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PubMed1990

The controllable lifestyle factor and students' attitudes about specialty selection.

Questionnaires were distributed to 346 fourth-year students in nine medical schools. The students were asked to state their selected specialty and to rank the importance that each of 25 influences, listed as questionnaire items, had had in making their choice of specialty. Factor analysis showed that particular items were significantly associated with particular factors. The first factor emphasized perceived lifestyle (items in this category gave importance to remuneration, personal time, and prestige); the second factor emphasized cerebral activities and a practice orientation; and the third factor stressed altruistic values and attitudes. The authors classified the selected specialties into three groups: those characterized as having a non-controllable lifestyle (NCL), those with a controllable lifestyle (CL), and surgery. (CL specialties were defined as those that allow the physician to control the number of hours devoted to practicing the specialty.) Data were analyzed using factor analysis, and analysis of variance, and the Scheffé method. Analysis indicated that the perceived lifestyle factor was most closely associated with the responses of those students choosing CL specialties. Furthermore, this factor received the highest total loading of the three factors from all the students, thus indicating the level of interest in lifestyle factors. Responses to items that defined the cerebral and practice factor were highest from the group of students choosing CL specialties and lowest from the group choosing NCL specialties. The NCL students scored highest in the altruism factor and the CL students scored the lowest. The surgery and NCL groups were similar in attitude patterns, and both were substantially different in attitude patterns from those of the CL groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Altruism↗
PubMed1998

Successful peer review of courses: a case study.

The authors describe their school's system of peer review for courses, established in 1988 to facilitate faculty evaluation and continual course and curriculum improvement. (The system has been temporarily suspended while the school's new curriculum becomes established.) They explain how the system was created and then report how faculty reviews of courses over the five-year operation of the system compared with students' reviews of the same courses. The faculty and students' ratings were in agreement 75% of the time. When not in agreement, the students' ratings tended to upgrade courses that were not very demanding, had easy grading, and emphasized clinical details, often at the expense of basic concepts and the big picture. The authors then document how the work of the peer review system favorably influenced the transformation of the school's curriculum. They also provide guidelines for the creation and operation of a course review process that uses faculty peers. The authors maintain that the peer review system worked because it was run by a committee of experienced and respected teachers who had been selected by their peers, the other faculty. Additional reasons for its success were that the school's faculty supported and respected the committee and its work, that course directors helped evaluate their courses, and that peer reviewers took their work seriously despite having no remuneration, and the clearly positive impact of the review system on faculty interaction, faculty-student interaction, and the reform of the curriculum.

Curriculum↗
PubMed2002

Volunteerism and Shriners Hospitals for Children.

Shriners Hospitals for Children exemplifies the spirit of volunteerism and the remarkable effectiveness of this spirit in providing orthopaedic and burn care to thousands of children around the world. The voluntary efforts of Shriners have included fund raising, hospital planning and development, governance, identification of patients in need, and patient transportation. Until the 1980s, orthopaedic surgeons received little or no remuneration for their work in caring for children in Shriners hospitals. Subsequently, numerous factors have caused a conversion of a part-time voluntary medical staff to full-time and contracted part-time staff. Even so, many Shriners hospitals' medical staff members continue to volunteer their own time in caring for children in less fortunate countries, and as a corporation, Shriners Hospitals for Children has provided volunteer medical teams during times of major international disasters.

Child↗
PubMed2000

The promise and pitfalls of explicitly rewarding physicians based on patient insurance.

In a large multi-specialty group practice treating approximately equal numbers of health maintenance organization (HMO) and fee-for-service (FFS) patients, we analyzed a natural experiment by the administration to introduce a dual incentive system for physicians. We examine the impact on care when they announced that each physician would be remunerated for HMO care based on a per capita budget, but for FFS care based on billable services. Data were 86,230 episodes for treating patients under age 65 with seven common illnesses. There was no evidence that the intended impact (reducing HMO care) occurred; instead, there were undesired and unintended effects (reduced care for FFS and upset physicians and threats to their corporate culture).

Efficiency, Organizational↗
PubMed2002

The effects of nurses' job satisfaction on retention: an Australian perspective.

