Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Generalists”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,189 records · Page 66Linked to original sources
PubMed1996

Changes in marketplace demand for physicians: a study of medical journal recruitment advertisements.

OBJECTIVE: To measure trends in marketplace demand for physicians in different specialties. METHODS: Retrospective review of physician recruitment advertisements appearing in the September issues of 7 medical journals in 1984, 1987, 1990, 1993, and 1995. MAIN OUTCOME MEASURE: Number of advertised positions in each of the studied specialties. RESULTS: Steep declines in the number of advertised positions for specialist physicians over the past 5 years were consistently observed with the exception of pediatric specialists. The most dramatic changes occurred in the number of internal medicine specialist positions, which declined by 75% since 1990. For physicians as a whole, there were 4 specialist positions for every generalist position advertised in 1990; by 1995, this ratio dropped to 1.8. Family medicine exhibited continuous growth in the number of advertised positions, more than doubling during the period studied. CONCLUSIONS: Our data suggest a recent decline in marketplace demand for physicians, particularly those in specialist fields. Among generalists, demand for internists and pediatricians is rising. Ongoing analysis of these advertisements will provide timely information about the demand for physicians in a rapidly changing health care system.

Advertising↗
PubMed1996

Restructuring dermatology education at Cleveland medical centers affiliated with Case Western Reserve University.

We describe our response to the changing needs for dermatologic education and training at Cleveland medical centers affiliated with Case Western Reserve University School of Medicine (CWRU) located in Cleveland, Ohio. Our departmental plan for change is a multifaceted approach that alters the number of dermatology residents we train and also the way we interact with and educate our generalist colleagues. Like many other dermatologists, we have both idealistic and practical reasons for increasing our involvement in interdisciplinary education. One of our primary objectives is maximizing quality of care for dermatologic patients in our community. Traditionally, the majority of skin care in the United States has been provided by nondermatologists, and with the growth of managed care, this proportion is increasing. This has motivated us to increase our medical student teaching activities and to support the American Academy of Dermatology in its current efforts to develop a dermatology core curriculum for students. We should also be involved in the education of generalist physicians, since prior studies have suggested that their knowledge of dermatology needs improvement. Our goals should be both to improve the direct patient care skills of primary care physicians and to teach clinically appropriate referral thresholds. The American Academy of Dermatology has recently issued guidelines for the referral of dermatology patients in managed care settings to help ensure that our specialty has input into this process. In addition, teaching gatekeeper physicians to use appropriate referral criteria is important to many dermatologists in capitated managed care systems who often prefer limited as opposed to unrestricted access to their services.

Curriculum↗
PubMed1996

[Does the general practitioner have a place in future medicine?].

The structure and content of the health care services are changing rapidly. General practice will be justified just as long as patients, doctors and society at large consider it important, useful, safe and economically sound. In order to survive it is important for the general practitioner, as a "Jack of all trades", to set honest limits for his or her own competence, and learn to use the new information technology to retrieve relevant knowledge quickly. The "patient" patient will become less frequent and more demanding consumers are emerging. The generalist is getting additional, new roles as the patient's teacher and adviser. The government and other payers will expect more documentation of outcome, cost-effectiveness and quality assurance from general practice. For the generalist, one of the major challenges will be a necessary transition from being an individualist to becoming more of a team player.

Family Practice↗
PubMed1996

Loupe microsurgical tubal sterilization reversal. Experience at a community-level naval hospital.

OBJECTIVE: To evaluate the success rates of loupe microsurgical tubal sterilization reversal procedures performed by a generalist obstetrician-gynecologist at a community-level naval hospital. STUDY DESIGN: Consecutive patients who underwent microsurgical tubal anastomosis under loupe magnification by the author during a 16-month period were subjected to a review for outcome in this case series report. RESULTS: Twenty-three patients who underwent reversal of tubal ligation by the author were examined for outcome. By 29 months after the last case studied, the overall conception rate was 78.3% and intrauterine pregnancy rate 68.6%. The miscarriage and ectopic rates were 13.0% and 8.7%, respectively. CONCLUSION: Loupe microsurgical tubal reversal by a properly trained generalist obstetrician-gynecologist at a community hospital rendered success rates comparable to those published in the literature.

