Year Of Medical School Graduation Research Articles

Predicting Peak Productivity in Urologic Medicare Practice via Work-Relative Value Units

ObjectivesTo explore factors associated with productivity in urologic practice. Work-relative value units (wRVUs), the basis for Center for Medicare & Medicaid Services (CMS) and private payer reimbursements, commonly serve to estimate physician productivity. Limited data describes which practice factors predict increased wRVU productivity. MethodsThe 2017 and 2018 CMS databases were retrospectively queried for urologic Medicare provider demographics and procedural/service details. Medical school graduation year was used to estimate years in practice and generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict wRVU production. ResultsIncluded were 6,773 Medicare-participating urologists across the United States. Millennials produced 1115 wRVUs per year, while Gen X and Baby Boomers produced significantly more (1997 and 2104, respectively, p<.01). Post-War urologists produced numerically more (1287, p=.88). In adjusted analyses, predictors of Medicare wRVU productivity included FPMRS (exponentiated beta estimate (β) 1.46, 95% CI 1.32-1.60), men’s health (β 1.22, 95% CI 1.13-1.32), and oncologic sub-specialization (β 1.08, 95% CI 1.02-1.14), female gender (β 0.87, 95% CI 0.82-0.92), wRVUs generated from inpatient procedures (β 1.08, 95% CI 1.06-1.09) and office visits (β 0.88, 95% CI 0.87-0.89), and the level of education (β 1.10, 95% CI 1.07-1.14) and percent impoverished patients (β 0.85, 95% CI 0.83-0.88) in provider’s practice zip code. ConclusionsUrologic experience, specialization, demographics, practice patterns, and patient demographics are significantly associated with wRVU productivity in Medicare settings. Further work should incorporate quality metrics into wRVUs and ensure patient demographics do not affect reimbursement.

Prescription Trends of Thiazide Diuretics in a Canadian Primary Care Population From 2015 to 2021

BackgroundHypertension Canada 2017 guidelines favoured the use of thiazide (TZ)-like diuretics, such as CLTD (chlorthalidone) and indapamide (IND) over hydrochlorothiazide (HCTZ). Health Canada warned in 2019 that HCTZ may be associated with increased risk of skin cancer. Our study looked at the changes in TZ prescriptions from 2015 to 2021 in Ontario, Canada. MethodsA retrospective cohort study was conducted of adults with hypertension, using electronic medical record data from the University of Toronto Practice-Based Research Network database covering mostly the Greater Toronto area. Outcomes included the proportion of patients who received a prescription of HCTZ, CLTD, or IND each month. Interrupted time-series analysis was used to evaluate the change in outcomes after publication of the 2017 guidelines and 2019 safety warning. Prescription trends were stratified by prescribing physicians’ sex and year of medical school graduation. ResultsA total of 100,428 patients with hypertension were included in the cohort, with 31,700 patients who received at least one TZ prescription from 343 family physicians. We found a declining trend in HCTZ prescriptions over time, accompanied by an increase in IND and CLTD prescriptions, with statistically significant but transient changes in prescription rates after publication of the 2017 guidelines and the 2019 safety warning for all 3 medications. Female physician and early-career physician prescription rates changed faster than that of their counterparts immediately after the Health Canada safety warning was issued. ConclusionsTZ diuretic prescription patterns have changed in recent years, but Hypertension Canada’s 2017 guidelines and the 2019 Health Canada safety warning did not have a sustained significant impact on the change in prescription rates of HCTZ, IND, and CLTD.

Gender differences among shoulder arthroplasty surgeons: past, present, and future

