Physician Age Research Articles

Executive Coaching for Leadership Development: Experience of Academic Physician Leaders

To identify the perceived impact and benefit of executive coaching by a physician coach in the context of their leadership roles. A descriptive qualitative inquiry was conducted. Individual semi-structured interviews ex post facto were conducted with physician leaders who completed an executive coaching program during the period 2015-2016.Interviews were transcribed verbatim, and data were analyzed by applying an emergent thematic analysis approach. Five interviews were conducted. Participants were female specialist physicians age 25-50 years with leadership experience that was minimal (one), more than two years (one), five years (one) or greater than 10 years (two). The experiences of the interview participants captured seven themes: isolation, time management, self-doubt, support, productivity, moving forward and workplace culture change/shift. For all participants, executive coaching appeared to positively impact their personal and professional development. There was a high degree of congruence in the experience of the executive coaching program by participants. The physician leaders who underwent a series of executive coaching sessions had very similar experiences overall. The added professional development tool of executive coaching for specialist physicians may have a significant role in supporting productivity, increasing workplace engagement and transforming the culture of medical practice.

Influence of Age, Sex, and Generation on Physician Payments and Clinical Activity in Ontario, Canada: An Age-Period-Cohort Analysis

To compare the effect of age, sex and generation on physician practice patterns in Ontario, Canada. Retrospective cohort study. Physician and patient data from 1992-2013 were used to calculate the yearly number of physicians, distinct patients seen, patient visits, government payments, physician age, sex, specialty, and year of birth. Age-period-cohort models were used for analysis. There was a negligible change in the number of distinct patients for all physicians and family physicians and a 20.6% decrease for ophthalmologists. There were small declines in yearly visits for all physicians (14.2%) and family physicians (17.3%) and a 10.0% increase for ophthalmologists. There were a lower number of visits (and patients for ophthalmologists) in each succeeding recent birth cohort. For all groups and birth cohorts, male physicians had a significantly greater number of visits and patients. Median payments increased over time in all groups and were less for women with an average women-to-men ratio of 0.64 for all physicians, 0.75 for family physicians, and 0.59 for ophthalmologists. After adjusting for the number of visits and patients, sex differences in payments remained significant for all physicians and ophthalmologists but were no longer significant for family physicians. Younger cohorts of Ontario physicians have greater yearly payments compared with older cohorts at the same age despite similar or a slightly lower number of visits and patients. The sex gap of payments was mostly explained by differences in the number of patients and visits for family physicians but remained significant for all physicians and ophthalmologists.

Physician Use of Electronic Health Records: Survey Study Assessing Factors Associated With Provider Reported Satisfaction and Perceived Patient Impact.

BackgroundThe effect electronic health record (EHR) implementation has on physician satisfaction and patient care remains unclear. A better understanding of physician perceptions of EHRs and factors that influence those perceptions is needed to improve the physician and patient experience when using EHRs.ObjectiveThe objective of this study was to determine provider and clinical practice factors associated with physician EHR satisfaction and perception of patient impact.MethodsWe surveyed a random sample of physicians, including residents and fellows, at a US quaternary care academic hospital from February to March 2016. The survey assessed provider demographics, clinical practice factors (ie, attending, fellow, or resident), and overall EHR experience. The primary outcomes assessed were provider satisfaction and provider perceptions of impact to patient care. Responses on the satisfaction and patient impact questions were recorded on a continuous scale initially anchored at neutral (scale range 0 to 100: 0 defined as “extremely negatively” and 100 as “extremely positively”). Independent variables assessed included demographic and clinical practice factors, including perceived efficiency in using the EHR. One-way analysis of variance or the Kruskal-Wallis test was used for bivariate comparisons, and linear regression was used for multivariable modeling.ResultsOf 157 physicians, 111 (70.7%) completed the survey; 51.4% (57/111) of the respondents were attending physicians, and of those, 71.9% (41/57) reported a >50% clinical full-time-equivalency and half reported supervising residents >50% of the time. A total of 50.5% (56/111) of the respondents were primary care practitioners, previous EHR experience was evenly distributed, and 12.6% (14/111) of the total sample were EHR super-users. Responses to how our current EHR affects satisfaction were rated above the neutral survey anchor point (mean 58 [SD 22]), as were their perceptions as to how the EHR impacts the patient (mean 61 [SD 18]). In bivariate comparisons, only physician age, clinical role (resident, fellow, or attending), and perceived efficiency were associated with EHR satisfaction. In the linear regression models, physicians with higher reported perceived efficiency reported higher overall satisfaction and patient impact after controlling for other variables in the model.ConclusionsPhysician satisfaction with EHRs and their perception of its impact on clinical care were generally positive, but physician characteristics, greater age, and attending level were associated with worse EHR satisfaction. Perceived efficiency is the factor most associated with physician satisfaction with EHRs when controlling for other factors. Understanding physician perceptions of EHRs may allow targeting of technology resources to ensure efficiency and satisfaction with EHR system use during clinical care.

