Physician Work Research Articles

Market, Gift, Everyday Ethics, and Emmanuel Levinas in Patient Care.

A simple, and brief, human gesture may turn a routine visit into a healing encounter. We need a conceptual nudge; otherwise, we are left stranded at the lowest common denominator of value, money. Physicians work long and hard to perfect our craft, but might some element of our therapeutic abilities be seen, like the artist’s native talent, as gift? The beginning lies in a way of thinking that places protection of the vulnerable human person front and center.

Comparison of Work Patterns Between Physicians and Advanced Practice Practitioners in Primary Care and Specialty Practice Settings

ImportanceDespite the increasing involvement of advanced practice practitioners (APPs; ie, nurse practitioners and physician assistants) in care delivery across specialties, the work patterns of APPs compared with physicians and how they are integrated into care teams have not been well characterized.ObjectiveTo characterize differences between physicians and APPs across specialty types related to days with appointments, visit types seen, and time spent using the electronic health record (EHR).Design, Setting, and ParticipantsThis nationwide, cross-sectional study used EHR data from physicians and APPs (ie, nurse practitioners and physician assistants) at all US institutions that used Epic Systems’ EHR between January and May 2021. Data analysis was performed from March 2022 to April 2023.Main Outcomes and MeasuresAppointment scheduling patterns, percentage of new and established and level of evaluation and management (E/M) visits, and EHR use metrics per day and week.ResultsThe sample consisted of 217 924 clinicians across 389 organizations, including 174 939 physicians and 42 985 APPs. Although primary care physicians were more likely than APPs to have more than 3 days per week with appointments (50 921 physicians [79.5%] vs 17 095 APPs [77.9%]), this trend was reversed for medical (38 645 physicians [64.8%] vs 8124 APPs [74.0%]) and surgical (24 155 physicians [47.1%] vs 5198 APPs [51.7%]) specialties. Medical and surgical specialty physicians saw 6.7 and 7.4 percentage points, respectively, more new patient visits than did their APP counterparts, whereas primary care physicians saw 2.8 percentage points fewer new patient visits than did APPs. Physicians saw a greater percentage of level 4 or 5 visits across all specialties. Medical and surgical physicians spent 34.3 and 45.8 fewer minutes per day, respectively, using the EHR than did APPs in their specialties, whereas primary care physicians spent 17.7 minutes per day more. These differences translated to primary care physicians spending 96.3 minutes more per week using the EHR than APPs, whereas medical and surgical physicians spent 149.9 and 140.7 fewer minutes, respectively, than did their APP counterparts.Conclusions and RelevanceThis cross-sectional, national study of clinicians found significant differences in visit and EHR patterns for physicians compared with APPs across specialty types. By underscoring the different current usage of physicians vs APPs across specialty types, this study helps place into context the work and visit patterns of physicians compared with APPs and serves as a foundation for evaluations of clinical outcomes and quality.

BODY MASS INDEX (BMI) - PREDICTOR OF DISEASES ONSET AND REGULATOR OF PREVENTION?

The Body Mass Index (BMI) is a well-known tool for measuring normal, healthy weight. Nowadays, we can also use it as a prognostic factor for various diseases. Purpose: Our study aims to confirm or decline the correlation between body mass index and the onset of different diseases. Methods: The study was conducted among a random sample of 550 people (324 women and 226 men) from the district of Stara Zagora, Republic of Bulgaria. The participants in the study were aged between 18 and 65. The connection between BMI and the occurrence of diseases of different systems has been researched. A statistically significant relationship was found at p<0.05. The statistically significant influence of BMI on the occurrence of diseases is proved by the results of the ANOVA procedure. Results: The results give us reason to believe that not only obesity but also overweight is a risk of cardiovascular disease. This is evidenced by our study, according to which people with the highest average BMI (BMI = 28.72 kg/m2) have diseases of the cardiovascular system. People with a BMI around and above 25.87 kg / m2 often suffer from diseases of the endocrine system, and those with a BMI around 25.60 kg / m2 are at risk for diseases of the musculoskeletal system. Conclusions: BMI would find its daily implementation in the activities of every physician working in every field of medicine. BMI can be used as a tool to predict the onset of disease and a regulator of prevention.

