Private Office Practice Research Articles

Office laboratory tests. Perceptions of profitability.

Theoretic modeling suggests that common office tests as a group are profitable. To determine whether practicing internists perceive this profitability and whether their perceptions differ for different tests or for patients with different types of insurance coverage, the authors surveyed 111 physicians in private office practice. Respondents' estimates of receipts for tests done on patients with Medicare or Blue Cross/Blue Shield coverage were higher than their estimated costs for the testing. Estimates of receipts from Medicaid patients were lower than estimated costs of testing. After standardizing the estimated receipts from patients with different insurance coverages, the authors found that the average estimated profits for different tests on an "average insured patient" varied sixfold, from $5.99 for an electrocardiogram to $1.01 for a urinalysis. The authors suggest that perceived financial incentives are extremely variable by test. Different insurance coverages are perceived as providing varying financial incentives for testing; Medicaid provides a disincentive. Appropriate reform of the existing fee schedules should be selective by test and coverage.

Treatment of Staphylococcus aureus infections in children in office practice.

One hundred five Staphylococcus aureus infections occurring in 79 children who were seen in a private office practice were evaluated for response to antibiotic therapy. The value of in vitro disk susceptibility testing in directing antibiotic selection in treatment failures was also examined. Of the total episodes studied, the types of infection studied included vesicular pyoderma (48%), secondary pyoderma (13%), bullous pyoderma (5%), furunculosis (14%), carbunculosis (12%), cellulitis (3%), suppurative otitis media (4%), and paronychia (2%). Comparative treatment efficacy was obtained with perioral erythromycin estolate and erythromycin ethylsuccinate, cefaclor and cephalexin, and clindamycin hydrochloride and dicloxacillin sodium. Penicillin V potassium, ampicillin, and topical bacitracin were generally ineffective. In 23 patients, 27/105 infections were initial treatment failures. Antibiotic disk susceptibility testing predicted these clinical failures and/or the antibiotic that would produce a clinical response in 21 of these 23 patients, suggesting that this office procedure can be of considerable value.

Psychiatric perspectives on psychotherapy

D URING MODERN TIMES, psychotherapy has held a central position within the practice of psychiatry. Recently, numerous questions have been raised regarding the efficacy and efficiency of the many psychotherapies. In order to clarify the continued importance of psychotherapy in psychiatric practice, this article presents a framework delineating the focus and goals of psychotherapy within four major task areas: medical, rehabilitative, educative-developmental and societal-legal. Within these areas, the physician-patient role relationship, and the perspectives that are adopted will be examined so that the many approaches to psychotherapy can be better understood. From the end of World War II until the mid 1960s psychotherapy generally was viewed as the most sophisticated tool in psychiatry’s technologic armamentarium. Within many psychiatric educational programs, proficiency in developing the skills required to become a competent psychotherapist was a central training goal. The 1960s witnessed a period of major social experimentation, some of whose programs had major impact upon psychiatry and psychotherapy. The passage of the Medicare, Medicaid and Community Mental Health Center Acts dramatically increased accessibility of services and changed the financing and structures of health care delivery. In psychiatric practice the consequences were enormous. In 1955, approximately 1.7 million episodes of care were provided with one-half of these services occurring in inpatient state and county mental hospitals. Less than one-quarter of the 1.7 million episodes in that year were provided in ambulatory mental health facilities. In 1975, almost 6.4 million episodes of care were provided in mental health facilities. The vast majority of these services were outpatient services. Community mental health centers accounted for 29% of services and organized outpatient psychiatric services accounted for 47% (about 20% of the total episodes were seen in private office practice). ’ During this period, insurance coverage for psychiatric illness and disorders was significantly increased, and ambulatory services were more adequately covered. In the early 1960s it was anticipated that the number of psychiatric patients presenting for service would massively exceed the capacity of psychiatrists to care for them, a prediction clearly borne out by history. Thus, the federal government began programs to dramatically increase the number and types of available nonmedical practitioners. The NIMH sponsored training for members

Nodular Secondary Syphilis

The great imitator of yesteryear is still with us, although syphilis is not a common disease in private office practice. When syphilis produces unusual skin lesions, the diagnosis is often delayed. We report an illustrative case of a middle-aged man who had a recent history of red nodules and indurated plaques on his arms and genitalia and in which the clinical diagnosis was lymphoma. The presence of syphilis was considered almost as an afterthought. <h3>Report of a Case</h3> A 57-year-old man originally consulted one of us (W.R.G.) because of a four-month history of asymptomatic nodules and plaques that had initially developed on the genitalia and, subsequently, involved the arms and hands. The patient's general health was excellent; he had no complaints of lymphadenopathy, fever, chills, weight loss, sore throat, skin ulcers, or respiratory problems. The initial diagnostic considerations were lymphoma, sarcoidosis, deep fungus infection, and, remotely, syphilis. Results of physical

Predicting individual phenytoin serum levels of patients seen in a private office practice.

