Full-time Equivalent Physicians Research Articles

A Survey of Ophthalmologists in 52 Cities in the Southern United States

Background: The United States (US) supply of surgical specialty practitioners in 2025 is projected to fall short by 24,340 physician full-time equivalents. The greatest deficit is projected for ophthalmology with the most affected region noted to be the southern US. Aims: To better understand the distribution of our ophthalmology workforce in the southern US and to identify cities with less access to subspecialty-specific vision care. Objective: To determine the prevalence of ophthalmologists as well as rates of ophthalmology subspecialists and practice types in the three largest cities of each state within the southern US. Methods: The American Academy of Ophthalmology’s “Find an Ophthalmologist” online listing was queried on a city-by-city basis from December 2020 to April 2021. The number and location of ophthalmologists were determined in the three largest cities, according to population, in the southern US. Data collected on each ophthalmologist included sex, primary subspecialty, practice type, year of first board certification, and academic affiliation. Results: There were 1,735 total ophthalmologists identified in the three largest cities of each state, 52 cities in total, within the southern US. The majority were male (n= 1,369, 78.90%) and board-certified prior to or during 1997 (n= 913, 52.62%). There were 12,308 persons per ophthalmologist (P/O) in the southern US. Cities with the highest P/O ratio were Rio Rancho, NM (101,475 P/O), Southaven, MS (28,691 P/O), and Houston, TX (27,868 P/O). The lowest P/O ratios included Morgantown, WV (1,587 P/O), Charleston, WV (2,263 P/O), and Wilmington, DE (3,025 P/O). Less populated cities (<300,000 persons) had a significantly higher proportion of comprehensive ophthalmologists in the southern US (p-value=0.007). Conclusion: A total of 550 ophthalmologists were evaluated in southwestern cities and 1,185 were evaluated in southeastern cities. Our results suggest that less populated cities are driven by comprehensive ophthalmology practices. This data suggests greater vulnerability in certain cities with less access to subspecialty-specific vision care.

Impacts of Decision Support Systems on Hospital Efficiency: A Data Envelopment Analysis Model

This study examined whether decision support systems (DSS) matter in hospital efficiency. We used data envelopment analysis to measure the hospital’s efficiency, with four inputs and three outputs - inpatients, outpatients, and total patient revenue. Results showed hospitals with more DSS were significantly more efficient than hospitals with fewer DSS. Furthermore, hospitals with fewer full-time equivalent physicians, more full-time registered nurses, and more beds had greater efficiency. For hospital efficiency, the number of beds was the highest impact factor, followed by the number of registered nurses, and the number of full￾time equivalent physicians.

Overlapping shifts to improve patient safety and patient flow in emergency departments

Emergency departments (ED) act as primary patient access points for millions of people seeking medical care. However, the sheer volume of patient arrivals and variability among cases makes ED prone to crowding, a well-recognized public health, and patient safety issue. In addition, patient care transitions from one physician to another, known as handoffs, increase with crowding and negatively impact patient safety and satisfaction. This research focused on utilizing a novel hybrid modeling approach to represent the physician and patient activities in the ED to identify physician shift policies that can improve patient safety and patient flow by minimizing handoffs and patient time in the ED. Compared to the current practices that utilize a non-overlapping schedule for staffing the physicians, policies that restrict physicians from taking new patients during the end of their shift can reduce the number of handoffs by as much as 11.2%, with no significant difference in patient time in the ED. Furthermore, comparing current practices to overlapping staffing policies with restrictions, we observed that handoffs and patient time in the ED could be reduced to 41.5% and 14%, with a slight increase in physician full-time equivalents. Finally, we also observed that the ED could immediately accommodate a 10%–15% increase in patient volume with an overlapping staffing policy and still achieve the current performance metrics. However, implementing these policies in a specific ED would call for a risk–cost–benefit analysis considering ED demands, resource availability, and staffing costs.

The Challenge of Employee Retention in Medical Practices across the United States: An Exploratory Investigation Into the Relationship between Operational Succession Planning and Employee Turnover.