A Health Equity Fellowship Based in Experiential Learning Through a Rural Academic-Community Partnership

While rural communities continue to experience significant health disparities, investment in graduate medical education (GME) focused on rural health remains uneven.1 Investing in rural GME could allow early-career physicians to address health disparities by providing leadership training and mentored experience generating systems change. Leadership skills and systems change are especially important when physicians work in communities they are not from. There is a steep learning curve to understanding a community's priorities, governance structures, and building their trust. Despite best intentions, unprepared physicians may fail to make lasting beneficial change for the community, and communities risk losing physicians to burnout and turnover.The Massachusetts General Hospital Fellowship Program in Rural Health Leadership teaches skills in leadership and health systems change to early-career primary care physicians through a rural-based experiential learning model based on Kolb's Learning Styles Inventory.2 Fellows develop attitudes, knowledge, and skills in leadership and health equity by moving through 4 stages of learning: (1) experiencing and reflecting on the rural experience; (2) acquiring new knowledge and concepts; (3) practicing new ideas through discussion; and (4) taking action and learning from the result.Fellows spend a quarter per year of the 2-year program at the rural community partner site in Rosebud, South Dakota, working clinically as independent attending-level physicians. Rosebud is the home of the Sicangu Lakota Oyate and Indian Health Service Rosebud Service Unit and has long experienced some of the worst health outcomes in the country due to sustained historical, systemic, and infrastructure challenges. As the Rosebud community experiences many of the same challenges facing rural communities across the United States, fellows learn skills in leadership and health equity that can be translated in their future careers to other sites with challenged infrastructure.Faculty support is provided by a network of academic teaching physicians experienced in rural health through a combination of asynchronous/synchronous and remote/on-site forums, including weekly meetings where difficult clinical cases and systems improvement work is discussed, a de-identified encrypted group chat, monthly discussion exchanges with other global and rural fellowships, weekly fellow seminars, and shared reading lists. These teaching interactions provide fellows with new concepts to apply to their experiences, as well as opportunities to articulate their reflections and test their new ideas through discussion.A key aspect of the fellowship is the completion of a mentored capstone project in any aspect of systems change—research, policy, advocacy, quality improvement, or education are a few examples. Focused mentorship and a program-funded Master of Public Health are pillars of the capstone project support. These capstone projects allow fellows to apply their lessons learned to new practice and to observe the results.The key values of the program are imbued in the structure of experiential learning and are seen in the fellows' activities during the program and beyond (Table).In a 2021 GME survey of fellows, the clinical breadth and intense experiential learning in clinical and leadership roles was consistently named as a major strength of the program.Successful graduates from the program should be prepared to move directly into a leadership position in rural and community health. Since the first fellowship class graduated in 2017, the fellowship has produced 7 graduates. Since graduation, fellows have gone on to positions in medical education leadership, policy, and leading innovative clinical programs with rural and underserved populations.

Socioeconomic and demographic disparities in rectal cancer treatment.

e15512 Background: Early treatment (tx) improves survival in rectal cancer (ca). We explored whether socioeconomic and demographic attributes are associated with time to tx initiation for rectal ca patients (pts) in New York's largest and most diverse healthcare system. Methods: 283 rectal ca pts were identified from three multidisciplinary tumor boards from 2019-2022. Time to tx was calculated as time from biopsy to first tx (surgery, chemotherapy, or radiation). Social work assistance was defined as an intervention by a social worker for home care, housing, or transportation assistance. Reasons for tx delay were assessed from physician and social work notes. Results: Median time to tx for all pts was 41 days. Time to tx was longer for Black/African American (BAA) (56.5 days; p < 0.001) and Medicare only (46.5 days; p = 0.005) pts. No differences were seen in time to tx for all pts when stratified by first tx modality (surgery, chemotherapy, or radiation). In a univariable linear regression, BAA pts (vs Asian or White; p < 0.001), Medicare only pts (vs Medicaid, Medicare with Supplemental, or Commercial Insurance; p = 0.001), and pts requesting social work assistance (p = 0.001) predicted longer time to tx. Employed pts (vs unemployed or retired; p = 0.034) predicted shorter time to tx. In a multivariable model, BAA (p = 0.013), Medicare (p = 0.022), and social work assistance (p = 0.029) predicted longer time to tx. The most common reasons identified for tx delay in BAA and Medicare pts were hospitalization during diagnosis (9%), evaluation of metastatic disease (9%), and tx hesitancy (7%). The odds ratio of being hospitalized during initial workup was 2.8 times higher for BAA than Asian or White pts (p = 0.007). Conclusions: Analysis of time to tx in rectal ca showed a notable delay for BAA pts, Medicare only pts, and pts requesting social work assistance. These findings may empower further studies to assess which factors are causal and to implement interventions that promote equity in timely tx for rectal ca pts. Reasons for tx delay were also not well documented and should be further elucidated. [Table: see text]

Current status and future of cardio-obstetrics-review.

