Practice Ownership Research Articles

Use of a New Combined Vaccine in Pediatric Practices

On December 13, 2002, Pediarix, a combination vaccine that contains diphtheria, tetanus, acellular pertussis; hepatitis B; and inactivated polio vaccines, was licensed by the Food and Drug Administration for use in the primary immunization series. Use of this vaccine decreases the number of injections that children receive when completing their primary immunization series at the 2-, 4-, and 6-month well-child visits. The objective of this study was to determine the factors that influence the use of this combined vaccine in private pediatric practices, with particular attention to the perceived economic impact of Pediarix and actions taken to address this impact within the private pediatric setting. A mail survey study was conducted of a random sample of 565 practicing pediatricians that was obtained from the American Medical Association Masterfile. Frequency distributions were developed for all responses, and the vaccine financing policies of the state of practice for each respondent were determined. Chi2 analysis was performed to assess any associations of the predictor variables with the outcome variables of interest, use or consideration of use of the Pediarix vaccine. Logistic regression was used to determine the independent association of the predictor variables with use or consideration of use of Pediarix. Regression models that did and did not include practice ownership as a predictor variable were developed. Response rate was 63% (N = 355). A total of 39% (n = 123) of the respondents' practices were purchasing Pediarix for use with their private patients. An additional 18% (n = 55) were considering purchasing the vaccine. Those who were in practices that were owned by hospitals or health systems were more likely than those who were in solo or group practices to purchase Pediarix for their private patients. Approximately half of the remaining respondents order Pediarix through their state immunization program. Among the 52% of respondents who did not, 23% reported that the vaccine was not yet available through their state program, and 47% stated that they did not want to use different vaccines for their public and private patients. Only 11% believed that Pediarix was not compatible with their other vaccine products. Physicians that currently were purchasing or considering purchasing Pediarix were more likely to be influenced by both parental and provider desire to decrease the number of injections at a single visit and the reduced time for immunization delivery. Fewer than 1% of respondents reported either having experienced or expecting to experience a significant decrease in practice revenue as a result of the use of Pediarix. Although use of the vaccine results in fewer administration fees for most physicians, the magnitude of the change seemed not to be significant for the majority of respondents or was outweighed by other factors. It also is possible that larger practices or buying cooperatives were able to negotiate discounted rates for Pediarix relative to the constituent products. This may have been a strategy of manufacturers and/or distributors to provide incentive for practices to switch to the combination product. Of note was the appreciation of respondents for the preferences of patients for fewer vaccines and, to a lesser degree, for the decrease in office staff time required to provide vaccination with multiple antigens when using Pediarix. Also, the role of the availability of a given vaccine through the Vaccines for Children program is important in its adoption into practice.

Travelling the Route from Designation to Local Action: The Case of the Underground Railroad Settlement in Buxton, Ontario, Canada

Canada’s Buxton Settlement National Historic Site is a striking illustration of the multi‐faceted conservation of a cultural landscape, from federal designation through to local action. Buxton is designated as a ‘continuing landscape’ distinguished by its establishment in 1849 as a 9,000 acre (3,600 ha)1 terminus for black fugitives travelling north along the so‐called Underground Railroad, escaping the tyranny of slavery in the USA. A social experiment, in the form of a block farming settlement, waited for them at the end of their journeys. Over the intervening years inevitable shifts in agricultural practice and property ownership have transformed this rather ordinary but strongly evocative heritage resource. This is a case common to many other significant cultural landscapes—the management of the inevitable evolution that comes with a landscape that continues. This agricultural landscape confronts many of the challenges that are the focus of heritage studies today: how to give local people a voice while coordinating conservation across multiple scales of government policy.

Effects of Compensation Methods and Physician Group Structure on Physicians' Perceived Incentives to Alter Services to Patients

To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. Nationally representative data on physicians are from the 2000-2001 Community Tracking Study Physician Survey (N=12,406). Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage.

Taxonomy of Health Networks and Systems: A Reassessment

To assess a widely recognized multihospital system taxonomy. The original taxonomy was based on American Hospital Association (AHA) Annual Survey Data for the years 1994 and 1995 and a reexamined version, on 1998 AHA data. We assess the appropriateness of using data designed to capture local hospital/system interrelationships to develop a taxonomy of multihospital systems. DATA ABSTRACTION METHODS: The original and reexamined taxonomies used dichotomous measures of service availability, physician practice ownership, and managed care offerings. The data and measures used to formulate the taxonomy are not appropriate for classifying multihospital systems at the company level. Taxonomic studies of multihospital systems are very much needed; future taxonomic studies should make clear distinctions between systems at local versus company levels.

