Internal Medicine Specialties Research Articles

Primary Care Clinician Perspectives on Patient Navigation to Improve Postpartum Care for Patients with Low Income.

Birthing individuals experience significant physical and psychosocial transitions during the postpartum period. Despite amplified health needs, many individuals do not successfully transition from obstetric to primary care. Patient navigation provides a patient-centered solution that has been applied to other health care specialties resulting in improved care coordination and patient engagement for populations in greatest need. Our objective was to understand primary care clinician perspectives regarding the role of navigators in improving postpartum care for individuals with low income. In this qualitative investigation, we conducted focus groups with primary care clinicians from family and internal medicine specialties. Semistructured interview guides addressed clinician perceptions of navigator roles during the postpartum period and recommendations for navigator training. Focus group discussions were digitally recorded, transcribed, and analyzed via a constant comparative method. Twenty-eight primary care clinicians, including 26 physicians and 2 advanced practice registered nurses, participated in 8 focus groups. Participants reported favorable attitudes toward implementation of a postpartum patient navigation program. Themes regarding useful navigation services included streamlining obstetric to primary care transition, enhancing visit effectiveness, creating personalized postpartum care, and providing patient- and clinician-focused education. Recommendations for navigator training included education on basic medical concerns that are common in the postpartum period, health information privacy and electronic health record use, health care systems, and community resources. Primary care clinicians were highly receptive to the concept of patient navigation as a process to improve health in the postpartum period through enhanced care coordination and improved patient knowledge, engagement, and self-efficacy.

'So near and yet so far': the early women of the Royal Australasian College of Physicians - the first 20 female MRACP 1938-1947.

At the time of the inauguration of the Royal Australasian College of Physicians in 1938, there were 232 Foundation Fellows, but only fivewere women. Those who wished to gain a postgraduate qualification for internal medicine or related specialties then sat for Membership of the new College. In the first decade (1938-1947), 250 gained Membership, but only 20 were women. These women lived in an era of professional and societal restrictions. Still, they all showed great determination and contributed significantly to their chosen fields, while many combined a busy practice with family life. They improved the path for those women who followed. Their stories, however, are rarely reported.

Perceptions and Barriers Related to Outpatient Management of Low-Risk PE Patients: A Community Center Experience

Introduction: Pulmonary emboli (PEs) exert a significant morbidity and mortality burden worldwide, with an increasing incidence of diagnosis over the past two decades. This has relayed to an increase in hospitalizations for PE, with a mean length of stay of 4 days, and a mean cost of $8674. Despite the increased incidence, the mortality associated with PE has been decreasing over the past two decades, and this has led to the development of many risk prognostication indices to better assess the need of hospitalization versus home management. Patients identified as low-risk using extensively validated prognostication models such as the PE severity index (PESI) or simplified PESI have been found to be safely managed at home. Despite the change in recommendations and guidelines, many low-risk patients continue to be hospitalized. Current literature is sparse on the barriers faced by providers in different specialties involved in the care of patients with PE, and in particular low-risk PEs. We conducted an anonymous survey across our hospital system to identify barriers and perceptions revolving around home management of low-risk PE patients. Methods: A short multiple choice survey was created and distributed to both teaching and non-teaching personnel of our hospital system, using an anonymous platform. The survey included residents and attendings across the specialties of internal medicine, primary care and emergency medicine. 150 invitations to the survey were sent out, and 44 responses were received. Results: 43 of the 44 responses were from teaching attendings or residents, whereas 1 response was recorded from a primary care practitioner in a non-teaching setting. 63.6% of the survey-takers reported being in practice <3 years, while 9.1% of this group reported being in practice >10 years. 81.8% believed that not all patients with PE warrant admission. 33 providers, or 75% were aware of risk-stratification models like the PE Severity Index (PESI) or simplified PESI index, and 31 (70.5%) stated they use these risk stratification models to assess a patient's need for admission, once they are diagnosed with a PE. Lack of social work/case management support to send patients home emerged as the primary barrier to out-patient management (61.4% or n= 27), followed by beliefs about consequences of not admitting patients with PE (45.5%, n=20). Fear of litigation was another prominent reported barrier (31.8%, n=14), followed by lack of knowledge on current guidelines (38.6%, n=17) and finally lack of knowledge regarding anticoagulation options (27.3%, n=12). Of 27 participating physicians that practice in an outpatient setting, 25 (92.6%) reported sending patients to the ED strictly to get immediate definitive testing done, and were comfortable managing the patient once a diagnosis was achieved. Conclusions: Several barriers to outpatient management of low-risk patients diagnosed with PE exist in the community setting. They mainly consist of lack of social work support, false beliefs about consequences of not admitting patients with PE, and fear of litigation. Integrated education for various medicine specialties regarding anticoagulation and management guidelines should be instituted, with emphasis on utilization of risk-prognostication tools like sPESI. In addition, maximum utilization of social work and case management may further mitigate some of the barriers encountered in the community setting.