Cardio-obstetrics refers to an approach to maternal care that is based upon teamwork with specialists from maternal-foetal medicine, cardiology, anaesthesiology, neonatology, nursing, social work, and pharmacy that work together to achieve appropriate outcomes for the pregnant patient. The aim of this paper is to highlight and provide a narrative review on the currently published research on the current status and future of cardio-obstetrics. A short review on the hemodynamic physiology in pregnancy has also been described in this paper. The authors have discussed the major risk factors associated with exacerbation of pregnancy and the possible remedies that are currently available in this paper in accordance to the updated research. The cardio-obstetrics team provides advice about healthy pregnancy planning before conception. Proper cardio-obstetric care is associated with better outcomes in women with a high cardiovascular risk with decreased adverse maternal and foetal outcomes. Such care should be given to underserved and marginalized communities with great care as they have largely lacked such care in the past. The authors conclude the paper by recommendations to advance this newly emerging field by way of further scientific research and public awareness. This review can serve helpful to any physician working in the healthcare as well as the public that are interested in awareness about the multidisciplinary needs of pregnant women with cardiovascular disease.

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

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

Challenges of Integrating New Technologies for Orthopedic Doctors to Face up to Difficulties during the Pandemic Era.

In the field of orthopedics, competitive progress is growing faster because new technologies used to facilitate the work of physicians are continuously developing. Based on the issues generated in the pandemic era in this field, a research study was developed to identify the intention of orthopedic doctors to integrate new medical technologies. The survey was based on a questionnaire that was used for data collection. The quantitative study registered a sample of 145 orthopedic doctors. The data analysis was performed based on the IBM SPSS program. A multiple linear regression model was applied, which analyzed how the independent variables can influence the dependent variables. After analyzing the data, it was observed that the intention of orthopedic doctors to use new medical technologies is influenced by the advantages and disadvantages perceived by them, the perceived risks, the quality of the medical technologies, the experience of physicians in their use, and their receptivity to other digital tools. The obtained results are highly important both for hospital managers and authorities, illustrating the main factors that influence doctors to use emergent technologies in their clinical work.

Work–Life Balance for the Modern Neurosurgeon: Her/His Perspective

Physician work–life balance has gained significant attention in the last few years as the rates of burnout among physicians have increased. Burnout is defined as a state of mental and physical exhaustion caused by one's professional life.[1] It leads to exhaustion, cynicism, and adversely affected work productivity, patient outcomes, and interpersonal relationships. Although work–life balance applies to all professions, physicians find it especially hard to achieve, with almost half of U.S. surgeons being unsatisfied with their work–life dynamic.[2]

Letter: Commentary: The Anatomy of Disvalued Codes: The 63047 and the 22633.

Letter: Commentary: The Anatomy of Disvalued Codes: The 63047 and the 22633.

Planetary Health in der curricularen Lehre im Fach Humanmedizin – eine qualitative Studie zur Evaluation einer Lehr-/Lernintervention