Sex Differences in Achievement and Faculty Rank in Academic Infectious Diseases.

This study assesses differences in faculty rank between female and male infectious diseases (ID) faculty with academic appointments at US medical schools. We analyzed a complete database of US physicians with medical school faculty appointments in 2014. This database consists of a linkage between the American Association of Medical Colleges faculty roster and a physician database from Doximity, and includes physician age, sex, years since residency completion, publications, National Institutes of Health grants, and registered clinical trials for all academic physicians by specialty. We used multivariable logistic regression models with medical school-specific fixed effects to assess sex differences in full professorship by specialty and the relationship between these factors and achieving the rank of full professor within ID. We compared this adjusted difference in ID to that of peer subspecialties. Among a total of 2016 academic ID physicians, there were 742 (37%) women who together accounted for 48.1% of assistant professors, 39.7% of associate professors, and 19.2% of full professors. Women faculty had fewer total (16.3 vs 28.3, P < .001) and first/last author publications (9.8 vs 20.4, P < .001). In adjusted models, the rate of full professorship (vs assistant or associate) among female compared to male ID physicians was large and significant (absolute adjusted difference, -8.0% [95% confidence interval, -11.9% to -4.1%]). This difference was greater in ID than in cardiology. Significant sex differences in achieving the rank of full professor exist in academic ID, after adjustment for multiple factors known to influence these outcomes. Greater efforts should be made to address equity in academic ID.

Physician age and the abandonment of episiotomy.

To determine whether women treated by older physicians are more likely to undergo episiotomy. Hospital discharge data from Pennsylvania for the period 1994 to 2010. We examined the impact of the year in which physicians started delivering babies (a proxy for age) in Pennsylvania on episiotomy rates using a linear probability model with hospital fixed effects. Using diagnosis and procedure codes, we identified women delivering vaginally (N=1658327) and determined the proportion who had an episiotomy. The average physician-level episiotomy rate declined from 54 percent in 1994 to 13 percent in 2010. Rates declined among older and younger physicians, but, at any point in time, women treated by older physicians were more likely to have an episiotomy. A 10-year difference in physician age is associated with a 6 percentage point increase in episiotomy rates. Results indicate that older physicians, who entered practice when episiotomy was common, were slow to adjust their practices in response to evidence showing that routine episiotomy is unnecessary.

Effect of Financial Bonus Size, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance

Despite limited effectiveness of pay-for-performance (P4P), payers continue to expand P4P nationally. To test whether increasing bonus size or adding the behavioral economic principles of increased social pressure (ISP) or loss aversion (LA) improves the effectiveness of P4P. Parallel studies conducted from January 1 to December 31, 2016, consisted of a randomized clinical trial with patients cluster-randomized by practice site to an active control group (larger bonus size [LBS] only) or to groups with 1 of 2 behavioral economic interventions added and a cohort study comparing changes in outcomes among patients of physicians receiving an LBS with outcomes in propensity-matched physicians not receiving an LBS. A total of 8118 patients attributed to 66 physicians with 1 of 5 chronic conditions were treated at Advocate HealthCare, an integrated health system in Illinois. Data were analyzed using intention to treat and multiple imputation from February 1, 2017, through May 31, 2018. Physician participants received an LBS increased by a mean of $3355 per physician (LBS-only group); prefunded incentives to elicit LA and an LBS; or increasing proportion of a P4P bonus determined by group performance from 30% to 50% (ISP) and an LBS. The proportion of 20 evidence-based quality measures achieved at the patient level. A total of 86 physicians were eligible for the randomized trial. Of these, 32 were excluded because they did not have unique attributed patients. Fifty-four physicians were randomly assigned to 1 of 3 groups, and 33 physicians (54.5% male; mean [SD] age, 57 [10] years) and 3747 patients (63.6% female; mean [SD] age, 64 [18] years) were included in the final analysis. Nine physicians and 864 patients were randomized to the LBS-only group, 13 physicians and 1496 patients to the LBS plus ISP group, and 11 physicians and 1387 patients to the LBS plus LA group. Physician characteristics did not differ significantly by arm, such as mean (SD) physician age ranging from 56 (9) to 59 (9) years, and sex (6 [46.2%] to 6 [66.7%] male). No differences were found between the LBS-only and the intervention groups (adjusted odds ratio [aOR] for LBS plus LA vs LBS-only, 0.86 [95% CI, 0.65-1.15; P = .31]; aOR for LBS plus ISP vs LBS-only, 0.95 [95% CI, 0.64-1.42; P = .81]; and aOR for LBS plus ISP vs LBS plus LA, 1.10 [95% CI, 0.75-1.61; P = .62]). Increased bonus size was associated with a greater increase in evidence-based care relative to the comparison group (risk-standardized absolute difference-in-differences, 3.2 percentage points; 95% CI, 1.9-4.5 percentage points; P < .001). Increased bonus size was associated with significantly improved quality of care relative to a comparison group. Adding ISP and opportunities for LA did not improve quality. ClinicalTrials.gov Identifier: NCT02634879.

How do physician demographics, training, social media usage, online presence, and wait times influence online physician review scores for spine surgeons?

OBJECTIVEThe purpose of this study was to assess the impact of certain demographics, social media usage, and physician review website variables for spine surgeons across Healthgrades.com (Healthgrades), Vitals.com (Vitals), and Google.com (Google).METHODSThrough a directory of registered North American Spine Society (NASS) physicians, we identified spine surgeons practicing in Texas (107 neurosurgery trained, 192 orthopedic trained). Three physician rating websites (Healthgrades, Vitals, Google) were accessed to obtain surgeon demographics, training history, practice setting, number of ratings/reviews, and overall score (January 2, 2018-January 16, 2018). Using only the first 10 search results from Google.com, we then identified whether the surgeon had a website presence or an accessible social media account on Facebook, Twitter, and/or Instagram.RESULTSPhysicians with either a personal or institutional website had a higher overall rating on Healthgrades compared to those who did not have a website (p < 0.01). Nearly all spine surgeons had a personal or institutional website (90.3%), and at least 1 accessible social media account was recorded for 43.5% of the spine surgeons in our study cohort (39.5% Facebook, 10.4% Twitter, 2.7% Instagram). Social media presence was not significantly associated with overall ratings across all 3 sites, but it did significantly correlate with more comments on Healthgrades. In multivariable analysis, increasing surgeon age was significantly associated with a lower overall rating across all 3 review sites (p < 0.05). Neurosurgeons had higher overall ratings on Vitals (p = 0.04). Longer wait times were significantly associated with a lower overall rating on Healthgrades (p < 0.0001). Overall ratings from all 3 websites correlated significantly with each other, indicating agreement between physician ratings across different platforms.CONCLUSIONSLonger wait times, increasing physician age, and the absence of a website are indicative of lower online review scores for spine surgeons. Neurosurgery training correlated with a higher overall review score on Vitals. Having an accessible social media account does not appear to influence scores, but it is correlated with increased patient feedback on Healthgrades. Identification of ways to optimize patients' perception of care are important in the future of performance-based medicine.

Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

ObjectiveIndicator condition (IC)-guided HIV testing is a strategy for the diagnosis of patients with HIV. The aim of this study was to assess the impact on the proportion of HIV...