Reducing differences in the gender representation of shoulder arthroplasty surgeons may help optimize patient care. This work aims to determine (a) the current gender distribution of surgeons performing shoulder arthroplasty, (b) how gender relates to practice patterns among shoulder arthroplasty surgeons, and (c) how gender distribution has been changing over time. The Medicare Provider Utilization and Payment Data for years 2012-2020 was utilized to identify orthopedic surgeons performing anatomic and reverse total shoulder arthroplasty (current procedural terminology [CPT] code 23472). The dataset provides self-reported gender, credentials, national provider identifier (NPI), annual volume for all procedures (based upon CPT) that were performed at least 11 times in the calendar year, and location for all included providers. The dataset was linked to the Medicare physician compare dataset using NPI numbers to determine hospital affiliations, year of medical school graduation, and graduating medical school. All included hospitals were queried to determine academic status (affiliated orthopedic residency or fellowship program). The American Shoulder and Elbow Surgeons (ASES) directory was reviewed to determine gender breakdown of current members. The number of surgeons performing at least 11 shoulder arthroplasty annually increased from 821 (13 females; 1.6%) in 2012 to 1,840 (53/1,840 females; 2.9%; p=0.05) in 2019. One female ranked in the top 100 surgeons by shoulder arthroplasty volume in 2012 and in 2020. Female surgeons graduated more recently from medical school (mean: 2005) compared to male surgeons (mean: 1997; p<0.001). About 10% of female (10.8%, 12/111) and male surgeons (9.1%, 229/2528) practiced at hospitals with orthopedic residents (p=0.50). Female surgeons performing shoulder arthroplasty were less likely than males to perform total knee arthroplasty (29.4% versus 54.1%; p<0.001) and total hip arthroplasty (12.6% versus 34.7%; p<0.001). There were 86 female members of the ASES (6.7%; 86/1275), with a significant difference in the proportion of women in differing membership categories (p=0.017). A diverse cohort of high-volume shoulder replacement surgeons is integral to delivering high-quality shoulder arthroplasty. Currently, the proportion of women performing high volume shoulder replacement in the US is small, with little improvement in recent years. However, women performing shoulder arthroplasty are younger, often involved in academic practices, and the membership of the ASES is increasingly female. Continued efforts to promote orthopedics, and mentor women residents and medical students interested in shoulder surgery, may bring real change to the gender differences among shoulder replacement surgeons over the coming years.

Response time of high impact factor medical journals versus an expert-curated, online oncology platform before and during the COVID-19 pandemic.

465 Background: The objective of this study was to characterize the publication speed of high impact factor medical journals (HIFMJ) compared with the dissemination speed of a private, expert-curated, online platform (ECOP) designed for oncologists. We also aimed to describe determinants of response speed to questions on this platform. Methods: We selected 100 HIFMJ and calculated their reported peer review time (Submission to Acceptance [STA]). The platform database was queried between the dates 2017 and 2022 with information collected about day of query, response time (RespT), and poster gender, region, and medical school graduation year. This data was analyzed utilizing univariable median regression analyses and two t-tests as appropriate. Results: Of the 26 available medical journal response times, the average STA was 57.36 days (range: 2.6 - 204 days). Of the 4,346 online platform questions and answers (Q+A), the mean RespT was noted to be significantly lower at 2.63 days (CI, 2.19 - 3.07 days). With the ECOP, the mean RespT for male posters (mean: 2.58 days; CI, 2.08 - 3.08) and female posters (mean: 2.72 days, CI, 1.89 - 3.56) was not significantly different (p=0.61). RespT from 2017 to 2019 increased slightly (p&lt;0.001) before trending down during the COVID pandemic (p&lt;0.02). Mean RespT before the Covid pandemic in the United States, March 15, 2020 (2.68 days, CI, 2.11 - 3.25), was non-significantly reduced as compared with questions after March 15, 2020 (2.17 days, CI, 1.88 - 2.46, p=0.13). Conclusions: Traditional peer review proves a lengthy process in contrast to real-time, Q+A-based oncology platforms. An ECOP allows physicians the ability to provide their expertise regarding rare, nuanced patient cases in order to better ensure all patients receive the highest level of clinical care. During the onset of the COVID-19 pandemic, the ability to share medically curated information to ensure safe and effective oncologic care in a timely manner proved imperative, as information regarding the virus was evolving rapidly. During this unprecedented time, this platform provided oncologists with a novel way to quickly vet case reports and disseminate scientific information. This, in turn, translated into cancer care “best practices” during a rapidly evolving crisis.

