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PubMed1999

The family physician and house calls. A survey of Colorado family physicians.

BACKGROUND: Visiting patients at home has long been one of the activities of the family physician, but the practice of making house calls has diminished significantly during the second half of the 20th century. The goal of this study was to describe physicians' attitudes about house calls and their practice of making them in the rapidly changing health care environment of the United States. METHODS: A 30-item, self-administered questionnaire was designed to obtain demographic information about physicians and their attitudes toward house calls, practice experiences with making house calls, and any additional factors that influence making house calls. It was mailed to all members of the Colorado Academy of Family Physicians, during the summer of 1997. RESULTS: A 66% response rate was obtained from practicing physicians. Overall attitudes toward house calls were positive. Fifty-three percent of the respondents reported making house calls, and 8% reported making more than 2 house calls per month. Male physicians, those older than 40 years, those in rural settings, and those trained in a community-based residency were more likely to make house calls. Patient payer mix and practice setting were also related to whether a physician made house calls. House calls were most frequently made to geriatric patients, cancer patients, trauma patients, and patients with transportation difficulties. Many physicians reported using home health agencies for assessment and treatment of patients needing home care. CONCLUSIONS: Family physicians agree that house calls are good for patients. More than half of the respondents reported that they occasionally make house calls. However, few physicians routinely perform house calls.

Adult↗
PubMed2005

A physician fitness program: enhancing the physician as an "exercise" role model for patients.

BACKGROUND: Physically active physicians are more apt to counsel patients about exercise. PURPOSES: The purpose of this study was to determine the effect of a physician fitness program on resident physician cardiovascular fitness, physical activity behavior/stage of change, and physical activity counseling behavior/attitudes. METHODS: A prospective, intervention study with measurements at baseline (before intervention), 3 months (immediately after intervention), and 6 months (3 months after intervention) evaluated a multifaceted exercise program for 48 internal medicine residents. Resident physician cardiovascular fitness, energy expenditure, physical activity stage of change, knowledge, attitudes, and counseling behavior were measured. RESULTS: Resident physician fitness significantly declined over time (baseline VO(2)-170 = 29.1 ml/kg/min, first follow-up VO(2)-170 = 27.3 ml/kg/min, and second follow-up VO(2)-170 = 26.2 ml/kg/min; p = .001). Although there was no change in overall energy expenditure, the number of resident physicians in the precontemplation or contemplation stage of change significantly declined with a corresponding increase in the number in a "higher" stage of change at first (p = .0034) and second follow-up (p = .024). There was a nonsignificant increase in self-reported patient counseling. Resident physician counseling confidence and perceived success significantly improved at first follow-up only (p = .01 and p = .03, respectively). CONCLUSION: Although resident physician fitness and energy expenditure did not improve after intervention, a significant improvement in resident physician physical activity stage of change and attitudes toward patient counseling was noted. Randomized controlled trials are needed to confirm whether these changes are attributable to the intervention.

Attitude of Health Personnel↗
PubMed1998

Effect of compensation method on the behavior of primary care physicians in managed care organizations: evidence from interviews with physicians and medical leaders in Washington State.

The perceived relationship between primary care physician compensation and utilization of medical services in medical groups affiliated with one or more among six managed care organizations in the state of Washington was examined. Representatives from 67 medical group practices completed a survey designed to determine the organizational arrangements and norms that influence primary care practice and to provide information on how groups translate the payments they receive from health plans into individual physician compensation. Semistructured interviews with 72 individual key informants from 31 of the 67 groups were conducted to ascertain how compensation method affects physician practice. A team of raters read the transcripts and identified key themes that emerged from the interviews. The themes generated from the key informant interviews fell into three broad categories. The first was self-selection and satisfaction. Compensation method was a key factor for physicians in deciding where to practice. Physicians' satisfaction with compensation method was high in part because they chose compensation methods that fit with their practice styles and lifestyles. Second, compensation drives production. Physician production, particularly the number of patients seen, was believed to be strongly influenced by compensation method, whereas utilization of ancillary services, patient outcomes, and satisfaction are seen as much less likely to be influenced. The third theme involved future changes in compensation methods. Medical leaders, administrators, and primary care physicians in several groups indicated that they expected changes in the current compensation methods in the near future in the direction of incentive-based methods. The responses revealed in interviews with physicians and administrative leaders underscored the critical role compensation arrangements play in driving physician satisfaction and behavior.

