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HMOs and the medical groups that they contract with are increasingly developing hospitalist delivery models to assist them with their inpatient care. This article offers a case study of how not to create a hospitalist program as well as tips for success.
Results of the 2001 Physician Executive Compensation Survey are in and they show that physician executives working in practice/hospital management companies or single specialty groups earn the highest pay. Physician executives with advanced degrees appear to earn more, as well.
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The authors describe the major findings of a 1978 national survey of 4,500 physician's assistants. Seventy-four percent of the respondents were working in primary care specialties, and two-thirds were located primarily in institutions rather than private practice settings. Almost half (47 percent) of the respondents were working in communities of fewer than 50,000 persons. Physician's assistants were more likely than physicians to be working in nonurban areas. The average income of a physician's assistant in 1978 was $17,611, and there was little variation by major specialty or practice-setting categories. Since 1974 there appeared to have been a shift within the profession toward employment in family practice, in institutional settings, and in urban areas. There also had been a notable increase in numbers of women, persons with more extensive educational backgrounds, and persons with civilian allied health backgrounds in the physician's assistant profession.
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Is there any congruence between vocational training as general practitioner and the needs of patients in primary care in Switzerland? What are the respective needs in the next century? These questions are discussed, based on the personal experience of the author after having completed his vocational training as general practitioner, on three years of experience as research fellow in a descriptive, cross-sectional and observational study of 300 consultations on the premises of six general practitioner-investigators and on a review of key research literature. Controversial views on the potential and the gaps in today's primary care are shown, focused on definition, training and research in the field of general or family practice. Of a broad range of experiences, two are pointed out: significant interindividual differences in practice patterns in primary care and emerging differences between primary care and teaching hospital medicine. The exceptional potential of primary care consultations has much to contribute to needed reforms in medical education and the health care system for the 21st century. Primary-care-based research and training will develop improved skills e.g. in communication, medical decision-making and patient management. Primary care is a discipline which includes insecurity and individuality; therefore, open questions and constant changes will be part of present and future for us and our patients.
OBJECTIVE: To examine current trends in practice organization among postresident patient care physicians in the United States. DESIGN AND SETTING: The American Medical Association's Socioeconomic Monitoring System (SMS), a series of periodic surveys of nationally representative samples of nonfederal postresident patient care physicians. Physicians were divided into 3 categories based on the organization of their main practice. They were classified as employee physicians if they had no ownership interest in their practice, as self-employed solo physicians if they were in 1-physician practices in which they had an ownership interest, and as self-employed group physicians if they were in multiple-physician practices in which they had an ownership interest. PARTICIPANTS: Nonfederal, postresident patient care physicians who provided more than 47 000 responses to SMS surveys between 1983 and 1994. MAIN OUTCOME MEASURE: The proportion of nonfederal postresident patient care physicians who were employees between 1983 and 1994. RESULTS: Between 1983 and 1994, the proportion of patient care physicians practicing as employees rose from 24.2% to 42.3% (P<.001), the proportion self-employed in solo practices fell from 40.5% to 29.3% (P<.001), and the proportion self-employed in group practices fell from 35.3% to 28.4% (P<.001). Most of these changes occurred in the latter half of the 12-year period. These trends, which are evident in virtually every segment of the patient care physician population, are especially prominent among young physicians. The growing proportion of employee physicians is associated with increases in the earnings of employee physicians relative to those of self-employed solo physicians. CONCLUSIONS: Current trends in the US health care system are rapidly changing the career opportunities of patient care physicians and, hence, physicians' choice of practice arrangement.
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The new proton therapy facility is being assembled at the Paul Scherrer Institute (PSI). The beam delivered by the PSI sector cyclotron can be split and brought into a new hall where it is degraded from 590 MeV down to an energy in the range of 85-270 MeV. A new beam line following the degrader is used to clean the low-energetic beam in phase space and momentum band. The analyzed beam is then injected into a compact isocentric gantry, where it is applied to the patient using a new dynamic treatment modality, the so-called spot-scanning technique. This technique will permit full three-dimensional conformation of the dose to the target volume to be realized in a routine way without the need for individualized patient hardware like collimators and compensators. By combining the scanning of the focused pencil beam within the beam optics of the gantry and by mounting the patient table eccentrically on the gantry, the diameter of the rotating structure has been reduced to only 4 m. In the article the degrees of freedom available on the gantry to apply the beam to the patient (with two rotations for head treatments) are also discussed. The devices for the positioning of the patient on the gantry (x rays and proton radiography) and outside the treatment room (the patient transporter system and the modified mechanics of the computer tomograph unit) are briefly presented. The status of the facility and first experimental results are introduced for later reference.
Controversy has arisen regarding the length and nature of the preoperative fast that should be required of patients with normal gastric emptying time undergoing elective surgery. Various studies and editorials have indicated that the traditional preoperative fasting policy of "NPO after midnight" may be illogical as it makes no distinction between solid foods and clear fluids. Successive National Surveys conducted in the United States of America (USA) have shown an increasing number of Ambulatory Surgery Hospitals adopting more liberal preoperative fasting guidelines. Jamaican practitioners have also begun implementing some of these new liberal practices, even in institutions where "NPO after midnight" remain the official policy of the institution in which they practice. This has created a discordance between individual practice and institutional policy. In view of the fact that the extent of this discrepancy has not yet been studied and documented in Jamaica, and in an effort to better characterize the nature of the changes taking place in preoperative fasting practices in Jamaican hospitals, including those related to knowledge and attitude of practitioners, we embarked on this National Survey. The survey consisted of a questionnaire comprised of 13 questions which were to be completed by all surgeons and anaesthetists practising in a wide cross-section of public hospitals throughout Jamaica, providing an initial sample size of 201 subjects. We had a response rate of 74%, or 148 responses. At all the hospitals surveyed, the traditional NPO policy continued to be the official institutional policy. However, at the individual level, 37% of respondents had already revised their policy, and were allowing their patients to have clear fluids up to three hours before the induction of anaesthesia. Also, 66%, 68%, and 73% of respondents stated that, in the future, they were prepared to allow their patients a solid meal up to eight hours, light breakfast up to six hours, and clear fluids up to three hours, respectively. We concluded that, whilst the traditional NPO policy remained firmly entrenched at the institutional level, many anaesthetists and surgeons show a positive inclination towards more liberal fasting practices. We recommend the formation of a local task force to determine what aspects of the new liberal guidelines may be safely and effectively adopted, taking account of local circumstances.
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