Employee turnover is a growing challenge for health-care providers delivering patient care today. US population demographics are shifting as the population ages, which leaves the field of health care poised to lose key leaders and employees to retirement at a time when patient care has grown more complex. This means health care will lose its core of key employees at a time when skilled leadership and specialized knowledge is most needed and directly impacts health care's ability to deliver quality care. Operational succession planning (OSP) may be one solution to manage this looming challenge in health care, as the process identifies and develops the next generation of leadership. Thus, this exploratory national study used a quantitative and cross-sectional design to examine the relationship between OSP and employee turnover. Demographic and 10-point Likert scale data were collected from n = 66 medical practices, using an online survey instrument. Data were analyzed using various descriptive and inferential statistical methods. Distribution (frequency and chi-square) analyses of the study sample, one-way analysis of variance (ANOVA), and regression analyses were performed across seven demographic characteristics of the medical practices: Specialty, Ownership Structure, Number of full-time equivalent (FTE) Physicians, Number of FTE Clinical Employees, Number of FTE Nonclinical Employees, Number of FTE Employees Left Position, and Region. Study results provided statistically significant evidence to support the relationship between OSP and employee turnover, highlighting that OSP was associated with lower employee turnover. The finding suggests that OSP can serve as an effective mechanism for increasing employee retention.

Primary care workforce paradox: A physician shortage and a PA and NP surplus.

Primary care workforce projections continue to predict significant physician shortages. An oversupply of primary care physician assistants (PAs) and NPs also is predicted. This paradox calls into question the assumptions that underlie workforce projection models, which likely underestimate the primary care contributions of PAs and NPs. Federally qualified health center data from the 2016-2019 Uniform Data System were used to calculate the number of clinic visits per full-time equivalent (FTE) physician, PA, and NP. Visits per FTE were compared across provider type to determine provider-specific productivity ratios. The combined PA and NP productivity ratio increased relative to physicians in each year, ranging from 0.85 in 2016 to 0.88 in 2019. Clinic visits per FTE for PAs and family physicians were nearly equivalent. Primary care workforce projection models should be reexamined to more accurately capture the productivity of PAs and NPs.

Neonatology's race to the bottom: RVUs, cFTEs, and physician time.

The clinical productivity of neonatology divisions is often defined as relative value units (RVUs) produced per clinical full-time equivalent physicians (cFTEs). Based on the realities of neonatology clinical billing, commonly daily bundled charges, and one cFTE defined as a fixed number of clinical hours per year, the RVU:cFTE ratio will inevitably be proportional to the number of NICU patients per physician clinical hour. As a result, increasing productivity defined as the RVU:cFTE ratio, a commonly incentivized goal in neonatology, requires decreasing physician time per patient. As neonatology groups seek to surpass RVU:cFTE benchmarks based upon productivity of peer institutions, they end up in a "race to the bottom," each striving to spend less time per patient than their peers. This definition of physician productivity fails to consider the importance of time itself as an essential "product" provided by physicians, and can undermine the clinical mission and quality of care.

Clinician Care Team Composition and Health Care Utilization.

ObjectiveTo test the hypothesis that a greater proportion of physician time on primary care teams are associated with decreased emergency department (ED) visits, hospital admissions, and readmissions, and to determine clinician and care team characteristics associated with greater utilization.Patients and MethodsWe retrospectively analyzed administrative data collected from January 1 to December 31, 2017, of 420 family medicine clinicians (253 physicians, 167 nurse practitioners/physician assistants [NP/PAs]) with patient panels in an integrated health system in 59 Midwestern communities serving rural and urban areas in Minnesota, Wisconsin, and Iowa. These clinicians cared for 419,581 patients through 110 care teams, with varying numbers of physicians and NP/PAs. Primary outcome measures were rates of ED visits, hospitalizations, and readmissions.ResultsThe proportion of physician full-time equivalents on the team was unrelated to rates of ED visits (rate ratio [RR] = 0.826; 95% confidence interval [CI], 0.624 to 1.063), hospitalizations (RR = 0.894; 95% CI, 0.746 to 1.072), or readmissions (RR = –0.026; 95% CI, 0.364 to 0.312). In separate multivariable models adjusted for clinician and practice-level characteristics, the rate of ED visits was positively associated with mean panel hierarchical condition category (HCC) score, urban vs rural setting, NP/PA vs physician, and lower years in practice. The rate of inpatient admissions was associated with HCC score, and 30-day hospital readmissions were positively associated with HCC score, lower years in practice, and male clinicians.ConclusionCare team physician and NP/PA composition was not independently related to utilization. More complex panels had higher rates of ED visits, hospitalization, and readmissions. Statistically significant differences between physician and NP/PA panels were only evident for ED visits.