Clinician Adoption of an Artificial Intelligence Algorithm to Detect Left Ventricular Systolic Dysfunction in Primary Care.

ObjectiveTo compare the clinicians’ characteristics of “high adopters” and “low adopters” of an artificial intelligence (AI)–enabled electrocardiogram (ECG) algorithm that alerted for possible low left ventricular ejection fraction (EF) and the subsequent effectiveness of detecting patients with low EF. MethodsClinicians in 48 practice sites of a US Midwest health system were cluster-randomized by the care team to usual care or to receive a notification that suggested ordering an echocardiogram in patients flagged as potentially having low EF based on an AI-ECG algorithm. Enrollment was between June 26, 2019, and July 30, 2019; participation concluded on March 31, 2020. This report is focused on those clinicians randomized to receive the notification of the AI-ECG algorithm. At the patient level, data were analyzed for the proportion of patients with positive AI-ECG results. Adoption was defined as the clinician order of an echocardiogram after prompted by the alert. ResultsA total of 165 clinicians and 11,573 patients were included in this analysis. Among patients with positive AI-ECG, high adopters (n=41) were twice as likely to diagnose patients with low EF (33.9%) vs low adopters, n=124, (16.9%); odds ratio, 1.62; 95% CI, 1.21 to 2.17). High adopters were more often advanced practice providers (eg, nurse practitioners and physician assistants) vs physicians, Family Medicine vs Internal Medicine specialty, and tended to have less complex patients. ConclusionClinicians who most frequently followed the recommendations of an AI tool were twice as likely to diagnose low EF. Those clinicians with less complex patients were more likely to be high adopters. Trial registrationClinicaltrials.gov Identifier: NCT04000087.

Representation of Women in Internal Medicine Specialties in North America, the United Kingdom, and Australasia: Cardiology's Outlier Status and the Importance of Diversity

Decades of research demonstrate the value of workplace diversity. Reports from individual countries show that women are underrepresented in internal medicine workforces. However, large pooled international studies are not available. This study investigates the current representation of women in the internal medicine workforce internationally and identifies specialties in which underrepresentation is evident. Peer-reviewed studies, government reports, and medical association reports were used to determine proportions of specialists and doctors training in internal medical specialties and in comparator surgical specialties. Data were available from Australia, Canada, England, New Zealand, the United States, Wales, Scotland, and Northern Ireland. A total of 380,263 doctors were studied, including 268,822 practicing specialist physicians (also known as attendings or consultants) and 53,226 doctors in internal medicine specialty training programs (also known as residents, fellows, advanced trainees, or specialist registrar trainees). Among practicing physician specialists, the rate of representation of women was 35% (95,195/268,822, p <0.001). Among trainees, the rate of representation of women was 43% (22,728/53,226, p <0.001). Among physician specialties evaluated, cardiology (15%, 4,152 of 27,328), gastroenterology (20%, 3,765 of 18,893), and respiratory/critical care (24%, 5,255 of 21,870) had the lowest representations of women compared with men (p <0.001 for all). Cardiology and particularly the subspecialty of interventional cardiology were clear outliers as the internal medicine specialties with the lowest representation of women at practicing specialist and trainee levels. In conclusion, this study is the largest international study of women in internal medicine specialties. It found that cardiology, gastroenterology, and respiratory/critical care specialties have the most substantial underrepresentation of women. These data are a global call to action to establish more successful strategies to provide a diverse and representative cardiology workforce.

Variation in detected adverse events using trigger tools: A systematic review and meta-analysis

Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely. This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence. Systematic review and meta-analysis. To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review. Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9-37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4-164.7. Overall studies' risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation. Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.

