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PubMed2001

Burn-out of urologists in the county of Schleswig-Holstein, Germany: a comparison of hospital and private practice urologists.

PURPOSE: Mental and physical burden of physicians, especially surgeons, is high. The degree of burn-out was estimated among urologists in the German federal county of Schleswig-Holstein, with special emphasis on differences related to age, qualification and hospital versus private practice. MATERIALS AND METHODS: The Maslach Burnout Inventory was mailed to all urologists and urologists in training registered in the county of Schleswig-Holstein to determine the frequency and intensity of the 3 burn-out subscales of emotional exhaustion, depersonalization and low personal accomplishment, together with a questionnaire covering demographic data. RESULTS: Of 128 urologists 75 (58.6%) replied. Levels of burn-out in the subscales of emotional exhaustion and depersonalization were increased among hospital urologists, urologists in training and urologists younger than 45 years. Urologists in private practices, fully trained urological specialists and urologists older than 45 years showed a low degree of burn-out, corresponding to normal values, whereas young urologists in training and working in hospitals had the highest risk of burn-out. The personal accomplishment level was generally high in all groups. CONCLUSIONS: The constellation of being a urologist in private practice and older than 45 years appears to provide some protection against burn-out that might be due to a more personal relationship to the patients, lesser hierarchical situation and workload related income. In times of increasing pressure on the health care system, the personal situation of physicians in training should not be overlooked.

Adult↗
PubMed1998

Chronic depression: a case series of 203 outpatients treated at a private practice.

OBJECTIVE: To determine the prevalence of chronic depression among outpatients seen for depression. DESIGN: Case series. SETTING: Private practice. PATIENTS: Two hundred and three outpatients with mood disorders, excluding patients with comorbid substance abuse disorders and severe personality disorders. OUTCOME MEASURES: Prevalence rate and patient variables (diagnosis, age at baseline, age at onset, sex, number of previous episodes of depression, atypical features, psychiatric comorbidity, psychosis, duration of illness and baseline severity). RESULTS: The prevalence of chronic depression was 46.7%, which is higher than previously reported. The number of depressive episodes was higher, the presence of psychotic symptoms was more common and the duration of illness was longer in patients with chronic depression than in those with nonchronic depression. CONCLUSIONS: Chronic depression is more severe than nonchronic depression and is a prevalent illness in outpatients with depression seen in private practice.

Chronic Disease↗
PubMed1992

Evils in the private practice of psychotherapy.

The private, and especially solo, practice of psychotherapy often poses conflicts of interest between patient and therapist, which, because of the field's ambiguities and equivocal guidelines, may tend to be resolved in favor of the therapist and to the detriment of the treatment. The author delineates these potential conflicts so that awareness and training can minimize their pernicious effects.

Ethics, Professional↗
PubMedDate not supplied

Clinical similarities and demographic differences between residency and private practice patients.

BACKGROUND: This study compared the clinical and demographic mix of patients at a family practice residency site in South Carolina to those from other regions and demonstrated the effectiveness of a computerized medical record in facilitating such analysis. METHODS: Patient visits to Richland Family Practice Center (RFP), the outpatient care site for the University of South Carolina School of Medicine, were retrospectively sampled for the period July 1992-June 1993. Data analysis used descriptive statistics and contingency tables. A time test comparing manual and computerized data retrieval was also performed. RESULTS: The patients seen were predominantly female (75.2%) and African-American (68%). RFP treated proportionately more federally funded and minority patients than did community-based physicians. The top five principal diagnoses at RFP were hypertension, diabetes mellitus, general medical examination, normal pregnancy, and acute upper respiratory infection; the top 20 principal diagnoses accounted for 51.3% of all visits. When compared to the top 20 diagnoses for all family and general practice physicians in the southern United States, considerable overlap was present, confirming clinical similarity between patient populations at residency and private practice sites. Computerized data retrieval was faster and more complete than manual data retrieval. CONCLUSIONS: Diagnoses encountered at RFP and reported by other family practice residencies generally parallel those documented in family practice in various geographic regions. However, residencies differ from private practices in that they care for more economically disadvantaged patients. Computerized medical records systems facilitate research within a residency program.

