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A primary concern of many physicians is the accumulation of adequate funds while practicing to maintain their lifestyles after retirement. Take a look at how some business arrangements can affect retirement planning.
In the spring of 1986, medical school admissions personnel were surveyed on their institutions' admissions practices and the use of Medical College Admission Test (MCAT) data in student selection. The admissions officers listed sources of information considered in processing applications. The variables accorded high importance were: overall and science undergraduate grade-point averages, quality of degree-granting institutions, letters of evaluation, interview ratings, MCAT scores, extracurricular activities, work in areas related to health care, breadth and/or difficulty of course work, and state of legal residence. Variables judged of medium importance were: nonscience grade-point average, graduate study, narratives supplied through the American Medical College Application Service or supplemental narratives, demographic factors, and undergraduate research. The respondents divided the 15-point MCAT scale into exemplary, acceptable, and unacceptable ranges of performance. These responses varied widely among institutions. The mean response for the bottom of the acceptable range was a score of seven, and the mean for the beginning of the exemplary range was 11. In considering individual MCAT subtest scores, 34 percent of the admissions officers regarded the six scores individually and equally, 51 percent weighted the areas in ways related to their curricula, and 43 percent summed or averaged scores with equal weights at some point. Thirty-one percent used MCAT scores to adjust grade-point averages across undergraduate institutions.
In the UK, and in many Commonwealth countries, a university degree is accepted by registration bodies as an indication of competence to practice as a PRHO or intern. Concerns have been raised that the quality of university examinations may not always be sufficient for such high-stakes decision-making. Assessments of clinical competence are subject to many potential sources of error. The search for standardization, and high validity and reliability, demands the identification and reduction of measurement errors and biases due to poor test design or variation in test items, judges, patients or examination procedures. Generalizability and other research studies have identified where the likely sources of error might arise and have been taken into account in the development of published guidelines on international best practice, which institutions should strive to follow. The purpose of this paper is to describe the development of the integrated final-year assessment of clinical competence at the University of Sheffield. The aim was to introduce a range of strategies to ensure the examination met the best practice guidelines. These included blueprinting the assessment to achieve a high degree of content validity; lengthening the examination by adding a written component to the OSCE component to ensure an adequate level of reliability; providing training and feedback for examiners and simulated patients; paying attention to item development; and providing statistical information to assist the examination committee in standard setting and decision-making. This evidence-based approach should be readily achievable by all medical schools.
A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.
The department of dentistry of the Hospital for Sick Children has actively maintained a quality assurance system since the early 1980s. In addition, members of the department have taught courses and published articles on risk management and quality assurance for over a decade. The decision to achieve ISO 9002 registration led to an intensive 10-month process to adapt ISO systems and standards to Canadian institutional dental practice. This article describes the ISO registration system and the changes required for an existing quality assurance program to conform to ISO standards.
As national health systems pursue the common goals of containing expenditure growth and improving quality, many have sought to replace autonomous modes (systems) of physician control that rely on initial professional training and subsequent peer review. A common approach has involved extending bureaucratic modes of physician control that employ techniques such as hierarchical coordination and salaried positions. This paper applies concepts from studies of professional work to frame an empirical analysis of emergent bureaucratic modes of physician control in US hospital-based systems. Conceptually, we draw from recent studies to update Scott's (Health Services Res. 17(3) (1982) 213) typology to specify three bureaucratic modes of physician control: heteronomous, conjoint, and custodial. Empirically, we use case study evidence from eight US hospital-based systems to illustrate the heterogeneity of bureaucratic modes of physician control that span each of the ideal types. The findings indicate that some influential analysts perpetuate a caricature of bureaucratic organization which underplays its capacity to provide multiple modes of physician control that maintain professional autonomy over the content of work, and present opportunities for aligning practice with social goals.
BACKGROUND: Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. METHODS: Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. RESULTS: Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. CONCLUSION: In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted.