Abstract P301: The Proportion Of Physician Notes Addressing Elevated Blood Pressures Varies Dramatically Across Internal Medicine Specialties

Introduction: Approximately 20% of U.S. adults are unaware that they have a diagnosis of hypertension (HTN). Of those diagnosed, almost half are uncontrolled. This study provides a potential explanation of these care gaps: providers whose specialization does not include cardiovascular disease rarely document HTN, even when the patient has markedly elevated blood pressures (BPs) during their visit. Methods: We randomly sampled ten thousand patients with clinic visits after Jan 1, 2017.We then selected notes from only these visits with patient BPs above 140/90. The assessment and plans (A/Ps) of these notes were searched for words related to elevated BP or HTN. A/Ps with no mention of BP or HTN were considered not to have addressed hypertension. Results were grouped by the specialties listed in the figure. Results: We found 5674 clinic visits with associated BPs above 140/90. A/Ps from nephrology, cardiology, and general internal medicine visits mentioned elevated BP at least 50% of the time (in 55 of 77, 206 of 366, and 251 of 438 encounters, respectively). In contrast, A/Ps from encounters with allergy/immunology, endocrinology, and rheumatology specialists referenced the patient’s BP less than 10% of the time (in 3 of 52, 0 of 15, and 10 of 124 encounters, respectively. See figure). Discussion: Our results suggest specialties focused on the management of HTN are substantially more likely to address elevated BP in their documentation. However, there appears to be room for improvements in documentation across all specialties. Future studies will measure the impact of these missed opportunities on the diagnosis and management of HTN.

Place des internistes dans la prise en charge hospitalière de la médecine adulte non programmée : enquête auprès des internistes en formation et en exercice

IntroductionFrench internal medicine specialists are trained in clinical immunology and rare diseases as well as frequent ones. The latest activity is rarely highlighted by practitioners themselves and their representative authorities. Frequent diseases care in French hospitals are also the tasks of physicians without internal medicine specialty, mostly trained in general medicine, who practice in departments carrying various names. MethodsWe conducted a survey to estimate the part of frequent diseases’ care and unplanned hospital medicine in the practice of specialists and residents in internal medicine in France, and its designation, through two surveys released by the “Collège National Professionnel de Médecine Interne” (for the internal medicine specialists), and the “Amicale des Jeunes Internists” (for the internal medicine residents). ResultsA total of 180 and 247 responses were obtained among the residents and the specialists, respectively, representing 31.3% and 24.8% of the internal medicine specialist's workforce. The most suitable qualifier for frequent diseases’ care and unplanned hospital medicine, primarily post-emergency, was “general hospital medicine” for 48.9% of the residents and “general internal medicine” for 35.6% of the specialists. Unplanned hospital medicine was considered to represent a large part of the internal medicine activity by 66.7% and 64.7% of residents and specialists, respectively. A 50% and more hourly part of the activity devoted to it was reported by 71.4% of the residents and 76.1% of the specialists. General hospital medicine was reported to be distinct from internal medicine-clinical immunology by 46.1% of the residents and 47.4% of the specialists. ConclusionFrench internists devote a large part of their activities to frequent diseases’ care and unscheduled medicine, the name of which was not consensual. However, their work could not be summarized to it, often involving a specific activity named internal medicine - clinical immunology.

Prevalence of communicable and non-communicable diseases among adult immigrants from Venezuela at a university hospital in Colombia from 2017 to 2018.

Since 2015 immigration has increased significantly into Colombia. As immigrants who are not insured to the national health system present to public hospitals for medical care. However, there is little knowledge about the prevalence of communicable and non-communicable diseases amongst them. Ours was a cross-sectional study at a university hospital reviewing 154 medical records of Venezuelan immigrants treated by the Internal Medicine Specialty between 2017 & 2018. Non-communicable diseases representing 66.3% are the main cause of hospitalization, possibly owing to poor primary care.

Self-reported anatomy skills among Norwegian physicians - Need for improved postgraduate teaching provision

Anatomy skills are considered essential in all aspects of medical practice, and more so now than before with increasing use of diagnostic imaging techniques and advanced surgery. In conjunction with the revision of the medical study curriculum at the University of Oslo in 2014, we investigated Norwegian physicians’ assessment of their own anatomy knowledge and the educational provision of anatomical skills during and after specialization. A total of 902 Norwegian physicians divided into the specialties of general medicine, internal medicine, surgery, neurology and radiology responded to an anonymous survey. As many as 73% of the physicians had at some time point experienced insufficient anatomy knowledge in their own practice, most commonly among surgeons and neurologists. The respondents expressed a need for supplementary educational provision in anatomy during and after specialization, and 36% were unfamiliar with such offers. Notably, dissection courses seemed unavailable during specialization. Our findings demonstrate a requirement for an improved supply of anatomy education during and after specialization. Anatomy courses that combine dissection, radiological images and clinical application would seem desirable.

