Medical School Physicians Research Articles

Abstract WP93: Academic Vascular Neurology - Lingering Effect Of Gender Inequity On Compensation, Career And Burnout

Introduction: Despite rising numbers of women physicians in medical schools and the workforce, gender inequity persist. This cumulates in disempowerment, burnout, limited career advancement and devaluation of women. The aim of this study was to explore the disparity among academic vascular neurologists in terms of compensation, career development and burn-out. Methods: A total of 19 academic neurology departments in the United States were sent a survey in 2021-2022 on demographics, career, compensation, equity, and burnout. There were 425 academic neurology faculty members who responded. This study analyzed the cohort of academic vascular neurology (AVN) faculty. Results: A total 47 AVN faculty were included, of which 62% (29) were women. Majority of the respondents were Caucasian (68%, n=32) and were instructors or assistant professors (55%, n=26). Among the AVN faculty, only 51% (n=24) were satisfied with their current compensation. Majority of those who were satisfied were men (54%, n=13). Majority of those who were dissatisfied were women (75%, n=15). The most common reason for dissatisfaction was compensation being below national benchmark or compared to colleagues. 59.5% of AVN faculty members, majority of whom are females, perceived lack of gender equity in pay. Implicit gender bias was reported to have a negative effect on career development by 23% of AVN faculty. Moderate to severe burn out was reported by 26% (n=12) AVN faculty, among which majority (75%, n=9) were females. Those who reported burnout have been AVN faculty for 5.9±3.3 years. Half of those who reported burn out was dissatisfied with compensation and have felt that gender bias affected their careers, while 67% indicated absence of career sponsorship and 42% had no mentorship. Conclusions: This study described specific disparities in compensation, burn-out and career development among academic vascular neurology faculty. This information offers preliminary information for academic vascular neurology programs to explore areas of improvement when it comes to AVN faculty pipeline development, recruitment and retention as it aligns with DEI efforts. Future studies should be done to explore how interventions can improve the disparities noted.

Academic Promotion of Physicians in Medical Schools: A Special Focus on Primary Health Care in Taiwan.

The quality and quantity of papers published in journals play a crucial role in achieving an academic promotion in medical schools. Reports on the criteria for promotion and their impact on different specialties, especially on primary health care, which has low research output, are rare. We investigated the scoring systems generally adopted for academic promotion at most medical schools in Taiwan. The weighted scores were derived from the multiplication of weights from categories of paper, journal impact factor, or ranking in a certain category by impact factor, and author order. To determine the thresholds of papers required for different levels of promotion, we took papers in the highest- or lowest-ranked journals in the primary health care category in 2019 Journal Citation Reports as examples. Considering publications in the highest-ranked journals, a median of 4.6 first or corresponding author papers were required for a professorship, as well as 3.3 for an associate professorship, and 2.5 for an assistant professorship. In contrast, a median of 30, 20, and 13.5 papers in the lowest-ranked journals was required for the corresponding positions. Thus, academic promotions for primary health care educators in Taiwan are highly demanding. The detrimental effects of scoring systems deserve further research.

Clinical and epidemiological characteristics of COVID-19 during the early phase of the SARS-CoV-2 pandemic: a cross-sectional study among medical school physicians and residents employed in a regional reference teaching hospital in Northern Italy.

The aim of the study was to evaluate the clinical presentation and burden of SARS-CoV-2 infections among medical school physicians and residents, mainly young medical doctors. The awareness of COVID‑19 clinical manifestations can improve the early detection of mild cases, possibly reducing further transmission to colleagues and patients. The study was carried out in March-May 2020, involving medical school physicians in a teaching hospital in northern Italy, with a working population of 881 medical doctors. Data collection was performed using a structured form investigating clinical and epidemiological information. One hundred sixty-two medical doctors contacted the Occupational Health Service reporting acute respiratory symptoms or close contact exposure to a confirmed COVID‑19 case. Among the confirmed COVID‑19 cases, most were male doctors during residency, and 85% presented a mild clinical picture. Fever (70.3%) and cough (51.4%) represented the most prevalent symptoms of COVID‑19. As revealed by the univariate analysis, the prevalence of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) positivity increased with age (OR = 1.08, 95% CI: 1.02-1.14, p = 0.012), working in a COVID‑19 ward (OR = 3.33, 95% CI: 1.09-10.21, p = 0.031), presenting alteration or loss of smell/taste (OR = 10.00, 95%CI: 2.80-35.69, p < 0.001) and myalgia (OR = 3.20, 95% CI: 1.00-10.26, p = 0.046), while being a resident (OR = 0.20, 95% CI: 0.05-0.80, p = 0.030) was associated with reduced odds of being infected, compared to staff physicians. Age and loss of smell/taste were the only factors independently associated with RT-PCR positivity. The majority of COVID‑19 cases showed a mild clinical syndrome, ranging from absence or paucity of symptoms to common cold or influenza-like symptoms. The findings of the present study increase the accuracy of the clinical diagnosis for the prompt identification and management of suspected COVID‑19 cases, being particularly useful during resurges of the SARS-CoV-2 pandemic. Int J Occup Med Environ Health. 2021;34(2):189-201.