Abortion, Spontaneous↗
PubMed1996

[Evolution of internal medicine and its specialties in the last decades: an outward view].

The development of the subspecialties of internal medicine in the western world is reviewed from a historical perspective, focusing on the case of the United States of America. During the last decades, changes both in society and in medicine as a whole have prompted a great dispersion of medical practice styles, not always well-defined in their contents and goals, and ranging from primary care to ultra specialization. The definition of the general internist and of the subspecialist together with the attributes of each category according to an American College of Physicians task force group are commented upon. Some of the possible reasons accounting for a decreased interest in general internal medicine during the eighties together with figures supporting a recent reversal of this trend are given. New proposals have originated in government as well as in medical circles to promote the development of general internists, conceived as physicians knowledgeable in the classic subspecialties but also skilled in clinical epidemiology, informatics, behavior medicine, decision-making, clinical economics, ethics, and problem solving. The American College of Physicians, on the other hand, considers that allowing the community-based general internists to disappear, strengthening the generalist's identity as a primary care-oriented physician who provides no subspecially care, becoming hospital-based generalists who act mainly as consultants, or becoming fully trained subspecialists who also provide primary care, are all rejectable options. These arguments illustrate the fact that even in highly developed societies a degree of indefinition remains as to the best balance between general internal medicine and its subspecialties.

History, 20th Century↗
PubMed1997

Retraining physicians for primary care. A study of physician perspectives and program development.

OBJECTIVE: To determine the number and kinds of programs that medical schools and managed care organizations offer or plan to offer to retrain physician specialists to practice primary care medicine and to discover physicians' attitudes toward such retraining. DESIGN: A survey was mailed in 1994 to all 126 medical schools and the 19 largest US managed care organizations to collect detailed information about existing and potential retraining programs. Physicians' attitudes toward retraining were elicited from participants in 3 geographically diverse focus groups. Selected specialists were polled through the national survey of the American Medical Association's Socioeconomic Monitoring System to ascertain the demand for retraining. RESULTS: The majority of institutions contacted perceived a need for retraining, but few programs had been established. Programs being "considered" varied widely in duration, class size, target audience, accreditation, and projected training settings. Although unenthusiastic about retraining, physicians preferred programs that would expand their patient base, maintain the practice population, be inexpensive and close to home, and provide hands-on training in the eventual practice environment. Physicians also preferred a goal-oriented, part-time retraining program in a large group practice or managed care setting that would allow them to practice their specialty while retraining. Few planned or existing programs incorporate many of these features. The most likely candidates for retraining are subspecialty physicians who currently provide some primary care and are employed by a medical plan. CONCLUSIONS: Despite efforts by those who perceive that a need for more generalist physicians is stimulating interest in retraining specialists and subspecialists to provide primary medical care, physician interest and program availability remain low, and programs under development are not being designed to attract those who may seek retraining. This situation is probably fortuitous, because changed perceptions about the adequacy of the generalist physician workforce since the beginning of this study have diminished the call for retraining.

Adult↗
PubMed1997

[Dermatology in current medicine].

Dermatology evolved in the second part of the last century as a branch of internal medicine and was for many years confined to morphologic descriptions. Skin diseases are common and vary enormously in severity. Although most of the conditions are not life threatening, many of them are debilitating due to functional loss, pain and itch, and the social problems they cause. Skin diseases are a major public health problem in developing countries. After the second world war there has been an explosion both in the amount of scientific knowledge and with regard to the treatment of dermatoses, many of which can now be managed adequately. The dermatologist is also involved in prevention of skin diseases, as e.g. contact dermatitis and malignant tumors of the skin. Increasing specialisation within dermatology has become more common with the expansion of expertise in dermatopathology, photodermatology, contact dermatology, dermatological surgery, dermatologic pediatrics, phlebology. There are too many dermatologists in our country. If an increasing role in caring for minor skin diseases would be assigned to the generalist, the government he will have to decide how contraction of dermatology manpower would occur and how the dermatology training of the generalist should be improved.

Belgium↗
PubMed1997

Who cares for you?