612. In-Person vs Tele-Infectious Disease Care: Is One Better?

BackgroundTelemedicine (TM) has allowed physicians to expand beyond traditional in-person practice to provide care at remote locations. Initial performance of TM programs in ID has been reported, including favorable outcomes, but limited data exists on how inpatient Tele-ID compares to in-person.1,2 To address this gap, we analyzed data from hospitals that transitioned from in-person ID care to Tele-ID.References MethodsTravel time between the 3 rural Pennsylvania hospitals (total 432 inpatient beds) by car is 1 hour 40 minutes. All in-person consults were provided by an independent ID physician who traveled daily between sites. Starting July 2018, all consults were provided by Tele-ID consisting of one full-time equivalent physician. This included live audio-video visits and e-consults. Data were extracted from electronic health record; between 1/1/2018-6/30/2018 for in-person and 7/1/2018-12/30/2018 for Tele-ID. Key outcomes assessed were number of initial encounters, length of stay (LOS) after ID consult, proportions of patients discharged home, transferred to tertiary centers, and ID related readmission at 30 days.ResultsStudy population consisted of 642 encounters with majority being Caucasian, female and average age 67 years (Table 1). Tele-ID had higher comorbidity scores vs in-person ID (Table 1). Total encounters were significantly greater for Tele-ID than in-person ID (Table 2; p=0.018). LOS after ID consult, transfers to tertiary centers, readmissions at 30 days, and discharges home were similar between the two groups (Table 2). Most common diagnosis was “bacteremia;” notably Tele-ID made a broader range of diagnosis (Figure 1). Limitations include a small sample size and possibility of a temporal bias, although the patient characteristics were similar except for higher co-morbidity for the Tele-ID service. ConclusionThis comparative study shows that patient outcomes are similar between in-person and Tele-ID, despite higher volume and complexity encountered by Tele-ID. The greater number of consults and broader range of diagnosis made by Tele-ID suggests greater productivity, possibly related to travel time elimination. Tele-ID appears to be a good alternative solution for rural locations that lack in-person access to ID care.DisclosuresJ. Ryan Bariola, MD, Infectious Disease Connect (Employee)Mayne Pharma (Advisor or Review Panel member)Merck (Research Grant or Support) John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer)

The need for home care physicians in Japan \u2013 2020 to 2060

BackgroundJapan faces the most elderly society in the world, and the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060.MethodsOur estimation is based on modification of major health work force analysis methods using previously reported official data. Two models were developed to estimate the necessary number of full-time equivalent (FTE) home care physicians: one based on home care patient mortality, the other using physician-to-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of patients dying at home. Lastly, we converted estimated FTE physicians to an estimated head count.ResultsResults were concordant between our two models. In every instance, there was overlap of high- and low-estimations between the mortality method and the physician-to-patient method, and the estimates show highly similar patterns. Furthermore, our estimation is supported by the current number of physicians, which was calculated using a different method. Approximately 1.7 times (1.6 by head count) the current number of FTE home care physicians will be needed in Japan in the late 2030’s, peaking at 33,500 FTE (71,500 head count). However, the need for home care physicians is anticipated to begin decreasing by 2040.ConclusionThe results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress future need for physicians. After the late 2030’s, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.

Association of Primary Care Team Composition and Clinician Burnout in a Primary Care Practice Network.

ObjectiveTo determine the relationship of the emotional exhaustion domain of burnout with care team composition in a Midwestern primary care practice network.Participants and MethodsWe studied 420 family medicine clinicians (253 physicians and 167 nurse practitioners/physician assistants [NP/PAs]) within a large integrated health system throughout 59 Midwestern communities. The observational cross-sectional study utilized a single-question clinician self-assessment of the emotional exhaustion domain of burnout on a scale of 0 (never) to 6 (daily) conducted between March 1 and April 2, 2018, and administrative data collected between January 1, 2017, and December 31, 2017. We used a multivariable linear mixed model for data analysis, adjusted for clinical- and team-level factors, including clinician sex, panel size and complexity, clinician type (physician or NP/PA), clinician full-time equivalent (FTE), total care team panel size, and number of clinicians on the care team.ResultsAmong 217 survey respondents (51.7%), the median frequency of the emotional exhaustion domain of burnout was once per week. Adjusted analyses revealed that a greater proportion of physician FTE on the care team was associated with a lower emotional exhaustion domain of burnout among individual clinicians (P=.05). Female clinicians had a higher emotional exhaustion domain of burnout than male clinicians (P=.05). None of the other variables in the model were associated with emotional exhaustion.ConclusionPrimary care teams containing both physicians and NP/PAs had lower levels of emotional exhaustion with increasing proportion of physician FTE. More work is needed to explore what other variables may be associated with burnout in primary care team-based practices.