Administrative Personnel↗
PubMed2005

Physicians in retainer ("concierge") practice. A national survey of physician, patient, and practice characteristics.

BACKGROUND: Retainer practices represent a new model of care whereby physicians charge an up-front fee for services that may not be covered by health insurance. The characteristics of these practices are largely unknown. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional mail survey of 144 retainer physicians (58% response rate) and a national random sample of 463 nonretainer physicians (50% response rate) to compare retainer and nonretainer practices. Outcomes of interest included physician demographics, size and case-mix of patient panel, services offered and, for retainer practices, characteristics of practice development. RESULTS: Retainer physicians have much smaller patient panels (mean 898 vs 2303 patients, P<.0001) than their nonretainer counterparts, and care for fewer African-American (mean 7% vs 16%, P<.002), Hispanic (4% vs 14%, P<.001), or Medicaid (5% vs 15%, P<.001) patients. Physicians in retainer practices are more likely to offer accompanied specialist visits (30% vs 1%), house calls (63% vs 26%), 24-hour direct physician access (91% vs 40%), and several other services (all P values <.05). Most retainer physicians (85%) converted from nonretainer practices but kept few of their former patients (mean 12%). Most retainer physicians (84%) provide charity care and many continue to see some patients (mean 17%) who do not pay retainer fees. CONCLUSIONS: Despite differences between retainer and nonretainer practices, there is also substantial overlap in services provided. These findings, in conjunction with the scope of patient discontinuity when physicians transition to retainer practice, suggest that ethical and legal debates about the standing of these practices will endure.

Attitude to Health↗
PubMed2002

Dispelling the myths about rural consultant physician practice: the Victorian Physicians Survey.

OBJECTIVE: To quantify the barriers to practising as a rural consultant physician. DESIGN: Cross-sectional postal survey. PARTICIPANTS: All 981 practising consultant physicians in Victoria, Australia, who were Fellows of the Royal Australasian College of Physicians in 1999; 52 (100%) of rural physicians and 634 (68.2%) of metropolitan physicians completed the survey. MAIN OUTCOME MEASURES: Demographic and practice characteristics; barriers to rural practice. RESULTS: There were no rural female consultant physicians, and 35 of the 52 rural consultant physicians (67.3%) were born in a rural area. The most important perceived barriers to rural practice identified by both metropolitan and rural physicians were children's schooling (72.2%), spouse's occupation (65.7%), other issues related to children (66.7%) and difficulties getting back into metropolitan practice (45.7%). Among metropolitan physicians, barriers to rural practice differed by age, sex, place of birth and nationality. Returning to metropolitan practice, children and concern over procedures were more likely to be reported as barriers to rural practice among those aged 40 years or under, 41-50 years and 51 years and over, respectively. CONCLUSION: The major barriers to rural practice identified by physicians lie outside the health sector, and particularly concern a perceived need for wider opportunities in children's education and spouse employment.

Adult↗
PubMed1985

Effect of physician dress style on patient-physician relationship.

This study evaluates the effect of physician dress and other variables (i.e., sex of physician and patient, age, and type and site of visit) on patient-physician rapport. Three hundred eighty-six teens filled out a questionnaire, at the end of an office visit, which evaluated their attitudes regarding their physician and their preference for physician dress. The physicians alternated between very informal, informal, formal-white coat, and formal-suit/dress styles. Dress style made no statistical difference in patients' attitudes toward their physician. When asked what they preferred their doctor to wear 43% responded "makes no difference," 26% said "white coat," 14% said "pants and shirt," 10% said "jeans and shirt," and 4% said "suit and tie." Female patients were significantly more comfortable (3.6 versus 3.3, p less than 0.01) with female physicians. Male patients did not show a preference for a same-sex physician.

Adolescent↗
PubMed1984

Effect of rising percentage of female physicians on projections of physician supply.

The Graduate Medical Education National Advisory Committee (GMENAC) in 1980 projected a surplus of 145,000 physicians in the year 2000. Inherent in the GMENAC prediction are several assumptions, including the assumption that the current percentage of female physicians will remain unchanged. However, the number of female physicians is increasing at a rapid rate. Since it has been estimated that female physicians work 40 percent fewer hours during their lifetimes than their male counterparts, the increasing percentage of female physicians will result in a decrease in overall physician productivity as measured by total practice hours. Using an adjustment to the GMENAC model that will take into account the changing male/female ratios of physicians, the estimated physician surplus in the year 2000 is reduced by 41,000 physicians, or approximately 28 percent of the GMENAC-predicted surplus.

