Nonacademic Practices Research Articles

Recent Trends in Academic Vs Non-academic Radiologist Compensation and Clinical Productivity.

Recent radiologist compensation and clinical productivity trends have not been well characterized, especially across academic vs. non-academic practice settings. To assess recent trends in in financial compensation and clinical productivity between academic and non-academic settings in diagnostic (DR) and interventional radiology (IR). We studied deidentified data from the Medical Group Management Association (MGMA) for both DR and IR radiologists in academic and non-academic practices from 2014 to 2023. Median, 25th and 75th percentile, and mean values were analyzed for compensation, collections and work relative-value-units (wRVUs). Compensation and productivity data were compared by radiology subspecialty (DR vs IR), practice type (academic vs non-academic provider), geographical region of the US, and practice size. Trends in absolute changes were analyzed with linear regression. The MGMA Survey data for 2023 included responses for 3769 radiologists (2883 in DR and 886 in IR). In 2023, non-academic radiologists had greater total median compensation than academic faculty in both DR (by 27%) and IR (by 32%). From 2014 to 2023, median compensation increased faster for academic DRs (3.2% annually) than for non-academic DRs (1.9% annually). In 2023, DRs produced greater median wRVUs than IRs (by 53 % for non-academic and 46 % for academic radiologists) with higher collections, but IRs had higher compensation (by 16% in non-academic and 10% in academic settings). Over the last decade, IR physician compensation increased by 3.9% and 3.4% annually for non-academic and academic IR physicians respectively while median work RVUs trended downward (by -1.5 % for non-academic and -2.4 % for academic physicians) with declining collections (by -4.4 % annually for non-academic and -2.1 % for academic physicians). Over the last decade, the salary gap between academic and non-academic radiologists has narrowed. Physician compensation has increased at a faster pace in IR, despite relatively lower clinical productivity and declining collections.

Does exposure matter? Association between exposure to clinical trial conduct during training and intent to participate in clinical trials post-training among oncology fellows: An ASCO State of Cancer Care in America study.

69 Background: Clinical trials are part of standard cancer care. Yet, a quarter of oncology fellows in a 2023 survey reported feeling underprepared to conduct research after training and nearly half did not identify research as important to their practice. In a 2024 survey, we explore the impact of exposure to research activities in fellowship on intentions to conduct research post-training. Methods: Fellows who took the 2024 ASCO Medical Oncology In-Training Exam (ITE) were invited to an optional IRB-exempted post-exam survey to measure (1) research exposure during training and (2) anticipated research participation once in practice. Responses of moderate and great amount are combined as frequent (vs. never, rarely, occasionally as not frequent). Rates of frequent research engagement in future practice are compared by frequent/not frequent research exposure during fellowship, expected practice setting, and program year using chi-squared analysis. Results: Of the 1884 US medical oncology fellows taking the ITE, 1491 (79%) participated in this study, 33% 1st year, 37% 2nd year, 39% 3rd year. 891 (60%) expect their first post-training role to be in academics, 527 (35%) in a non-academic practice, and 67 (5%) in other settings. Anticipated engagement in enrollment and management of participants on clinical trials post-training was associated with exposure to those activities in fellowship and with expected practice setting. Overall, 827 (63%) anticipate frequent participation in research once in practice. 531 (76%) of 701 with frequent exposure in training compared to 296 (37%) of 790 with not frequent exposure anticipate frequent participation in practice (p<0.001). 610 (78%) of fellows expecting to practice in an academic setting vs. 192 (40%) in a non-academic setting anticipate frequent future participation in practice (p<0.001). For research leadership activities (writing clinical research protocols, applying for clinical research grants, serving as principal investigator), 622 (49%) anticipate frequent participation once in practice. 390 (79%) of 519 with frequent vs. 229 (29%) of 855 with not frequent exposure to leadership activities during fellowship anticipate frequent future engagement (p<0.001). 523 (67%) of fellows expecting to practice in an academic setting vs. 76 (16%) in a non-academic setting anticipate frequent leadership engagement after training (p<0.001). Anticipated future participation did not vary by program year for either type of research activity. Conclusions: Findings show an urgent need to increase exposure to research during fellowship training to improve participation in clinical trials by practicing oncologists. This is a critical component of improving patient access to research.

Increasing access to biomarker-driven treatment for lung cancer in Alabama: The Alabama Access initiative.