Lessons in creating a rewarding career.

Lessons in creating a rewarding career.

An Empirical Investigation of the Differences Between Male and Female Medical School Physicians

The purpose of this research was to investigate gender-related differences among medical school faculty in a variety of areas such as information technology, medical malpractice, compensation, patient care, and carrier satisfaction. The Center for Studying Health System Change's 2008 Health Tracking Physician survey data consisting of 326 medical school faculty belonging to the American Medical Association were used in this study. t Tests indicate that female physicians practicing in medical schools were younger, had less experience, reported lower compensation, and were more likely to be primary care physicians. Male medical school physicians were significantly more concerned about being involved in a malpractice lawsuit. They reported a significantly higher percentage on income based on productivity-related factors. Male physicians also reported getting a significantly higher level of goods and services from drug companies. They also provided more hours of medical service for no or reduced fee in the previous month and higher levels of career satisfaction. Implications of this research are discussed.

The history of the rise and fall in importance of the clinicopathologic conference in American medicine

This article is a review of the history of the clinicopathologic conference, a teaching method used for and by physicians in medical schools and hospitals throughout the United States since the beginning of the 20th century.

Evidence-based medicine: discrepancy between perceived competence and actual performance among graduating medical students

Since at the time of graduation from medical school physicians are expected to demonstrate adequate professional competence including mastery of critical appraisal skills, we conducted a preliminary, cross-sectional, web-based study to examine the extent to which fourth year medical students in the US are competent in core areas of evidence-based medicine (EBM). Using self-assessment instruments, subjects (n = 150) were asked to demonstrate their ability to understand the practical meaning of key methodological and data analysis constructs as they relate to patient care, to rate their perceived competence in core areas of EBM and to disclose their attitudes toward critical appraisal of the literature and EBM. The mean score in our cohort was 55% suggesting that students may have knowledge gaps that interfere with their ability to critically appraise the medical literature. There was an apparent chasm between subjects’ perceived competence and their actual performance on the assessment instrument. These findings, if corroborated in larger studies, (1) suggest that better education in EBM is needed so as to avoid the possibility that patient care may inadvertently be jeopardized; and (2) cast doubt on the use of self-assessed knowledge as a proxy for actual skills with respect to EBM and medical decision-making.