IntroductionClimate change is the greatest threat to human health and therefore has a direct impact on the work of physicians. At the same time, the health sector is also an originator of pollutants that burden the climate. The concept of Planetary Health describes, among other things, ways in which the health sector can counter the effects of climate change. Nevertheless, the inclusion of contents on sustainable action in the education of health professionals has not been made mandatory to date. The aim of this study is to answer the question of how an intervention has to be designed so that medical students specifically develop an interest in dealing with the topic on their own. MethodsThe intervention consisted of•learning about Planetary Health in a preparatory seminar for family medicine internship at a German university,•completing a specifically developed checklist (comprising eight items on mobility, energy and material) during the two-week internship in a family medicine teaching practice and•allowing access to a curated collection of materials on this topic (open educational resources like texts, podcast episodes and videos) on a learning platform.For evaluation purposes, a qualitative study with guided focus group interviews of attendees was conducted. The fully transcribed focus group transcripts were analysed using Mayring’s structuring qualitative content analysis. Additionally, we checked the semester evaluation for feedback on the intervention. ResultsFour focus groups comprising n = 14 medical students (11 female, 3 male) were conducted. Dealing with Planetary Health as a topic during medical education was considered relevant. The partially restrained to negative reaction of the teaching practice staff involved to the checklist had a demotivating effect. A lack of time was given as a further reason for not dealing with the topic independently. Participants suggested integrating specific Planetary Health content in mandatory courses and considered environmental medicine to be especially suited. As a didactic method, case-based working in small groups seemed to be particularly appropriate. In the semester evaluation, we found both approving and critical commentaries. DiscussionParticipants considered Planetary Health a relevant topic in the context of medical education. The intervention proved to be of limited use in motivating students to deal with the topic independently. A longitudinal integration of the topic in the medical curriculum seems to be appropriate. ConclusionsFrom the students’ perspective, it is important to teach and acquire knowledge and skills regarding to Planetary Health in the future. Despite a high level of interest, additional offers are not being utilised due to a lack of time and should therefore be made part of the mandatory curriculum, where possible.

Comparison of Value per Operative Time between Primary and Revision Surgery for Adult Spinal Deformity: A Propensity Score-Matched Analysis.

Retrospective cohort study. To compare the relative value units (RVUs) per minute of operative time between primary and revision surgery for adult spinal deformity (ASD). Surgery for ASD is technically demanding and has high risks of complications and revision rates. This common need for additional surgery can increase the overall cost of care for ASD. RVU is used to calculate reimbursement from Medicare and to determine physician payments nationally. In calculating RVUs, the physician's work, the expenses of the physician's practice, and professional liability insurance. Cost effectiveness of surgeries for ASD have been evaluated, except for RVUs per minute compared between primary and revision surgery. Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥18 years who underwent surgery for spinal deformity between 2011 and 2019 were identified and included. To ensure a homogenous patient cohort, those who underwent anterior-only and concurrent anterior-posterior fusions were excluded. Propensity score matching analysis was performed, and Mann-Whitney U test, Pearson chi-square test, or Fisher's exact test were used to compare matched cohorts as appropriate. A total of 326 patients who underwent revision surgery were matched with 206 primary surgery patients via propensity score matching. Demographic characteristics, comorbidities, preoperative laboratory values, and readmission and reoperation rates were not significantly different between groups. The revision surgery group had significantly higher mean RVUs per minute than that of the primary surgery group (0.331 vs. 0.249, p <0.001), as well as rates of morbidity and blood transfusion. Compared to primary surgery, revision surgery for ASD is associated with significantly higher RVUs per minute and total RVUs and higher rates of 30-day morbidity and blood transfusions. Readmission and reoperation rates are similar between surgeries.

97 Burning a Hole in Our Pockets: 12 Year Trends of Medicare Reimbursement for Burn Procedures

Abstract Introduction Burn injuries cost the USA ~$976.6 million annually. Physician reimbursement has lagged despite years of lobbying by physician groups. The Centers for Medicare and Medicaid Services plan to cut physician reimbursement by 4.2% in 2023. Evaluating reimbursement data for hospital-based procedures is timely, including burn procedures. We hypothesized Medicare reimbursement trends for common burn procedures decreased from 2010-2022. Methods We obtained pricing data from the publicly-available Medicare Physician Fee Schedule Look-Up Tool for 26 Current Procedural Terminology (CPT) codes: “Burns–preparation of wound bed” (15002-15005), “Burns–split thickness skin graft” (15100-15101 &amp; 15120-15121), “Burns–skin substitute” (15271-15278), “Cultured epidermal autograft” (15150-15152 &amp; 15155-15157), and “Cell Suspension Epidermal Autograft” (15110-15111 &amp; 15115-15116). We calculated percent differences for reimbursement; compound annual growth rate (CAGR); and percent differences for work, facility, non-facility, and malpractice relative value units (RVUs). Analysis was conducted in R 4.1.2. Results The three largest reimbursement increases were for CPT codes 15272 (24.6%), 15155 (23.7%), and 15003 (10.9%); the three largest decreases were for 15121 (-16.8%), 15120 (-6.1%), and 15275 (-5.0%). The three largest CAGR increases were for CPT codes 15272 (2.2%), 15155 (1.8%), 15274 (0.9%), and 15003 (0.9%); the three smallest were for 15121 (-1.5%), 15120 (-0.5%), and 15275 (-0.5%). Table 1 shows trends of RVUs. Conclusions Our 12-year analysis of Medicare reimbursement trends for 26 burn procedures demonstrated an overall increase in hospital reimbursement and parallel net decrease in physician work RVUs. Reimbursements were increasingly allocated away from surgeons to facility fees and malpractice insurance. Cultured epidermal autograft to the head, neck, hands, and feet (15155) saw the largest increase in Medicare reimbursement with no change in direct physician reimbursement while split-thickness skin grafts to the head, neck, &amp; genitals (15120 &amp; 15121) showed decreased rates. Future work is needed to understand why these trends are occurring to advocate against physician reimbursement cuts. Applicability of Research to Practice Studies contributing to price transparency allow stakeholders to focus on why burn surgeons are receiving lower reimbursements.