We evaluated the practicality of predicting phenytoin serum levels in an office practice. Once two phenytoin serum levels were obtained on two different dosage regimens, a table of future doses and predicted serum levels was calculated and plotted on a graph. Subsequent dosage adjustments resulted in serum levels that correlated well with predictions. In 7 of 10 patients, the predicted serum levels were within 2 micrograms per milliliter of the actual values. To improve compliance, the plot was used as a visual aid in patient education.

Computerization of intraocular lens data.

We have developed a method of computerization to collect intraocular lens research data in a private office practice. More than 30 separate variables are now being collected on all patients, and over 1300 cases have been studied. Information is transcribed from patient records to data sheets and typed directly into an office Teletype 43 terminal, which is connected by an acoustic coupler to an IBM 370-148 computer. The data are stored in a systems library which is equipped with an editing mode for rapid updating and addition of data. It also allows jobs to be submitted and returned through the remote terminal. The system is compatible with a statistical package which allows a wide range of statistical analyses.

Transformation of a hospital clinic to a private office practice.

Transformation of a hospital clinic to a private office practice.

Computed tomography in a private practice office.

Since 1975, the author examined over 6,000 outpatient and hospital inpatients with computed tomography in a private practice CT office. The patients were referred by 368 physicians and 26 hospitals. A CT center in a private radiology office available for immediate utilization by several hospitals and many physicians is an effective method of controlling costs and containing unnecessary capital equipment expenditures, and contributes to the preservation of the private practice of radiology and medicine.

Psychiatrists and Their Patients: A National Study of Private Office Practice.

Psychiatrists and Their Patients: A National Study of Private Office Practice.

Ambulatory care in one community

We present a profile of the people who use ambulatory services, their reasons, the settings, and at what cost, for a community probability sample of 2,147 adults. The panel design was based upon two interviews four weeks apart; 37% of the sample (804 persons) recalled one or more visits to an ambulatory care setting in the previous four weeks. Symptoms of an illness were responsible for more than 75% of these visits; a physician was seen at 88% of visits, and the most frequent setting visited was the private practice office (91%). Although only a small proportion of the total number were visits to a nurse or physician's assistant, such visits were more convenient in terms of travel and waiting time, and the charges were only half those of the physician visits. There were also differences in visit charges for the general practitioners as compared with specialists.

Review of Psychiatrists and their patients: A national study of private office practice and Varieties of psychotherapeutic experience: Multivariate analyses of patients' and therapists' reports.

Review of Psychiatrists and their patients: A national study of private office practice and Varieties of psychotherapeutic experience: Multivariate analyses of patients' and therapists' reports.

Distribution of Private Practice Offices of Physicians with Specified Characteristics Among Urban Neighborhoods

The office location of New York County physicians in private practice is determined for a verified subpopulation of the "Medical Directory of New York State" listing for the year 1970-71. Physicians are categorized by specialty status, medical schools attended, dates of graduation, and hospital affiliations. Multiple regression analysis is performed to relate numbers of physicians per Health Area (average population: 20,000) to demographic, economic, and medical care characteristics of the areas. There is considerable unevenness in the number of private physician offices among Health Areas (mean, 66; standard deviation, 173; range, 1 to 1,043). Multiple regression analysis shows a strong, positive association between practice location and median area income. The influence of population size on practice location is also found to be significant for many categories of physicians but less strong than that of income. Other independent variables are found to have a weaker to nonsignificant impact on practice location. Disaggregation of physicians into specified categories reveals differences in elasticity of location estimates that would have gone undetected had only the aggregated physician population been investigated. Itis concluded that policy decisions concerning physician distribution should be made on the basis of data on smaller areas than has been done in the past, and on specified categories of physicians rather than on aggregates.

Psychiatrists and Their Patients: A National Survey of Private Office Practice

Psychiatrists and Their Patients: A National Survey of Private Office Practice

&lt;bold&gt;Psychiatrists and Their Patients: A National Study of Private Office Practice&lt;/bold&gt;. By Judd Marmon. Washington, D.C. : Joint Information Service of the American Psychiatric Association and the National Association for Mental Health, 1975. 181 pp. $7.50