MP72-08 PREDICTING PEAK PRODUCTIVITY IN UROLOGIC PRACTICE VIA WORK-RELATED VALUES

You have accessJournal of UrologyCME1 Apr 2023MP72-08 PREDICTING PEAK PRODUCTIVITY IN UROLOGIC PRACTICE VIA WORK-RELATED VALUES Logan Briggs, Jamie Ye, Muhieddine Labban, Peter Herzog, David-Dan nguyen, Christopher J.D. Wallis, Christopher Wolter, and Quoc-Dien Trinh Logan BriggsLogan Briggs More articles by this author , Jamie YeJamie Ye More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Peter HerzogPeter Herzog More articles by this author , David-Dan nguyen David-Dan nguyen More articles by this author , Christopher J.D. WallisChristopher J.D. Wallis More articles by this author , Christopher WolterChristopher Wolter More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are limited data on which physician and practice factors are associated with increased productivity. Work-relative value units (wRVUs), the basis for the Center for Medicare & Medicaid Services (CMS) and private payers’ reimbursements, are commonly used to estimate physician productivity. We aimed to determine what factors are associated with urologic wRVUs productivity. METHODS: The CMS database from 2017 to 2018 was retrospectively queried for urologic Medicare provider demographics and procedural/service details. Urologists’ medical school graduation year was used to estimate years in practice and urologist’s generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict Medicare specific wRVU production. RESULTS: A total of 6,773 practicing urologists (8.8% female) across the US were included: 10.1% Millennials, 44.6% Gen X, 39.8% Baby Boomers, and 5.6% Post War urologists. Additionally, 57% were general, 18% were oncologic, 17% were endo/MIS, 4.4% were men’s health, 3.2% were FPMRS, and 0.4% were reconstructive urologists. Millennial, Gen X, Baby Boomer, and Post-War urologists produced 1115, 1997, 2104, and 1287 Medicare wRVUs per year, respectively. In adjusted analyses, predictors of wRVU productivity included Gen X and Baby Boomer generations, FPMRS, men’s health, and oncologic sub-specialization, male gender, generating more wRVUs from inpatient procedures and less from office (especially new-patient office) visits, and seeing fewer educated and impoverished patients. CONCLUSIONS: The most significant predictor of urologists’ productivity is practice experience, which follows a bell curve over time that peaks 20 to 35 years after graduation; the average Gen X or Baby Boomer urologist produced nearly double the annual Medicare wRVUs of Millennial or Post-War urologists. Further work is needed to incorporate quality metrics into wRVUs or reimbursements, and to ensure that patient demographics do not affect or predict reimbursement. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1027 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Logan Briggs More articles by this author Jamie Ye More articles by this author Muhieddine Labban More articles by this author Peter Herzog More articles by this author David-Dan nguyen More articles by this author Christopher J.D. Wallis More articles by this author Christopher Wolter More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Gender Discrepancies in Middle Author Publications in US Academic General Surgery

IntroductionTo explore gender discrepancies in publications at general surgery departments, we performed a cross-sectional comparing the number of women and men at each academic rank and their number of first author (FA), middle author (MA), last author (LA), and total publications. MethodsThirty academic general surgery departments were randomly selected. For each faculty, we tabulated: first, middle, last names, gender, academic rank, educational leadership, year of medical school graduation, and additional graduate degrees. Bibliography, H-index, and citations were downloaded from the Scopus database. ResultsOne thousand three hundred twenty-six faculty sampled, 881 (66.4%) men and 445 (33.5%) women. Men outnumbered women at all ranks, with increasing disparity at higher ranks. Men outnumbered women in all subspecialties—largest difference in transplant surgery (84.4% versus 15.6%, P < 0.001). Men at all ranks had more MA publications: assistant professor (rate ratio 1.20; 95% confidence interval, 1.01-1.43, P = 0.024), associate professor (1.65; 1.31-2.06, P < 0.001), and professor (1.50; 1.20-1.91, P = 0.008). Men associate professors had more LA publications (1.74; 1.34-2.37, P < 0.001). No differences found in FA publications at any rank, nor LA publications at assistant professor and professor ranks. At subspecialty level, men in surgical oncology (1.95; 1.55-2.45, P < 0.001) and transplant surgery (1.70; 1.09-2.66, P = 0.02) had more MA publications. ConclusionsWhile FA and LA publications did not differ significantly across genders, the largest difference lies in MA publications, beginning at junior ranks and persisting with seniority. Discrepancies in MA publications may reflect gender discrepancies in collaborative opportunities, hence total publications should be used cautiously when determining academic productivity.