Factors associated with the prescription of vaginal pessaries for pelvic organ prolapse

OBJECTIVE:To identify the factors associated with the prescription of vaginal pessaries (VPs) as a conservative treatment for pelvic organ prolapse (POP).METHODS:A cross-sectional study was performed during two annual urogynecology and general obstetrics and gynecology meetings in 2017 (São Paulo, SP, Brazil). A 19-item deidentified questionnaire regarding experiences and practices in prescribing VPs for POP patients was distributed among gynecologists. Our primary outcome was the frequency of prescribing VPs as a conservative treatment for POP. The reasons for prescribing or not prescribing VPs were also investigated. Univariate and multivariate analyses with crude and adjusted odds ratios (ORs) were performed for variables associated with the prescription of pessaries.RESULTS:Three hundred forty completed surveys were analyzed. Half of the respondents (53.53%) were between 30-49 years old; most of them were female (73.53%), were from the Southeast Region (64.12%), were trained in obstetrics and gynecology (80.24%) or urogynecology (61.18%) and worked in private offices (63.42%). More than one-third (36.48%) attended four or more POP cases/week, and 97.65% (n=332) had heard or knew about VPs for POP; however, only 47.06% (n=160) prescribed or offered this treatment to patients. According to the multivariate analysis, physicians aged 18-35 years (OR=1.97[1.00-3.91]; p=0.04), those who participated in a previous urogynecology fellowship (OR=2.34[1.34-4.09]; p<0.01), those with relatively high volumes of POP cases (4 or +) (OR=2.23[1.21-4.47]; p=0.01) and those with PhD degrees (OR=2.75[1.01-7.54]; p=0.05) prescribed more pessaries.CONCLUSIONS:Most gynecologists did not prescribe VPs. Younger physician age, participation in a previous urogynecology fellowship, a PhD degree, and a relatively high volume of POP cases were associated with increased VP prescription rates.

Higher Physician Body Mass Index is Associated with Increased Weight Bias in an Arab Country with High Prevalence of Obesity.

Background:Obesity is a worldwide problem. The Arab world, and particularly the Middle East, has witnessed a recent dramatic rise in obesity and obesity-related diseases. Yet, little is known about physician attitudes toward or management of obesity in this region of the world. The purpose of this study is to explore physician perceptions and attitudes toward obesity in the United Arab Emirates (UAE).Methods:A cross-sectional, self-administered anonymous survey of primary care physicians was performed between December 2015 and January 2017 at academic medical centers in the UAE.Results:A total of 573 of 698 physicians (82% response rate) completed the survey. Thirty-seven percent of respondents met body mass index (BMI) criteria for overweight and 12% for obesity. Physicians had sufficient knowledge but lacked training in obesity management. Physician subspecialty impacted knowledge with internal medicine physicians showing better obesity knowledge (Chi-square 392, df 210, P = 0.00). There was no significant relationship between knowledge and attitudes with physician age, gender, or nationality. Attitudinal responses toward obesity management were generally positive. However, there was an inverse correlation between physician BMI and positive attitudes toward obesity management (Chi-square 1551, df 323, P = 0.00).Conclusions:Although our study did not find significant weight bias, negative attitudes were directly correlated with physician BMI, a significant concern as half of physicians surveyed reported BMIs consistent with overweight and obesity.

Frequency of cesarean sections in female physicians and medical students in Babylon governorate

Background: Cesarean sections (CSs) defined as delivery of the fetus through abdominal incision. In certain condition, it is a life-saving surgical procedure for both mother and her fetus. Objectives: The aim of this study was to evaluate the frequency and causes of CSs in female Physicians and medical student in Babylon Governorate. Materials and Methods: It was a cross-sectional study conducted in Babylon. The duration of the study was over a period of 5 months, included a convenient sample of 345 female physicians and medical students delivered by CSs who worked at central and peripheral hospital mentioned who agreed to participate in this study, data were collected using a predesigned questionnaire by which female physicians and medical student were interviewed. Results: The mean age of female physicians whom delivered by CSs is (30.32 ± 4.38) years. More of them are para one CS (65.8%), no period of subfertility (92.5%), no history of miscarriage (78.6%), and delivered after 37 weeks of gestation (89.6%). Threatened miscarriage represented (47.3%) fallowed by anemia (14.2%) and preeclampsia (8.8%). The main indication of CSs was patient's wishes which represented (43.2%) of CS, (77.2%) of them had CS without any medical reason only afraid from the pain of normal vaginal delivery, (9.4%) had a history of primary subfertility, (6%) had bad obstetric history, (4.7%) had a history of pregnancy complications such as threatened miscarriage, gestational hypertension, and gestational diabetes mellitus. Conclusions: CSs rate in female physicians and medical student in Babylon Governorate were much higher than the optimal range recommended by the World Health Organization. In spite of their knowledge about the complications of CSs, more of them preferred CSs with no medical reason because of afraid from vaginal delivery pain.

