From academics to practice; reflections upon entering private practice.
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Career Choice↗
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Similarities of a general medicine clinic in a teaching hospital to internal medicine practice. Clinic compared with private practice.
The authors undertook this study to determine whether a general medicine clinic in a teaching hospital provided an experience similar in content to that in the office of a general internist. Data on all patient visits to the university clinic during 1979 were collected. Analyses of 4856 visits revealed significant differences (p less than 0.001) in duration of visit, admission rate, and referral rates between the clinic and internists studied by the National Ambulatory Medical Care Survey (NAMCS). However, the 12 most common problems seen in the clinic were among the 15 most common problems seen by NAMCS physicians despite some differences in the prevalence of certain diagnoses. Knowing the relative prevalence of specific diagnoses in this setting helps teach cost--benefit principles of ordering diagnostic studies designed to detect uncommon problems. This study supports the value of a teaching hospital ambulatory care experience as preparation for the practice of general internal medicine.
Adolescent↗
How to survive in the private practice of psychiatry.
The private practice of psychiatry is being transformed by the new economics of medical care. Patients are paying more out-of-pocket for necessary care (demand-side cost sharing), and health care providers are being asked to assume part of the risk of treatment through prospective payment (supply-side cost sharing). Specific survival strategies for psychiatrists in private practice include development of a balanced practice, expansion of referral networks, participation in alternative delivery systems such as health maintenance organizations and preferred provider organizations, active involvement in utilization and claims review, participation in outcome studies, and expansion of patient care advocacy and community involvement.
Health Maintenance Organizations↗
Rates of missed appointments among pediatric patients in a private practice: Medicaid compared with private insurance.
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Appointments and Schedules↗
[The role of nursing in private practice and at a private clinic].
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Nurses↗
Practice patterns in percutaneous image-guided intraabdominal abscess drainage: survey of academic and private practice centers.
PURPOSE: To evaluate current practice patterns of percutaneous image-guided abdominal and pelvic abscess drainage in academic and private practice centers. MATERIALS AND METHODS: The institutional review board did not require approval for this study. In a survey conducted between November 2002 and February 2003, 493 questionnaires were sent to 193 academic and 300 private practice radiology departments in the United States. All recipients were informed of the study purpose. The survey included questions about departmental demographics, patient selection criteria for percutaneous abscess drainage (eg, abscess diameter at imaging, laboratory parameters such as white blood cell count, and clinical indications such as fever), use of analgesia or conscious sedation, drainage method, and imaging technique. The statistical significance of differences between respondent subgroups was analyzed with a Pearson or Mantel-Haenszel chi(2) test. RESULTS: Academic centers returned 95 questionnaires (49%), and private practice centers, 72 (24%). Percutaneous abscess drainage is performed by a fellowship-trained radiologist at 92 (97%) of 95 academic centers and 41 (79%) of 52 private practice centers (P < .001). Among 95 academic respondents and 52 private practice respondents, respectively, 56 (59%) and 33 (63%) do not perform drainage if an abscess has a diameter of less than 3 cm; 30 (32%) and nine (17%), if the white blood cell count is normal; and 16 (17%) and six (12%), if the patient is afebrile. Most (90 [95%] of 95 academic, 45 [87%] of 52 private practice) respondents use conscious sedation. A transabdominal approach and 8-12-F catheters are most frequently used by both groups. Academic respondents more frequently use transvaginal and transrectal approaches (54 [57%] and 51 [54%] of 95, vs 16 [31%] and 15 [29%] of 52 private practice respondents; P = .003) and 14-F catheters (69 [73%] of 95 vs 18 [35%] of 52; P < .001). CONCLUSION: Percutaneous drainage is usually performed by fellowship-trained radiologists in abscesses of more than 3 cm in diameter, for appropriate clinical indications (multiple parameters above the established threshold), by using conscious sedation and 8-12-F catheters.
Abdominal Abscess↗
Private practice: nutritional counseling. III. Solving problems in private dietetic practice.
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Cooking↗
Prepaid medical practice. Obvious and hidden tradeoffs in leaving private practice.