The "Instituto de Salud Carlos III" is the Central Public Health Laboratory in Spain with an important component of scientific research in health related areas, such as cancer, cardiovascular diseases, infectious diseases and environmental health. The article describes the development of the Public Health Institutes. arising from the introduction and development of scientific and laboratory based medicine and the introduction of vaccination and sanitation with the control of water and food. At about the same time, the discoveries in microbiology and immunology were produced, being the research activities incardinated with the practical advances in the control of products. To cope with the practical needs, Institutions were created with the responsibility of providing smallpox vaccine but incorporating very soon production of sera and other vaccines and water and sanitation control and foods control. At the same time. colonization of countries specially in Africa, South East Asia and explorations in Central America confront the Europeans with new diseases and the need of laboratories where to study them. These circumstances gave rise to the birth of the Central Public Health Laboratories and the National institutes of Health at the beginning of the XX century in many countries. In Spain, the Spanish Civil War was a breaking point in the development of such an institution that finally was reinvented with the creation of the Instituto de Salud Carlos III, in 1986, incorporating research and epidemiological surveillance and control of diseases and also the responsibilities of the Food and Drug Control, lately separated from it.
Gastrointestinal stromal tumour is now recognized as a distinct pathological malignancy and has received much attention over the last few years. Despite almost universal resistance to chemotherapy, a novel therapy, Imatinib, which targets the KIT receptor, has changed the natural history of this disease. We have audited the first 26 consecutive patients with gastrointestinal stromal tumour treated over 4 years at a single institution. A practical guide to the management of common toxicities and drug resistance is reported with a review of the published reports. Many of the strategies used are likely to be widely applicable to the use of targeted therapies in other malignancies.
Recommended guidelines for medical practice are instituted in France as a contribution to a reduction of health care expenses. The methodology, applications, and implications in pediatrics, are presented.
Physicians are perplexed by the ongoing erosion of their individual professional autonomy. While the economic forces underlying such change have received much attention, the evolution of new organizational forms that modify and often diminish medical autonomy is less well understood. The practice of medicine is becoming more organized and more hierarchical. We emphasize the importance of organized medical groups, including the medical staff organization, as structures for appropriate peer monitoring, and for counterbalancing the burgeoning influence of governance and administrative constraints on practice. There is an ongoing tension within organizations between management, governance, and physicians. Over time one or another of these groups achieves some measure of dominance, but good management requires a balance of power. The role of the medical staff, which is poorly represented in some health care institutions and under threat in others, is considered. In general, we find that medical work is becoming more hierarchical, and that physician "leaders" do not substitute for collegial processes.
As of August 1965, 54.4 per cent of the 31,551 California physicians in active practice indicated that they receive all of their income from fees-for-service, with another 7.9 per cent receiving at least some of their income in this manner. A total of 8,025 M.D.'s, or 25.4 per cent, are on full-time salaries with no other source of professional income, and the remaining 12.2 per cent are members of group practices, whether on an income sharing or a salaried basis. Almost two-thirds of California physicians (66.6 per cent) consider themselves to be primarily self-employed. Of the 21,011 self-employed physicians, 76.3 per cent are in individual practice, 10.5 per cent in partnerships or groups (without income-sharing arrangements) and the remaining 13.2 per cent in group practice (income-sharing). Slightly over one-fifth of all salaried physicians are employed by some Federal agency, primarily in the armed forces. Among the other four-fifths, more than half are hospital employees, with most of the remainder working for other physicians, clinics or educational institutions. General Practice remains the most heavily populated specialty in California, accounting for 26.3 per cent of all physicians; among self-employed physicians only, G.P.'s number more than one out of every three physicians, or 34.6 per cent. Internists, General Surgeons, Psychiatrists and Obstetrician-Gynecologists rank next in order among all physicians; however, the positions of Psychiatrists and OB.'s is reversed among self-employed physicians.
There are many reports in the literature of management innovations to redesign nursing roles and care delivery systems in response to the dramatic changes taking place in the healthcare environment. Few of these innovations have been evaluated systematically in terms of the dynamics and effects of change at the work group level. The authors present results of a longitudinal study evaluating the work group outcomes of a professional practice model implemented in an academic medical center. The strategy of integrating ongoing data collection and feedback into a process of continuous change also are presented.