Organisational commitment, job satisfaction and intention to leave among physicians in the public health sector of Cyprus: a cross-sectional survey

ObjectivesOrganisational commitment, job satisfaction and intention to leave constitute important characteristics of health professionals’ employment status. Our study aimed at investigating the level of organisational commitment, job satisfaction in association...

Interventional Pulmonology: Approaches to the Treatment of Benign Subglottic and Tracheal Stenosis

Benign subglottic/tracheal stenosis is a condition that negatively impacts patient quality of life and often morbidity. In cases of benign tracheal stenosis, a multidisciplinary and multimodal approach to treatment has been shown to result in the best outcomes with respect to successful management and recurrence rate. Interventional Pulmonology (IP) physicians work in conjunction with other specialties to manage these conditions. The procedures employed by IP physicians incorporate techniques via rigid bronchoscopy, flexible bronchoscopy, and occasionally hybrid approaches. Often, multiple modalities are utilized during a case, including mechanical dilation (rigid scope and balloon), laser therapies, electrocautery, spray cryotherapy, and pharmacologic therapies. The goal is to reduce the risk of restenosis and/or palliate symptoms in patients who may not be operative candidates for short-segment tracheal stenosis or laryngotracheal resection and reconstruction. Benign subglottic/tracheal stenosis is a condition that negatively impacts patient quality of life and often morbidity. In cases of benign tracheal stenosis, a multidisciplinary and multimodal approach to treatment has been shown to result in the best outcomes with respect to successful management and recurrence rate. Interventional Pulmonology (IP) physicians work in conjunction with other specialties to manage these conditions. The procedures employed by IP physicians incorporate techniques via rigid bronchoscopy, flexible bronchoscopy, and occasionally hybrid approaches. Often, multiple modalities are utilized during a case, including mechanical dilation (rigid scope and balloon), laser therapies, electrocautery, spray cryotherapy, and pharmacologic therapies. The goal is to reduce the risk of restenosis and/or palliate symptoms in patients who may not be operative candidates for short-segment tracheal stenosis or laryngotracheal resection and reconstruction.

Measuring emergency physician productivity and work patterns.

I propose a methodology to compare individual emergency physician (EP) work patterns. This is intended to generate discussion within the specialty. A work pattern graph shows individual EP productivity and, assuming the EPs case selection is similar, can be used to compare group activity. Using a simple mathematical model, an averaged calculation can be made of the number of patients needed to be seen by each treating clinician during a standard shift.

Impact of virtual visits on primary care physician work flows.

To understand the impact of virtual visits on primary care physician (PCP) work flows. Qualitative semistructured interviews. Primary care practices within 5 regions in southern Ontario. Physicians representing primary care practices of various sizes and remuneration models (eg, capitation and fee-for-service models). Interviews were conducted with PCPs involved in a large-scale pilot project implementing virtual visits (via a Web-based application) into clinical practices. Convenience and purposive sampling were used to recruit PCPs between January 2018 and March 2019. To obtain a representative sample, participants were sought from a variety of practice types and geographic regions. High and low users of virtual visits were included. Interviews were audiorecorded and transcribed. An inductive thematic analysis was used to identify prominent themes and subthemes. Twenty-six physicians were interviewed (n=15 using convenience sampling and n=11 through purposive sampling). Four themes were identified: PCPs employ diverse approaches to integrate virtual care into their work flow; PCPs recognize that implementing virtual visits requires upfront time and effort but have variable perceptions regarding long-term impact of virtual care on processes; asynchronous messaging is preferable to synchronous audio or video visits; and strategies were identified to improve the integration of virtual visits. The potential of virtual care to improve work flow is dependent on the way these visits are implemented and used. Dedicated time for implementation, emphasis on using asynchronous secure messaging, and access to clinical champions and structured change management support were associated with more seamless integration of virtual visits.