In May 1995 the NSW Health Department released their Report Issues Relating to Specialty Nursing Vacancies. The Report was commissioned when the NSW Health Department's reporting system revealed the re-emergence of specialty nursing vacancies as an issue in NSW. Ten focus groups were held during February and March 1995 in six health service areas representative of metropolitan, rural and remote health service delivery in NSW. The aim of the study was to identify generic factors, if any, which applied across all specialty nursing disciplines which affected recruitment and retention of specialist nurses. It was considered these factors, had general application. Specialty nurses are drawn from a generalists pool of nurses and the Department wanted to know why generalist nurses were not moving into specialist areas.

Australia↗
PubMed1997

Helminth ectoparasites of sillaginid fishes (Perciformes: Percoidei) have low species richness.

Just nineteen species of ectoparasitic helminths were found in a survey of over 1,500 individuals of 26 species of sillaginid fishes in the Indo-west Pacific. A twentieth worm is known only from the literature; a twenty-first, also known only from the literature, is considered a doubtful record. Fifteen of the twenty worms are branchial monogeneans, one is a monogenean of the pharyngeal plates, one is an ectoparasitic digenean living under the scales, and three are leeches of the mouth cavity and fins. The most common monogeneans were diplectanids (Diplectanum spp. and Monoplectanum spp.) and microcotylids (Polylabris spp.), each with five recently described or redescribed species. Of the remaining monogeneans, three were extremely rare, and two were uncommon. Pseudobivagina sp. and Polynemicola sp. (Microcotylidae) and Pseudempleurosoma sp. (Ancyrocephalidae) were represented by only a single worm each from three different hosts (Sillago robusta, S. sihama, and S. ingenuua, respectively). The gyrodactylid Gyrodactylus sp. is widespread and was recorded from four species of sillaginids (S. ciliata, S. japonica, S. schomburgkii and S. sihama). Encotyllabe chironemi Robinson (Capsalidae) is recorded for the first time from sillaginids, but only on S. aeolus. Two additional monogeneans are known from sillaginids only in the literature: Dactylogyrus sp. (Dactylogyridae) is known only from cultured S. sihama; the single specimen of Microcotyle sp. (Microcotylidae) recorded from Sillaginodes punctata is probably a contaminant, since the haptor was missing. The generalist trematode Transversotrema licinum Manter (Transversotrematidae) was found for the first time in samples of four species of sillaginids (Sillago analis, S. ingenuua, S. lutea and S. sihama). Three species of piscicolid leeches were encountered: Austrobdella translucens Badham was common on the fins of three large inshore sillaginids (S. ciliata, S. schomburgkii and S. analis); a single specimen of the generalist species Zeylanicobdella arugamensis De Silva was recovered from S. soringa; and specimens of Z. stellata (Moore) infected S. schomburgkii and S. analis. The diversity of host-specific worms in Sillaginidae is low compared with those of some other Indo-west Pacific fishes.

Animals↗
PubMed1997

Allied health and physician assistants: a progressive partnership.

The recently published report of the National Commission on Allied Health stressed the perceived need for the development of more multi-skilled, generalist Allied Health professionals as a means of responding to the primary care focus of health care in the United States. There are many significant barriers to the development of such a professional in terms of educational requirements and licensing among other issues. Physician assistants have fulfilled this role in health care for nearly 30 years. The relationship between Allied Health and physician assistant education is not always clear although many Allied Health professionals pursue further education as physician assistants. Further development and clarification of this relationship presents an opportunity for Allied Health to participate in the training of generalist practitioners without complicating the educational requirements of other Allied Health professional programs.

Allied Health Personnel↗
PubMed1997

Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications, and resource utilization.