Health care delivery is a major industry in the United States, consuming large quantities of human and physical capital and generating impressive quantities of products, ideas, trained personnel and health services. The focus of current public policy attention upon the medical profession, which has only in this century become a highly respected scientific profession, is not on its substantial accomplishments, but on the health care delivery system as a consumer (generator?) of over 10% of our annual gross national product. The overwhelming focus of current public policy and public sentiment is on cost containment (i.e., developing strategies to limit the flow of resources into the existing health care delivery system). This shift in public sentiment and new focus of public policy is, in some sense, a paradox in view of the spectacular advances in medical science and access to health care that the medical profession has delivered in the last 2 decades. The source of this anxiety and the cause of current initiatives in public policy and private practices with respect to health care is costs. The health care sector has not only consumed more resources than anticipated, but has also been characterized by unusually rapidly escalating prices and skyrocketing government resource commitments. As a result, we are asking new questions and seeking new initiatives. We are asking whether the institutions and practices that characterize the existing health care delivery system are the most suitable arrangements for our future. This article raises some of the issues entailed by these questions and details some of the choices which lie ahead for the health care industry.
Evidence-based medicine (EBM) is a fashionable and an extremely hot topic for clinicians, patients and the health service planners. Evidence-based cytology (EBC) is an offshoot of EBM. The EBC is concerned with generating a reproducible, high quality and clinically relevant test result in the field of cytology. This is a rapidly evolving area with high practical importance. EBC is based entirely on research data. The various professional bodies on cytology design and recommend guidelines on the basis of evidences. Once the guideline is implemented and practiced then the experiences of the practicing cytopathologists may be used as a feed back to alter the existing guideline. The various facets of EBC are sampling and specimen adequacy, morphological identification and computer based expert system, integrated reporting, identification of the controversial areas and high quality researches for evidences. It is the duty of the individuals and institutions to practice EBC for better diagnosis and management of the patients. In this present paper, the various aspects of EBC have been discussed.
Comparison of the implementation and findings of a "gold standard" evaluation of social work intervention and its experimental analog based on available clinical information illustrates the strengths and weaknesses of each. From a practice-research integration perspective, however, "clinical data-mining" may be a credible alternative to randomized controlled experiments.
Finance managers can play a leading role in determining the success of physician employment by addressing physicians' financial concerns. Physicians can benefit from financial managers' help in clarifying how practice decisions affect financial outcomes, and making the entire process transparent. Communication should include validation of data integrity, development of targeted reports, education, and frequent opportunities for dialogue.
Emergency department overcrowding is a critical problem nation-wide. A survey by the Lewin Group in 2002 found that 90 percent of Level 1 trauma centers and hospitals with more than 300 beds reported being over capacity. Although ED overcrowding has many causes, external factors are most commonly blamed--too many patients, lack of inpatient capacity, inappropriate use of the ED, the Emergency Medical Treatment and Active Labor Act (EMTALA), lack of primary care availability, and lack of access to health care for the uninsured. In this article, we describe a series of changes that were implemented in the ED of a regional medical center. Those changes improved operational efficiency, expedited patient care, and reduced ED overcrowding. The changes focused on patient input, throughput, and output. In terms of input, we revamped the triage and admission processes. To improve throughput, we modified the physical layout of the urgent care area to maximize efficiency in staff movement and communications, changed staffing patterns to match anticipated patient volume, and revised our policies regarding exchanges with the radiology staff. To facilitate patient flow out of the ED, we identified the causes of delays in discharges and admissions, instituted the practice of flagging the charts of patients ready for discharge, and implemented admission orders to decrease patient waiting times. Improving patient throughput increases ED efficiency, and thus capacity, in terms of the number of patients that can be treated over a given time period, and it promotes the cost-effective use of institutional resources. Decreased waiting times should ultimately lead to increased patient satisfaction and better patient care.