Ohio Physicians Research Articles

Physician's Attitudes Toward Patients With Opioid Use Disorder and Use of Medications for Opioid Use Disorder Vary by Training.

This study compared whether different addiction treatment educational experiences were associated with physicians' attitudes toward patients with opioid use disorder (OUD) and perceived efficacy of medications for opioid use disorder (MOUD). Ohio physicians (n = 2757) with and without a waiver to prescribe buprenorphine (Drug Addiction Treatment Act 2000 [DATA 2000] waiver) were surveyed regarding their attitudes toward treating patients with OUD and on the effectiveness of MOUD. We divided physicians into 3 groups: physicians with DATA 2000 waivers, non-waivered physicians with experiential training, and non-waivered physicians without experiential training. We defined experiential training as educational experience directly working with individuals with OUD including those in recovery. Analysis of variance was used to detect statistically significant group differences. We found significant main effect differences in attitudes toward patients with OUD and perceived efficacy of MOUD between groups (P ≤ .01) for all but one attitude. Post hoc comparisons revealed waivered physicians had the most favorable attitudes. Among physicians without a waiver, those with experiential training had significantly more favorable attitudes toward treating OUD and perceived MOUD to be more effective, including items such as "OUD are treatable illnesses" and "medication assisted treatment is a crucial part of treatment for OUD." The results suggest that physicians with DATA 2000 waiver and experiential training, as compared to physicians without either a waiver or experiential training in OUD, are associated with less stigmatizing views of treating patients with OUD and prescribing MOUD. While legislation in December 2022 eliminated DATA 2000 waiver training requirement, these findings suggest an ongoing need for training opportunities.

From the Editor

HEALTHCARE PROFESSIONAL BURNOUT has long been a well-known but not effectively addressed topic as the COVID-19 pandemic and the growing shortage of physicians have brought into the spotlight.In “Ohio Physicians’ Retrospective Pre-Post COVID-19 Pandemic Reports of Burnout and Well-Being” (page 8), Rebecca McCloskey et al discuss the results of a survey regarding physician burnout and mental health experiences prior to and during the COVID-19 pandemic.Achieving licensure and relocating to a new culture is difficult and stressful—akin to burnout. In “Facilitating the Path to Licensure and Practice: International Medical Graduates in Canada” (page 18), Ilona Bartman et al present a study that questions whether International Medical Graduates (IMGs) obtaining Canadian medical licenses in 2022 is more challenging or less challenging than it was in 2002. Efficiently licensing a large and diverse additional pool of healthcare professionals may reduce burden on the existing workforce.In “The Oregon Wellness Program (OWP): Serving Healthcare Professionals in Distress from Burnout and COVID-19” (page 27), Donald Girard and David Nardone expand upon the 2020 JMR OWP article by Divers et al. It includes an evaluative component of both client-users and mental health professionals, offering insight to understand factors, influence client stress, and guide programmatic optimizations.Medical licensing application questions regarding health conditions carry stigma. That may lead physicians to not disclose or seek care for health conditions—particularly mental health conditions. Fisayo Aruleba et al review this problem in “Do Medical Licensing Questions on Health Conditions Pose a Barrier to Physicians Seeking Treatment? A Literature Review” (page 35).And remember, as in the opening quote, we need you to make it.

Ohio Physicians’ Retrospective Pre-Post COVID-19 Pandemic Reports of Burnout and Well-Being

ABSTRACT This cross-sectional, retrospective, pre-post repeated measures study aimed to describe Ohio physicians’ burnout and mental health experiences as perceived prior to and during the COVID-19 pandemic. A one-time online survey was completed by 1,613 physicians registered with the State Medical Board of Ohio (SMBO). Wilcoxon signed-rank tests were used to assess differences between physicians’ self-reports of burnout and mental health prior to and during the pandemic. Mann-Whitney U tests examined response differences between physicians and residents. Data revealed statistically significant differences between physicians’ pre-pandemic and pandemic experiences for all measures of burnout and mental health (p < 0.001) with moderate effect sizes for feeling emotionally drained from work (Z = −16.71, r = 0.43); feeling down, depressed, or hopeless (Z = −18.09, r = 0.46); feeling less accomplished (Z = −11.03, r = 0.29); and caring less about what happens to patients (Z = −12.04, r = 0.31). Small effect sizes were found for thoughts of suicide and concerns about one’s substance use. Additionally, resident physicians were more likely than physicians to report many burnout and mental health concerns prior to and during the pandemic, although these effect sizes were small. These findings can inform stakeholders’ efforts toward the prevention and reduction of physician burnout and improvement of well-being.