Physician-Peer Relationships and Patient Experiences With Specialist Care

Peer relationships may motivate physicians to aspire to high professional standards but have not been a major focus of quality improvement efforts. To determine whether peer relationships between primary care physicians (PCPs) and specialists formed during training motivate improved specialist care for patients. In this quasi-experimental study, difference-in-differences analysis was used to estimate differences in experiences with specialist care reported by patients of the same PCP for specialists who did vs did not co-train with the PCP, controlling for any differences in patient ratings of the same specialists in the absence of co-training ties. Specialist visits resulting from PCP referrals from 2016 to 2019 in a large health system were analyzed, including a subset of undirected referrals in which PCPs did not specify a specialist. Data were collected from January 2016 to December 2019 and analyzed from March 2020 to October 2022. The exposure was PCP-specialist overlap in training (medical school or postgraduate medical) at the same institution for at least 1 year (co-training). Composite patient experience rating of specialist care constructed from Press Ganey's Medical Practice Survey. Of 9920 specialist visits for 8655 patients (62.9% female; mean age, 57.4 years) with 502 specialists in 13 specialties, 3.1% (306) involved PCP-specialist dyads with a co-training tie. Co-training ties between PCPs and specialists were associated with a 9.0 percentage point higher adjusted composite patient rating of specialist care (95% CI, 5.6-12.4 percentage points; P < .001), analogous to improvement from the median to the 91st percentile of specialist performance. This association was stronger for PCP-specialist dyads with full temporal overlap in training (same class or cohort) and consistently strong for 9 of 10 patient experience items, including clarity of communication and engagement in shared decision-making. In secondary analyses of objective markers of altered specialist practice in an expanded sample of visits not limited by the availability of patient experience data, co-training was associated with changes in medication prescribing, suggesting behavioral changes beyond interpersonal communication. Patient characteristics varied minimally by co-training status of PCP-specialist dyads. Results were similar in analyses restricted to undirected referrals (in which PCPs did not specify a specialist). Concordance between PCPs and specialists in physician age, sex, medical school graduation year, and training institution (without requiring temporal overlap) was not associated with better care experiences. In this quasi-experimental study, PCP-specialist co-training elicited changes in specialist care that substantially improved patient experiences, suggesting potential gains from strategies encouraging the formation of stronger physician-peer relationships.

1305. PrEParing for success: An intervention to increase HIV prevention awareness among internal medicine residents.

Abstract Background PrEP (Pre-Exposure Prophylaxis) is a strategy that involves a combination of antiretrovirals medications aimed to reduce HIV transmission among at-risk individuals. The purpose of this quality improvement project is to increase internal medicine residents' knowledge and prescribing of PrEP. Methods We administered an anonymous paper survey to internal medicine residents at all stages of training at our suburban community hospital in the Hudson Valley, NY in the summer of 2021 during the academic half-day of their ambulatory block rotation. The survey consisted of questions about the residents’ demographics, PrEP knowledge, and previous prescribing of PrEP. Following the survey participants were given a 1-hour lecture by the authors on sexual history and PrEP including indications, available options, dosing, monitoring, side effects, and access to the therapy. Six months later we reissued the same survey to the residents. Surveys were analyzed using descriptive statistics. Results All 74 eligible residents completed the survey. Out of the 74, 35 (47.3%) identified as male and 40 (52.7%) identified as female. Medical school graduation year range between 2007 to 2021. Only 69 residents completed the post-survey. To Q1 “which medications are FDA approved to be used as PrEP,” 40 (54.05%) answered correctly prior to the intervention, whereas 51 (73.91%) did after. When they were asked Q3 “How effective was PrEP at reducing the risk of contracting HIV through sex,” 21 (28.38%) responded correctly, which improved to 46 (66.67%) after. To the other knowledge-based questions there was no significant improvement (see table). The number of people who reported prescribing PrEP increased from 2 (2.7%) to 7 (10.14%). PrEP survey Pre and Post results Conclusion Although experiencing this educational intervention did not improve long-term retention of knowledge among the participants, there was a substantial increase in the number of residents who prescribed PrEP. One of the limitations that can contribute to these results; is the short time frame between the intervention and post-survey. These findings demonstrate the need for early introduction of this topic into medical school and residency program curricula. Disclosures All Authors: No reported disclosures.

Coworker Reports about Unprofessional Behavior in Plastic Surgery.

