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Biomedical subjects

Amy E Wallace

Publications and source records attributed to Amy E Wallace.

At least 19 recordsLinked to original sources
PubMed2006

Association of race and gender with general surgeons' annual incomes.

BACKGROUND: Specialty, work effort, and gender have been shown to be associated with physicians' annual incomes. Although female plastic, oral, and cardiothoracic surgeons have been shown to have lower incomes than their male counterparts, differences in incomes attributable to gender or race among general surgeons have not been evaluated. STUDY DESIGN: We used survey responses collected during the 1990s from 771 actively practicing general surgeons and linear regression modeling to determine the association of race and gender with general surgeons' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. RESULTS: Compared with Caucasian men, both African-American male and Caucasian female general surgeons reported having fewer patient visits (10% fewer and 17% fewer, respectively), but working more annual hours (14% more and 6.7% more, respectively). Caucasian women were more likely than the other groups to be nonpractice-owner employees. African-American men and Caucasian women were less likely than their Caucasian male counterparts to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, African-American men's mean annual income was $248,048, or $49,205 (17%) lower than that for Caucasian men (95% CI: $129,645 lower to $31,236 higher, p=0.2); Caucasian women's was $233,397, or $63,856 (21%) lower (95% CI: $120,367 to $7,345 lower, p=0.03). CONCLUSIONS: During the 1990s, among Caucasian general surgeons, female gender was associated with considerably lower annual incomes; among male general surgeons, African-American race was associated with lower annual incomes, but not substantially so. These findings warrant additional exploration to ensure that income differences among physicians are not unjustly determined by race or gender.

Black or African American↗
PubMed2006

Race and gender differences in general internists' annual incomes.

BACKGROUND: Specialty, work effort, and female gender have been shown to be associated with physicians' annual incomes; however, racial differences in physician incomes have not been examined. OBJECTIVE: To determine the influence of race and gender on General Internists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. DESIGN: Retrospective survey-weighted analysis of survey data. PARTICIPANTS: One thousand seven hundred and forty-eight actively practicing General Internists who responded to the American Medical Association's annual survey of physicians between 1992 and 2001. MEASUREMENTS: Work effort, provider and practice characteristics, and adjusted annual incomes for white male, black male, white female, and black female General Internists. RESULTS: Compared with white males, white females completed 22% fewer patient visits and worked 12.5% fewer hours, while black males and females reported completing 17% and 2.8% more visits and worked 15% and 5.5% more annual hours, respectively. After adjustment for work effort, provider characteristics, and practice characteristics, black males' mean annual income was 188,831 dollars or 7,193 dollars (4%) lower than that for white males (95% CI: -31,054 dollars, 16,669 dollars; P=.6); white females' was 159,415 dollars or 36,609 dollars (19%) lower (95% CI: -25,585 dollars, -47,633 dollars; P<.001); and black females' was 139,572 dollars or 56,452 dollars (29%) lower (95% CI: -93,383 dollars, -19,520 dollars; P=.003). CONCLUSIONS: During the 1990s, both black race and female gender were associated with lower annual incomes among General Internists. Differences for females were substantial. These findings warrant further exploration.

Black People↗
PubMed2006

The influence of provider sex on neurologists' annual incomes.

OBJECTIVE: We sought to determine the influence of provider sex on neurologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. METHODS: We used survey responses collected throughout the 1990s from 216 actively practicing neurologists and linear regression modeling to determine the independent influence of provider sex on neurologists' annual incomes. RESULTS: White female neurologists reported seeing 11% fewer visits and working 6% fewer annual hours than their white male counterparts. White female neurologists had practiced medicine for fewer years than white males (p = 0.01). In addition, females were less likely to be employees, as opposed to having an ownership interest in the practice, and were more likely to be board certified, though not statistically significantly so. After adjustment for work effort, provider characteristics, and practice characteristics, white female neurologists' mean annual income was 165,321 dollars, or 47,854 dollars (22%) lower than that for white males (95% CI: 82,710 dollars lower to 12,997 dollars lower, p = 0.007). CONCLUSION: During the 1990s, female sex was associated with lower annual incomes among neurologists. Just as policymakers are exploring sex differences in access to and outcomes health care, they should further explore these findings to ensure that income differences among physicians who provide that care are not unjustly driven by provider sex.

Certification↗
PubMed2006

Gender differences in diagnostic radiologists' annual incomes.