Adolescent↗
PubMed2000

Ten-year follow-up survey of clinical neuropsychologists: part II. Private practice and economics.

Analyses of a 10-year follow-up survey of clinical neuropsychologists demonstrated significant changes in employment settings away from institutions, placing a clear majority of the field in private practice settings in 1999 (Sweet, Moberg, & Suchy, 2000). The present paper compares characteristics of practices and beliefs of clinical neuropsychologists who work in institutions versus private practice, using data from 1989, 1994, and 1999. Previous survey data had not been analyzed along the dimension of work setting. Among the significant findings are differences in age, referral sources, hours per week engaged in specific professional activities (clinical, neuropsychological, forensic, supervisory, research, teaching), ages of patients, type and frequency of data gathered in assessments, hours spent per evaluation, use of an assistant to gather data, and journal subscriptions. Economic changes within the last 5 years have had a differential impact for the two groups in terms of yearly income and hourly reimbursement. However, approximately half of the neuropsychologists in both groups have increased hours performing clinical work, hours performing administrative duties, and patient load to compensate for economic changes in the last 5 years. Decreases in clinical research and teaching activities are apparent in both groups, but in different amounts.

Female↗
PubMedDate not supplied

A target-based model for increasing influenza immunizations in private practice. Genesee Hospital Medical Staff.

OBJECTIVE: To measure the impact of a population-based tracking system on influenza immunization rates. DESIGN: Thirteen practices with 45 physicians were randomized to a control and two intervention groups. SETTING: Private practices. PATIENTS: All patients aged 65 years and over who were seen in participating physicians' practices within the preceding two years. INTERVENTION: In both intervention groups influenza immunization rates for physicians were recorded weekly as cumulative percentages of their target populations, using a specially prepared poster. In addition, postcard reminders were sent to all the patients in one of the intervention groups. MEASUREMENTS AND MAIN RESULTS: Immunization rates in the two intervention groups were 30% higher than in the control group; the control group immunized 50% (2,405/4,772) of its target population, while the poster and poster/postcard groups immunized 66% (1,420/2,149) and 67% (2,427/3,604), respectively. CONCLUSION: A population-based strategy that monitors performance can significantly improve rates of influenza immunization in private practices.

Aged↗
PubMed2004

Motivation and values of hospital consultants in south-east England who work in the national health service and do private practice.

In the UK, a small private health care sector has always existed alongside the national health service (NHS). The conventional assumption is that doctors who work as salaried employees of the NHS are guided in their clinical practice by professional values which encourage them to put their patients' interests first. A common suspicion is that doctors undertaking fee-for-service practice in the private sector are motivated by self-interest, with commitment to their patients compromised by consideration for their purse. The great majority of hospital consultants are salaried employees of the NHS, but most also undertake some private practice. This paper uses findings from an interview study of 60 surgeons and physicians engaged in dual practice of this kind to investigate their reasons for working in this way and look at how they reconcile their personal, professional and public sector values and responsibilities with the temptations of the market. The existence of the private sector and their own engagement in it was regarded by almost all respondents as a net benefit, not only to themselves and their private patients, but also to the NHS, so long as they handled it properly. The interviews revealed a complex range of beliefs and assumptions through which these doctors justify their activities and a variety of informal principles for dealing with such conflicts of interest as they acknowledge. Neither their values nor their actions can be adequately explained using generic concepts of professional self-interest or public service values without consideration of what such concepts represented in the specific social, economic, professional and policy context of health care in south-east England at the time of the study.

Career Choice↗
PubMed1998

Managed care's impact on the financial well-being of social workers in private practice.

