To evaluate caring for the poor and uninsured in divisions of general medicine (DGMs), and to document the impact of recent reimbursement changes on division ambulatory care activity, the authors conducted a survey of DGM directors. Questionnaires mailed to directors of 214 divisions or residency programs yielded 120 responses. DGMs staffed, on average, three ambulatory sites, with a median of 17,000 visits per site. Overall, 66% of visits were by poor, underinsured, and uninsured patients. The majority of directors (75%) considered care of the poor a goal of their divisions. The most commonly reported response to the cost containment environment was implementation of revenue-generating measures (66%); 19% reported reductions in care to the poor; and 20% reported increased service to this group. It is concluded that DGMs care for large numbers of poor and uninsured patients and therefore must carefully evaluate the impacts of current policy proposals on their future ambulatory care activities.

Ambulatory Care↗

PubMedDate not supplied

Human rabies postexposure prophylaxis during a raccoon rabies epizootic in New York, 1993 and 1994.

We describe the epidemiology of human rabies postexposure prophylaxis (PEP) in four upstate New York counties during the 1st and 2nd year of a raccoon rabies epizootic. We obtained data from records of 1,173 persons whose rabies PEP was reported to local health departments in 1993 and 1994. Mean annual PEP incidence rates were highest in rural counties, in summer, and in patients 10 to 14 and 35 to 44 years of age. PEP given after bites was primarily associated with unvaccinated dogs and cats, but most (70%) was not attributable to bites. Although pet vaccination and stray animal control, which target direct exposure, remain the cornerstones of human rabies prevention, the risk for rabies by the nonbite route (e. g., raccoon saliva on pet dogs' and cats' fur) should also be considered.

Adolescent↗

PubMedDate not supplied

Women in academic medicine: perceived obstacles to advancement.

To investigate perceived obstacles to the advancement of women in academic medicine, we sent a questionnaire assessing perceptions of the fairness and supportiveness of the academic environment to the 229 female teaching and research faculty of the School of Physicians & Surgeons at Columbia University. The overall response rate was 85%. Forty-six percent believed that they had not had the same professional opportunities as their male colleagues, 52% believed that salaries were not equivalent for men and women in similar positions, and 50% believed that promotions were awarded in a biased manner. Thirty percent reported that sexist behavior was common and that sexual harassment occurred in the workplace. Eighty-one percent experienced conflicts between their professional and personal lives and most believed that the institution failed to adequately address the needs of women with children. This survey indicates that there are significant perceived obstacles to the advancement of women in academic medicine that must be addressed.

Career Mobility↗