Adult↗
PubMed1999

Self-reported physician specialties and the primary care content of medical practice: a study of the AMA physician masterfile. American Medical Association.

BACKGROUND: Many internal medicine physicians report both primary and secondary specialties in the American Medical Association (AMA) Physician Masterfile. Usually, those represent combinations of general internal medicine and medical subspecialty practice. Whether reported specialty combinations can be used to assess the contribution of specialists to primary care is unknown. OBJECTIVES: To examine whether internists' primary and secondary specialties reported in the Masterfile reflect the amount of primary care that they provide, and whether changes over time in internists' reported specialties reflect changes in primary care provision. DESIGN: The Masterfile was used to identify internists' reported specialties in 1992 and in 1996. A mail questionnaire was used to assess the primary care content of physicians' practices. The association between reported specialties and the amount of primary care provided was evaluated using analysis of variance. SUBJECTS: A stratified random sample of internists in active clinical practice. MEASURES: The percentage of visits which were for the general medical care of patients for whom the physicians maintained ongoing responsibility. In addition, how often the physicians initiated the provision of preventive care for their regular patients, provided general medical care to these patients, and organized and coordinated the care received by these patients from other providers. RESULTS: There was a strong association between the internists' primary and secondary specialties reported in the Masterfile and measures of the primary care content of physicians' practices (P < 0.0001). In contrast, changes over time in internists' reported specialties were not associated with physicians' assessments of changes in the primary care content of their practices. CONCLUSIONS: Aggregate estimates of the availability of primary care in the US could be adjusted by taking into account the primary and secondary specialties reported by internal medicine physicians in the AMA Physician Masterfile.

American Medical Association↗
PubMed1994

Women's priorities regarding physician behavior and their preference for a female physician.

Studies report that women have diverging preferences for physician gender. The present study explores some aspects of how women's preferences for physician gender are formed. Using data from a postal survey among Norwegian women, the association between preferences for physician gender and women's priorities regarding physician behavior is examined. Women who, in particular, value their physicians' democratic attitudes tend to prefer female physicians, in contrast to those who prefer a more dominating physician role. Surprisingly, women who especially emphasize the caring qualities of their physicians, do not have strong preferences for a female physician.

Adult↗
PubMed1989

Physician and patient determinants of difficult physician-patient relationships.

In an effort to account for the effects of both physician and patient characteristics in understanding difficult physician-patient relationships, family physician participants in the Michigan Research Network, a practice-based research network in the state of Michigan, were assessed for their perceptions of "difficult" patients. Twenty-two family physicians responded to a mail survey in which they selected from among their respective practices a sample of patients whose care they considered to be particularly difficult. This sampling procedure resulted in a total of 205 difficult patients. Physicians' perceptions of these patients were obtained through ratings of the applicability of 40 behavioral and physical characteristics drawn from the literature. Factor analysis of these data resulted in the identification of two factors underlying physicians' perceptions of difficult patients: medical uncertainty, characterized by particularly vague, difficult to describe, undifferentiated medical problems; and interpersonal difficulty, reflected in a perceived abrasive behavioral style. In addition, physicians self-rated the importance of various motivations for practicing medicine. The top six ranked mean ratings indicate that the primary motivations for practicing medicine were satisfaction derived from solving medical problems and the desire to help people. The interaction of these physician and patient characteristics is offered as a partial explanation for the development of difficult physician-patient relationships.

Adult↗
PubMed1984

Physicians treating their own spouses: relationship of physicians to their own family's health care.

Fifty-one family physicians and a comparable group of 65 lawyers were surveyed to determine how each group treated the medical problems of their spouses. There was no significant difference between physician and lawyer controls in the treatment of headaches, sore throats, vomiting, depression, pregnancy, and warts. In fact, the controls treated back pain and stomachaches more often. The physicians treated earaches and deep lacerations more often. The physicians more frequently took a symptom history and examined their spouse. Both groups treated their spouses' headaches, sore throats, and stomachaches at a high rate. This study supports the impression from a literature review and case studies that unique multiple interacting factors determine whether a physician will treat his or her spouse. These factors are feeling of responsibility to answer a request for treatment, cost, convenience, confidentiality, lack of confidence, emotional involvement or detachment, ego needs, and legal considerations. It is concluded that (1) physicians do not generally treat their spouses more often, but they do evaluate their spouses' symptoms more often than do nonphysicians, and (2) the decision to treat by the physician may compromise good care for his or her spouse. It is recommended that physicians and their spouses have an alternative, nonrelated physician to care for their health.