RATIONALE AND OBJECTIVES: Specialty, work effort, and gender have been shown to be associated with physicians' annual incomes; however, careful examination of the association between provider gender and physician incomes after correcting for other factors likely to influence income has not been conducted at the subspecialty level. We sought to determine the association between provider gender and diagnostic radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. MATERIALS AND METHODS: Using survey responses that were collected throughout the 1990s from 491 actively practicing white diagnostic radiologists, we generated a linear regression model to determine the association between provider gender and radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. RESULTS: White female radiologists reported working 2% fewer annual hours than their white male counterparts. Female radiologists had practiced medicine for fewer years than males, were more likely to be employees, as opposed to having an ownership interest in the practice, and were equally likely to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, female radiologists' mean annual income was $273,907, or $80,090 (23%) lower than that for white males (95% CI: $113,930 lower to $46,250 lower, P < .001). CONCLUSIONS: During the 1990s, female gender was associated with lower annual incomes among diagnostic radiologists. Researchers should further explore the relationship between physician gender and incomes to determine what factors might cause the differences that we found.

Income↗
PubMed2006

Women's primary care providers and breast cancer screening: who's following the guidelines?

OBJECTIVE: Screening mammography for woman ages 50 to 69 years has resulted in early breast cancer detection and reduced mortality rates. However, the providers who are responsible for women's preventive health care differ in breast cancer screening guideline adherence. We compared screening practices across provider specialty and training degree types. STUDY DESIGN: Using a retrospective cohort design, we examined 472 patient records that represented 16 million preventive health care visits among women ages 50 to 69 years from the 2000 National Ambulatory Medical Care Survey. We calculated relative risk ratios for breast examination and mammography during preventive visits across provider specialty and training types. RESULTS: Among specialists, gynecologists are more likely than internists or general/family practitioners to follow breast cancer screening guidelines. Across training degree types, mid-level providers are more likely than medical doctors or osteopaths to adhere to guidelines. CONCLUSION: Regardless of specialty type or training degree, women's health care providers should adhere to breast cancer screening guidelines during preventive care visits.

Aged↗
PubMed2006

The influence of physician race and gender on obstetrician-gynecologists' annual incomes.

OBJECTIVE: A study using 1998 data concluded that incomes of male and female obstetrician-gynecologists were essentially equivalent, after considering only differences in productivity. We examined the association between gender, race, and obstetrician-gynecologists' incomes, after correcting for productivity and other important practice and provider characteristics. METHODS: Survey responses obtained from 1992 to 2001 from 962 actively practicing obstetrician-gynecologists and linear regression modeling were used to estimate the influence of race and gender on physicians' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. RESULTS: Compared with white male and black female obstetrician-gynecologists, black men reported seeing 5% more patient visits and working 18% more hours, while white women reported seeing 18% fewer visits and working 10% fewer annual hours. Women were more likely to be nonowner employees than men. White female obstetrician-gynecologists were less likely than the other groups to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, black men's mean reported annual income was 210,859 dollars, or 78,905 dollars (27%) lower than that for white men (95% confidence interval [CI] 120,082 dollars to 37,729 dollars lower; P < .001); white women's was 242,721 dollars, or 47,043 dollars (16%) lower (95% CI 70,127 dollars to 23,958 dollars lower; P < .001); and black women's was 246,355 dollars, or 43,409 dollars (15%) lower (95% CI 92,296 dollars to 5,478 dollars higher, P = .08). CONCLUSION: During the 1990s, both black race and female gender were associated with substantially lower annual incomes among obstetrician-gynecologists. These findings warrant further exploration to ensure that income differences among physicians are not unjustly driven by race or gender.

Adult↗
PubMed2006

Tobacco cessation counseling across the ages.

OBJECTIVES: To examine recent rates of tobacco cessation counseling and whether patient age or sex was associated with providers' adherence to tobacco cessation guidelines. DESIGN: Survey study. SETTING: The 2002 National Ambulatory Medical Care Survey (NAMCS). PARTICIPANTS: Analysis of 22,605 records representing 687 million ambulatory care appointments with adults from the 2002 NAMCS. MEASUREMENTS: The proportion of visits by sex and age category during which physicians identified a patient's tobacco use status and counseled tobacco users to quit. RESULTS: The rates at which providers inquired about tobacco use were similar across groups, ranging from 65% of visits with men aged 20 to 44 to 73% of visits with women aged 45 to 59, but providers' rates of tobacco cessation counseling differed by age, ranging from 27% of visits with male tobacco users aged 45 to 59 to 6% of visits with male tobacco users aged 75 old and older. CONCLUSION: Although providers frequently ask their patients about tobacco use, they infrequently counsel patients to quit, especially if those patients are older men. Provider time constraints, misconceptions about older patients' ability and willingness to quit, or doubt about the potential health benefits of tobacco cessation in this age group may explain the lower counseling rates provided to older male patients. Because rates of counseling have declined in the last decade, providers should be reeducated about the need for and effectiveness of tobacco cessation counseling for men and women of all ages.