A comparative evaluation of the publications of French public teaching hospitals from 2004 to 2014

Care, teaching, and research are all priorities of the French public teaching hospitals. In 2004, the remuneration method evolved from a global endowment to a fee-for-services system, based on the use of bibliometric tools. These were used in the present study to describe the research patterns of public teaching hospitals in regards to care and teaching activities. The present study was based on data from the 32 French public teaching hospitals, between 2004 and 2014. Records concerning the publications number, hospital stays, full-time equivalent (FTE) practitioners, and residents per FTE physician were accessed. Statistical analyses were performed using means, Pearson correlation coefficients, and regression lines. The mean number of publications per FTE physician was 0.73, the mean number of hospital stays per FTE physician was 235.8 and the mean number of residents per FTE physician was 0.63. There was a moderate positive correlation between the number of publications per FTE physician and the number of residents per FTE physician (R=0.53) and a negligible correlation between the number of residents per FTE physician and the number of hospital stays per FTE physician (R=0.12). There was a low negative correlation between publication numbers per FTE physician and the number of stays per FTE physician (R=-0.41). All public teaching hospitals presented different patterns in terms of care, teaching, and research activities. None of the 32 hospitals performed well in all three activities. Only nine performed well in at least two out of the three missions.

Physician Time Burden Associated with Querying Prescription Drug Monitoring Programs.

Prescription drug monitoring programs (PDMPs) enable prescribers to review patient prescription histories, and their use is mandatory in many states. We estimated the cost of physicians retrieving PDMP patient reports compared with a model where a delegate (i.e., administrative staff) retrieves reports. We performed a cost analysis with a one-year time horizon, from the perspective of physicians' employers. We obtained specialty-specific estimates of controlled substance prescribing frequency from the National Ambulatory Medical Care Survey, 2012-2014. We defined three PDMP usage cases based on the frequency of queries: comprehensive (before every Schedule II-IV controlled substance prescription), selective (before new Schedule II-IV prescriptions and every six months for continuing medications), and minimal (before new Schedule II or III prescriptions and annually for continuing medications). The delegate model was less costly for all specialties in the comprehensive usage case and most specialties in the selective usage case, and it was similar to physician model costs in the minimal usage case. Estimated annual costs of the physician model to a large health care system (1,000 full-time equivalent physicians) were $1.6 million for comprehensive usage, $1.1 million for selective usage, and $645,313 for minimal usage. The delegate model was less costly in the comprehensive (savings of $907,283) and selective usage cases (savings of $156,216). Relying on delegates vs physicians to retrieve reports is less costly in most cases. Automation and integration of PDMP data into electronic health records may reduce costs further. Physicians, health care systems, and states should collaborate to streamline access to PDMPs.

Activity and Capacity Profile of Transplant Physicians and Centers in Australia and New Zealand

We conducted a study to analyze and report on indicators of hematopoietic cell transplant (HCT) physician time use and HCT center output measures. HCT centers in Australia and New Zealand (A&NZ) were invited to provide demographic and time use details for physicians participating in HCT patient care (HCT physicians). Resource details for adult and pediatric centers were included. From a total of 46 centers that were invited to participate, completed data were received from 37 centers (80%) representing 185 HCT physicians, with a median age of 48 (range, 33 to 72), of whom 31% were women. Just over half of HCT physicians cited prior work experience in large overseas HCT centers (97, 52%) and over one-third (79, 43%) possessed postgraduate qualifications other than specialist training. Total annual mean HCTs per HCT physician full-time equivalent (FTE) were 14.2 for centers performing both allogeneic and autologous HCT, 6.6 for autologous only centers, and 10.6 for all centers. For all HCT physicians surveyed the mean proportion of time spent on HCT related tasks was 31.7%. In A&NZ, for centers that perform both allografts and autografts, there was a mean of 4.0 allogeneic HCT annually per HCT bed, compared with 2.6 for the United States and 7.1 allogeneic HCT annually per HCT physician FTE (United States, 6.3). Projections of the A&NZ HCT physician workforce indicated that the numbers of HCT physicians are likely to stay within the region of 170 to 190 for the next 10 years, whereas HCT activity will likely continue to climb steadily. Healthcare and government authorities should be prepared to enable and support greater HCT activity in A&NZ in the future.