Ohio physician attitudes toward medical Cannabis and Ohio\u2019s medical marijuana program

BackgroundOhio’s medical cannabis program is one of three states that require physicians to become certified to recommend medical cannabis to their patients. The current study examines the attitudes of Ohio physicians toward medical cannabis and Ohio’s program to ascertain how likely physicians are to participate in Ohio’s program.MethodsPhysicians were invited to complete an internet survey that asked them about their concerns regarding medical marijuana, Ohio’s program, their likelihood of recommending medical cannabis, and becoming certified within the state. Ordinal and logistic regressions were used to understand the physicians’ likelihood of recommending cannabis, of becoming certified to recommend cannabis, and their attitude toward Ohio’s program.ResultsIn total, 11,665 physicians licensed to practice in Ohio were contacted by email, and 344 responses were received for a response rate of 2.9%. Only 42 physicians reported being certified or had plans to become certified to recommend marijuana, and 62% were unlikely to recommend marijuana to their patients. Overall, the belief that medical cannabis should be legal had the greatest association with the likelihood of recommending cannabis (OR = .37, 95% CI = .24–.54), of becoming certified (OR = .21, 95% CI = .10–.38), and believing that Ohio’s program is too strict (OR = .39, 95% CI = .30–.51). However, the study sample precludes generalizing the results beyond this study. The 2.9% response rate could indicate a bias toward physicians who have strong opinions about the legality of medical cannabis.ConclusionThe results show that many physicians have concerns about medical cannabis and Ohio’s program, and many physicians may not participate in the program. This could be a problem for patients who would like to use cannabis for medical reasons; therefore, these patients, may need to utilize one physician for cannabis and another for regular care. Physicians will likely be caring for patients who are using cannabis regardless of their own beliefs about it. The lack of training regarding cannabis in healthcare, along with requiring “certified recommenders” to have training could result in a fractured healthcare system.

The distribution of Ohio\u2019s Certificates to Recommend: who will \u201cprescribe\u201d medical marijuana?

BackgroundUnder Ohio Medical Marijuana Control Program rules, Ohio physicians that recommend medical marijuana (MMJ) to patients must possess a Certificate to Recommend (CTR) from the State Medical Board. Although a pre-program state survey indicated that more than a quarter of Ohio physicians were likely to recommend MMJ, only 473 physicians obtained CTRs in the first year of the program, amounting to just 1.39% of the physician workforce. The purpose of this study is to evaluate demographic factors that influence a physician’s decision to obtain the CTR.MethodUsing physician demographic data extracted from Ohio’s databases of medical licensees and CTR holders, as well as the American Medical Association Physician Masterfile, prevalence ratios for CTR holders were calculated for specialty, medical degree (Doctor of Medicine, MD, vs. Doctor of Osteopathy, DO), age and gender. A multivariate model was implemented to generate adjusted prevalence ratios (aPRs) reflecting the independent effects of specialty, degree, and age. To assess temporal variations in CTR acquisition, per-specialty CTR counts were also plotted as a function of program month.ResultsThe best-represented specialties among CTR holders were Family Medicine (29.11%), Internal Medicine and its subspecialties (22.57%), and Anesthesiology (9.07%). Expressed as an adjusted per-specialty prevalence ratio in reference to Family Medicine, the dominant specialty was Physical Medicine and Rehabilitation (aPR 2.08, 95% CI 1.34–3.24), with the lowest measurable prevalence ratios found in Pediatrics (aPR 0.17, 95% CI 0.10–0.30) and Surgery (aPR 0.33, 95% CI 0.22–0.50). DOs were more likely to obtain CTRs than MDs (aPR 1.72, 95% CI 1.39–2.15). The mean age of CTR holders was 54.03 +/− 11.43, vs. 51.13 +/− 13.38 for non-CTR holders (p < .0001). Although gender could not be included in the multivariate model, males were more likely than females to obtain a CTR (PR 1.54, 95%CI 1.26–1.89). A plot of per-month CTR acquisition by specialty demonstrated a fairly consistent specialty distribution of CTRs in the first year, as well as variations in overall CTR acquisition that may correspond to program-operational events.ConclusionSpecialty, type of medical degree, and age all correlate independently with the likelihood of registering to recommend medical marijuana in Ohio. Specialty distribution of CTRs remained fairly consistent in the program’s first year, although overall CTR acquisition may be sensitive to program-operational events such as delays in dispensary opening or product availability.