After 11 years of private practice this primary care physician objected to such growing distractions as increasing paperwork, governmental control, and liability concerns. His work consumed so much time that he had little left for his personal life--most importantly, his wife and children. He therefore made the decision to join the staff of a prepaid medical practice. Having already weighed the known advantages and disadvantages of doing so, he later found that there were additional pros and cons. The author tells how he has modified some of the drawbacks of working for an HMO in order to maintain his preferred standard of medical care, and how he has come to terms regarding his commitment to the field of medicine.
Decision Making↗
Two management systems in a nursing private practice group.
Entry into private practice can be rewarding for nurses who are willing to risk personal, financial, and professional security. Among the problems faced by the nurse in this new role is the administration of the practice, since few, if any, adequate models exist. This article describes the struggle of nurses in one private nursing practice, Creative Health Services, to meet their needs for individual freedom within an organization that is regulated sufficiently to maintain its viability.
Colorado↗
The effect of faculty private practice experience on appropriate charging for professional services.
Private practice experience is widely considered invaluable for academic family physicians, especially for clinical efficiency and for charging appropriately for professional services. This study tested the hypothesis that faculty members with private practice experience charged more appropriately for professional services. Patient-physician encounters were rated in terms of propriety of charges by consensus of two faculty physicians and compared to the actual level of service marked on the encounter form. Private practice experience for faculty resulted in less undercharging (21% of encounters undercharged versus 31% for faculty without that experience, P = .03). Physicians with private practice experience undercharged on average $.36 per encounter, versus $1.94 for providers without that experience (Kruskal-Wallis test, P = .27). Physicians with private practice experience also tended to perform more procedures but not to bill for more. Academic family physicians with private practice experience demonstrated more appropriate billing practices for professional services, but ideally preference for this type of academic physician should be based on other attributes, such as breadth of experience and efficiency in patient care.
Faculty, Medical↗
Combination vaccines: practical considerations for public health and private practice.
BACKGROUND: Although the current immunization schedule for children requires as many as four or five injections at a single visit, both parents and health care providers hesitate to administer more than two or three simultaneous injections. Therefore new combination vaccines that include multiple unrelated antigens are needed. METHODS: Individuals from the Immunization Division of the Colorado State Department of Health and pediatricians in private practice in Denver, CO, were interviewed and asked about incorporating new combination vaccines into their practice. RESULTS: At a state health department level the transition to combination vaccines will likely require reprioritizing of public health resources. In addition state health officials are important information resources for public and private providers, as well as for the community. At the level of the private provider combination vaccines hold promise for simplifying the immunization schedule, but successful implementation will require education and guidance on how best to integrate the new combination into practice. CONCLUSIONS: Combination vaccines are the immediate solution to the addition of new childhood vaccines and will alleviate the concern of parents and physicians regarding the trauma related to multiple injections at a single visit.
Colorado↗
Teledermatology--the requirements of dermatologists in private practice.
Eighty-four dermatologists in private practice in Bavaria were surveyed by postal questionnaire. Of the 45 who responded (a 54% response rate), 96% used a computer in their private practice. Fifty-seven per cent of respondents owned systems with Pentium processors, while 23% were still using 386 or 486 processors. Most of them used the Windows 95, UNIX or Apple operating system. Of the respondents who had a modem, 74% used ISDN. There were few modems connected to the ordinary telephone network. Of all respondents, 56% used email regularly. Several possible teledermatology applications were proposed in the survey (i.e. teleconsultation, on-line/off-line videoconferencing, email attachments). Fifty-six per cent of respondents said that they would perform teleconsultations with dermatology clinics, 40% preferred a teleconsultation via telephone and computer, and 42% sending files via email. The survey demonstrated that a high proportion of dermatologists in private practice would use a teledermatology service.
Adult↗
Perceptions and practices of vaginal birth after Caesarean section among privately practicing obstetricians in Kenya.
