North Carolina Medical Board Research Articles

The evolving sex, race, and ethnic composition of the surgical workforce: North Carolina is a bellwether of national change

BackgroundNorth Carolina, as a state with a significant Black population and fast-growing Hispanic population, serves as bellwether of demographic changes nationally and the challenges facing the nation to recruit and retain a general surgery workforce that mirrors the population. MethodsAnnual licensure data from the North Carolina Medical Board were analyzed between 2004 and 2019. Physicians self-reporting a specialty of abdominal surgery, critical care surgery, colon and rectal surgery, general surgery, trauma surgery, proctology, and surgical oncology were categorized as general surgeons. ResultsFemale surgeons made the most gains from 2004, at just 8% of the workforce in 2004 to 26% of the workforce in 2019. Over the same period, Black surgeons increased from just 5% to 6% of the workforce, with those gains largely represented by Black female surgeons. Almost half of North Carolina’s Black physicians are aged 46 and 55 and will be nearing retirement in the coming decade. Nearly two-thirds (64%) of Hispanic general surgeons were 45 or younger, and one-third of these young surgeons were international medical graduates. ConclusionAlthough the general surgery workforce in North Carolina is slowly diversifying, growth in the Black surgeon workforce has stagnated in the last 15 years at levels much lower than their representation in the population. More research is needed on the individual and life course phenomena that drive this underrepresentation.

State Medical Board Policy and Opioid Prescribing: A Controlled Interrupted Time Series

In March 2016, the Centers for Disease Control and Prevention issued opioid prescribing guidelines for chronic noncancer pain. In response, in April 2016, the North Carolina Medical Board launched the Safe Opioid Prescribing Initiative, an investigative program intended to limit the overprescribing of opioids. This study focuses on the association of the Safe Opioid Prescribing Initiative with immediate and sustained changes in opioid prescribing among all patients who received opioid and opioid discontinuation and tapering among patients who received high-dose (>90 milligrams of morphine equivalents), long-term (>90 days) opioid therapy. Controlled and single interrupted time series analysis of opioid prescribing outcomes before and after the implementation of Safe Opioid Prescribing Initiative was conducted using deidentified data from the North Carolina Controlled Substances Reporting System from January 2010 through March 2017. Analysis was conducted in 2019-2020. In an average study month, 513,717 patients, including patients who received 47,842 high-dose, long-term opioid therapy, received 660,912 opioid prescriptions at 1.3 prescriptions per patient. There was a 0.52% absolute decline (95% CI= -0.87, -0.19) in patients receiving opioid prescriptions in the month after Safe Opioid Prescribing Initiative implementation. Abrupt discontinuation, rapid tapering, and gradual tapering of opioids among patients who received high-dose, long-term opioid therapy increased by 1% (95% CI= -0.22, 2.23), 2.2% (95% CI=0.91, 3.47), and 1.3% (95% CI=0.96, 1.57), respectively, in the month after Safe Opioid Prescribing Initiative implementation. Although Safe Opioid Prescribing Initiative implementation was associated with an immediate decline in overall opioid prescribing, it was also associated with an unintended immediate increase in discontinuations and rapid tapering among patients who received high-dose, long-term opioid therapy. Better policy communication and prescriber education regarding opioid tapering best practices may help mitigate unintended consequences of statewide policies.

Association between the North Carolina Medical Board opioid guideline update and opioid prescriptions in Medicare Part D beneficiaries.

To examine if North Carolina (NC) opioid prescribing guidelines were associated with changes in opioid prescribing. Retrospective secondary analysis of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets from 2013 to 2015. Providers who prescribed at least one opioid from 2013 to 2015 and paid by Medicare Part D. Per-prescriber Medicare-population adjusted number of analgesic opioid claims and per-prescriber average day supply. Generalized estimating equations (GEE) were used to analyze the data. There were significantly higher per-prescriber Medicare adjusted opioid claims in 2014 compared to 2015 (p < 0.001) but no difference between 2013 and 2015 (p = 0.584). GEE results also indicated that there was a significant increase in 2015 in per-prescriber average day supply, compared to 2013 and 2014 (both p < 0.0001). State opioid prescribing guidelines published in mid-2014 may have slowed the escalation of numbers of opioid prescriptions in NC. Future research should examine whether the guidelines were associated with changes in morphine equivalent dosing in NC during the same timeframe.

Generational differences in practice site selection criteria amongst primary care physicians.

Background and Objectives: Generational differences are often viewed as shaping the overall attitudes and actions of different age cohorts. It is essential to understand the motivations and generational differences in primary care physicians for efforts to recruit, retain, and educate the future physician workforce. Determining what factors most influence different generations of primary care physicians when choosing a practice site is essential to build our future primary care system. This study examined generational differences in the factors that attracted primary care physicians to their current practice. Methods: A survey instrument was mailed to all active members of the North Carolina Medical Board who listed their primary occupation as a primary care specialty. The survey consisted of 24 demographic questions regarding personal and practice variables and a list of 21 reasons for choosing a practice location measured on a 7-point Likert type scale. A total of 975 surveys were returned and usable for the final analysis, for a return rate of 34.5%. Data were analyzed using regression and correlation procedures to determine attitudes of each generation and factors that significantly influenced responses. Results: While slight differences between generations did exist, the overall choices for choosing a site remained stable across generations. Personality of the practice, on-call responsibilities, ability to practice comprehensive care, and location were deemed the most important factors for all generations. Differences between various demographic groups and Family Medicine versus other primary care specialties were minor with very little alteration of the top ten items being seen between groups. Conclusion: This study indicated that there were few differences between generations regarding primary reasons for choosing a practice site. In addition, factors remained remarkably similar across different specialties, family situations, genders, and ethnic groups. Several of the top reasons that primary care physicians indicate are the most important for site selection were also potentially modifiable, such as on-call responsibilities, practice personality, and ability to practice comprehensive care. Managers, clinicians, and educators can potentially utilize this information to better prepare and recruit current and future generations of primary care physicians.