Psychiatrists and Their Patients: A National Study of Private Office Practice. By Judd Marmon. Washington, D.C. : Joint Information Service of the American Psychiatric Association and the National Association for Mental Health, 1975. 181 pp. $7.50 Psychiatrists and Their Patients: A National Study of Private Office Practice. By Marmon Judd. Washington, D.C.: Joint Information Service of the American Psychiatric Association and the National Association for Mental Health, 1975. 181 pp. $7.50. Donald Brieland Donald Brieland Search for other works by this author on: Oxford Academic PubMed Google Scholar Social Work, Volume 21, Issue 2, March 1976, Page 173, https://doi.org/10.1093/sw/21.2.173 Published: 01 March 1976

Vulvovaginitis and Other Local Lesions of the Vulva

Vulvovaginitis is the most common gynaecological lesion seen in children, both in hospital clinic practice and in private office practice. The causes for this are multiple and one should seek the aetiology before therapy is instituted. The complete diagnostic workup done on some of the patients is outlined. However, we find the practical approach to vulvovaginitis in children which begins with simpler procedures and reserves the more complicated and expensive diagnostic procedure for later to be worthwhile. This works nicely in office practice in our hands.

PEDIATRIC PRACTICE IN THE UNITED STATES

This is a report of a mail survey undertaken on behalf of the Subcommittee on Pediatric Manpower of the Council on Pediatric Practice of the American Academy of Pediatrics. Its purposes were: (1) to collect information about how practitioners of pediatrics utilize their own time and that of other health workers for the performance of specific tasks carried out in the course of ambulatory pediatric care; (2) to ascertain the degree to which practice characteristics, including task delegation, were related to characteristics of the physician, his practice arrangement and his practice load; and, (3) to sound out general pediatric opinion concerning task delegation in ambulatory pediatric care. The genesis of this survey and its relationship to current health manpower shortages have been discussed elsewhere.1 Prior to this survey no information on a national basis had been available concerning the extent and nature of task delegation in pediatric office practice or the opinions of pediatricians about this subject. Although most American children receive preventive and therapeutic health care from physicians in private office practice, extraordinarily little information about the characteristics of this system of care is available. A structured, precoded questionnaire was designed to collect the desired information. In the summer of 1967, the first version was pretested on 273 Regular Fellows of the Academy of Pediatrics residing in Massachusetts and a 2% random sample of Fellows residing in the other 49 states and the District of Columbia. The results of this major pretest have been described elsewhere. Slight modifications were made in the original version of the questionnaire and the revised version was mailed in the late fall of 1967 to 6,820 Regular Fellows of tile American Academy of Pediatrics residing in the United States.

PRIVATE OFFICE PRACTICE

Acta Psychiatrica ScandinavicaVolume 45, Issue S211 p. 53-57 PRIVATE OFFICE PRACTICE First published: February 1970 https://doi.org/10.1111/j.1600-0447.1970.tb02061.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume45, IssueS211February 1970Pages 53-57 RelatedInformation

Medical Staff Organization and Administration

In our society today, the medical staff of a voluntary nonprofit hospital is an organizational anomaly. The individual physicians in most communities are private entrepreneurs. They establish a private practice in any location in the community that they want. They determine for themselves exactly what services they will provide in their own office. Their existence in their own office practice is relatively uncomplicated and unregulated. However, physicians are considered part of a profession that has both moral and social obligations to the community in which they live. Because of this, they must participate in activities affecting the entire community and not just that portion they see in their private office. From the beginning, physicians live in a dichotomous world. The first aspect of the dichotomy is expressed in their private office practice. The second facet is expressed in their use of the hospital. It is in the hospital setting that

Medical staff organization and administration

In our society today, the medical staff of a voluntary nonprofit hospital is an organizational anomaly. The individual physicians in most communities are private entrepreneurs. They establish a private practice in any location in the community that they want. They determine for themselves exactly what services they will provide in their own office. Their existence in their own office practice is relatively uncomplicated and unregulated. However, physicians are considered part of a profession that has both moral and social obligations to the community in which they live. Because of this, they must participate in activities affecting the entire community and not just that portion they see in their private office. From the beginning, physicians live in a dichotomous world. The first aspect of the dichotomy is expressed in their private office practice. The second facet is expressed in their use of the hospital. It is in the hospital setting that

Year Book of Nuclear Medicine,

Of the 18 Year Books in the various fields of medicine, all but two concern well-recognized specialties or subspecialties of clinical practice. One of the two mavericks is this newest addition to the family, and its appearance certainly justifies the query—just whatisnuclear medicine? This is a legitimate question. I know of no one in the United States whose sole source of income derives from the private office practice of nuclear medicine (although it would be nice to know that such a practitioner exists). There is no American Board of Nuclear Medicine. If you cannot taste it, smell it, or see it, how can you write about it? Marshall Brucer, that venerated but still youthful parent of this foundling, has defined nuclear medicine as amixeddisciplineemphasizingradioisotopes in diagnosis and therapy ( italics mine), and the contents of this volume bear out these points. Here we find the