Colonoscopy resource availability and colonoscopy utilization in Ontario, Canada

ABSTRACTObjectiveEvidence of long wait times for colonoscopy and regional variations in colonoscopy utilization have raised concerns that the availability of colonoscopy resources may be insufficient to meet current needs. This study described colonoscopy resource availability in Ontario, Canada, evaluated regional variations in colonoscopy resource availability and utilization, and examined the association between colonoscopy resource availability and colonoscopy utilization.
 ApproachThis is a population-based cross-sectional study of colonoscopy resource availability in Ontario, Canada from 2007 to 2013 using linked administrative health databases from the Institute for Clinical Evaluative Sciences (ICES). We defined the catchment areas for colonoscopy resources using physician networks that were built upon existing patient flow patterns, with comparisons to observed colonoscopy patient travel patterns to ensure the networks reflected colonoscopy referral patterns in the province. Colonoscopy physicians were identified from physician billing data. Network-level colonoscopy availability was measured in terms of physician density, specialty, and quality, use of private colonoscopy clinics, and distance that patients travel for colonoscopy. Network-level age- and sex-standardized colonoscopy utilization rates were calculated for 2007 to 2013. Associations between colonoscopy resource availability and colonoscopy utilization were analyzed using Spearman’s rank correlation.
 Results The availability of colonoscopy resources in Ontario increased between 2007 and 2013. Physician density increased from 8.7 full-time equivalent (FTE) physicians per 100,000 residents in 2007 to 9.4 FTE per 100,000 residents in 2013. The proportion of colonoscopy physicians who achieved the recommended colonoscopy completion and polypectomy rates increased from 60% to 77%, and 28% to 53%, respectively. Use of private colonoscopy clinics also increased. In 2007, 21% of colonoscopies were completed in private clinics, and by 2013, that proportion increased to 30%. Across Ontario, we observed strong geographic variation in these measures of colonoscopy resource availability as well as in the utilization of colonoscopy. Colonoscopy utilization was positively correlated with physician availability (r=0.48, p=0.001), physician quality (r=0.6, p<0.0001) and use of private clinics for colonoscopy (r=0.5, p=0.001).
 ConclusionThe availability of colonoscopy resources improved in Ontario between 2007 and 2013. However, the geographic variation in resource availability and findings that higher colonoscopy resource availability is associated with higher colonoscopy utilization suggest that certain areas of the province may be under-resourced. These areas may be appropriate targets for efforts to improve colonoscopy capacity in Ontario.

Comparing Some Production Functions for Inpatient Health Services in Selected Public Hospitals in Spain

ABSTRACTTo investigate the adequacy of the widely used Cobb-Douglas and transcendental logarithmic (translog) models of the production functions of hospital inpatient services, the authors fitted these and additive models to data for the four most productive health services of 10 public hospitals in Galicia, Spain (the same four in each). Production, measured as admissions weighted in accordance with their diagnosis-related groups (DRGs), was treated as a function of physician full-time equivalents as surrogate labor factor and number of beds as surrogate capital factor. The results suggest that while the Cobb-Douglas and translog models suffice to represent the production functions of services with low average DRG weight, the greater flexibility of additive models is required for services with higher average DRG weight when only these two inputs are considered.

Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis

BackgroundAlthough health care reforms may improve efficiency at the macro level, less is known regarding their effects on the utilization of health care personnel. Following the 2002 Norwegian hospital reform, we studied the productivity of the physician workforce and the effect of personnel mix on this measure in all nineteen Norwegian hospitals from 2001 to 2013. MethodsWe used panel analysis and non-parametric data envelopment analysis (DEA) to study physician productivity defined as patient treatments per full-time equivalent (FTE) physician. Resource variables were FTE and salary costs of physicians, nurses, secretaries, and other personnel. Patient metrics were number of patients treated by hospitalization, daycare, and outpatient treatments, as well as corresponding diagnosis-related group (DRG) scores accounting for differences in patient mix. Research publications and the fraction of residents/FTE physicians were used as proxies for research and physician training. ResultsThe number of patients treated increased by 47% and the DRG scores by 35%, but there were no significant increases in any of the activity measures per FTE physician. Total DRG per FTE physician declined by 6% (p < 0.05). In the panel analysis, more nurses and secretaries per FTE physician correlated positively with physician productivity, whereas physician salary was neutral. In 2013, there was a 12%–80% difference between the hospitals with the highest and lowest physician productivity in the differing treatment modalities. In the DEA, cost efficiency did not change in the study period, but allocative efficiency decreased significantly. Bootstrapped estimates indicated that the use of physicians was too high and the use of auxiliary nurses and secretaries was too low. ConclusionsOur measures of physician productivity declined from 2001 to 2013. More support staff was a significant variable for predicting physician productivity. Personnel mix developments in the study period were unfavorable with respect to physician productivity.