Medical Board Complaints against Physicians Due to Communication: Analysis of North Carolina Medical Board Data, 2002–2012

ABSTRACT Anecdotal evidence suggests that communication issues are one of the primary reasons for physician complaints, but quantitative studies have yet to examine this assertion. The North Carolina Medical Board's Complaint Department maintains data on physician complaints and categorizes each complaint based on its primary cause. Using data from 2002–2012, our research focused on complaints against physicians licensed by the North Carolina board to determine the extent to which communication issues contribute to complaints against physicians. An analysis of this data reveals that physician complaints based on communication issues are consistently the most prevalent reason for complaints against physicians in the state of North Carolina. In addition, communication-based complaints account for more than one in five complaints made against North Carolina physicians. These results are discussed in light of their implications for the field of medicine as it seeks to improve patient care.

A survey of pediatricians’ attitudes and experiences with court in cases of child maltreatment

Objectives To explore pediatricians’ attitudes and experiences with the court system in child maltreatment cases. Design An anonymous, cross-sectional survey of a random sample of pediatricians registered with the North Carolina Medical Board. Results The response rate of the study was 60% ( N = 270). Few pediatricians (10%) reported that they had “ever” suspected maltreatment but decided not to report it. Pediatricians were equally likely to recall positive and negative experiences in court for child abuse cases. Pediatricians with negative court experiences were more likely to view reporting as time-consuming and were more than twice as likely not to report suspected cases of maltreatment (OR 2.4, 95% CI 1.04, 6.0). Seventy-five percent of pediatricians felt that court is harmful or distressing for children. Conclusions The majority of pediatricians report suspected cases of child maltreatment. Pediatrician's court experiences play a role in the response to child maltreatment cases, influencing attitudes towards the legal system and the process of caring for maltreated children. Future research efforts should address physicians’ concerns about the impact of court on children, ways to improve the working relationship between the legal system and physicians, and the training needs of physicians in child maltreatment, including testifying and understanding the court process.

Addressing Pain Management and Palliative Care: The Official Position of the North Carolina Medical Board

Addressing Pain Management and Palliative Care: The Official Position of the North Carolina Medical Board

The role of physician recommendation in women's mammography use: is it a 2-stage process?

To explore the use of a 2-stage model in explaining the role of physician recommendation in women's use of mammography screening and to provide an integrated framework for understanding the mammography-use process. Data on 1,301 women aged > or =52 years from the North Carolina Breast Cancer Screening Program (NC-BCSP) questionnaire were combined with information from 91 of their physicians from the North Carolina Medical Board. A 2-stage system of equations using women's characteristics (demographic, health, access), physicians' characteristics (demographic, practice), women's beliefs, and women's report of a physician recommendation was created and statistically tested. The model was estimated using 2-stage logistic and probit estimation. The 2-stage approach produced different results compared with the single pooled model. In the second-stage mammography-use model, younger age, family history of breast cancer, and a woman's having ever requested a mammogram retained significance (P < or = 0.05) in addition to the predicted value of physician recommendation obtained from the first stage. Women's characteristics significantly associated with physician recommendation in the first stage included some access, health risk, and demographic variables as well as physician age and race (P < or = 0.05). A 2-stage model for estimating mammography use among women with regular physicians may be more informative than a single model. These results imply that programs designed to increase mammography rates should focus on ensuring appropriate physician recommendations in addition to encouraging women to request screening. Future research should consider using an integrated framework for evaluating utilization of mammography and other preventive services.

North Carolina Physician Access to Drug Information Resources

Each year the increasing number of new medications marketed and treatment guidelines established makes it very difficult for busy physicians to keep abreast of new developments. Thus, it is necessary for physicians to have convenient access to sources of drug information (Df). The purpose of this study was to assess physicians’ access to DI resources. Approximately 1000 physicians specializing in internal medicine, family medicine, or pediatrics were randomly selected from a listing of physicians registered with the North Carolina Medical Board. A survey questionnaire designed to identify printed and computerized medication resources to which the physician has immediate access was mailed. The survey also asked the physician to estimate how often he/she consulted other health care professionals for medication-related information. Access to formal drug information centers through affiliation with an academic institution, managed care organization, or another source was also identified. Of the 279 surveys returned, 262 of them were evaluable. The most common print references responding physicians reported having access to in daily practice were the Physicians’ Desk Reference (PDR) (99%) and various medical journals (50%). Approximately one third of the physicians reported having access to Medline, while less than 25% have access to the Internet. Of the various human DI resources, physicians reported using pharmacists most frequently, followed by physician colleagues. Physicians infrequently reported using DI centers as sources of information. Overall, surveyed physicians indicated a desire to increase their access to drug information resources in daily clinical practice.