Advance healthcare directives: Knowledge and attitudes of Irish consultant physicians.

The Assisted Decision-Making (Capacity) Act 2015 provides a legislative framework for advance healthcare directives in Ireland. This study assessed Irish consultant physicians' knowledge of the provisions of the Act relating to advance healthcare directives, and their attitudes towards advance healthcare directives in general. Data were collected between May and October 2016. A questionnaire was distributed to all consultant physicians listed in the Irish Medical Directory under general internal medicine specialties. True/false questions assessed knowledge of the provisions of the Act. Likert-type questions assessed attitudes towards advance healthcare directives. The overall response rate was 28.7% (238/830). Only 42.1% of respondents were aware of the provisions of the Act relating to advance healthcare directives. Of the seven questions that assessed knowledge of those provisions, the mean score was 3.31/7.78.7% agreed that advance healthcare directives are helpful when making treatment decisions for incapacitated patients. Only 15.7% regularly advise their patients to create advance healthcare directives. Irish physicians are broadly supportive of advance healthcare directives but there are deficiencies in their knowledge of the law relating to them. Efforts should be made to educate physicians regarding the provisions of the Act prior to its commencement.

Providers Electing to Receive Electronic Result Notifications: Demographics and Motivation.

Automated electronic result notifications can alert health care providers of important clinical results. In contrast to historical notification systems, which were predominantly focused on critical laboratory abnormalities and often not very customizable, modern electronic health records provide capabilities for subscription-based electronic notification. This capability has not been well studied. The purpose of this study was to develop an understanding of when and how a provider decides to use a subscription-based electronic notification. Better appreciation for the factors that contribute to selecting such notifications could aid in improving the functionality of these tools. We performed an 8-month quantitative assessment of 3,291 notifications and a qualitative survey assessment of 73 providers who utilized an elective notification tool in our electronic health record. We found that most notifications were requested by attending physicians (∼60%) and from internal medicine specialty (∼25%). Most providers requested only a few notifications while a small minority (nearly 5%) requested 10 or more in the study period. The majority (nearly 30%) of requests were for chemistry laboratories. Survey respondents reported using the tool predominantly for important or time-sensitive laboratories. Overall opinions of the tool were positive (median = 7 out of 10, 95% confidence interval: 6-9), with 40% of eligible respondents reporting the tool improved quality of care. Reported examples included time to result review, monitoring of heparin drips, and reviewing pathology results. Developing an understanding for when and how providers decide to be notified of clinical results can help aid in the design and improvement of clinical tools, such as improved elective notifications. These tools may lead to reduced time to result review which could in turn improve clinical care quality.

Cluster Analysis of Primary Care Physician Phenotypes for Electronic Health Record Use: Retrospective Cohort Study.

BackgroundElectronic health records (EHRs) have become ubiquitous in US office-based physician practices. However, the different ways in which users engage with EHRs remain poorly characterized.ObjectiveThe aim of this study is to explore EHR use phenotypes among ambulatory care physicians.MethodsIn this retrospective cohort analysis, we applied affinity propagation, an unsupervised clustering machine learning technique, to identify EHR user types among primary care physicians.ResultsWe identified 4 distinct phenotype clusters generalized across internal medicine, family medicine, and pediatrics specialties. Total EHR use varied for physicians in 2 clusters with above-average ratios of work outside of scheduled hours. This finding suggested that one cluster of physicians may have worked outside of scheduled hours out of necessity, whereas the other preferred ad hoc work hours. The two remaining clusters represented physicians with below-average EHR time and physicians who spend the largest proportion of their EHR time on documentation.ConclusionsThese findings demonstrate the utility of cluster analysis for exploring EHR use phenotypes and may offer opportunities for interventions to improve interface design to better support users’ needs.