Commentaries on health services research

Commentaries on health services research

Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025

Prior studies forecast demand for radiation therapy to grow 10 times faster than supply between 2010 and 2020. We updated these projections for 2015 to 2025 to determine whether this imbalance persists and to assess the accuracy of prior projections. Demand for radiation therapy between 2015 and 2025 was estimated by combining current radiation utilization rates determined by Surveillance, Epidemiology, and End Results data with population projections provided by the Census Bureau. Supply of radiation oncologists was forecast using workforce demographics and full-time equivalent (FTE) status provided by the American Society for Radiation Oncology (ASTRO), current resident class sizes, and expected survival per life tables from the Center for Disease Control. Between 2015 and 2025, the annual total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 19%, from 490,000 to 580,000. Assuming a graduating resident class size of 200, the number of FTE physicians is expected to increase by 27%, from 3,903 to 4,965. Compared to prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline). This decrease is attributable to an overall reduction in the utilization of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections. In contrast, the new projected supply of radiation oncologists in 2020 increased by 275 FTEs compared to the prior projection for 2020 (a 7% relative increase), attributable to rising residency class sizes. The supply of radiation oncologists is expected to grow more quickly than demand for radiation therapy from 2015 to 2025. Further research is needed to determine whether this is an appropriate correction or will result in excess capacity.

Economic assessment of US physician participation in short-term medical missions.

BackgroundShort term medical missions (STMMs) are a form of unregulated and unsanctioned, grass roots, direct medical service aid from wealthier countries to low and middle income countries. The US leads the world in STMM activity. The magnitude of monetary and man power inputs towards STMMs is not clear. The objective of this study is to estimate the prevalence of physician participation in STMMs from the US and the related expenditures of cash and resources.MethodsAn online survey solicited information on physician participation in STMMs. Responses regarding costs were aggregated to estimate individual and global expenditures.ResultsSample statistics from 601 respondent physicians indicate an increasing participation by US physicians in STMMs. Including opportunity cost, average total economic inputs for an individual physician pursuing an STMM exceed $11,000. Composite expenditures for STMM deployment from the US are estimated at near $3.7 billion annually and the resource investment equates with nearly 5800 physician fulltime equivalents.ConclusionsSTMM participation and mission numbers have been increasing in the millennium. The aggregate costs are material when benchmarked against formal US aid transfers. Understanding the drivers of physician volunteerism in this activity is thereby worthy of study and relevant to future policy deliberation.

Determinants of Pediatric Echocardiography Laboratory Productivity: Analysis from the Second Survey of the American Society of Echocardiography Committee on Echocardiography Laboratory Productivity

The American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity aimed to study factors that could influence the clinical productivity of physicians and sonographers and assess longitudinal trends for the same. The first survey results indicated that productivity correlated with the total volume of echocardiograms. Survey questions were designed to assess productivity for (1) physician full-time equivalent (FTE) allocated to echocardiography reading (echocardiograms per physician FTE per day), (2) sonographer FTE (echocardiograms per sonographer FTE per year), and (3) machine utilization (echocardiograms per machine per year). Questions were also posed to assess work flow and workforce. For fiscal year 2013 or academic year 2012-2013, the mean number of total echocardiograms-including outreach, transthoracic, fetal, and transesophageal echocardiograms-per physician FTE per day was 14.3±5.9, the mean number of echocardiograms per sonographer FTE per year was 1,056±441, and the mean number of echocardiograms per machine per year was 778±303. Both physician and sonographer productivity was higher at high-volume surgical centers and with echocardiography slots scheduled concordantly with clinic visits. Having an advanced imaging fellow and outpatient sedation correlated negatively with clinical laboratory productivity. Machine utilization was greater in laboratories with higher sonographer and physician productivity and lower for machines obtained before2009. Measures of pediatric echocardiography laboratory staff productivity and machine utilization were shown to correlate positively with surgical volume, total echocardiography volumes, and concordant echocardiography scheduling; the same measures correlated negatively with having an advanced imaging fellow and outpatient sedation. There has been no significant change in staff productivity noted over two Committee on Pediatric Echocardiography Laboratory Productivity survey cycles, suggesting that hiring practices have matched laboratory volume increases.