A Brief Review of the History of Global and Croatian Neurosurgery

Neurosurgery is the oldest, but also the youngest medical discipline. Namely, archaeological findings confirm the existence of cranial bone trepanations in the Late Stone Age, while neurosurgery as a separate discipline was founded only at the beginning of the 20th century. Descriptions of head/spinal injuries, and trepanations, date back to ancient Egypt (Edwin Smith papyrus) and physicians like Hippocrates, the Alexandrian school, and Galen, who described his classification of cranial fractures, perfected trepanation and contributed to neuroanatomy and physiology. Unfortunately, with his disappearance, the study of the central nervous system ceased during the next millennium. Medieval contribution to neurosurgery is due to the work of Arab and Persian physicians (Albucasis, Avicenna), who collected, preserved, and improved the medical knowledge of ancient times, including neuroscience. With the arrival of the Renaissance in the early 16th century, significant advances in anatomy, medicine, surgery, and neuroscience began. Berengario da Carpi, Andreas Vesalius, and Ambroise Paré stood out as progenitors of this era. During the 19th century, at a time of progress in medicine and surgery, preconditions were created for more extensive and long-lasting neurosurgical procedures, while the era of modern neurosurgery began in the early 20th century with the pioneering activities of MacEwan, Horsley, Cushing, Elsberg, Dandy and many others. Further progress in neurosurgery was made through the use of an operating microscope, which from 1965 marked the era of modern microneurosurgery, founded by Yaşargil. The beginnings of neurosurgical activity in Croatia date back to the end of the 19th century when Theodor Wickerhauser published a record of the first craniotomy done in our country in 1886. In conclusion, modern neurosurgery as one of the most advanced medical professions is based on the achievements of its historical leaders, and on the cutting-edge diagnostic and surgical armamentaria, together with the superior neurosurgical service organization.

Overcoming Burnout and Promoting Wellness in Radiation Oncology: A Report From the ACR Commission on Radiation Oncology

Burnout, defined by the presence of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment, impacts a significant portion of radiation oncologists. This has been exacerbated by the COVID-19 pandemic, is notably worse for women, and has been identified as an international concern. Key contributors to burnout within radiation oncology include inadequate clinical and administrative support, imbalanced personal and professional lives including time with family and for self-care, decreased job satisfaction secondary to increased electronic medical record and decreased patient time, unsupportive organizational culture, lack of transparency from leadership and inclusion in administrative decisions, emotionally intensive patient interactions, challenges within the radiation oncology workforce, financial security related to productivity-based compensation and increasing medical training-related debt, limited education on wellness, and fear of seeking mental health services due to stigma and potential negative impacts on the trajectory of one’s career. Limited data exist to quantify the impacts of these factors on the overall levels of burnout within radiation oncology specifically, and additional efforts are needed to understand and address root causes of burnout within the field. Strategies should focus on improving the systems in which physicians work and providing the necessary skills and resources to thrive in high-stress, high-stakes work environments.

The tic douloureux of Alexis Pujol (1739-1804).

In 1787, Alexis Pujol (1739-1804) wrote the first monograph exclusively on trigeminal neuralgia which he called "tic douloureux", or painful tic. Although it was not a seminal description, his monograph was a valuable clinical summary that helped his contemporaries make an exact diagnosis, even though it did not offer proven treatments. Unlike most in his day, Pujol adhered to the theory of electricity, seeing it as the vector of information transmission by the nerve. This made him a precursor and put him in a position to propose a novel pathophysiological theory of pain, not yet qualified as neuralgic. His thinking illustrates that, at the dawn of the nineteenth century, a provincial physician working alone was able to make his contribution to building medical knowledge, particularly in the field of neurology. After a brief biography of Pujol, this article will cite from his book to show the relevance of his clinical observations, which are still valuable today. Without omitting the inspiration, he took from his predecessors, this article also mentions the work of those who followed in his footsteps.