Patient reports of unprofessional conduct by surgeons have been linked to postprocedure complications and increased risk for malpractice claims. Coworkers are also positioned to observe and report unprofessional behaviors, including concerns related to delivery of competent medical care, clear and respectful communication, integrity, and responsibility. This study compared rates of coworker concerns between plastic surgeons and other physicians (other surgical specialists and nonsurgeons), and characterized whether plastic surgery subspecialties differed in their rates of complaints. Coworker concern data from January 1, 2014, to December 31, 2019, were retrieved from the Vanderbilt Center for Patient and Professional Advocacy's Coworker Observation Reporting System database. Specialty was classified as plastic surgery, non-plastic surgical, and nonsurgical. The plastic surgery cohort was further characterized by sex, medical school graduation year, predominant practice type (reconstructive only, aesthetic only, or hybrid), and postresidency training (ie, completion of a fellowship). The study cohort included 34,170 physicians (302 plastic surgeons, 7593 non-plastic surgeons, and 26,275 nonsurgeons). A greater proportion of plastic surgeons (13.6%) had one or more coworker concerns compared with nonsurgeons (10.8%) and non-plastic surgeons (6.1%) ( P < 0.001). The most prevalent concern category reported for plastic surgeons was clear and respectful communication. Among plastic surgeons who had no concerns versus those who had at least one concern, there was no significant difference when comparing sex, medical school graduation year, predominant practice type, or postresidency training. Plastic surgeons in this cohort study received more coworker reports than other surgeons and nonsurgical physicians. These data may be used by institutions to identify plastic surgeons at risk for preventable postprocedure complications and intervene with peer feedback intended to promote self-regulation.

Benchmarking Surgeons' Gender and Year of Medical School Graduation Associated With Monthly Operative Workdays for Multispecialty Groups.

BackgroundFemale surgeons reportedly receive less surgical block time and fewer procedural referrals than male surgeons. In this study, we compared operative days between female and male surgeons throughout Florida. Our objective was to facilitate benchmarking by multispecialty groups, both the endpoint to use for statistically reliable results and expected differences.MethodologyThe historical cohort study included all 4,060,070 ambulatory procedural encounters and inpatient elective surgical states performed between January 2017 and December 2019 by 8,472 surgeons at 609 facilities. Surgeons’ gender, year of medical school graduation, and surgical specialty were obtained from their National Provider Identifiers.ResultsFemale surgeons operated an average of 1.0 fewer days per month than matched male surgeons (99% confidence interval 0.8 to 1.2 fewer days, P < 0.0001). The mean differences were 0.8 to 1.4 fewer days per month among each of the five quintiles of years of graduation from medical school (all P ≤ 0.0050). Results were comparable when repeated using the number of monthly cases the surgeons performed.ConclusionsAn average difference of ≤1.4 days per month is a conservative estimate for the current status quo of the workload difference in Florida. Suppose that a group’s female surgeons average more than two fewer operative days per month than the group’s male surgeons of the same specialty. Such a large average difference would call for investigation of what might reflect systematic bias. While such a difference may reflect good flexibility of the organization, it may show a lack of responsiveness (e.g., fewer referrals of procedural patients to female surgeons or bias when apportioning allocated operating room time).

Otolaryngology workforce trends by gender – When and where is the gap narrowing?

PurposeTo describe the changes in workforce gender distribution over time and characterize geographically where women are finding job opportunities within the field of otolaryngology. Materials and methodsThe Centers for Medicare and Medicaid Services (CMS) publishes a Physician Compare National Downloadable File, which lists all active providers registered within CMS, as well as specialty, medical school graduation, and current practice location. The file of March 2021 was filtered for all providers that listed “otolaryngology” as their primary specialty. Providers were sorted based on medical school graduation year. Physicians were organized into five-year and ten-year quantiles, based on career experience. For each quantile, the gender distribution was recorded. For each decade of experience, the geographic distribution of gender was recorded at a state-by-state level. Descriptive statistics were conducted to characterize the number of female otolaryngologists per state. The geographic distribution of male versus female physicians was superimposed onto state boundary files as published by the U.S. Census Bureau using R Studio (2020) [13]. ResultsThe Physician Compare National Database listed 1719 women (19.0%) and 7292 men (81.0%) otolaryngologists actively registered to practice in the United States. By career periods, the following proportions of otolaryngologists were women: 1–5 years, 317/971 (32.6%); 6–10 years, 417/1291 (32.3%); 11–15 years, 299/1159 (25.8%); 16–20 years, 207/1108 (18.7%); 21–25 years, 190/1156 (16.4%); 26–30 years, 138/1141 (12.1%); 31–35 years, 86/968 (8.9%); 36+ years, 60/1212 (5.0%). The linear regression of the male-female distribution data suggests that the proportion of men and women in practice in otolaryngology will equalize nationally in the 2030s. By geographic distribution, the mean and median number of female otolaryngologists per state was 34.3 (19.0%) and 21 (17.2%), respectively. The number of female otolaryngologists by state ranged from 2 (Idaho) to 258 (California). States with the lowest percentage of female otolaryngologists included Idaho (2/51, 3.9%), Oklahoma (5/86, 5.8%), and Utah (6/99, 6.1%). There has been a national increase in the percentage of women practicing in otolaryngology over the last several decades. ConclusionsThere is a significantly higher proportion of female otolaryngologists within earlier practice years, which suggests that progress has been made toward closing the gender gap within this field. The geographic distribution of female otolaryngologists is highly variable and should be studied further to assess what factors contribute to more females choosing to practice in these regions to continue to build regional support networks for women within the field.