OBJECTIVE: The effectiveness of any strategy that aims to improve recruitment and retention in the nursing profession will depend in part upon understanding the factors and influences on nurses' job satisfaction. BACKGROUND: The nursing work force is aging. The question now commonly asked by the nursing profession worldwide is: Who will replace this work force? Although the number of employed nurses continues to decline, patient acuity and turnover in our healthcare system continues to increase. This increasing dilemma is further deepened by progressively falling annual recruitment of new nurses and has resulted in an alarming shortfall of nurses. METHODS: This study used a multigroup longitudinal design to elicit nurses' attitudes toward their job satisfaction and retention plans. RESULTS: The results revealed that professional status was found to be significant of retention. The results indicated that job satisfaction remained relatively stable with time for experienced nurses (N = 528/332). For new graduates (N = 506/110) the issue of pay became a significant area of dissatisfaction in the transition from student to registered nurse. CONCLUSION: The results from this study contribute to the expanding body of knowledge that indicates professional status, autonomy, and remuneration are career issues of great concern for nurses and is particularly relevant for the retention of the newly registered nurse.

Adult↗
PubMed2003

Charges and reimbursement at a rural level I trauma center: a disparity between effort and reward among professionals.

BACKGROUND: A Level I trauma center must provide immediate availability general (trauma) surgical expertise. In the current practice few patients require a general surgical procedure. The expertise of subspecialists may also be required and frequently these patients will require subspecialty operative care. We hypothesized that trauma surgeons would receive less reimbursement than their subspecialty colleagues despite a greater commitment of time and effort in taking care of the multiply-injured patient. METHODS: Three fellowship trained trauma surgeons were specifically hired to cover the trauma service for the year 2000. Professional billings, contribution to margin (reimbursement minus direct costs) of the trauma surgeons and subspecialists were obtained from the hospital financial information system. A surrogate for effort was assessed by the number of attending notes in the chart. A surrogate for complexity of care was assessed by the length of notes in the chart. Weekly time sheets assessed the percentage of time involved in the care of trauma patients. RESULTS: There were 344 patients cared for exclusively on the trauma service for the year 2000. The billing generated per patient was $1005 for the trauma surgeon, $5904 for the subspecialists, and $27,554 for the hospital. Orthopedics and radiology generated more professional billing on the trauma patients than the trauma surgeons. The trauma surgeons spent 52% of their weekly clinical activity in the care of trauma patients, yet this activity accounted for only 16% of their billings (the rest came from general surgery and ICU care). The effort and complexity of care provided by the trauma surgeons was significantly greater than the subspecialists. CONCLUSION: The Level I trauma service is a conduit for patients coming into the hospital that provides a significant remuneration to the subspecialty services. Trauma surgeons are able to bill much less than many of their subspecialty colleagues despite expending significantly greater amounts of time and effort in the care of these patients. Strategies for improved reimbursement for trauma surgeons must be devised or trauma surgery will suffer the same fate as other areas of surgery, losing our brightest and best to more financially sound subspecialty services such as radiology and orthopedics.

Adult↗
PubMed1997

Daily energy expenditure of women by factorial and heart rate methods.

To compare the minute-by-minute heart rate (Flex-HR) reference method with the factorial method, total daily energy expenditure (TDEE) and the pattern of daily energy expenditure (EE) were measured in nonpregnant, nonlactating women 19-40 yr of age, working at their household chores (at home, N = 20) or for remuneration in various kinds of employment (at work, N = 28). The factorial method used three data sets described in the compendium of Ainsworth et al. (CMD), FAO/WHO/UNU (FAO), and James and Schofield (J&S). Measurements were repeated on three rounds separated by 3 months. The TDEE by Flex-HR method, by round, was 9.0 +/- 2.6, 8.9 +/- 1.4, and 10.3 +/- 3.4 MJ.d-1 in the women at home and 9.7 +/- 2.3, 11.4 +/- 3.2, and 11.3 +/- 3.6 MJ.d-1 in the women at work. Values using the CMD data set were not significantly different from Flex-HR in either group in any round, but FAO and J&S data sets gave significantly lower values than both of the former methods in all rounds. The same statistical results were obtained for the patterns of activity. Since the timing of activities by the observers was the same, it is concluded that the major source of error in applying the factorial method is in the values for energy expenditure assigned to the various activities and the ability of investigators to properly judge EE from available data sets.

Activities of Daily Living↗
PubMed2003

Nuclear medicine and radionuclide imaging: a survey of recruitment issues in the United Kingdom.

This wide ranging survey has highlighted difficulties in recruiting trained and committed individuals into nuclear medicine and radionuclide radiology. Several key factors have been recognised that reduce the attractiveness of the training. Recommendations include the rotation of medical senior house officers through nuclear medicine, reconsideration of dual accreditation in nuclear medicine and medicine, an increase in the number of consultant posts in nuclear medicine, parity of remuneration for nuclear medicine trainees and finally, an appropriate sessional provision for those providing radionuclide radiology services.

Education↗
PubMed1997

Plastic surgeons: a gender comparison.