159 Background: Lung cancer is the leading cause of cancer death in Alabama, with an estimated 2,550 deaths in 2024. Non-small cell lung cancer (NSCLC) represents 85% of these cases. Despite national guidelines recommending comprehensive biomarker testing (CBT) for metastatic NSCLC, significant disparities persist in the utilization of CBT and targeted therapies among Alabama residents. Methods: In March 2024, we launched the "Alabama Access" initiative – a partnership between the LUNGevity Foundation and the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham – to foster academic and community oncology partnerships to increase access to biomarker-driven treatments. We used a population health science and geospatial mapping approach to visualize oncology practices serving counties with Alabama's highest lung cancer burden. Practices in Walker, Dothan, Marengo, Morgan, Jackson, Marshall, and Montgomery counties were identified as the highest priority based on annual mortality rates. Key interventions will include virtual molecular tumor boards and oncology navigation to facilitate the integration of resources and expertise and ensure that patients in nonacademic practices benefit from the latest advances in precision oncology. After roll-out, we will collect feasibility and acceptability data around program integration. Results: Our analysis revealed that 62.0% of the state’s population resides in Primary Care Health Professional Shortage Areas (HPSAs), and 58 out of 67 counties are classified as Medically Underserved Areas. The poverty rate in 89.6% of counties surpasses the national average, contributing to higher lung cancer incidence and mortality rates, with 62.0% of cases diagnosed at advanced stages. The state also shows a higher smoking prevalence, affecting 97.0% of counties compared to national figures. We will present practice-level testing data, including barriers to CBT. Conclusions: This pilot aims to mitigate disparities in CBT through enhanced collaboration between academic and community oncology settings. Integrating molecular navigation into community practices will be pivotal in disseminating program information and collecting data on current testing practices to improve overall lung cancer care quality in Alabama.

Hypofractionated Radiation Therapy: A Cross-sectional Survey Study of US Radiation Oncologists.

For many malignancies, hypofractionated radiotherapy (HFRT) is an accepted standard associated with decreased treatment time and costs. United States provider beliefs regarding HFRT likely impact its adoption but are poorly studied. We surveyed US-based radiation oncologists (ROs) to gauge HFRT utilization rates for prostate (PC), breast (BC), and rectal cancer (RC) and to characterize the beliefs governing these decisions. From July to October 2021, an anonymized, online survey was electronically distributed to ROs actively practicing in the United States. Demographic and practice characteristic information was collected. Questions assessing rates of offering HFRT for PC, BC, and RC and perceived limitations towards using HFRT were administered. A total of 203 eligible respondents (72% male, 72% White, 53% nonacademic practice, 69% with 11+ years in practice) were identified. Approximately 50% offered stereotactic body radiation therapy (SBRT) for early/favorable intermediate risk PC. Although >90% of ROs offered whole-breast HFRT for early-stage BC, only 33% offered accelerated partial-breast irradiation (APBI). Overall, 41% of ROs offered short-course neoadjuvant RT for RC. The primary reported barriers to HFRT utilization were lack of data, inexperience, and referring provider concerns. HFRT is safe, effective, and beneficial, yet underutilized-particularly prostate SBRT, APBI, and short-course RT for RC. Skills retraining and education of ROs and referring providers may increase utilization rates.

Practice Patterns and Barriers to Vascular Genetic Testing Among Vascular Surgeons

Engaging patients living with or at risk of aortic dissection via the Aortic Dissection Collaborative, physician education in vascular genetics was identified as a research priority. We surveyed vascular surgeons to characterize practice patterns, motivations, and barriers regarding aortopathy genetic testing. An anonymous 27-question survey was distributed on social media platforms between November and December 2022. Domains included demographics, vascular genetic education, testing attitudes and utilization, and experience in treating patients with genetic vascular aortopathies. The analysis included summary statistics and unpaired t-test to compare responses by interest in incorporating testing and practice type. A total of 171 vascular surgeons from 15 countries responded to the survey (23% trainees). Over half received vascular genetics education during training (59%), and most (86%) were interested in incorporating genetic testing into their practice. Academic surgeons were more likely to have cared for a patient with a known genetic aortopathy over the past year than surgeons in hospital-based and private practices (83% vs. 56% vs. 27%; P<0.01), to have ever made a referral to a medical geneticist (78% vs. 51% vs. 9%; P<0.01), and have access to genetic counselors or geneticists (66% vs. 46% vs. 0%; P<0.01). Barriers to genetic testing were rated as more significant by surgeons in nonacademic practices, with top barriers being insurance coverage of testing, cost of genetic testing, and access to genetic counselors. Evidence-based professional society guidelines were the strongest rated motivating factor for testing incorporation among respondents. Vascular surgeon attitudes are not major barriers to incorporating genetic testing for patients with aortopathies; however, practical challenges regarding genetic testing and counseling are barriers to implementation especially for vascular surgeons in nonacademic practices. Future efforts should focus on evidence-based society guidelines, continuing medical education to increase adoption, and facilitating access to genetic counseling.