BIOBOARD

ASIA – Gene mutation discovered to cause severe growth retardation in newly discovered disease. ASIA – Singapore scientists make major breakthrough to treat fibrotic diseases that cause organ impairment and failure. ASIA – DcR3 is the key factor of endometriosis. ASIA – Singapore Volition signs MOU with National Taiwan University to conduct two large clinical studies. EUROPE &amp; CIS – NPL relaunches to accelerate access to new health innovations. EUROPE &amp; CIS – The hard truth about Eczema: It’s something in the water. EUROPE &amp; CIS – Gastric acid suppressant lansoprazole may target tuberculosis. EUROPE &amp; CIS – Long-term aspirin use reduces incidence of digestive cancers by up to 47 per cent. AMERICAS – Rockefeller University biologist Michael W. Young honored with Nobel Prize for pioneering studies on circadian rhythm. AMERICAS – Ohio physicians contribute to groundbreaking stroke research. AMERICAS – A poorly explored immune cell may impact cancer immunity and immunotherapy. AMERICAS – Superbugs have a new foe. AMERICAS – Approved drug or herbal treatment: How to choose?

Geographical Distribution of Office Based Opioid Treatment with Buprenorphine in Ohio

Objectives: The geographical distribution of Ohio physicians listed on the Buprenorphine Treatment and Physician Locator published by SAMHSA was analyzed to evaluate availability and accessibility from the patient perspective and the relationship between supply of and demand for services at the county level. Methods: 693 physicians listed on the Buprenorphine Treatment Physician Locator were contacted by telephone during February/ March 2016 to determine whether the physicians were accessible by telephone and provided OBOT with buprenorphine. The Buprenorphine Treatment Physician Locator allows individuals to search by city, state, or zip code, and provides the physician’s name, address, and phone/fax numbers to facilitate access to treatment. Results: OBOT using buprenorphine services vary greatly across Ohio. There are a net total listed waivered physicians of 663. 24.6% were unable to be reached by phone despite repeated attempts. 15.2% indicated buprenorphine services were not provided. 60.2% indicated that buprenorphine services were provided. The distribution of DATA 2000 waivered physicians by county was not correlated to unintentional overdose drug overdose rates (r=0.25). 42.0% of counties, including nine with unintentional drug overdose rates over the state mean, had no DATA 2000 waivered physicians confirmed by the survey. Conclusions: The Buprenorphine Treatment Physician Locator resource overstates the availability and accessibility of OBOT using buprenorphine. Only a subset of listed physicians provides services and these physicians are maldistributed geographically.

The Patient Protection and Affordable Care Act (ACA) of 2010 and Ohio physicians

Purpose – This paper aims to explore the perspectives of Ohio physicians on the Patient Protection and Affordable Care Act (ACA) of 2010. While much has been debated about ACA, relatively few studies have focused on how ACA will impact on physicians' practice behavior. Design/methodology/approach – The research data came from a mailed survey of ninety physicians randomly selected from the Cigna Directory of Physicians practicing in Ohio. Study examined how informed were physicians about ACA, and explored how much the effect of ACA has been discussed in their practice, how they think ACA will impact their practice, and whether or not they are in favor of the provisions under the Act. Findings – Overwhelmingly, while the physicians surveyed were familiar with the specific provisions of ACA, almost half of them opposed it. Primary care physicians reported generally favorable opinions about ACA. All but one of the physicians concluded that ACA, much like managed care provisions, has undermined and will continue to reduce the autonomy and professional independence of physicians. Research limitations/implications – This study is limited by its small sample and reliance on a small set of physicians. Practical implications – This study has practical implications for examining how Ohio physicians are responding to the new health care reform in the United States. It has broader implications for addressing the problem of the uninsured and the role of the federal government in health care provision. Social implications – If physicians are opposed to this reform as the study seems to suggest, it might have broader implications for future career aspirations for physicians. Originality/value – So far as we can tell, there has not been any exploratory study in Ohio examining the perspectives of physicians on ACA.

Physician demography and policy implications.

This 28-year retrospective analysis of 1980-2008 U.S. Census data found increases in Ohio's physicians, minority physicians, ages, work hours, and a consistent shortage of physicians in rural underserved areas. Ohio was below the national ratios of physicians per 100,000 people, with less than 6% of physicians in non-metropolitan areas. In 1980, only 13% of physicians were females. By 2008, about 31% of physicians were females. In 1980, less than 21% of physicians were members of an ethnic minority group, and this figure rose to 29% in 2008. The proportion of African American physicians approximately doubled, from less than 3% in 1980 to about 6% in 2008. To ensure the adequate capacity of the future physician workforce, physician demography should approximate the population served. Long-term investment in the rural practice environment is recommended for attracting and retaining rural practice physicians. Increasing the hiring of physician assistants can support the development of an integrated rural primary care workforce.