Exploring the influence of resiliency on physician trust in patients: An empirical study of Chinese incidents.

BackgroundThe tension in doctor-patient relationships is becoming progressively greater due to the high expectations of patients and the physicians’ work pressure. Recent studies have addressed factors which affect the tension of doctor-patient relationships, and our study continues this trend by looking at the influence of resiliency and physician trust in the patient (PTP), that is, how much the doctor trusts the patient.MethodsBased on a survey of 329 physicians, a descriptive analysis of measured data was done using SPSS 19.0. Pearson correlation coefficient analysis was used to examine the correlation between PTP and resilience and the demographic variables. KMO and Bartlett methods were used to examine the correlation between PTPS and resilience. The method of factor analysis was used for multicollinearity tests, and multiple stepwise regression analysis was used to explore the demographic factors correlated with PTP and resilience.ResultOur results indicate that the level of PTP is influenced by the age, education, and income of the doctors. Physician age and income are significantly and positively correlated with PTP, but education is significantly and negatively related. Age, education, and income also affect the level of psychological resilience of physicians. Resilience is positively correlated with age and education but is negatively related to income. Resilience positively influences PTP.ConclusionThe direct factors of PTP include resilience, age, education, and income, while gender, title, and hospital department were found to be indirect influencing factors. To meet goals expressed in Chinese government policy related to these issues, we suggest improving the level of education of the doctors, providing reasonable annual salary increases for doctors, easing the tensions involved in medical treatment, reducing the physicians’ work pressure, improving the physicians’ work environment, and enhancing the physicians’ professional sympathy. Through such measures, the level of PTP will be enhanced.

875. Sex Differences in Academic Achievement and Faculty Rank in Academic Infectious Diseases

BackgroundSex differences in faculty achievement in academic medicine have been described, but little is known about these differences in infectious diseases (ID). This study assesses differences in faculty rank between female and male infectious disease faculty with academic appointments at US medical schools.MethodsWe analyzed a complete database of US physicians with medical school faculty appointments in 2014. This database consists of a linkage between the American Association of Medical Colleges faculty roster and a comprehensive physician database from Doximity, a professional networking website for doctors and includes physician age, sex, years since residency completion, publications, National Institutes of Health grants, and registered clinical trials for all academic physicians by specialty. We estimated sex differences in key metrics of academic achievement, including publications and faculty rank, among faculty physicians within ID. Multivariable regression models with medical school-specific fixed effects were used to assess sex differences in full professorship by specialty and the relationship between these factors and achieving the rank of full professor within ID.ResultsAmong 2,016 academic ID physicians [Female: 742 (37%)], women accounted for 48.1% of assistant professors, 39.7% of associate professors, and 19.2% of full professors, when compared with men at each level. Women faculty members were younger than men (mean: 48.4 years vs. 54.0 years, P < 0.001) and had fewer total (mean: 24.1 vs. 37.8, P < 0.001) and first/last author publications (mean: 16.7 vs. 32.2, P < 0.001). In adjusted models, the rate of full professorship (vs. assistant or associate) among female compared with male infectious disease physicians was large and highly significant (absolute adjusted difference = −8.0%; 95% confidence interval [CI]: −11.9% to −4.1%). This adjusted difference was greater in ID than in cardiology (−4.7%, 95% CI: −7.9% to −1.3%), hematology (−1.5%, 95% CI: −6.2% to 3.2%), or endocrinology (−0.2%, 95% CI: −4.9% to 4.6%).ConclusionSignificant sex differences in publications and achieving the rank of full professor exist in academic ID, after adjustment for multiple factors known to influence these outcomes. Greater efforts should be made to address equity in academic ID.Disclosures All authors: No reported disclosures.

Correlation of leadership and care coordinator performance among primary care physicians.