Narratology, applied

Abstract Criminology is foundationally an applied discipline, or one whose knowledge seeks to shape some non-academic practice. Narratives – particularly the narratives of parties to ‘crime’ – are essential to criminology, but criminologists have hardly engaged with narratology. This paper tracks the progression from traditional narrative research involving harm agents and criminalized persons to a relatively new narrative criminology that is attentive to narrative forms and strategies inasmuch as it considers these as shaping harm. In addition, the paper forecasts narrative criminology’s fruitful engagement in concepts from rhetorical narratology. Interviews with men who perpetrated violence and insights from restorative justice encounters are used to demonstrate the potential value of rhetorical narratological concepts to narrative criminology and to interventions informed by narrative criminology.

Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States: An analysis of geographical distribution, academic, leadership, and demographic characteristics.

The Limb Lengthening and Reconstruction Society (LLRS) is a premier orthopedic specialty organization that promotes limb reconstruction for all ages. LLRS membership characteristics, however, are poorly reported. This study delineates orthopedic surgeon LLRS members' demographic traits, academic achievement, leadership attainment, and geographical distribution across the United States. To inform aspiring orthopedic professionals, as well as to promote growth and diversity in both the LLRS organization and overarching field. This cross-sectional study examined United States LLRS members' academic, leadership, demographic, and geographical attributes. After reviewing the 2023 LLRS member directory, Google search results were matched to the listings and appended to the compiled data. Sex and ethnicity were evaluated visually utilizing retrieved images. The Hirsch index (H-index) of academic activity, residency and fellowship training, other graduate degrees, leadership positions, practice type (academic or non-academic), and spoken languages were categorized. LLRS members per state and capita determined geographic distribution. The Mann-Whitney U test was applied to compare H-index between males and females, as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities. The study included 101 orthopedic surgeons, 78 (77.23%) Caucasian and 23 (22.77%) non-Caucasian, 79 (78.22%) male and 22 (21.78%) female. Surgeons with DO degrees comprised only 3.96% (4) of the cohort, while the vast majority held MDs [96.04% (97)]. Mean H-index was 10.55, with male surgeons having a significantly higher score (P = 0.002). Most orthopedic surgeons (88.12%,) practiced in academic centers. Of those professionals who occupied leadership positions, 14% were women, while 86% were men. Additionally, 19 (37.25%) United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon. Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people. Over 21% of LLRS members are women, surpassing prior benchmarks noted in orthopedic faculty reporting. LLRS members' high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space. Gender disparities in leadership remain, however, necessitating greater equity efforts. A low rate of LLRS representation per capita must be addressed geographically as well, to affect improvements in regional care access. This study can serve to support aspiring orthopedic professionals, inform diversity, leadership, and field advancement strategies, and maintain the continued goal of enhanced patient care worldwide.

Mifepristone Use Among Obstetrician-Gynecologists in Massachusetts: Prevalence and Predictors of Use

ObjectivesWe estimated the prevalence of mifepristone use for evidence-based indications among obstetrician-gynecologists in independent practice in Massachusetts and explored the demographic and practice-related factors associated with use. MethodsWe used data from a cross-sectional survey administered to Massachusetts obstetrician-gynecologists identified from the American Medical Association Physician Masterfile. We measured the prevalence of mifepristone use for four clinical scenarios: early pregnancy loss, medication abortion, cervical preparation before dilation and evacuation procedures, and cervical preparation before induction of labor. Multivariate regression was used to calculate the odds of mifepristone use for these scenarios based on practice type, years in practice, physician sex, and history of medication abortion training. ResultsA total of 198 obstetrician-gynecologists responded to the survey (response rate = 29.0%); this analysis was limited to 158 respondents who were not in residency or fellowship. Overall, 46.0% used mifepristone for early pregnancy loss and 38.6% for medication abortion. Fewer used mifepristone for cervical preparation before dilation and evacuation (26.0%) or before induction of labor (26.4%). Respondents in academic practice settings, with more years in practice, of female sex, and with sufficient medication abortion training were significantly more likely to use mifepristone for one or more evidence-based clinical indications. ConclusionsSufficient medication abortion training during residency significantly predicts whether obstetrician-gynecologists use mifepristone in practice. The U.S. Supreme Court's overturning of Roe v. Wade will allow state-level abortion bans and restrictions to be in effect, which will reduce exposure to abortion training during residency. Increasing training in and utilization of mifepristone are critical for equitable access to reproductive health services. Further interventions may need to be developed to increase mifepristone use in nonacademic practice settings.