OBJECTIVE: To determine perceptions, preferences and practices of vaginal birth after Caesarean. DESIGN: Cross-sectional descriptive study. SETTING: Private clinics of obstetricians in five major towns of Kenya. SUBJECTS: Obstetricians in private practice. MAIN OUTCOME MEASURES: Practice and experiences in trial of labour (TOL); need for, and application of, selection criteria in TOL; perceptions on outcomes of TOL and patient preference; perception on trends of vaginal birth after Caesarean (VBAC) and need for policy on TOL. RESULTS: Nearly all respondents (98.4%) believed in the need for, and application of, selection criteria for allowing TOL. However, only 23% believed in routine screening with radiological pelvimetry, while 63.2% believed in routine foetal weight estimation. All obstetricians (100%) have ever managed TOL in private practice, and 74% had managed at least one case in the last six months. Despite lack of tangible selection criteria, 83.1% think that most women prefer TOL while 95.1% discourage it if perceived as inappropriate. Failure rate of TOL was perceived to be more than 50% by 35.2% of the respondents. A majority of the respondents (about 75%) would prefer TOL on themselves or their spouses. Those who perceived that there was a falling trend of VBAC were 58%, citing increased demand by mothers (45.7%), obstetricians' convenience (40.0%) and fear of litigation (26.8%) as the reasons for this observation. A fluid policy of "TOL whenever it is deemed as appropriate" was preferred by 88.7%. CONCLUSION: The perception of obstetricians is that desire for VBAC predominates over elective repeat Caesarean. However, consensus on appropriate selection criteria is lacking, which leaves the obstetrician in a management dilemma. Hence, there is need to study outcomes of both ERC and TOL in order to come out with objective policy guidelines on management of one previous Caesarean in pregnancy.
Adult↗
Occupational therapists in private practice.
Although increasing numbers of occupational therapists are choosing to work in private practice, little data exist describing this sector of the profession. In the present study, experienced occupational therapists were asked about their moves into private practice, including (a) their motivation, (b) their preparation, and (c) their perceptions of the move's risks and benefits before and after the move. A survey was sent to a national random sample of 105 occupational therapists, 74 of whom responded. According to the survey, autonomy was the most important motivating factor for occupational therapists moving into private practice. However, once they were in private practice, the occupational therapists noted that increased income was a major benefit. These occupational therapists had planned for the risks of reimbursement, referral sources, and overhead but had not anticipated problems with staffing shortages. Incomes increased for occupational therapists who moved into private practice. The survey compared the incomes of occupational therapists before and after they entered private practice. It also compared their income and educational levels. Other comparisons included income and work experience, income and work role, and income and geographic location. Autonomy and financial considerations appear to be the overriding issues for occupational therapists choosing careers in private practice. Almost unanimously, the survey respondents said that private practice was a good career choice.
Adult↗
Using private practice settings for academically intensive family practice clerkships.
The Department of Family Medicine and Practice at the University of Wisconsin has designed and conducted an academically intensive third-year three-month family practice clerkship based in private practice settings. This experience differs from more traditional preceptorships in the amount of academic structure and quality control applied to the student's learning experience. This clerkship has demonstrated that extramural experiences can be as academically intensive and carefully monitored as traditional, referral-hospital-based clerkships in family practice or other basic medical disciplines. Increases in the level of continuity of care occur over the entire 12 weeks.
Clinical Clerkship↗
Private practice of psychiatry: future roles.
Psychiatrists in private practice have contributed more to treating the mentally ill in America than is generally known. The private practice sector may be viewed as a massive national outpatient and inpatient service for the mentally ill. The impact of national health insurance on the future character of the private practice of psychiatry and the thorny problems to be resolved are discussed and compared with the experiences of England, the Soviet Union, and China. Future trends will most likely include increased emphasis on adjuvant techniques, greater emphasis on resident training in general psychiatry, briefer forms of therapy, and psychiatry's return to the medical model.
Attitude of Health Personnel↗
Surgical audit in private practice.
Surgical audit in private practice is not only simple to perform but is very rewarding. It is intellectually stimulating and inevitably improves outcome. Computer literacy is helpful though not essential.
Computer Literacy↗
Reimbursement in private practice.
Occupational therapists in private practice must develop sound business policies and procedures to help ensure third party reimbursement for their services. Carefully delineated protocols and proper documentation in treatment are of utmost importance. Fee schedules are established within the framework of local government regulations, using one or a combination of the following methods: unit value system, modalities and procedures, cost-plus or overhead, and state relative value system or maximum allowable fees. Blue Cross/Blue Shield or other private third party payers, Medicare or Medicaid, and workers' compensation insurers are the usual parties billed for services rendered. Therapists must use good public relations methods to educate their present and future reimbursers and act as advocates for private practitioners in occupational therapy.
Documentation↗