Prosthodontics as a Specialty Private Practice: Net Income of Private Practitioners

The aim of this study was to use data from a survey of prosthodontists in the US to examine average net earnings of prosthodontists in private practice. A survey of 2500 prosthodontists in the US was used to estimate the net earnings of practicing prosthodontists. The national average net earnings of prosthodontists in private practice was estimated along with average earnings for subgroups of prosthodontists. Estimates for private practitioners by age, gender, size of practice, full-time/part-time status, practice ownership, and by type of treatment procedures rendered by the practitioner were also included. Average earnings for prosthodontists in private practice on a primary or secondary basis were estimated to be $215,300 and for prosthodontists who own or share in the ownership of a private practice, $233,920. Reported earnings estimates ranged from $96,160 for non-owners of a private practice and $103,350 for part-time private practitioners to $233,920 for practice owners and $275,170 for prosthodontists in practice with two prosthodontists. The average earnings of prosthodontists who are practice owners were estimated to be 35% higher than the corresponding general practitioners. Average net earnings are often used to examine the current economic health of a profession. The average net earnings of prosthodontists in private practice exceed the average net income reported by the American Dental Association for all dentists and all general practitioners and they are competitive with earnings among all specialty groups. This evaluation of the net earnings of prosthodontists shows that prosthodontics offers a competitive career opportunity for the general dentist with a personal desire to pursue advanced dental education in a specialty as a profession.

AVMA-Pfizer Business Practices Study

The goal of the AVMA-Pfizer business practices study was to identify management behaviors, attitudes and actions that had an impact on the incomes of practicing veterinarians. In March 2004, a survey was sent via mail and the World Wide Web to a random sample of 17,063 practicing veterinarians, including 2,255 veterinarians who had identified themselves as bovine veterinarians and 7,195 who had identified themselves as mixed animal practitioners. Responses were received from 2,655 (16%) practice owners and associates with 18% return from bovine veterinarians. Comprehensive statistical analyses were conducted on study findings. The study revealed that four demographics and environmental characteristics has strong relationships with personal income and accounted for as much as 30% of differences among incomes: practice ownership, gender (male), community size and household income of the practice area. However, these were basically uncontrollable. The study also identified seven key business/managerial behaviors in three basic categories that were correlated with income levels in food animal practices, including bovine practices. The behaviors and categories included personnel management (employee development), client relations (new client development, client loyalty), and financial management (business orientation, negotiating skills, frequency of financial data review, sound judgment). The difference in mean annual incomes between veterinarians who ranked in the upper versus lower third in the use of the seven business practices/skills ranged from a low of $2,880 (new client development practices) to the highest difference of $47,070 (business orientation).

Antibiotic prescribing by ambulatory care physicians for adults with nasopharyngitis, URIs, and acute bronchitis in Taiwan: a multi-level modeling approach

Imprudent prescribing of antibiotics in ambulatory care in Asia is of great concern. However, an adequate understanding of factors associated with antibiotic prescribing patterns in Asia has not been achieved. Our aim was to identify patient and physician characteristics that influence antibiotic prescribing for adults with nasopharyngitis (common colds), upper respiratory tract infections (URIs) or bronchitis in Taiwan. Generalized Estimating Equations (GEE) were used to analyze all 128,260 episodes of common colds, URIs and bronchitis generated by a random sample of 137,935 adult National Health Insurance (NHI) beneficiaries (> or = 18 years old) in Taiwan in 2000. Multivariate analysis results revealed substantial variations across different physician groups. Physician age and accreditation level of the physician's practice setting were the characteristics most associated with prescribing of antibiotics at the initial encounters for these episodes of care. Urban practising physicians (adjusted OR 1.69, 95% CI 1.29-2.21) and those who were self-dispensing or with on-site pharmacists (adjusted OR 1.32, 95% CI 1.19-1.46) were also higher prescribers of antibiotics for adults. Other significant physician predictors included physician specialty, patient volume, and ownership of practice setting. Results suggest that both accessibility to updated medical information and economic incentives of the attending physician may shape prescribing of antibiotics in ambulatory care in Taiwan. Interventions should be developed to influence these modifiable factors to reduce antibiotic prescriptions of questionable value.

Nationwide survey of dentist recruitment and salaries in community health centers.

Recruitment of dentists continues to be a problem in community health center (CHC) dental practices. This study was carried out to quantify the scope of the problem and to determine CHC dentist salaries and benefits. Community health center executive directors nationwide were surveyed regarding dentist vacancies, recruiting issues, and salary and benefit information. Of 345 surveys mailed, 159 responses were received (46.1%). Slightly fewer than half of the responding executive directors (47.8%) reported one vacant dentist position. An additional 11.9% of executive directors reported a second vacancy. The overall vacancy rate was 17.6%. Median salaries ranged from 78,000 dollars for entry-level dentists to 90,000 dollars for dentists with 10 or more years of experience, not including benefits. There are difficulties in recruiting dentists to CHC dental practices. Mean salaries in CHCs are slightly higher than in academic positions, but less than in private practice employment or ownership. Caution should be used when comparing salaried positions with substantial benefits to self-employment or sole proprietorships.