Integrating the business of oncology during oncology fellowship: An ASCO State of Cancer Care in America (SOCCA) study of professional preparedness and practice expectations among medical oncology fellow physicians in training between 2013 and 2023.

48 Background: The current healthcare climate calls for a deep understanding among physicians on the business side of medicine. Oncology fellows entering clinical practice face key issues related to the business of cancer care, prompting us to explore the preparation from fellowship training for those financial competencies that factor into day-to-day practice. Methods: All fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to participate in a post-exam survey which included items on perception of preparedness for future practice and expected practice setting. Respondents answering one or more survey items are included in this analysis. Practice setting expectations were compared to findings from the 2013 post-ITE survey (n=1536). Descriptive statistics and Chi-squared tests comparing responses by fellowship year and exam years are presented. Results: Overall, 2184 (97%) of 2231 fellows taking the 2023 ITE participated in this post-ITE survey study, including 704 in their first, 807 in their second, and 673 in their third year of fellowship. Overall, in areas of communication, most felt adequately prepared by their program: communicating with patients about treatment options (98%), multidisciplinary care coordination (97%), electronic records or other healthcare tech use (95%), staying up to date on changes in oncology (95%), and practicing cultural humility (92%). However, in areas on business of oncology, a greater proportion felt under- or unprepared; specifically, 30% of fellows felt unprepared or unsure about discussing the cost of medical care with patients, 35% on obtaining prior authorization, and 45% on participating in alternative payment models. Compared to 2013, the expected practice setting of the 2023 fellows remained unchanged with subsets anticipating an academic practice (62% in 2023 vs 61% in 2013), non-academic practice (hospital/health system or physician/independently owned; 32% in 2023 vs 34% in 2013), government/regulatory (2%), industry (&lt;1%), or other setting (3%). Conclusions: While nearly all oncology fellows reported high levels of preparedness for certain essential components of patient-centered multidisciplinary practice, over a third felt unprepared or underprepared to navigate domains under the business of oncology. These findings highlight the opportunity to augment oncology fellowship training to include financial competencies of clinical practice and care, which collectively form the foundation of cancer care.

Multilevel factors impacting clinical trial participation: An ASCO State of Cancer Care in America (SOCCA) analysis of oncology fellows’ perceptions of preparedness to conduct clinical research in practice and importance of clinical trial participation.

110 Background: Despite cancer treatment advances from clinical trials, the proportion of those with cancer enrolling on oncology studies remains low, due to system-, patient-, and physician-level facilitators and barriers to participation. To better understand the upstream context impacting oncologists’ consideration of trials, we studied oncology fellows’ perceptions of trial participation and preparedness for clinical research. Methods: All year 1 (Y1), Y2, &amp; Y3 fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to take a post-ITE optional survey. After consent, fellows answered whether they agree, disagree or are unsure of their preparedness by their fellowship program to address key elements of practice and research and their perceived importance of trial participation after training, ranging from Very Important, Important, Moderately, Slightly, or Not Important, the latter 3 ratings aggregated and labeled as ‘less important.’ Descriptive statistics and Chi-squared tests comparing responses by fellowship year are presented. Results: Overall, 97% of fellows (2184/2231) taking the 2023 ITE participated in this study and are included in this analysis; 32% were in Y1, 37% Y2, 30% Y3. When asked ‘my fellowship training program is adequately preparing me to address the following in my future,’ nearly one in four fellows felt unsure or disagreed that their program prepared them for (a) treating patients outside of an academic medical center (Y1 24%, Y2 24%, Y3 23%) or (b) conducting clinical research (Y1 26%, Y2 26%, Y3 28%). When asked ‘how important is it to you to have the opportunity to participate in clinical trials following completion of your training,’ nearly half of oncology fellows (Y1 49%, Y2 46%, Y3 40%, p.038) felt trial participation was ‘less important.’ When considering future practice setting, two out of 3 fellows (66%) planning a non-academic practice and one of 3 fellows (33%) planning an academic practice rated trial participation as ‘less important’ (p&lt;.0001). When compared to fellows who reporting being unsure or unprepared by their programs to conduct clinical research, those who felt adequately prepared were more likely to rate trial participation as important/very important (57% vs 49%, p=.005). Conclusions: Our findings show that value of clinical trial participation is assigned early in oncologists’ careers during fellowship training. Addressing barriers to clinical trial participation calls for multilevel interventions that include efforts to identify and augment clinical research learning needs of oncology fellows and ensuring broad exposure during fellowship to successful and efficient conduct of cancer clinical trials.