RESOURCE UTILIZATION AMONG NEONATOLOGISTS IN A UNIVERSITY CHILDREN'S HOSPITAL. ▴ 1123

Objective. We studied factors affecting length of hospital stay and resulting hospital charges among patients managed by two separate groups of neo- natologists in the same academic health science center. Design. Retrospective analysis of clinical and finan- cial data base information. Methods. Neonatal intensive care was provided in the same acute care nursery in a large university chil- dren's hospital by: (1) neonatologists in a full-time aca- demic division (group A) and (2) a group associated with a private managed care organization (group B). Clinical and financial parameters of all neonates admitted in fiscal year 1994 were compared for the two provider groups. Stepwise regression analysis was used to evalu- ate factors influencing hospital charges and length of hospital stay (LOS) and to adjust for differences in clin- ical variables between the two groups. Results. Group A physicians provided care for 340 infants, while 137 were treated by those of group B. Group A included older patients, more outborns, more level III patients, more sepsis, more intermittent positive pressure ventilation, and more patent ductus arteriosus. The incidence of transient tachypnea of the newborn was higher among group B patients. Hospital charges were primarily determined by LOS, which was similar for the two groups. When the data were corrected for differences in risk and patient acuity, however, a significant relation- ship between physician group and LOS was demon- strated, with LOS being an average of 7.8 days shorter for group A. A net reduction of $3 114 969 in hospital charges might have been realized had group A physicians pro- vided care for all study patients. Conclusions. Hospital charges were determined by LOS. In this setting, academic neonatologists produced shorter LOS and comparable clinical outcomes, despite caring for a population at greater risk. The reduction in LOS could have resulted in more than $3.1 million in annualized savings had the academic group provided care for all of the study patients. Pediatrics 1997;99(6). URL: http://www.pediatrics.org/cgi/content/full/99/6/e2; resource utilization, hospital changes, length of stay, neo- natologists. ABBREVIATIONS. LOS, average length of hospital stay; PDA, patent ductus arteriosus. Steep increases in health care costs over the past decade have stimulated demands for cost contain- ment, particularly among large corporate purchasers of group health insurance. Numerous strategies for controlling health care costs have been marketed under the concept of managed care. Data are lacking regarding the impact of these market-driven health care strategies on children, particularly the care of the neonate. Academic health science center hospitals, includ- ing children's hospitals and their associated medical school faculty, often are depicted as being unable to deliver cost-effective health care. 1 Such institutions are deemed costly because of high rates of uncom- pensated care and cost shifting, personnel-intense and technology-oriented delivery systems, and their central role in development of innovative (and ex- pensive) new medical techniques. Patient care by medical school physicians is viewed as costly, and possibly inefficient, in comparison to the private sec- tor because of participation of physicians in training, detailed laboratory testing, and unwillingness to consider approaches that may compromise per- ceived standards of care. The high cost of neonatal intensive care is of particular concern. Despite the rhetoric surrounding these issues, little objective in- formation is available concerning the cost of neonatal care provided by academic physicians compared with physicians associated with managed care orga- nizations. Indicators most commonly used to analyze re- source utilization are hospital charges and length of hospital stay (LOS). Recent publications have em- phasized LOS as the primary determinant of cost of neonatal care 2,3 because of its relationship to low birth weight. Reduced costs have been demonstrated in association with nursery strategies that reduce LOS. 4,5

Changes in positions of authority held by US physicians: a fresh look at existing data.

Some experts contend that physicians have lost positions of authority in the past 40 years. Others argue the opposite, yet neither side bases its arguments on empirical data. This study examined longitudinal variables measuring authority positions held by physicians. Data on the relative position of physicians in medical schools show that medical doctors held 65.6% of the sampled positions in 1970 vs 72.8% in 1990. Yet, in the wider society and within the nonmedical school portion of the health sector, other data indicate that physicians occupy a smaller proportion of authority positions.

Conflict With Physician Pregnancy Revisited

A 10-year follow-up survey found medical school physicians (N = 200) at one institution were more interested in and accepting of pregnancy among colleagues. A greater number of physicians in 1990 than in 1980 reported that pregnant colleagues maintained their work efficiency and interest in medicine. Fewer physicians in 1990 reported being inconvenienced during a colleague's pregnancy, and fewer perceived hiring women of childbearing age to be a risk to the optimal functioning of their departments.

Development of a campus-based satellite medicine clinic.

The clinical facilities of many American medical schools are geographically separate from the main campuses of their parent universities. Traditionally, medical schools and teaching hospitals have made little effort to attract university faculty and staff members as patients. Academic medical centers have tried various strategies to maintain, expand, and broaden the patient population necessary for medical education, clinical research, and fiscal solvency. The University of California, San Diego, School of Medicine has established a campus-based ambulatory clinic to encourage university faculty and staff members to seek care from medical school physicians and to use its teaching hospital several miles away. This approach may be applicable to other institutions where the hospital and the major university campus are located at different sites.

Occupational health in Belgium

The author describes briefly the state of occupational health in Belgium. The organization and the activities of occupational health services and the legislation regarding the compensation of work accident and occupational diseases are first outlined. The training of occupational physicians in medical schools is also described as well as the trend of research activities in occupational health in Belgium.

Accelerated Medical Education

To the Editor.— I hope that Gullen is in no way involved in population control, for he states that the readoption of the Accelerated Program by medical schools would be a one-time bonus and not be recurrent ( 218 :742, 1971). If a woman produces a child every nine months for ten years, I trust Gullen will agree that the family would contain three more children than if one is produced only yearly. Despite the misgivings of the medical schools at that time, there is no evidence that physicians who graduated under the Accelerated Program during World War II are less qualified than their predecessors or successors. Two problems immediately arise to mind. First, full-time medical school physicians will have to spend more time teaching. Second, those curricula which have expanded to fill the summer terms (conforming to Parkinson's Law) may have to retrench. Nevertheless, this simple, proved, and inexpensive solution