Higher adenoma detection, sessile serrated lesion detection and proximal sessile serrated lesion detection are associated with physician specialty and performance on Direct Observation of Procedural Skills

ObjectiveAdenoma detection rate (ADR) and sessile serrated lesion detection rate (SSLDR) vary among physicians. We sought to determine physician characteristics associated with ADR and SSLDR in a population-based colon screening...

Personal Payments from Pharmaceutical Companies to Authors of Oncology Clinical Practice Guidelines.

Oncologists who author clinical practice guidelines frequently have financial relationships with the pharmaceutical industry. It is unknown whether participation on clinical practice guideline committees is associated with differences in the amounts of industry money received. We conducted a nested case-control study from August 2013 to December 2018. We manually abstracted membership records of National Comprehensive Cancer Network (NCCN) Guidelines committees for the 20 most common cancers and linked to Open Payments. The study sample included medical oncologists selected to join an NCCN Guidelines committee ("joiners") during the study period. Joiners were matched 1:2 to medical oncologists who had no participation on NCCN committees (controls) by gender, NCCN institution, and medical school graduation year. We performed difference-in-differences (DiD) estimation to assess whether selection to an NCCN committee was associated with the dollar value of payments received from industry, using generalized estimating equations to address correlation between matched pairs and between repeated observations of the same pair. During the study period, 54 physicians joined an NCCN Guidelines committee. These physicians received more payments than matched controls in the year prior to joining ($11,259 vs. $3,427; p=.02); this difference did not increase in the year after joining (DiD=$731; p=.45). Medical oncologists selected to NCCN Guidelines committees had greater financial ties to industry than their peers. The potential influence of industry in oncology clinical practice guidelines may be reduced through the selection of committee members with fewer ties to industry. Oncologists who author clinical practice guidelines frequently have financial conflicts of interest with the pharmaceutical industry. This creates concern about the potential for industry influence on guidelines. However, it is unknown whether oncologists who author guidelines have greater industry relationships than their peers. This study compared medical oncologists who were newly selected to join a National Comprehensive Cancer Network (NCCN) Guidelines panel with medical oncologists at the same institutions and at similar career stages. At the time they joined, oncologists joining NCCN Guidelines panels had received more than three times the dollar value of industry payments than their peers. The potential for industry influence may be reduced by the selection of less-conflicted panel members.

Unsolicited patient complaints among radiation, medical, and surgical oncologists.

Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs. This retrospective study reviewed UPCs associated with US radiation oncologists (ROs), medical oncologists (MOs), and surgical oncologists (SOs) from 35 health care systems from 2015 to 2018. Average total UPCs were compared by specialty in addition to sex, medical school graduation year, degree, medical school location, residency location, practice setting, and practice region. For continuous variables, linear regression was used to test for an association with total complaints. The study included 1576 physicians: 318 ROs, 1020 MOs, and 238 SOs. The average number of UPCs per physician was different and depended on the oncologic specialty: ROs had significantly fewer complaints (1.28; 95% confidence interval [CI], 1.02-1.54) than MOs (3.81; 95% CI, 3.52-4.10) and SOs (6.89; 95% CI, 5.99-7.79; P < .0001). In a multivariable analysis, oncologic specialty, recency of graduation, and academic practice were predictive of higher total UPCs (P < .05). UPCs described concerns with care and treatment (42.8%), communication (26.4%), accessibility (17.5%), concern for patient (10.3%), and billing (2.9%). ROs had significantly fewer complaints than MOs and SOs and may have a lower risk of malpractice claims as a group. In addition to oncologic specialty, a more recent year of medical school graduation and working at an academic center were independent risk factors for UPCs. Further research is needed to clarify the reasons underlying these associations and to identify interventions that decrease UPCs and associated risks. This study of 1576 oncologists found that radiation oncologists had significantly fewer complaints than medical oncologists, who in turn had significantly fewer complaints than surgical oncologists. Other characteristics associated with more patient complaints included recency of medical school graduation and practice in an academic setting. Oncologists' patient complaints provide information that may have practical applications for patient safety and risk management. Understanding and addressing the characteristics that increase the risk for complaints could improve patients' experiences and outcomes.