Burnout among neurologists caring for patients with cognitive disorders in Spain.

Physician burnout has a negative impact on both physicians and patients. Limited information is available on professional burnout of neurologists. The aim of this study was to assess the presence of burnout among neurologists caring for patients with cognitive disorders and to identify associated factors. An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists involved in the care of patients with cognitive disorders answered a survey composed of demographic characteristics, professional background, clinical practice setting, and behavioral factors. Burnout was assessed using a single-item measure from the Physician Work Life Study. A multivariate logistic regression analysis was conducted to determine the association between neurologists' characteristics and burnout. A total of 188 neurologists answered the survey. The mean age (standard deviation-SD) was 40.6 (11.3) years and 52.7% were male. The majority of participants were general neurologists (60.6%) who attending a median of 20 patients with cognitive disorders (interquartile range 10.0-30.0) weekly. Thirty-nine participants (20.7%) reported burnout. Participants with burnout had greater experiences of regret associated with past clinical decisions than their counterparts (mean Regret Intensity Scale scores of 2.3 and 1.9, respectively; p = 0.003). Burnout was associated with non-academic practice (OR = 3.02 [95% CI 1.18, 7.73], p = 0.021) and care-related regret (OR = 2.53 [95% CI 1.13, 5.64], p = 0.023) in the multivariate analysis after adjustment for confounders. Professional burnout was a common phenomenon among neurologists managing cognitive disorders. Identifying physician burnout and its associated factors may be critical for implementing preventive intervention strategies.

Characteristics associated with first job satisfaction and burnout in early-career gynecologic oncologists (031)

Objectives: To identify job characteristics associated with increased job satisfaction and decreased burnout in early-career gynecologic oncologists. Methods: U.S. gynecologic oncologists (GO) who were early-career (< 10 years since fellowship) SGO members were electronically contacted to participate in a one-time anonymous online survey about early-career job characteristics and satisfaction, practice patterns, and responses to the Maslach burnout inventory. First job characteristics were summarized, and burnout scores were correlated with respondent and job characteristics. Results: A total of 96 early-career (96/514, 18.6%) GO participated in the study. Respondents were majority female (79.2%), White (77.1%), board-certified (66.7%), in practice for <5 years (56.3%), and at academic centers (56.3%) and urban locations (57.3%). Respondents reported the following as most important (>80%) considerations for job satisfaction: availability of senior partners for back-up, practice/department culture, geographic location, work-life balance, and type of facility (Table 1). Seventy (72.9%) respondents reported they were somewhat or very happy with their job. Although only 25% of respondents reported a current mentorship/career development plan, 79.2% of respondents expressed this would be helpful in the first job. Burnout was present in one of three areas (emotional exhaustion, depersonalization, or professional accomplishment) in 62.5% of all respondents. Working solely at a non-academic practice was associated with burnout (p<0.01). However, gender, race, board-certification status, age, financial benefits, lifestyle/work schedule, and practice location were not associated with burnout and job satisfaction. More than 50% of respondents reported they would choose to become a physician again and specialize in gynecologic oncology, but only 38.6% of respondents would recommend a career in medicine to family/friends. Twenty-six (27.0%) respondents left their first job after a mean of 3.9 ± 2.9 years with the most common reasons attributable to leaving: better opportunity (53.8%), poor department culture and/or bullying (42.3%), salary (38.5%), lack of mentorship (38.5%), location (34.6%), poor work-life balance (30.8%), and <5% each of call schedule, lack of research opportunities, sexual harassment, and lack of administrative/clinical support. Compared to those who did not leave their first job, respondents who left their first job rated the following characteristics as significant in choosing a first job: case mix as more important, type of practice as less important, and work-life balance as less important (p<0.05). Objectives: To identify job characteristics associated with increased job satisfaction and decreased burnout in early-career gynecologic oncologists. Methods: U.S. gynecologic oncologists (GO) who were early-career (< 10 years since fellowship) SGO members were electronically contacted to participate in a one-time anonymous online survey about early-career job characteristics and satisfaction, practice patterns, and responses to the Maslach burnout inventory. First job characteristics were summarized, and burnout scores were correlated with respondent and job characteristics. Results: A total of 96 early-career (96/514, 18.6%) GO participated in the study. Respondents were majority female (79.2%), White (77.1%), board-certified (66.7%), in practice for <5 years (56.3%), and at academic centers (56.3%) and urban locations (57.3%). Respondents reported the following as most important (>80%) considerations for job satisfaction: availability of senior partners for back-up, practice/department culture, geographic location, work-life balance, and type of facility (Table 1). Seventy (72.9%) respondents reported they were somewhat or very happy with their job. Although only 25% of respondents reported a current mentorship/career development plan, 79.2% of respondents expressed this would be helpful in the first job. Burnout was present in one of three areas (emotional exhaustion, depersonalization, or professional accomplishment) in 62.5% of all respondents. Working solely at a non-academic practice was associated with burnout (p<0.01). However, gender, race, board-certification status, age, financial benefits, lifestyle/work schedule, and practice location were not associated with burnout and job satisfaction. More than 50% of respondents reported they would choose to become a physician again and specialize in gynecologic oncology, but only 38.6% of respondents would recommend a career in medicine to family/friends. Twenty-six (27.0%) respondents left their first job after a mean of 3.9 ± 2.9 years with the most common reasons attributable to leaving: better opportunity (53.8%), poor department culture and/or bullying (42.3%), salary (38.5%), lack of mentorship (38.5%), location (34.6%), poor work-life balance (30.8%), and <5% each of call schedule, lack of research opportunities, sexual harassment, and lack of administrative/clinical support. Compared to those who did not leave their first job, respondents who left their first job rated the following characteristics as significant in choosing a first job: case mix as more important, type of practice as less important, and work-life balance as less important (p<0.05).