PurposePrimary care physicians have to deal with many aspects of the patients’ health problem, which needs cooperation with other health professionals or even nonhealth individuals. To achieve effective results, the primary care physicians should have leadership and coordinating skills, especially when dealing with the health challenges in Asia Pacific region. The care coordinator role of primary care physicians is important to create the bridge between population and health. This study aims to determine the correlation between care coordinator performance and leadership factors among primary care physicians.Materials and methodsA cross-sectional study was conducted, and data collection involved a total of 84 primary care physicians who were randomly selected from a total of 44 subdistricts and worked in 40 randomly selected village government-owned primary healthcare facilities in Jakarta. Pearson’s correlation, independent t-test, and one-way ANOVA were used to measure the correlation between care coordination and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as the sociodemographics of the physicians and the professional practice factors. Multiple regressions were conducted to determine the most important factors influencing care coordinator performance.ResultsRespondents were mainly female (94%) with an average age of 36 years and were mostly medical doctors without any additional postgraduate degrees (95.2%). There was no correlation between care coordinator scores and organizational culture or commitment. There were positive and significant correlations between care coordinator scores and clinical leadership score (r=0.66; P<0.001), transformational leadership score (r=0.54; P<0.001), job satisfaction score (r=0.31; P=0.004), physician’s age (r=0.34; P=0.002), length of time since graduation (r=0.30; P=0.005), duration of employment at their health center (r=0.33; P=0.003), training in family medicine (P=0.04), and employment status (P=0.005). The most important factors in care coordinator performance were clinical leadership (r=0.53; P<0.001) and transformational leadership (r=0.23; P=0.03), with the total R2 being 0.47.ConclusionClinical leadership and transformational leadership were the most important factors for care coordinator performance. Therefore, the leadership skills of primary care physicians are important to be considered as a certain competency in practice to manage various resources and coordinate with related healthcare providers for controlling patients’ illness as well as dealing with the challenges and managing the overall health.

Associations with Wellbeing and Medication Adherence in Young Adults Receiving Kidney Replacement Therapy.

Young adults receiving kidney replacement therapy (KRT) have impaired quality of life and may exhibit low medication adherence. We tested the hypothesis that wellbeing and medication adherence are associated with psychosocial factors. We conducted a cross-sectional online survey for young adults on KRT. Additional clinical information was obtained from the UK Renal Registry. We compared outcomes by treatment modality using age- and sex-adjusted regression models, having applied survey weights to account for response bias by sex, ethnicity, and socioeconomic status. We used multivariable linear regression to examine psychosocial associations with scores on the Warwick-Edinburgh Mental Wellbeing Scale and the eight-item Morisky Medication Adherence Scale. We recruited 976 young adults and 64% responded to the survey; 417 (71%) with transplants and 173 (29%) on dialysis. Wellbeing was positively associated with extraversion, openness, independence, and social support, and negatively associated with neuroticism, negative body image, stigma, psychologic morbidity, and dialysis. Higher medication adherence was associated with living with parents, conscientiousness, physician access satisfaction, patient activation, age, and male sex, and lower adherence was associated with comorbidity, dialysis, education, ethnicity, and psychologic morbidity. Wellbeing and medication adherence were both associated with psychologic morbidity in young adults. Dialysis treatment is associated with poorer wellbeing and medication adherence.

Transgender patient care in urology: an evaluation of attitudes, knowledge, and practice patterns among urologists in the New York metropolitan area

IntroductionTransgender (TG) individuals suffer from significant health disparities, due in part to deficiencies in physician knowledge or comfort with addressing TG health care needs. This study aims to assess the attitudes and clinical knowledge in caring for TG patients of a representative sample of urologists in the New York metropolitan area. MethodsAn anonymous, online-based questionnaire was sent to members of the New York Section of the American Urological Association. Statements evaluating knowledge and attitudes toward TG care were scored on a 5-point Likert scale. Results92 providers (83.7% male) participated in the study, of whom 78.3% (72/92) have been in practice for at least 15 years. With respect to physician attitudes, there was a trend toward greater comfort with discussion of gender identity and counseling on GCS based on total number of TG patients cared for over the course of their career. Regarding knowledge scores, there were no significant associations with physician age, gender, or years of practice. Despite the relatively weak self-reported fund of knowledge (2.64) and overall clinical competence (2.09), there was no overwhelming support to incorporate TG care into urology training curricula (3.11). ConclusionsDespite growing education and awareness of transgender-specific medical issues, many urologists self-report deficiencies in requisite knowledge and comfort in providing adequate, culturally competent care for TG patients. Further work is needed to increase our collective comfort level with this new and evolving aspect of our field.

