increasing age (p=0.006), and significantly less number of senior physicians showed this attitude compared with junior physicians (p=0.007). The most common source of information referred to by FPs (78.9%) and SPs (74.3%) during P-drug list preparation was “pharmaceutical company activities.” More than 80% of responders (80.9% of FPs and 83.6% of SPs) specified that a difference “exists” or “partially exists” between original and generic drugs. Approximately one in 10 physicians in both groups stated that they “rarely/never” consider their patients’ “liver/kidney disease” during prescribing.CONCLUSION:More prominently in male and senior physicians, the attitude of P-drug list preparation remained lower than expected. Moreover, it is remarkable that pharmaceutical company promotions are the most common source of information for drug selection. These findings disclose the need for the rational use of medicine dissemination interventions for all physicians focusing on more effective use of P-drug list.