Race- and sex-based variation in industry research and general payments to medical oncologists in the United States.

11050 Background: Industry partnerships offer financial incentives, prestige, and can facilitate career advancement in oncology. However, not all physicians may have equal access to these opportunities. We hypothesized that physicians who are underrepresented in the medical oncology workforce based on race, ethnicity, and gender receive less industry funding. Methods: All US medical oncologists (MOs) who received ≥1 industry research payment between 2016 and 2020 according to the Open Payments database were included in this retrospective study. Information extracted from Open Payments included MO’s name, institution, research payments (i.e. funding for a research project where the physician is a Principle Investigator), and general payments (i.e. fees not associated with research, such as consulting and travel fees). Additional web searches were conducted using institutional websites, NPPES NPI registry, LinkedIn, Doximity, Scopus, and NIH RePORTER to determine each MO’s race, ethnicity, sex, academic rank, degrees, h-index, institutional NIH research funding rank, and individual receipt of NIH funding. Log-linear regression was performed to identify associations of both industry and general payment data. Results: Of 7,542 physicians meeting inclusion criteria, 69% were male, 65% White, 29% Asian, 2% Black, and 4% Hispanic, which is comparable to the American Medical Association Physician Masterfile figures for MO. The median sum research payment and general payment was $134,857 and $11,537 per physician respectively. Significantly higher mean research payments were associated with an MS (+72%; P = 0.003) or PhD degree (+30%; P = 0.009), h-index (+3%; P &lt; 0.001), top 50 institution rank by NIH funding (+44%; P &lt; 0.001), and associate professor rank (+95%; P &lt; 0.001). Significantly lower mean research payment were observed for Black physicians (-36%; P = 0.022) and those with non-academic affiliation (-47%; P &lt; 0.001). No significant association was observed between sex and research payment. Significantly higher mean general payments were associated with male sex (+46%; P &lt; 0.001), MS degree (+171%; P &lt; 0.001), h-index (+2%; P &lt; 0.001), and Asian race (+72%; P &lt; 0.001). Significantly lower mean general payments were associated with an affiliation with a non-academic practice (-31%; P = 0.012). Conclusions: Black physicians received smaller sums of industry research payments compared to White physicians. Female sex was associated with decreased general payments compared to male sex. Further exploring the underlying mechanisms determining access to industry payments may help facilitate greater equity and inclusivity in oncology.

Opportunities for Excellence in Interventional Radiology Training: A Qualitative Study.