This study surveyed plastic surgeons for the purpose of identifying gender-related differences within the specialty. A confidential 108-item questionnaire was mailed to all female members and candidates of the American Society of Plastic and Reconstructive Surgeons (ASPRS) and to an equal number of male colleagues. The survey was conducted between September of 1992 and October of 1993 using a modified Dillman five-step computerized method. The response rate was 73 percent for women (157 of 216) and 57 percent for men (124 of 216). Of those who responded, 65 percent of women and 89 percent of men were married (p < 0.01). Fifty-two percent of women and 86 percent of men had biologic children (p < 0.001). The majority of surgeons surveyed (97 percent) were in full-time surgical practice. Many women reported delaying childbearing until they had begun full-time practice of plastic surgery (p < 0.001). No significant gender-related differences were noted with respect to medical school rank, training history, advanced degrees, subspecialty practiced, hospital affiliation, or hours worked. Women surgeons in academic practice held lower rank than men and were less likely to be tenured (p < 0.04). Gross annual income was lower for women (p < 0.001). In contrast to men (27 percent), most women (89 percent) perceived sexual discrimination and harassment (p < 0.001). The majority of plastic surgeons were satisfied with their financial situation (80 percent), work (94 percent), and family life (76 percent). Over 90 percent of both women and men were happy with their career choice and would encourage medical students to become surgeons. Plastic surgeons do not differ in training or professional practice characteristics. Discrimination and harassment and unequal promotion and remuneration of women in the university environment are problems that need to be eliminated.

Adult↗
PubMed1998

DRG reimbursement: geriatric hip fractures in the community hospital trauma center.

BACKGROUND: The purpose of this paper was to determine whether Medicare reimbursement for hip fracture reaches cost in geriatric patients. METHODS: We conducted a retrospective review using the hospital trauma registry. Demographics, operations, length of stay, clinical outcome, discharge disposition, hospital charges, and hospital costs were reviewed and compared with diagnosis-related group (DRG) reimbursement. RESULTS: The study included 153 Medicare patients. Mortality was 3.9%, 71% were discharged to a nursing home or rehabilitation unit, and 25% went directly home. DRG reimbursement constituted 58% of charges. Compared with costs, the DRG amount represented a mean loss of nearly $1,000 per patient. CONCLUSIONS: DRG reimbursement undercompensates the community hospital trauma center for treating a common malady among the geriatric population. A population shift toward the elderly, decreasing Medicare remuneration, and the advance of managed care will make correct identification and control of costs extremely important for the hospital caring for hip fractures in the geriatric population.

Aged↗
PubMed2004

Incentives to promote organ donation.

The worldwide shortage of organs has led to the development of incentives to promote organ donation. These incentives vary widely in nature ranging from financial remuneration to preferential access to conditional donation. Such strategies to increase organ donation present a variety of ethical dilemmas challenging traditional concepts of justice and equity of access. In addition, there are legal and logistic considerations that must be discussed. The case is made that schemes using incentives to promote organ donation must meet the requirements of society for justice, equity of access, and avoidance of racial or other bias.

Humans↗
PubMed2001

Lessons from the unexpected: the importance of data infrastructure, conceptual models, and serendipity in health services research.

In examining the importance of data systems, conceptual models, and serendipity in understanding health services, the case is made for a vigorous and responsive data infrastructure and more emphasis on conceptual development. Particularly important is the development of data systems that can keep pace with changes in health care organization and patterns of care. Three examples--from managed care, deinstitutionalization, and physician remuneration--demonstrate the need to empirically examine seemingly obvious assumptions about health patterns and trends, and the lessons to be learned when assumptions are proved incorrect. Major future challenges include incorporating patient preferences into outcomes research, meaningful communication about treatment options and health plan choices, and understanding how organizational culture and norms affect decision processes.

Health Maintenance Organizations↗
PubMed2003

Convergence or divergence? Reforming primary care in Norway and Britain.

Many countries are currently reorganizing their health services in response to cultural, economic, and technological changes. Because the changes are global, different countries are drawn toward similar reform programs. But countries' cultural, economic, and political differences also may lead to divergent responses. This article examines the convergence thesis by comparing recent changes in primary care in Norway and Britain. There seems to be a convergence in objectives, a divergence in remuneration systems, and both divergence and convergence in organizational structures. To understand the dynamics of change, divergence is discussed in relation to the social context of the political initiatives. Divergences are explained by economic, political, and cultural differences, as well as differences in physicians' political power and density.

Cross-Cultural Comparison↗
PubMed1991

Endodontics in the UK 1990: an overview.