CONTEXT: Although experimental studies show that insulin therapy can be safe and efficacious in improving glycemic control in type 2 diabetes under optimal conditions (ie, using patient volunteers with close monitoring under strict study protocols), little is known about its effectiveness, complication rates, and associated resource utilization in actual clinical practice. DESIGN: Cohort study. SETTING: Large staff-model health maintenance organization. PARTICIPANTS: A total of 8668 patients with type 2 diabetes cared for by generalist physicians from 1990 through 1993. OUTCOME MEASURES: Resource use (hospitalizations, outpatient visits, laboratory testing, and home glucose monitoring) and glycemic control were evaluated using combined clinical, survey, and administrative information systems data. Detailed clinical case-mix data, including a newly validated case-mix method, the Total Illness Burden Index, were collected on a subsample of 1738 patients. RESULTS: Among patients starting insulin therapy, hemoglobin A1c (HbA1c) decreased by 0.9 percentage point (95% confidence interval, 0.7-1.0) at 1 year compared with those receiving stable medication regimens; however, 2 years after starting insulin therapy, 60% still had HbA1c levels of 8% or greater. There was no evidence that some primary care physicians achieved better results than other primary care physicians when starting insulin therapy in their patients. Patients with the poorest baseline glycemic control achieved substantially greater HbA1c reductions; those with a baseline HbA1c level of 13% had a 3-fold greater decline in HbA1c than those whose baseline HbA1c level was 9%. For a subset of all patients for whom detailed clinical case-mix data were obtained, those taking insulin had higher resource use than those taking sulfonylureas, independent of illness severity. After adjusting for age, sex, race, socioeconomic status, disease duration, and severity of diabetes and comorbidities, insulin users had slightly more laboratory tests performed, 2.4 more outpatient visits per year, and almost 300 more fingersticks for home glucose testing per year compared with sulfonylurea users (all P<.01). Although 15% of patients receiving insulin therapy reported weekly symptoms of hypoglycemia, insulin therapy was not associated with an increase in emergency department visits (after case-mix adjustment) and resulted in only 0.5 hypoglycemia-related hospitalizations per 100 patient-years. CONCLUSIONS: For patients with type 2 diabetes who were cared for by generalist physicians, starting insulin therapy was generally safe and effective in achieving moderate glycemic control in patients who initially had poor glycemic control. However, insulin therapy was associated with increases in resource use and was rarely effective in achieving tight glycemic control, even for those with moderate control.

Adult↗
PubMed1998

Scientific evidence and research in primary care.

The key areas of scientific research in general internal medicine are (1) prevention; (2) the natural history of common illnesses; (3) improving the outcomes and efficiency of the health care system and (4) orphan diseases. Disease prevention is at the top of the list because of the enormous role preventable causes play in morbidity and mortality, above all tobacco. Research in this field is difficult because it touches such questions as individual behaviour and personal choice. Research in the natural history of common illnesses is critical to informed patient decision making. Recent studies show that procedures thought to be safe bear a high percentage of complications, when viewed from the generalist's point of view: high incidence of strokes after elective coronary bypass surgery; higher mortality rates among patients having had pulmonary catheterization; high incidence of incontinence and impotence after transurethral resection of the prostate. A third area for research in primary care is how to improve outcome and efficiency through improvements in the health care delivery system. This field touches the problem of unnecessary surgical interventions and inappropriate prescription of antibiotics. Orphan diseases in this context are conditions no speciality wants to study, such as dementia and low back pain. The most important obstacle for research in the field of general internal medicine is funding. It is much easier to be funded for research in high profile conditions, like heart disease, cancer and AIDS. A second barrier to research relates to the role of special interest groups in influencing not only funding but also policy. Important examples were the pressure on consensus conference decisions on the role of spinal fusion surgery for low back pain and on the question whether women between 40 and 50 should have annual mammography. For generalist research to be fruitful it is of outmost importance to have an adequate intellectual infrastructure, i.e. support by epidemiologists, biostatisticians, economists and research methodologists.

Evidence-Based Medicine↗
PubMedDate not supplied

Prevalence and patterns of physician referral to clergy and pastoral care providers.