Ohio Physicians' Intent to Adopt Electronic Prescribing

Background: Currently in health care, communication between prescribers and pharmacists routinely entails paper and a telephone. Many professional associations have strongly advocated the adoption of electronic prescribing (e-prescribing) in physicians' clinical practices to decrease medication errors and adverse drug events. However, very few physicians have adopted this technology in the US. Objective: To determine the relationship between Ohio physicians' demographics and their intention to adopt e-prescribing; assess the relationships between attitudes, subjective norms, and perceived behavioral control as applied to physicians' intention to adopt e-prescribing; and identify factors that can predict physicians' intention toward the adoption of e-prescribing. Methods: In this exploratory cross-sectional study, we used a self-administered survey. The survey was developed based on the constructs of the Theory of Planned Behavior. It was mailed to 1500 physicians currently practicing in Ohio. Demographic information about the respondents was collected. Pearson correlation was used to assess the relationship between demographics and intention to adopt e-prescribing. Multiple regression analysis was used to identify the factors predicting intention. Results: The overall survey response rate was 15.33% (N = 230). A significant weak negative correlation was found between physicians' ages (r = −0.180; p = 0.007) and their intent to adopt electronic prescribing. A statistically significant negative correlation was also found between practice type (r = −0.196; p = 0.003) and the intention to adopt electronic prescribing. Attitude was the strongest predictor of intention to adopt e-prescribing (β = 0.539; p = 0.000). Conclusions: Physicians with more positive attitudes, positive subjective norms, and positive perceived behavioral control have a stronger intention to adopt e-prescribing.

The Qualifications of Pain Physicians in Ohio

Pain physicians in Ohio come from many medical backgrounds and use different medical boards to claim board certification in the field of pain medicine. Our goal was to explore the number, demographics, and qualifications of pain physicians in Ohio. The names of Ohio physicians designating themselves as pain physicians were collected from the State Medical Board of Ohio and the American Medical Association. The directories of the American Board of Medical Specialties (ABMS), the American Board of Pain Medicine, the American Academy of Pain Management, and the American Board of Medical Acupuncture were referenced for certification in pain medicine, pain management, or medical acupuncture. The requirements for these credentials vary widely, yet they have all been used to claim "board certification." Board certification in medicine implies recognition by an ABMS member board as having completed the required training, met the standards, and then passed an examination that validates qualifications, and knowledge in a specific medical field. In 2002, there were 335 Ohio physicians designating themselves as pain physicians. Two-hundred-eighteen (65%) had at least one pain board certification. Ninety-six (29%) of the Ohio pain physicians were certified in pain medicine by the American Board of Anesthesiology, the American Board of Physical Medicine and Rehabilitation, or the American Board of Psychiatry and Neurology, which are all member boards of the ABMS. One-hundred-seventeen (35%) of the self-declared Ohio pain physicians held no pain-related board certification. Anesthesiologists comprise the majority of all pain physicians and are the majority in all four pain boards.

Gender bias of Ohio physicians in the evaluation of the personal statements of residency applicants

Sexism has been documented at every level of medical training as well as in the community of practicing physicians. Although there is speculation in the literature about sexist attitudes and perceived sexual discrimination influencing a medical student's choice of specialty, there are few data on gender bias in the evaluation of residency candidates applying in different specialties. In 1989, the authors created six personal statements of interest in a residency, each from a different type of fictitious residency candidate (three men, three women, at three levels of medical school achievement) and mailed one or another of the statements, chosen at random, to the 2,478 board-certified Ohio physicians practicing in six specialties in which U.S. women in residencies were underrepresented (less than 12%) compared with the percentage of women in medical schools, and to the 3,586 board-certified Ohio physicians in another six specialties in which women in residencies were overrepresented (more than 38%). The physicians consistently rated the women candidates more favorably than they did the men candidates.

Fluoride prescription practices of Ohio physicians.

In 1985 a fluoride supplement survey was mailed to all members of the Ohio Academy of Family Physicians and the Ohio chapter of the American Academy of Pediatrics. The response rate after two mailings was 60.2 percent. Of the respondents who were identified as either family physicians or pediatricians, 76.6 percent reportedly prescribed fluoride supplements for at least some of their child patients. Pediatricians were more likely to prescribe fluoride supplements than were family physicians. Younger physicians also were more apt to prescribe fluoride supplements than were their older colleagues. Only 6.2 percent of those physicians who prescribed fluoride adhered to a minimum protocol of inquiring about the fluoride content of the child's drinking water, having the water analyzed when the fluoride content was unknown, and continuing fluoride supplements until at least age ten. Medical schools, and especially residency programs, should include a preventive dental segment that uses a state-specific protocol for the prescription of fluoride, including where water may be analyzed. For those already in practice, the preferred method of providing information may be short articles in local journals or newsletters. Public health dentists should assist the medical profession in this educational process.