Adult↗
PubMed1980

Perceptions of the family physician by patients and family physicians.

The professional definition of the family physician is not based on research that considers both patient and family physician perceptions. Questionnaire responses from 86 family physicians and 287 patients from ten family practices in Los Angeles were analyzed to compare their attitudes, perceptions, and expectations of the family physician. Both groups agreed the family physician could handle most medical problems (including hospital care), should provide continuity, should emphasize preventive medicine, and should be caring. The physician's manner and skill were felt equally important. Family physician and patient expectations conflicted in four major areas: referral, the handling of emotional problems, concern with and care of family, and the issue of autonomy. Such research may help the development of family practice and improve the patient-family physician relationship through improved graduate and continuing medical education for family physicians.

Character↗
PubMed1989

Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department.

To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.

Attitude↗
PubMed2000

A physician survey of the effect of drug sample availability on physicians' behavior.

OBJECTIVE: Pharmaceutical companies often use drug samples as a marketing strategy in the ambulatory care setting. Little is known about how the availability of drug samples affects physicians' prescribing practices. Our goal was to assess: (1) under what circumstances and why physicians dispense drug samples, (2) if drug samples lead physicians to use medications other than their preferred drug choice, and (3) the physician characteristics that are associated with drug sample use. DESIGN: Cross-sectional survey. SETTING: University-based clinics at one academic medical center. PARTICIPANTS: 154 general medicine and family physicians. MEASUREMENTS AND MAIN RESULTS: Physicians' self-reported prescribing patterns for 3 clinical scenarios, including their preferred drug choice, whether they would use a drug sample and subsequently prescribe the sampled medication, and the importance of factors involved in the decision to dispense a drug sample. A total of 131 (85%) of 154 physicians responded. When presented with an insured woman with an uncomplicated lower urinary tract infection, 22 (17%) respondents reported that they would dispense a drug sample; 21 (95%) of 22 sample users stated that they would dispense a drug sample that differed from their preferred drug choice. For an uninsured man with hypertension, 35 (27%) respondents reported that they would dispense a drug sample; 32 (91%) of 35 sample users indicated that they would dispense a drug sample instead of their preferred drug choice. For an uninsured woman with depression, 108 (82%) respondents reported that they would dispense a drug sample; 53 (49%) of 108 sample users indicated that they would dispense a drug sample that differed from their preferred drug choice. Avoiding cost to the patient was the most consistent motivator for dispensing a drug sample for all 3 scenarios. For 2 scenarios, residents were more likely to report using drug samples than attendings (P <.05). When respondents who chose a drug sample for 2 or 3 scenarios were compared to those who never chose to use a drug sample, or chose a drug sample for only one scenario, only younger age was independently associated with drug sample use. CONCLUSION: In self-reports, the availability of drug samples led physicians to dispense and subsequently prescribe drugs that differ from their preferred drug choice. Physicians most often report using drug samples to avoid cost to the patient.

Adult↗
PubMed2004

Physician assistants in occupational medicine: how do they compare to occupational physicians?

BACKGROUND: Physician assistants (PAs) have been present in occupational and environmental medicine (OEM) in the USA since 1971, yet remarkably little is known about their activity. METHODS: An administrative study of PA activities was undertaken and compared with the activities of physicians in the same occupational medicine setting. Patients were not triaged to either provider and all resources of care were recorded for the visit. An episode of care approach was used for the analysis. RESULTS: The characteristics of patients seen by each provider were similar in age, gender ratio and severity of injury. Physicians saw a mean of 2.9 patients/h and PAs 2.5, but PAs worked more hours and saw more patients per year than physicians. The average charge per patient visit and total charge for an episode of care were similar. Differences between PAs and physicians were seen in the areas of 'limited duty' duration given to patients and on average PAs prescribed 15 days and physicians 17 days. PAs referred a patient 19.7% of the time, while physicians referred 17.4%. Most of the referrals were to physical therapy. The salary of a physician, based on an hourly rate, was approximately twice as much as a PA. CONCLUSION: The use of PAs in OEM may represent a cost-effective advantage from an administrative standpoint. Clearly, more research is necessary in determining the role and utilization of PAs in OEM and how they may improve the delivery of physician services.