BACKGROUND: There is a heightened interest in spiritual and religious interventions in clinical settings, an area marked by unease and lack of training by physicians. A potential resource for generalists is specialty consultation and referral services, although little is known about the prevalence and patterns of involvement of clergy or pastoral professionals in patient care. OBJECTIVES: To identify the prevalence and patterns of physician-directed patient referral to or recommended consultation with clergy or pastoral care providers and to describe attitudinal and demographic variables that can predict referring and nonreferring physicians. DESIGN: A mailed anonymous survey. SETTING: Family physicians in the United States. PARTICIPANTS: Active members of the American Academy of Family Physicians whose self-designated professional activity is direct patient care. Of the 756 randomly selected physicians for participation in the study, 438 (57.9%) responded. MAIN OUTCOME MEASURES: Physician reporting on their attitudes and referral behaviors, including referral frequency, and conditions or reasons for referral or nonreferral to clergy and pastoral care providers. RESULTS: More than 80% of the physicians reported that they refer or recommend their patients to clergy and pastoral care providers; more than 30% stated that they refer more than 10 times a year. Most physicians (75.5%) chose conditions associated with end-of-life care (ie, bereavement, terminal illness) as reasons for referral. Marital and family counseling were cited by 72.8% of physicians; however, other psychosocial issues, such as depression and mood disorders (38.7%) and substance abuse (19.0%), were less prevalent. Physicians who reported a greater degree of religiosity had a small increased tendency to refer (r = 0.39, P<.05) to these providers. In addition, physicians who were in practice for more than 15 years were more likely to refer to clergy (P<.01). CONCLUSIONS: Most family physicians accept clergy and pastoral professionals in the care of their patients. In medical settings, the providers of religious and spiritual interventions have a larger and more expanded role than previously reported.

Adult↗
PubMedDate not supplied

Are antibiotics necessary in the treatment of locally infected ingrown toenails?

CONTEXT: A wide variety of generalists and specialists treat locally infected ingrown toenails, with perhaps the most common treatment regimen including resection of the nail border coupled with oral antibiotics. OBJECTIVE: To determine whether oral antibiotic therapy is beneficial as an adjunct to the phenol chemical matrixectomy in the treatment of infected ingrown toenails. DESIGN: We prospectively enrolled healthy patients with infected ingrown toenails. Each patient was randomly assigned to 1 of 3 groups that received either 1 week of antibiotics and a chemical matrixectomy simultaneously (group 1), antibiotics for 1 week and then a matrixectomy (group 2), or a matrixectomy alone (group 3). SETTING: Institutional ambulatory outpatient clinic. PATIENTS: Fifty-four healthy patients with infected ingrown toenails were studied. Patients with immunocompromised states, peripheral vascular disease, or cellulitis proximal to the hallux interphalangeal joint were excluded. Groups were age matched for comparison. RESULTS: Mean healing times for groups 1, 2, and 3 were 1.9, 2.3, and 2.0 weeks, respectively. Subjects receiving antibiotics and a simultaneous chemical matrixectomy (group 1) healed significantly sooner than those receiving a 1-week course of antibiotics followed by a matrixectomy (group 2). There was not a significant difference in healing time between those that received a chemical matrixectomy alone (group 3) and those that received a matrixectomy coupled with a course of oral antibiotics (group 1). CONCLUSION: The use of oral antibiotics as an adjunctive therapy in treating ingrown toenails does not play a role in decreasing the healing time or postprocedure morbidity.

Adolescent↗
PubMed1996

Beyond CAGE. A brief clinical approach after detection of substance abuse.

Generalist physicians should incorporate alcohol and drug abuse detection and brief intervention in the care of their patients. A suggestion of alcohol or drug abuse or a positive response to the CAGE questions deserves further assessment such as clarification about adverse consequences, inquiry about loss of control, determination of the patient's perception of the substance use, and an assessment of the patient's readiness to change behavior. Brief intervention with the patient in the clinical setting about alcohol or drug use can be effective. Motivational interviewing, a directive, patient-centered counseling style for enhancing motivation for change, can make brief interventions more effective by incorporating the patient's readiness to address alcohol or drug use. A useful clinical approach is presented that is tailored to the patient's stage of readiness to change alcohol or drug abuse behavior.

Attitude to Health↗
PubMedDate not supplied

Treatment patterns among adult patients with asthma: factors associated with overuse of inhaled beta-agonists and underuse of inhaled corticosteroids.