Trends in geographic and home program preferences in the dermatology residency match: A retrospective cohort analysis

Trends in geographic and home program preferences in the dermatology residency match: A retrospective cohort analysis

Differences by Practice Year in Numbers of U.S. Female Neurosurgeons

We sought to determine the proportion and number of female neurosurgeons in the workforce at different stages of practice. The Physician Compare National Downloadable File data set was obtained from the Centers for Medicare & Medicaid Services for physicians who indicated "neurosurgery" as their primary specialty. Physician duplicates, physicians with no listed medical school graduation year, and physicians expected to be in residency (graduation years 2013-2019) were removed, yielding 4956 neurosurgeons. Five-year intervals were used to measure the number of male and female neurosurgeons by different stages of their careers. For example, graduates from years 2008-2012 were expected to be in their first 1-5 years of practice. There were 405 female (8.2%) and 4551 male (91.8%) neurosurgeons. At 1-5 years of practice, 13.8% (105/760) were women; 6-10 years, 11.5% (94/820) women; 11-15 years, 8.9% (64/720) women; 16-20 years, 8.7% (59/682) women; 21-25 years, 7.4% (46/619) women; 26-30 years, 3.8% (20/520) women; 31-35 years, 3.6% (15/413) women; and 36 years or more, 0.5% women (2/422). The number of female neurosurgeons varied among states, ranging from 0 in Hawaii to 53 in California. The states with the lowest percentage of female neurosurgeons were Hawaii (0%), Oklahoma (3.1%), and Nevada (3.6%). The states with the highest percentage of female neurosurgeons were New Hampshire (20.0%), Vermont (16.7%), and Rhode Island (15.8%). The number of practicing female neurosurgeons within the United States is increasing, as shown by the growing percentage of women who are earlier in their surgical careers.

Leadership Amongst Regional and National Surgical Organizations: The Tides Are Changing.

Introduction: Leadership amongst professional organizations is a key opportunity for scholarly activity which is essential for academic advancement. Our objective was to examine the differences between men and women in leadership within surgical organizations.Methods: Credentials were obtained through an internet search. Variables included organization type, leadership role, gender, advanced degree, medical school graduation year, and publications. A bivariate analysis was performed between genders. A p-value <0.05 was considered statistically significant.Results: Five hundred forty-three leaders were identified in 43 surgical organizations. There was a significant difference in the number of male and female leaders (72.7% vs 27.3%, p=0.016). Women were most likely to hold the role of “Other”, which consisted of lower-level leadership roles including committee chair positions and resident and medical student delegates (35.5%). Fewer women had publications (85.8% vs 92.9%, p=0.01), more women had advanced degrees (24.5% vs 17.0%, p=0.049), and women were involved earlier in their careers (5.9 years, 95% CI 4.1-7.7 years, p<0.001) than their male colleagues.Conclusion: Gender disparity in leadership of surgical organizations exists. Women are involved earlier in their careers and hold lower-level leadership positions reflecting potential for increased involvement in high-level leadership roles in the future. Data need to be trended to discern if women in surgical organizations rise within leadership roles as more women continue to enter surgical subspecialties.

Gender-Based Analysis of the Academic Pediatric Radiation Oncology Workforce

Pediatric radiation oncology represents a small yet essential aspect of the field. The demographic makeup of the pediatric academic radiation oncology workforce has not been previously investigated. The 51 National Cancer Institute-designated Comprehensive Cancer Centers were examined by internet investigation in September 2019. Data collected for each radiation oncologist included gender, year of medical school graduation, institution of employment, level of professorship, underrepresented minority status (African-American race and/or Hispanic ethnicity), and departmental leadership position (chair and/or program director). Variables were coalesced for statistical analysis using Fisher’s exact test. Among 993 total radiation oncologists, 79 pediatric radiation oncologists (8%) were identified, of whom 45.6% are women. 39.2% are assistant professors, 30.4% are associate professors, and 30.4% are full professors; 5% are underrepresented minorities. Eleven percent of pediatric radiation oncologists are department chairs, of whom 78% are men. Women comprise 42% of assistant professors, 54.2% of associate professors, and 41.7% of full professors, along with 50% of underrepresented minorities; these numbers exceed overall female representation in academic radiation oncology. Compared to the proportion of women outside of the pediatric academic radiation oncology workforce at each level of appointment, women were significantly less likely to be assistant professors (p = 0.007) and more likely to be full professors (p = 0.047), with no significant difference in the likelihood of associate professorship (p = 0.229). Overall, female representation was significantly higher in pediatric than non-pediatric academic radiation oncology (p = 0.012). Pediatric radiation oncology comprises less than 10% of the academic radiation oncology workforce, with the majority of academic pediatric radiation oncologists being men. The proportion of women significantly exceeds their overall representation in academic radiation oncology, which is statistically significant for full professorship. These findings indicate that unlike academic radiation oncology in general, women in pediatric radiation oncology find fewer barriers in achieving full professorship. These results deserve further investigation.