Pediatrician Attitudes and Practices Regarding Collaborative Asthma Education

Pediatric practices were surveyed in 10 regions of the country to determine physician attitudes and practices regarding approaches to asthma education. Many physician respondents thought that nurses were just as effective as physicians in providing asthma education. In almost all practices a physician was involved; in two thirds of practices, an allied health professional; and in almost half of practices (48%), a registered nurse was involved. The type of healthcare professional involved in education was not associated with percentage of patients with Medicaid insurance, practice ownership, or setting. Given the multidisciplinary approach to education in many pediatric practices, quality improvement efforts to enhance asthma education by pediatric practices could be further enhanced by directly involving allied health professionals who practice in primary care settings.

The relationship of managed care to business, professional, and organizational aspects of radiology practices.

We sought to determine the extent of managed care involvement among radiology practices of different types, locations, and sizes; the factors associated with differences in involvement; and the impact of managed care on professional, organizational, financial, and hospital-relations aspects of radiology practices. A survey was mailed in 1999 to a sample of 970 radiology practices; completed, usable surveys were returned by 66% of the practices. Three indicators of managed care were used: a practice's percentage of managed care (HMOs plus preferred provider organizations), local area HMO penetration rate, and self-reported perceived effect of managed care. Percentage of managed care averaged 30% but was 40% for multispecialty groups. It was relatively high in large metropolitan areas, for practices with no hospital activity, and for practices with any owners who were not practice members. The three measures of managed care were only moderately correlated (correlation coefficient, 0.25-0.33). None of the managed care variables had a statistically significant effect on days provided for vacation and continuing medical education, promptness of payment, years required for practice ownership (partnership), and percentage of practice members who were owners. Higher percentage of managed care was associated with higher collection rates, whereas greater perceived impact of managed care had the opposite association. Two thirds of practices belonged to at least one managed care-related organization such as an independent practice association. Most radiology practices reported no involvement in the managed care negotiations of hospitals, which was true even when the hospital's negotiations included the radiologists' fees or when the practice determined its level of involvement. Many negative outcomes most feared by radiologists regarding the effect of managed care have not materialized. Perceptions of practices as to the effect of managed care seem to reflect negative aspects of their general situation, not only realities of managed care.

An analysis of the impact of gender on physician practice patterns.

Through analysis of Community Tracking Study Physician Survey, a nationally representative survey of U.S. physicians, we find that women physicians are significantly less satisfied with time for patients than their male colleagues. Among primary care physicians, about one third of the gender difference is explained by physician attributes, practice characteristics, geographical location and patient profiles. Control variables explain all of the gender gap among specialist physicians. Among primary care physicians, the effects of practice type and perceptions of patient complexity on satisfaction with time for patients are mediated by physician gender. Among specialist physicians, gender interacts with practice ownership and hours spent in medically related activity to determine satisfaction with time for patients.

A beginner's guide to incorporation

THE expression 'corporate ownership', when referring to the veterinary profession, has become synonymous with large group or company ownership of multiple practices. However, 'incorporation' is not the exclusive domain of...

A practical flow-sensitive and context-sensitive C and C++ memory leak detector

This paper presents a static analysis tool that can automatically find memory leaks and deletions of dangling pointers in large C and C++ applications.We have developed a type system to formalize a practical ownership model of memory management. In this model, every object is pointed to by one and only one owning pointer, which holds the exclusive right and obligation to either delete the object or to transfer the right to another owning pointer. In addition, a pointer-typed class member field is required to either always or never own its pointee at public method boundaries. Programs satisfying this model do not leak memory or delete the same object more than once.We have also developed a flow-sensitive and context-sensitive algorithm to automatically infer the likely ownership interfaces of methods in a program. It identifies statements inconsistent with the model as sources of potential leaks or double deletes. The algorithm is sound with respect to a large subset of the C and C++ language in that it will report all possible errors. It is also practical and useful as it identifies those warnings likely to correspond to errors and helps the user understand the reported errors by showing them the assumed method interfaces.Our techniques are validated with an implementation of a tool we call Clouseau. We applied Clouseau to a suite of applications: two web servers, a chat client, secure shell tools, executable object manipulation tools, and a compiler. The tool found a total of 134 serious memory errors in these applications. The tool analyzes over 50K lines of C++ code in about 9 minutes on a 2 GHz Pentium 4 machine and over 70K lines of C code in just over a minute.

Using alumni research to assess a veterinary curriculum and alumni employment and reward patterns.