Costs and Cost Analysis↗
PubMed1992

Women physicians in dual-physician relationships compared with those in other dual-career relationships.

This study compared the career and domestic responsibilities of women physicians whose domestic partners were physicians (WP-Ps) with those of women physicians whose domestic partners were not physicians (WP-NPs). In 1988 the authors surveyed 602 women physicians in a large midwestern city regarding their career and domestic roles; 390 were physicians in training (students and residents), and 212 were physicians in practice (academic medicine and private practice). Overall, 382 (63%) responded; of the 382, 247 (65%) had domestic partners; of these 247, 91 (37%) were WP-Ps and 156 (63%) were WP-NPs. The WP-Ps were found to be twice as likely as the WP-NPs to interrupt their careers to accommodate their partners' careers. The WP-Ps also assumed significantly more domestic responsibilities and worked fewer hours practicing medicine than did the WP-NPs. The 163 women physicians in training (44-48%-of the WP-Ps and 119-76%-of the WP-NPs) demonstrated a more egalitarian division of labor overall, with no significant differences between the WP-Ps and the WP-NPs. The authors recommend that longitudinal studies be undertaken to determine whether women physicians in training continue this trend as they enter the practice of medicine.

Adult↗
PubMed1978

The tides of rural physicians: the ebb and flow, or why physicians move out of and into small communities.

To determine the characteristics of physicians who move into and out of rural areas, as well as their reasons for establishing or leaving such practices, we sent questionnaires to 67 physicians who began practice in selected rural counties in upstate New York and 88 physicians who left practices in roughly the same area. From the 52 physicians (77.6 per cent) who responded to the former survey we found that 1) good professional support is mandatory for maintaining a satisfying small community practice, 2) a predisposition to small community living is essential for physicians to be recruited for rural practice, and 3) there are substantial differences with respect to demographic characteristics among persons who share similar reasons for practicing medicine in this region. For the 68 physicians (72.0) per cent ) who responded to the latter survey, the reasons for leaving could be grouped in the following categories: economic, social, and professional logistic. Although all of these factors contribute to the decision to leave, physician geographical mobility seems to stem chiefly from an unsatisfactory professional situation. These findings suggest several strategies for improving the situations in which rural physicians practice, and thus altering the massive imbalance in physician:patient ratios in urban and rural areas.

Attitude of Health Personnel↗
PubMed2001

Physical symptoms and physician-experienced difficulty in the physician-patient relationship.

BACKGROUND: The practice of medicine has many expected and accepted challenges, but all physicians experience some patients as difficult to a degree that transcends these expectations. Physician-experienced difficulty is associated with a syndrome of three characteristics: patient psychopathology, abrasive interpersonal styles, and multiple physical symptoms. OBJECTIVE: To assess the roles played by the number of physical symptoms and by specific symptoms in determining whether physician-experienced difficulty occurs. DESIGN: New analyses of epidemiologic survey data from the Primary Care Evaluation of Mental Disorders (PRIME-MD) 1000 Study. SETTING: Four primary care clinics. PARTICIPANTS: 627 ambulatory patients seen by 27 physicians. MEASUREMENTS: Physician-experienced difficulty was measured by using the 10-item Difficult Doctor Patient Relationship Questionnaire (DDPRQ-10); patient-reported physical symptoms and physician-assessed psychopathology and somatoform symptoms were evaluated by using the PRIME-MD; and physical illnesses were measured by using a physician questionnaire. RESULTS: The number of physical symptoms and the number of somatoform symptoms correlated with difficulty (r = 0.39 and r = 0.37, respectively; P < 0.001), and the correlations remained significant after adjustment for physical and mental disorders (r = 0.20 for both correlations; P < 0.001). Difficult patients were more likely to have each of 16 physical symptoms; the odds of being difficult were greater for patients with 1 of 5 particular symptoms (stomach pain, fainting, loose stools/diarrhea, palpitations, and sleep problems), even after adjustment for physical and mental disorders. All 10 items on the DDPRQ-10 were influenced by physical symptoms, particularly those items that asked about physician frustration and whether patients were manipulative and time consuming. CONCLUSIONS: The association between physical symptoms and difficulty is due in part to the association between physical symptoms and mental disorders, but symptoms also contribute independently to difficulty. The independent component of symptom-associated difficulty may be due to 1) differences between patient and physician in expectations about treatment and 2) the part that symptoms play in conferring the "sick role" on a patient.

Communication↗