The training experience in interventional radiology (IR) residency programs varies widely across the country. The introduction of an IR training pathway has provided the impetus for the specialty to better define outstanding IR education and for programs to rethink how their curricula prepare IR trainees for real-world practice. Although ACGME competencies define several training components that are necessary for independent practice, few quantitative or qualitative studies have explored current perceptions on what constitutes optimal IR training. Our goal was to qualitatively explore program training features deemed most important to adequately prepare IR physicians for practice and assess whether there were differences in perception between academic and nonacademic practices. Semistructured interviews were conducted with 71 IR attending physicians, trainees, and support staff across the United States. All interviews were performed over the telephone by a single researcher for consistency and systematically coded by two independent coders for common themes. Frequency and prevalence of themes and facilitating features were analyzed. The most frequently perceived facilitating features included longitudinal patient care experience, practice-building education, interspecialty collaboration exposure, broad case mix, clinical decision-making exposure, diagnostic radiology training, procedural skills training, and graduated autonomy. Comparing nonacademic versus academic practice settings, significantly more nonacademic IR attending physicians expressed practice-building education (prevalence 72% versus 42%, frequency 2.2 versus 0.7, P < .01) as an important training experience. An understanding of perceived facilitating features for optimal IR trainee preparation, including potentially different needs between academic and nonacademic practices, can help programs prepare their trainees for a successful transition into practice.

Does International Surgical Mission Involvement During Residency Predict Involvement in Practice?

Despite efforts to incorporate global health rotations during residency, it is unclear whether this experience affects the likelihood that plastic surgeons will continue such missions during practice. The authors conducted a survey of the American Society of Plastic Surgeons and the American Council of Academic Plastic Surgeons members regarding the impact of international experiences before practice upon future involvement. 138 surveys were analyzed. Ten percent participated in missions before medical school, 13% during medical school, 53% in residency, and 61% in practice. Sixty-seven percent of surgeons in an academic practice continued to engage in international missions, versus 55% in nonacademic practices ( P = 0.152). No significant difference in the number of surgeons participating in missions was found between those who had attended their first mission before starting practice instead of those starting in practice ( P = 0.163). Surgeons who graduated recently were more likely to have attended a mission during residency ( P = 0.015). Fifty-four percent of surgeons reported that a mentor initiated their interest in missions, and 44% reported that their involvement in missions had decreased over the last 5 years, with most citing a financial disincentive. Given that over 2/3 of plastic surgeons from all practice types participate in international missions, it would behoove residency programs to offer formal training in global health to facilitate this interest. Our study is the largest thus far attempting to quantify the downstream effects of surgical mission participation in residency and highlights the need for further inquiry into this matter.

Modern Stylization of Ukrainian Song Folklore

The purpose of the research is to study contemporary musical culture and reveal the specifics of Ukrainian song folklore stylization in academic and non-academic practice. The research methodology is aimed at using a comparative method, with the help of which the difference between the processing of a folk song and the stylization of folklore is highlighted. The method of analysis is implemented to highlight the essential features of stylized folklore. Using the synthesis method, the results of research from academic and non-academic musical creativity have been extrapolated, in which the introduction of the stylization of folklore has been discovered. The scientific novelty of the research is examining the symbiosis of composer and folk art, as a result of which stylized song folklore appears in the modern musical culture of Ukraine. Conclusions. In the modern musical culture of Ukraine, the principle of stylization of song folklore is widely used. The introductions of adaptations of folk sources, along with stylization, are two options for the interaction of composer and folk art. The stylization is characterized by a deep interpenetration of elements of the author’s and folklore principles, which is accompanied by the formation of an original musical text that has a genetic relationship with folk Melos. The author’s text, which traces the presence of folk songs stylization, often includes typical intonational complexes with small ambitus, repetition of rhythmic formulas, and the prevalence of the variant-variative principle of the musical fabric development. The literary text of works related to the stylization of folklore is characterized by the use of folk texts or dialectics, lexemes that liken a vocal work with folklore. The effectiveness of folk stylization in musical culture is enhanced by the use of an authentic folk singing manner. The stylization of folklore is inherent both in the works of the leading classics of the Ukrainian composing school and in groups working in different directions of non-academic music of our time.

Vascular Surgeons as Expert Witnesses in Malpractice Litigation

This study investigates the role of vascular surgeons as expert witnesses in United States' malpractice claims. We reviewed the Westlaw database from 1999 through 2014 using the search terms "vascular" and "surgeon". Case defendant, plaintiff, allegation, and verdict were compiled. Surgeon expert witness demographic data including age, practice duration, scholarly impact (H-index) and practice setting were reviewed using faculty websites, state licensing boards, and Scopus database. A total of 785 cases were identified, Three-hundred seventy-seven with a vascular surgeon as the plaintiff or defense expert witness. Vascular surgeons were defense experts in One-hundred thirty one (34.75%) cases, plaintiff experts in One-hundred eighteen (31.3%), both plaintiff and defense experts in Ninty six (25.46%), or unspecified in Thiry two cases (8.29%). Two-hunder eighty three individual expert witnesses were identified. Vascular surgeon experts who testified 4 or more times were likely to be plaintiff experts (32.5% versus 18.7%, P <0.05). Mean years of practice (23.5 versus 24.2, P=0.10) between plaintiff and defense experts was comparable. Plaintiff experts were more likely in non-academic practice (64.4% versus 52.5%, P <0.05) with lower scholarly impact (H-index 12.8 versus 16.7, P <0.05). A small percentage of vascular surgeons were experts in multiple cases, especially as plaintiff witnesses. Vascular surgeons as plaintiff's witnesses have similar years of age, work less in an academics, and have lower scholarly impact than defense witnesses. While national organizations provide guidelines defining expert witness qualifications, the required credentials vary by State. Development of minimum qualifications nationally may improve consistency in expert credentialing and lead to more ethical trial representation.