Further training in rheumatology-Current status 2022

For the continued existence of the specialty of internal medicine and rheumatology and the assurance of a qualitative patient care, attractive further education for motivated resident physicians is of central importance. Continuing training in rheumatology takes place primarily in the inpatient setting, although reliable figures on outpatient and inpatient further education positions are not yet available. Further training in rheumatology is predefined by the model further training regulations (Musterweiterbildungsverordnung; MWBO) 2018, which have now been implemented by most state medical associations, in some cases with state-specific changes. Based on the MWBO of 2018, amodel curriculum was developed by the German Society of Rheumatology (DGRh) for further training in the specialty of internal medicine and rheumatology. This model curriculum is intended to provide orientation for trainees and trainers as well as to facilitate structured rheumatology training in inpatient and outpatient settings.

Physicians\u2019 knowledge on specific rare diseases and its associated factors: a national cross-sectional study from China

BackgroundRare disease patients often experience diagnosis delays or misdiagnosis, which may be due to lack of knowledge on rare diseases among physicians.ObjectiveTo assess Chinese physicians’ knowledge on specific rare diseases and identify its associated factors.MethodsThirty-four patient organizations with a unique disease of interest were invited to develop 3 knowledge questions for each rare disease to assess physicians’ knowledge on the disease that they felt most experienced in. The total knowledge score for each participant ranged from a score of 0 to 3. A national cross-sectional study conducted in a cohort of 3197 physicians from 6 provinces across western, central and eastern China. The demographic information of the participants was collected including gender, age, birthplace, income, education, hospital class, working title, working years, and specialty. A multiple linear regression analysis was performed to assess the independent associations between the physician variables and the total knowledge score.ResultsTwo thousand, one hundred and fifteen (66.16%) of the involved physicians obtained a total knowledge score of 2 or 3. The median knowledge scores of 10 (29.4%) rare diseases were a score of 1.5 or below. Physicians with female gender (β = 0.08, p < 0.05 for females vs. males), and a monthly income of 5000–10,000 RMB (β = 0.11, p < 0.01 for 5000–10,000 vs. < 5000) and 10,000–30,000 RMB (β = 0.14, p < 0.05) were associated with a higher score. Specialties of physicians who received a relatively higher score included internal medicine, obstetrics and gynecology, radiology, intensive care unit, and surgery.ConclusionsAlmost two thirds of the participants had an average or good level of knowledge on the specific rare disease that they felt most experienced in. Physicians with female gender, a monthly income of 5000–10,000 RMB and 10,000–30000 RMB, and specialties of internal medicine, obstetrics and gynecology, radiology, intensive care unit, and surgery, were associated with a relatively higher knowledge score.

Jak vést interní oddělení: primář - školitel

Internal medicine is the core medical discipline that is responsible for the care of adults with complex illness. Therefore, the preparation for the internal medicine specialty is demanding and requires close cooperation of trainees with the educational supervisor, who is usually the head of the internal medicine department. In addition to his medical work, the head of the department is also director of the training programme. Educational activities should have their allocated time, and all doctors who act as trainers should recognise their responsibility to participate in the postgraduate training of future physicians. Comprehensive assessment of trainees progress must be an integral part of the training programme. Almost one quarter of trainees fail board certification in internal medicine. Training institutions offering postgraduate education in internal medicine should focus on to improve their performance.

Burnout and Well-Being Among Medical Professionals in China: A National Cross-Sectional Study.

ObjectiveTo determine the profile of Chinese medical professionals with burnout symptoms at the national level and identify the association between capability well-being and burnout.Design and SettingA cross-sectional study in a nonrandom national sample of medical staff from 6 provinces across western, central and eastern China.ParticipantsPhysicians, medical laboratory scientists, nurses, and general practitioners aged 18 years or above who submitted a completed online questionnaire from June 2019 to January 2020 successfully (N = 25,120).Main Outcome MeasuresThe prevalence of burnout symptoms was assessed by the 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which consists of three domains: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). The overall high burnout was defined as EE score ≥27 or DP score ≥10. The capability well-being was measured by the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A) and the overall ICECAP-A score was calculated using the UK value set, ranging from a score of 0–1. Multivariable logistic regression analysis was used to identify the association between well-being and the overall high burnout.ResultsAmong the 25,120 participants, 60.8% of the participants reported at least one symptom of burnout, whereas 11.2% reported all three symptoms of burnout. In the adjusted model, ICECAP-A score was independently associated with high burnout (AOR = 0.018, 95% CI = 0.015–0.022). Medical staff who were males, with shorter working years, working in tertiary hospitals, and those with the specialties of psychiatry, intensive care, emergency medicine, internal medicine, oncology, and pediatrics were at higher risk of reporting burnout symptoms.ConclusionThe burnout symptoms were relatively common among Chinese medical staff and they were found to be independently associated with capability well-being in health professionals. Interventions should be enhanced on vulnerable groups to reduce burnout and promote well-being in future studies.