The authors used the rosters from the Register of Clinical Social Workers, the American Psychological and American Psychiatric Associations to contrast a random sample of 167 private practicing social workers, 158 psychologists and 187 psychiatrists from across the nation with respect to changes in these practitioners' financial well-being since joining managed care organization panels. Although no statistically significant differences were found between the three groups with respect to many indicators of financial well-being, each of the groups reported that their financial well-being had been adversely affected by managed care organization guidelines. Because the social workers in this study were found to spend a greater percentage of their time in private practice than psychologists and psychiatrists, managed care organizations' policies with respect to financial reimbursement are likely to impact them more adversely than professionals in other disciplines. Other changes in overhead costs, including office staffing, record keeping and malpractice insurance, as required by managed care organizations, were considered by many of the respondents to be among the most prominent issues affecting their financial well-being.

Educational Status↗
PubMed1992

Problems in performing a double-blind multicenter study using a hypnotic in private practice.

1. The procedure described--the immediate data transfer and entry system (ITES)--is suitable to improve the quality of data collected in multicentre studies in private practice. 2. The results of the study show that regarding influence on sleep quality and daytime well-being the non-benzodiazepine Z is significantly superior to placebo and slightly superior to the benzodiazepines F and T. 3. The advantage of Z treatment is the better daytime well-being after taking the hypnotic for sleep induction the night before. 4. This study shows that a quality standard equal to that in clinical practice may be achieved in private practice.

Adolescent↗
PubMedDate not supplied

A comparison of phenytoin dosing methods in private practice seizure patients.

In an attempt to evaluate the accuracy of phenytoin (PHT) pharmacokinetic dosage adjustments in a private practice setting, three single dose-concentration pair methods and three multiple point PHT pharmacokinetic dosing methods were studied. Dose and concentration data from 28 patients seen in a private neurology practice were utilized for the study. From a comparison of these methods in private practice seizure patients, it appears that the Bayesian feedback method may be the most accurate in making routine PHT dosage adjustments, perhaps by minimizing the contribution of unknown variables within the Bayesian approach.

Humans↗
PubMed2005

[Consultations with specialists in private practice in a Norwegian district].

BACKGROUND: After the Norwegian hospital reform of 2002, there has been increased acceptance of private-sector health-care providers. Still, the use of specialist services in private practice is less well documented. This article explores the use of private specialist health care in the south-east of Norway. MATERIAL AND METHODS: The article is based on several sources of data, including data from the Norwegian Patient Register and from the National Insurance Administration on reimbursements. Also a survey was sent out to a sample of general practitioner; in-depth interviews were carried out with a sample of hospital physicians and private specialists. RESULTS: The article shows that private specialists with contract with Helse Øst provided 151 consultations per 1000 inhabitants over the period September to November 2003, while the public outpatient clinics provided 186 consultations. The service provision varies geographically and between specialties. In one county the use of private specialists is 174 consultations per 1000 inhabitants; in another it is 80 per 1000 inhabitants. Private-sector specialists within the fields of eye, ear-nose-throat and skin provided two thirds of all outpatient services in their respective fields. INTERPRETATION: The results indicate that the services of specialists in private practice should be more focused on and discussed in relation to integrated healthcare and the relationship between specialised hospital services and primary healthcare.

Ambulatory Care↗
PubMed2003

The difficult patient in private practice physiotherapy: a qualitative study.

This qualitative study utilised the nominal group technique to identify a typology of the difficult patient in private practice physiotherapy and to determine strategies physiotherapists use, and would like to improve, when dealing with such patients. The two areas physiotherapists found most difficult to manage were behavioural problems of patients and patient expectations. Few differences were evident regarding ranking of difficult patient attributes between the experienced (n = 19) and less experienced (n = 18) physiotherapists except for the categories of pain and diagnosed psychological problems. While less experienced physiotherapists ranked the pain category highly, experienced physiotherapists did not identify this category. Further, more experienced physiotherapists specifically distinguished between patients with diagnosed psychological problems and patients with psychosocial concerns, while less experienced physiotherapists did not, and placed both these issues into one category. To assist in their interaction with difficult patients, physiotherapists (n = 37) identified that communication skills and behaviour modification techniques were strategies that they would like to learn more about. The results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy.