BACKGROUND: Overuse of inhaled beta-agonists and underuse of inhaled corticosteroids by patients with asthma may have adverse consequences. This study was performed to identify factors associated with misuse of these types of asthma medication. METHODS: We examined baseline data from a longitudinal survey of adult patients with asthma. The setting was a consortium of 15 national managed care organizations serving 11 large employers. Baseline surveys were completed by 6612 health plan enrollees at least 18 years old who had had at least 2 visits with a diagnostic code for asthma in the preceding 2 years. The main outcome measures were the overuse of inhaled beta-agonists and the underuse of inhaled corticosteroids. Independent variables were patient and process of care factors. RESULTS: Among patients with moderate or severe asthma, 16% of users of inhaled beta-agonists reported overuse (>8 puffs per day on days of use), and 64% of users of inhaled corticosteroids reported underuse (use on < or =4 days/wk or < or =4 puffs per day). Overuse of inhaled beta-agonists was most strongly associated with concomitant treatment with inhaled corticosteroids or anticholinergic agents, increased asthma symptom severity, problems in obtaining asthma medication, and male sex. Underuse of inhaled corticosteroids was associated with nonwhite race, younger age (18 to 34 years), lower use of inhaled beta-agonist, lower symptom severity, and not possessing a peak flow meter. Rates of misuse of medication also varied by speciality of the patient's provider (generalist, allergist, or pulmonologist). CONCLUSIONS: Overuse of inhaled beta-agonists may be caused by symptom severity, while underusers of corticosteroids may interrupt use as symptoms abate. This study demonstrated an important opportunity to improve medication use among patients with asthma.

Administration, Inhalation↗
PubMed2001

Use of the statins in patients after acute myocardial infarction: does evidence change practice?

OBJECTIVE: To compare the use of lipid-lowering agents in 42 628 elderly patients (aged > or =65 years) after acute myocardial infarction, before and after the publication of the Scandinavian Simvastatin Survival Study (4S), using the Ontario Myocardial Infarction Database. METHODS: Multivariate regression models were created to estimate changes in the rate of statin use over time in monthly cohorts of elderly patients after acute myocardial infarction in Ontario from April 1, 1992, to March 31, 1997. Changes in the rate of statin use over time were estimated using patient and prescriber characteristics. RESULTS: We found a 3.6-fold significant increase in the monthly rate of statin use after the publication of 4S compared with before the publication of 4S (P<.001); specifically, the rate of increase in simvastatin and pravastatin sodium use was higher after the publication of 4S (P<.001 for each). Before the publication of 4S, the rate of increase in statin use in younger patients (aged 65-74 years) was 2.7 times higher than in older patients (aged > or =75 years) (P =.02), while after the publication of 4S, the rate of increase in statin use was only 1.8-fold higher in the younger group (P<.001). After the publication of 4S, there was a 1.6-fold higher rate of increase in statin use in male compared with female patients (P =.006). Also after the publication of 4S, specialists (cardiologists and internists) had a 2-fold higher rate of increased use of the statins than did generalists (P<.001). CONCLUSION: It is possible to shift practice if the evidence of benefit is strong, the intervention is easy to implement, and the intervention is marketed aggressively.

Aged↗
PubMed2005

Physician strategies to reduce patients' out-of-pocket prescription costs.

BACKGROUND: Physicians often do not communicate with patients about out-of-pocket costs, although research indicates that physicians and patients value such discussion. METHODS: Cross-sectional national random sample mail survey of 1400 cardiologists and general internists to quantify barriers to communication about out-of-pocket costs and strategies used to assist patients in order of likelihood (from 5 [extremely likely] to 1 [not at all likely]). RESULTS: Overall, 519 (39.1%) of 1328 eligible physicians responded to the survey. The most common barriers were lack of habit, insufficient time, and concern over patient discomfort. The most common strategies used to assist patients were switching to a generic drug (mean, 4.34; SD, 0.86), using office samples (mean, 4.16; SD, 1.22), and discontinuing nonessential medicines (mean, 4.03; SD, 0.99). There were no statistically significant differences between cardiologists and general internists in barriers or strategies examined (P<.05). CONCLUSIONS: Our findings suggest that patient-physician communication about out-of-pocket costs is a problem affecting specialists and generalists nationwide. Despite barriers, physicians use multiple strategies that may vary in efficacy to assist patients burdened by these costs.

Adult↗