Distribution of Genomic Testing Resources by Oncology Practice and Rurality: A Nationally Representative Study.

Oncologists are increasingly using molecular profiling to inform personalized patient treatment decisions. Despite its promising utility, the integration of genomic testing into diverse clinical health care settings across geographic settings has been understudied. We used data from the National Survey of Precision Medicine in Cancer Treatment, a nationally representative sample of practicing US oncologists, to assess the availability of six genomic testing resources, including on-site pathology, contracts with outside laboratories, on-site genetic counselors, internal policies or protocols for using genomic and biomarker testing, electronic medical record alerts, and genomic or molecular tumor boards. We used multivariate logistic regression models to examine differences in the availability of each genomic testing resource by practice type and rurality while adjusting for payer mix and patient volume. A larger proportion of multispecialty group and academic practices had genomic testing resources available compared with solo and nonacademic practices. Electronic medical record alerts were the least available resource, whereas contracts with outside laboratories were the most available resource. Compared with urban practices, there were significantly fewer practices located in rural areas that had on-site pathology, on-site genetic counselors, protocols for genomic tests, and molecular tumor boards. Genomic testing resources varied by practice type and geography among a nationally representative sample of practicing oncologists. This variation has important implications for the development of interventions and policies to support the more equitable delivery of precision oncology to patients with cancer.

P.079 Factors influencing HINTS exam usage by Canadian Emergency Medicine Physicians

Background: The HINTS examination is a sensitive and specific tool for determining whether a patient presenting with an acute vestibular syndrome has had a stroke. Despite its efficacy, it is often not used by Emergency Medicine (EM) physicians when assessing patients with vertigo. Methods: To ascertain why, we surveyed, by email, physicians registered with the Canadian Association of Emergency Physicians, to gather information on their practices when assessing patients with vertigo, and their utilization and perspectives concerning the HINTS examination. Results: 185 participants responded to our survey, demographically representative of Canadian EM physicians. The majority regularly use the HINTS exam in the appropriate setting, but significant minorities employ the exam inappropriately, such as in patients without nystagmus, with other neurological findings, or alongside tests for intermittent vertigo. Misapplication was associated with older age, years of practice, non-academic practice settings, and less residency training (p&lt;0.05). The predominant reasons for not using this examination are lack of confidence in recalling and performing component exam techniques, particularly the head-impulse test, and doubts about the necessity, safety, or validity of this examination. Conclusions: HINTS examination use is limited by lack of provider skill, safety concerns, and doubts on its validity in excluding stroke when employed by EM physicians.

Automated Reporting of Patient Outcomes in Hand Surgery: A Pilot Study.

Obtaining patient-reported outcomes (PROs) is becoming a standard component of patient care. For nonacademic practices, this can be challenging. From this perspective, we designed a nearly autonomous patient outcomes reporting system. We then conducted a prospective, cohort pilot study to assess the efficacy of the system. We created an automated system to gather PROs. All operative patients for 4 surgeons in an upper-extremity private practice were asked to participate. These patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires preoperatively and received follow-up e-mails requesting patients to complete additional QuickDASH questionnaires at 3, 6, and 12 weeks postoperatively and to complete a 13-week postoperative satisfaction survey. Response rates and satisfaction levels are reported with descriptive statistics. Sixty-two percent of participants completed the 3-week assessment, 55% completed the 6-week assessment, and 43% completed the 12-week assessment. Overall, 35% of patients completed all questionnaires, and 73% completed at least 1 postoperative assessment. The collection of follow-up questionnaires required no additional time from the clinical staff, surgeon, or a research associate. Automated e-mail assessments can collect reliable clinical data, with minimal surgeon or staff intervention required to administer and collect data, minimizing the financial cost. For nonacademic practices, without access to additional research resources, such a system is feasible. Further improvements in communication with patients could increase response rates.