Influence of Age, Sex, and Generation on Physician Payments and Clinical Activity in Ontario, Canada: An Age-Period-Cohort Analysis

To compare the effect of age, sex and generation on physician practice patterns in Ontario, Canada. Retrospective cohort study. Physician and patient data from 1992 to 2013 were used to calculate yearly number of physicians, distinct patients seen, patient visits, government payments, physician age, sex, specialty, and year of birth. Age-period-cohort models were used for analysis. There was a negligible change in the number of distinct patients for all physicians and family physicians and a 20.6% decrease for ophthalmologists. There were small declines in yearly visits for all physicians (14.2%) and family physicians (17.3%) and a 10.0% increase for ophthalmologists. There was a lower number of visits (and patients for ophthalmologists) in each succeeding recent birth cohort. For all groups and birth cohorts, male physicians had significantly greater number of visits and patients. Median payments increased over time in all groups and were less for women with an average women-to-men ratio of 0.64 for all physicians, 0.75 for family physicians, and 0.59 for ophthalmologists. After adjusting for the number of visits and patients, sex differences in payments remained significant for all physicians and ophthalmologists but were no longer significant for family physicians. Younger cohorts of Ontario physicians have greater yearly payments compared to older cohorts at the same age despite similar or slightly fewer numbers of visits and patients. The sex gap of payments was mostly explained by differences in the number of patients and visits for family physicians, but remained significant for all physicians and ophthalmologists.

Future projection of the physician workforce and its geographical equity in Japan: a cohort-component model

IntroductionThe geographical inequity of physicians is a serious problem in Japan. However, there is little evidence of inequity in the future geographical distribution of physicians, even though the future physician...

The Evaluation of Professional Divisions of Traditional Chinese Medicine in Taiwan through Patient Visit Records of 2012.

For decades, professional divisions have been represented as the main structural divisions in Western medicine throughout the world. In Taiwan, medical policymakers are also interested in designing professional divisions of traditional Chinese medicine (TCM). Therefore, this study evaluated the current status and potentiality of professional divisions of TCM in Taiwan using data from the year 2012 obtained from the National Health Insurance Research Database; the database provides information regarding age and gender of TCM physicians (TCMPs); total visit counts; contracted medical institution codes; groupings of diseases classified under International Classification of Diseases, Ninth Revision, Clinical Modification codes; numbers of children and female patients seeking treatment; and claim disposition codes used by each TCMP. The results indicated that there were 5522 TCMPs in 2012, and 4876 (90.3%) TCMPs practiced in primary clinics. The proportions of pediatric visits to these TCMPs were mostly below 0.2, and acupuncture or traumatology-related visit proportions were below 0.5. Only a few of the studied Taiwan-based TCMPs practiced gynecology and pediatrics, but most of them performed “internal medicine”, or “acupuncture” or “traumatology” treatments. Thus, the number of TCM specialists practicing gynecology or pediatrics is insufficient, indicating that a policy that forms professional divisions of TCM practitioners in Taiwan should be reconsidered.

Why do German physicians reject managed care?

Approximately 20years after the launch of managed care (MC) in Germany, the initial dynamics have turned into an MC backlash with a poor image for MC among physicians and the insured. Factors in MC contract rejection by physicians have not previously been studied systematically. The objective of the study is to show that observed physician characteristics explain MC contract rejection in a quantitative model. These econometric findings will be related to suitable political measures to foster physicians' MC acceptance. Results are based on 500 completed responses to a survey among practicing physicians in Northern Germany. Physician cooperation, attitudes toward MC, and practice characteristics are addressed. A Heckman approach accounts for potential preselection of physicians by insurers. Econometric findings are complemented by a qualitative analysis of free-text answers. Private patient share, physician age, and number of physicians per practice significantly increase rejection probability, whereas it is decreased by rural location. Qualitatively, administrative burden and loss of professional autonomy are the main reasons for MC refusal. Current health policy focuses on institutional measures such as innovation funding to promote MC. Our results show that it may be more effective to turn attention to practicing physicians' preferences as a bottleneck to MC development.