Attitude of Health Personnel↗
PubMed2005

Symptom correlates of MMPI-2 scales and code types in a private-practice setting.

The purpose of this study was to determine empirical symptom correlates of MMPI-2 (Butcher et al., 2001) scales for private-practice clients, a very understudied yet important population. We examined the scores of 240 male and 407 female clients on the Clinical scales, Content scales, Supplementary scales, and frequently occurring code types. We used a factor analyzed version of the Adult Clinical scales of the Multiaxial Diagnostic Inventory (Doverspike, 1990) as a criterion measure. The results generally indicated that the symptom correlates for the MMPI-2 scales and code types were quite similar to those that have been previously reported in other outpatient and inpatient settings. We concluded that descriptors of MMPI-2 scales and code types generated in other settings may be used when interpreting MMPI-2 profiles of private-practice clients.

Female↗
PubMed1995

Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community.

OBJECTIVE: The purpose of this study was to compare the obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives, supervised by a private practice group of four obstetricians, with the obstetric outcome of that group's private practice patients. STUDY DESIGN: A retrospective cohort study was performed. Obstetric outcome of 496 clinic patients was compared with that of 611 private patients in the same community from Aug. 1, 1991, to March 31, 1994. RESULTS: Obstetric outcomes as measured by (1) perinatal morbidity and mortality, (2) Apgar score, (3) birth weights, and (4) prematurity rates were comparable between the two groups. Significant was the cesarean section rate of 13.1% (10.5% primary) for the clinic patients and 26.4% (18.5% primary) for the private patients and the high percentage (81.8%) of private patients who elected to have repeat cesarean sections. CONCLUSIONS: (1) Low-income, uninsured, and underinsured women who have access to excellent prenatal care with supervised certified nurse-midwives can have obstetric outcomes similar to women having prenatal care with private obstetricians. (2) Prenatal care with supervised certified nurse-midwives can reduce the cesarean section rate without compromising infant outcome. (3) Utilization of certified nurse-midwives supervised by obstetricians may provide the optimum model for perinatal care, particularly for those women who are at high risk because of social and economic factors and who are currently underserved.

Adult↗
PubMed1979

Illness behavior and depression compared in pain center and private practice patients.

Recent descriptions of illness behavior and personality factors in chronic pain patients reflect patient populations at clinics dealing with refractory, multiple referral pain problems. Pain patients from the University of Washington Pain Center were compared with patients from a private practice clinic with regard to illness behavior and depression. Private practice patients were significantly less depressed, showed less conviction of disease, general hypochondriasis, affect disturbance and were less somatically focussed than the Pain Center patients. Physicians in general practice treating pain patients should avoid forming stereotypes of chronic pain patients based on the experiences of referral clinics, for such characterizations may lead them to weigh psychologic factors too heavily in diagnosis.

Adolescent↗
PubMed1998

Health promotion in different medical settings: women's health, community health and private practice.

This paper describes the health promotion role of doctors in two medical practice settings: women's and community health centres, and fee-for-service practice. It proposes the establishment of divisions of primary health care in Australia which would be multi-disciplinary and focus on community-wide health issues. The paper is based on data from an interview survey of medical practitioners who had worked in metropolitan Adelaide women's and community health centres and from a questionnaire survey of GPs in private practice. The types of health promotion activity by the doctors in the different settings are discussed. It is concluded that private practice GPs are involved primarily in providing health education advice to individual patients. Doctors within women's and community health centres are more likely to report involvement in group health promotion activity and broader community development initiatives. The study concludes that health promotion which focuses on the health of the local community is best conducted within multidisciplinary health centres. GPs in private practice are limited by the structure of their setting (particularly the fee-for-service basis and reliance on a single discipline) to health promotion which focuses on the needs of individual patients.

Attitude of Health Personnel↗