Accountable care organizations and physician antibiotic prescribing behavior

BackgroundPhysician accountable care organization (ACO) affiliation has been found to reduce cost and improve quality across metrics that are directly measured by the Medicare ACO programs. However, little is known about potential spillover effects from this program onto non-measured physician behavior such as antibiotic prescribing. MethodsUsing a two-part structural selection model that accounts for selection into treatment (ACO group), and non-treatment (control group), we compare physician antibiotic prescribing across these groups with adjustment for volume, patient, physician and institutional characteristics. We also estimate heterogeneous treatment responses across specialties, focusing on physicians with a primary specialty of internal medicine, family or general practice, nurse practitioners, as well as general and orthopedic surgeons. ResultsWe find that ACO affiliation helps reduce antibiotic prescribing by 20.4 (95%CI = −26.65 to −14.16, p-value<0.001) prescriptions (about 19.5%) per year. We show that each additional hospital and practice affiliation increases prescriptions by 1.6 (95%CI = 1.27 to 1.95, p-value<0.001) and 1.7 (95%CI = 1.00 to 2.47, p-value<0.001), respectively. However, the use of electronic health records and high-quality medical training is associated with a decrease in antibiotic use of 7.9 (95%CI = −8.79 to −7.07, p-value<0.001) and 3.6 (95%CI = −4.47 to −2.73, p-value<0.001) claims, respectively. The treatment effects are found to vary with specialty, where internal medicine physicians experience an average decrease of 23.6 (95%CI = −29.98 to −17.20, p-value<0.001), family and general practice physicians a decrease of 22.1 (95%CI = −28.37 to −15.77, p-value<0.001), nurse practitioners a decrease of 7.1 (95%CI = −13.99 to −0.77, p-value = 0.028), general surgeons a decrease of 9.6 (95%CI = −16.02 to −3.25, p-value = 0.003), and orthopedic surgeons a reduction of 8.1 (95%CI = −14.84 to −1.42, p-value = 0.018) in their antibiotic prescribing per year. ConclusionsIn assessing the impact of Medicare ACO programs it is important to account for spillover effects. Our study finds that ACO affiliation has had a measurable impact on physician antibiotic prescribing.

Physicians’ characteristics and practices associated with the provision of cancer screening advice to their patients: the Spanish SUN cohort study

ObjectivesTo evaluate the association between cancer screening counselling provided by medical doctors to their patients and each doctor’s own anthropometrics, lifestyle, cancer screening practices, and personal and family history of...

What happy physicians have in common: A qualitative study of workplace perceptions of physicians with low burnout scores.

Introduction:Burnout is a phenomenon in the medical field that adversely affects patient care, physician retention, and physician well-being. The preponderance of burnout research has primarily focused on exploring what parts of medical practice and individual characteristics contribute to burnout. Our research aims to add to the growing body of evidence exploring what physicians who love their work have in common.Methods:Physician participants in this qualitative study were recruited through their local medical society from those who indicated a willingness to share tips for joy in practice. Potential participants were then screened for low probability of burnout using a validated single-item burnout inventory. Nine primarily mid- to late-career physicians engaged in semi-structured interviews and thematic analysis was used to analyze data. Of the interviewed physicians, five were practicing in the primary care specialties of family or internal medicine and four in specialties outside of primary care.Results:Six major themes arose from the nine interviews and included variety in work, a sense of empowerment, connection with patients, visible impact of one’s work, feelings of community with coworkers and colleagues, and experiencing a sense of calling.Conclusion:While further research is needed to demonstrate the transferability of the themes from these interviews, an asset-rooted approach to physician wellness is a direction for research and intervention that deserves further attention. Focusing only on alleviating the factors that contribute to burnout is a worthy goal, but ignores the necessity of designing training systems and workplaces that are built to foster the elements of medicine that bring joy and fulfillment to practice.