The first workshop on endodontics, in 1978, pointed out that the standard of endodontics in the United Kingdom was poor. The British Endodontic Society has subsequently attempted to improve the remuneration in the NHS by conducting and publishing a survey, and also establishing guidelines for minimum acceptable standards. Despite this, in the author's opinion, there has been no improvement. However, four ways of raising the standards of endodontics are proposed.

Education, Dental↗
PubMed2005

The adoption of new endodontic technology amongst Danish general dental practitioners.

AIM: To assess the adoption of new endodontic technology in a population of Danish practitioners. METHODOLOGY: Members of the Copenhagen Dental Association (n = 1156) were approached with a questionnaire concerning the frequency of various endodontic procedures. Three options were available: often, occasionally and never. Responses were anonymous. The statistical analyses were performed as studies of association in two- or three-way contingency tables, and with Goodman-Kruskal's gamma-coefficient as the basic tool chosen. RESULTS: Only data from general practitioners (GPs) in private practice were analysed (n = 956). The response rate was 72%. NiTi hand instruments were often used to negotiate canals by 18%, whilst 10% often used NiTi rotary systems. Electronic apex locators were often employed by 15%. Nineteen per cent reported that warm gutta-percha was often used. A majority (53%) often spend two sessions to instrument a molar, and 20% often needed three or more sessions to finish the shaping phase. To complete a treatment of a nonvital case most practitioners reported to use at least three appointments. Only 4% frequently applied rubber dam. CONCLUSIONS: The adoption of new endodontic technology is at an early stage amongst Danish GPs. A new revised remuneration system might influence the rate of adoption, allowing the practitioners to act more rationally and produce a higher frequency of good-quality root fillings. Progress towards high quality endodontics might be hindered by the nonuse of rubber dam.

Denmark↗
PubMed1994

Lessons from America? US magnet hospitals and their implications for UK nursing.

This paper examines possible implications of the US 'magnet hospital' concept for the UK nursing labour market. Magnet hospitals have been researched in the US and have been demonstrated to exhibit lower nurse turnover and higher levels of reported job satisfaction than other hospitals. Key characteristics include a decentralized organizational structure, a commitment to flexible working hours, an emphasis on professional autonomy and development, and systematic communication between management and staff. The paper examines the labour market characteristics of UK nurses and US nurses and finds many similarities. Detailed case studies of employment practice in 10 US hospitals and 10 Scottish hospitals are reported, with specific attention to remuneration practice, methods of organizing nursing care, establishment-setting and flexible hours. The paper concludes that there are features of the magnet hospital concept which are of relevance and applicable to the UK nursing labour market, but that piecemeal importation of ideas is unlikely to be beneficial.

Adult↗
PubMed1997

The general practice care of people with intellectual disability: barriers and solutions.

A questionnaire exploring general practitioners' (GPs') perceptions of the barriers and solutions to providing health care to people with intellectual disability was sent to 912 randomly selected GPs throughout Australia. A response rate of 58% was obtained. Results indicated that numerous barriers compromise the quality of health care able to be provided to people with intellectual disability. Communication difficulties with patients and other health professionals, and problems in obtaining patient histories stood out as the two most significant barriers. A range of other barriers were identified, including GPs' lack of training and experience, patients' poor compliance with management plans, consultation time constraints, difficulties in problem determination, examination difficulties, poor continuity of care, and GPs' inadequate knowledge of the services and resources available. General practitioners also suggested numerous solutions to these barriers, and emphasized the need for increased opportunities for education and training in intellectual disability. The GPs showed an overwhelming willingness to be involved in further education. Other major solutions included increasing consultation duration or frequency, proactively involving families and carers in patients' ongoing health care, and increasing remuneration.

Adult↗
PubMed1995

The transformation of nurses' work?

This paper offers a critical discussion of how current and planned changes in the labour process within the National Health Service (NHS), with particular reference to nursing as an occupational group, are likely to influence the industrial relations aspects of nursing management. An attempt is made to apply concepts developed within the wider sociology of work, to the reality of latter day nurses' experience. In this respect, the question will be addressed: do management approaches to the reorganization of work in health care settings constitute, or herald, an actual 'transformation' of nurses' work? The approach adopted places concern over the introduction of productivity or performance related pay, or the implementation of nursing skill-mix reviews within an analytic context which considers issues of control over working practices. As such, management and unions' responses to NHS Executive calls for increasing reorganization of nurses' work and remuneration structures may be illuminated by an understanding of this issue of control. This would entail a departure from simplistic analyses, focused solely upon narrowly defined efficiency concerns.

Efficiency, Organizational↗