Do neurosurgeons receive more patient complaints than other physicians? Describing who is most at risk and how we can improve.

The number of unsolicited patient complaints (UPCs) about surgeons correlates with surgical complications and malpractice claims. Using a large, national patient complaint database, the authors sought to do the following: 1) compare the rates of UPCs for neurosurgeons to those for other physicians, 2) analyze the risk of UPCs with individual neurosurgeon characteristics, and 3) describe the types of UPCs made about neurosurgeons. Patient and family complaint reports among 36,265 physicians, including 423 neurosurgeons, 8292 other surgeons, and 27,550 nonsurgeons who practiced at 33 medical centers (22 academic and 11 regional) from January 1, 2014, to December 31, 2017, were coded with a previously validated Patient Advocacy Reporting System (PARS) algorithm. Among 423 neurosurgeons, 93% were male, and most (71%) practiced in academic medical centers. Neurosurgical subspecialties included general practice (25%), spine (25%), tumor (16%), vascular (13%), functional (10%), and pediatrics (10%). Neurosurgeons had more average total UPCs per physician (8.68; 95% CI 7.68-9.67) than nonsurgeons (3.40; 95% CI 3.33-3.47) and other surgeons (5.01; 95% CI 4.85-5.17; p < 0.001). In addition, a significantly higher percentage of neurosurgeons received at least one UPC (71.6%; 95% CI 67.3%-75.9%) than did nonsurgeons (50.2%; 95% CI 49.6%-50.8%) and other surgeons (58.2%; 95% CI 57.1%-59.3%; p < 0.001). Factors most associated with increased average UPCs were younger age, measured as median medical school graduation year (1990.5 in the 0-UPC group vs 1993 in the 14+-UPC group, p = 0.009) and spine subspecialty (13.4 mean UPCs in spine vs 7.9 mean UPCs in other specialties, 95% CI 2.3-8.5, p < 0.001). No difference in complaints was seen in those who graduated from non-US versus US medical schools (p = 0.605). The most common complaint types were related to issues surrounding care and treatment, communication, and accessibility, each of which was significantly more common for neurosurgeons than other surgical specialties (p < 0.001). Neurosurgeons were more likely to generate UPCs than other surgical specialties, and almost 3 out of 4 neurosurgeons (71.6%) had at least one UPC during the study period. Prior studies have shown that feedback to physicians about behavior can result in fewer UPCs. These results suggest that neurosurgeons have opportunities to reduce complaints and potentially improve the overall quality of care delivered.

Academic and Gender Differences Among U.S. Otolaryngology Board Members.

To determine the representation of women in leadership positions within otolaryngology societies and to compare their academic rank and research productivity to men. The leadership positions of all U.S. otolaryngology societies were compiled. The Medicare Physician Compare database was used to obtain gender and medical school graduation year for all otolaryngologists. An online search was used to determine board member's academic faculty rank. The Scopus database was used to determine an individual's number of publications, citations, and h-index. All websites were accessed from July 2019 to October 2019. Of the 200 leadership positions, there were 160 unique individuals available for analysis. Of those, 23% were female. In comparison, 18% of all otolaryngologists in the United States are female. The average medical school graduation year was significantly more recent for female leaders (1997 vs. 1990, P < .001) than males, which is similar to all otolaryngologists (2001 vs. 1993, P < .001). Stratifying by gender alone, women averaged significantly fewer publications, citations, and h-indices compared to men (P < .05), and were also less likely to be professors (P < .01). When considering both gender and graduation year, significant differences among academic productivity were only noted for those graduating between 1990 to 1999. Among all board members who graduated after 2000, women comprised a majority of those in leadership positions (52%). Leadership positions in otolaryngology societies reflect the changing demographic of otolaryngologists in the United States. There is proportionate representation, and the more recently graduated female physicians show the same research productivity as their male counterparts. 4 Laryngoscope, 131:731-736, 2021.