The purpose of the study was to obtain an outcomes assessment of the professional degree program of a veterinary college and to determine whether recently published national gender differences were true for a program that has always been predominantly female. A survey was developed and mailed to all alumni of the veterinary degree program at North Carolina State University. Anonymous responses were collected by an independent organization for summation. Results were expressed numerically where possible, although the survey included numerous opportunities for textual responses. Responses were stratified by year of graduation, in five-year increments, and by gender of the respondents. Sixty-one percent of graduates remained within North Carolina. While most of the prerequisite courses were considered useful preparation for the curriculum, physics and calculus were exceptions. Over half the alumni thought time allocations to specific courses were appropriate. However, there were substantial differences between courses. The alumni were satisfied with most aspects of the training program, although there were differences between various components. There were substantial gender differences in length of first employment, salaries, species treated, practice ownership and type of ownership, and career satisfaction. Most alumni work in small animal private clinical practice. Ninety-four percent were employed within three months of graduating. Ninety-five percent did no work with the state's predominant agricultural species. Nineteen percent of alumni were either unsure, probably would not, or definitely would not become a veterinarian if they could choose again. The survey was a tremendously valuable source of information. Results provided support for curricular revision. The survey also provided comparative data in relation to national norms, where such norms were available. Unfortunately, few reports of this type are available, making inter-institutional comparisons difficult. The Association of American Veterinary Medical Colleges could assist with standardizing the process of outcomes assessment.

Why do rural primary care physicians sell their practices?

This study evaluates why rural primary care physicians sell their practices. A random sample of rural primary care practices in California, Utah, Ohio, Texas, and Virginia were surveyed to investigate changes in ownership of the practices during the period 1995-1998. These five states were selected because they represent areas with different experiences with physician-hospital integration and varied rates of managed care penetration. A series of logistic regressions were conducted to examine the factors that led independent physicians to sell their practices to either nonlocal buyers, local hospitals, or local physicians. Findings suggest that sales to nonlocal buyers represent the majority of practice ownership changes. The motivations for ceding control to nonlocal buyers center on managed care concerns, recruitment concerns, and administrative burdens. Sellers were also concerned about their level of net income prior to being acquired. However, the preacquisition financial concerns of sellers were not significantly stronger than the financial concerns of practices that remained independent. The environmental conditions that motivate rural physicians to sell their practices are not expected to improve. Therefore, additional sales of rural primary care practices to nonlocal buyers are expected. Further research is necessary to determine whether this shift in control will lead to changes in the quality or accessibility of care.

The mirage of available health care for the uninsured

The mirage of available health care for the uninsured

The Mirage of Available Health Care for the Uninsured

The Mirage of Available Health Care for the Uninsured

Emergency physician practice ownership

Emergency physician practice ownership

A survey on the career development of women dentists

Aim The aim of the study was to determine differences between male and female dental practitioners in the positions they occupy within their employment, and to analyse the correlates of such differences. Method Postal questionnaire survey of a 1 in 10 sample of individuals taken from the General Dental Council register. Results Female dental practitioners occupy lower positions in the employment hierarchies of the Community Dental Service and the Hospital Dental Service. Women general dental practitioners are significantly less likely to be sole proprietor of, or a partner in, a general practice. Ownership of a general practice is related to: sex, age, number of years qualified, number of children, and hours worked. Consultants in the Hospital Dental Service are more likely to be male, older, to have been qualified longer and (obviously) to hold more additional qualifications than their non-consultant colleagues. Senior Dental Officers and Directors of the Community Dental Service are more likely to be male, work longer hours and (again obviously) to hold more additional qualifications than Community Dental Officers. Conclusions Differences exist between male and female dental practitioners in the positions they occupy within employment hierarchies. Age, length of time since qualification and the acquisition of additional qualifications are consistently found to differentiate dental practitioners' status.

A study of the career development of male and female dental practitioners.

The aim of the study was to determine differences between male and female dental practitioners in the positions they occupy within their employment, and to analyse the correlates of such differences. Postal questionnaire survey of a 1 in 10 sample of individuals taken from the General Dental Council register. Female dental practitioners occupy lower positions in the employment hierarchies of the Community Dental Service and the Hospital Dental Service. Women general dental practitioners are significantly less likely to be sole proprietor of, or a partner in, a general practice. Ownership of a general practice is related to: sex, age, number of years qualified, number of children, and hours worked. Consultants in the Hospital Dental Service are more likely to be male, older, to have been qualified longer and (obviously) to hold more additional qualifications than their non-consultant colleagues. Senior Dental Officers and Directors of the Community Dental Service are more likely to be male, work longer hours and (again obviously) to hold more additional qualifications than Community Dental Officers. Differences exist between male and female dental practitioners in the positions they occupy within employment hierarchies. Age, length of time since qualification and the acquisition of additional qualifications are consistently found to differentiate dental practitioners' status.