Adult↗
PubMed2006

Rural-urban disparities in health-related quality of life within disease categories of Veterans.

CONTEXT: Compared to their urban counterparts, rural veterans have been found to have lower health-related quality of life. PURPOSE: To determine whether these disparities persist when examining disease categories of rural and urban veterans. METHODS: We obtained survey data on 748,216 veterans who were current or anticipated Veterans Health Administration patients. Using International Classification of Diseases (ICD)-9CM codes, we determined whether these veterans had diagnoses that fell into any of 30 physical health disease categories, and we used ZIP codes to determine whether veterans lived in rural or urban settings. We compared rural to urban prevalence of disease categories as well as urban to rural health-related quality-of-life physical health component summary scores (PCS) and mental health component summary scores (MCS) for each disease category. FINDINGS: Physical diagnoses were significantly more prevalent in the rural veteran population for most disease categories examined. For every disease category examined, PCS were significantly lower for veterans who lived in rural, compared to urban, settings (P < .001 for all); rural veterans also experienced lower MCS for all disease categories although differences were modest. Differences persisted after controlling for sociodemographic factors. CONCLUSIONS: Compared to the urban veteran population, within disease categories, the rural veteran population experiences higher disease prevalence and lower physical and mental quality-of-life scores. Policymakers should anticipate greater health care demands from the rural veteran population and work to meet that demand.

Aged↗
PubMed2006

Characteristics of rural and urban cadaveric organ transplant donors and recipients.

CONTEXT: Health disparities have been found when comparing rural and urban populations. PURPOSE: To compare characteristics of rural and urban cadaveric transplant donors and recipients. METHODS: We used deidentified individual-level data on 55,929 cadaveric transplant donor-recipient exchanges between 2000 and 2003 and examined the relative rates of donating and receiving cadaveric transplants for rural compared to urban residents, as defined by ZIP Codes. FINDINGS: When compared to their urban counterparts, rural organ donors were more likely to have died from head trauma, drowning, motor vehicle accidents, or suicide and less likely to have died from cerebrovascular events, cardiac events, or homicide (P < .001 for all). Rural transplant recipients had lower levels of educational attainment and were less likely to have had the transplant financed by private insurance (P < .001 for all). While we found no statistical difference in days wait to organ transplantation, rural residents were more likely to donate than to receive cadaveric organs (P < .001). CONCLUSIONS: The differences in organ donation that we found warrant further exploration.

Adult↗
PubMed2006

Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders.

OBJECTIVE: The authors studied whether rural and urban disparities in health-related quality of life, demonstrated previously among veterans, persist among veterans with common psychiatric disorders. METHODS: A cohort of 748,216 users or anticipated users of Veterans Affairs services completed the Veterans Short Form Health Survey in 1999. From the survey, the authors determined health-related quality-of-life scores (physical [PCS] and mental [MCS] health component summaries) and used ICD-9-CM codes to identify veterans with six mental health disorders-depression, anxiety, posttraumatic stress disorder, alcohol dependence, schizophrenia, and bipolar disorder. With Rural-Urban Commuting Area codes to determine urban residency, the prevalence of psychiatric illness and health-related quality of life were compared across rural and urban groups. RESULTS: All psychiatric disorders except anxiety disorders not related to posttraumatic stress disorder were more prevalent in urban settings. However, rural veterans within mental illness cohorts had worse PCS and MCS scores. Differences in PCS scores were substantial, ranging between 2.27 for schizophrenia and 3.39 for alcohol dependence (p<.001 for all diagnoses). Differences in MCS scores were statistically significant but modest. In regression models, rural-urban disparities within psychiatric disorder cohorts persisted after sociodemographic factors were controlled for. CONCLUSIONS: Although less likely than their urban counterparts to have mental disorders, rural veterans with mental illness experienced a greater disease burden and were likely to incur greater health care costs. Improving access to mental health care for veterans in rural settings may narrow quality-of-life disparities among rural and urban veterans.

Adult↗
PubMed2004

Substance abuse intensive outpatient treatment: does program graduation matter?

Program graduation, even after controlling for length of stay, may predict for improved outcomes in some substance abuse treatment settings. We investigated the role of program graduation by comparing social outcomes and inpatient utilization the years before and after treatment among graduates and dropouts of a Veterans Administration substance abuse intensive outpatient program. At enrollment, graduates and dropouts were similar in all spheres measured. Patients who completed the treatment program used significantly fewer psychiatric inpatient bed days of care the year after they completed the program, both in comparison to their own prior use and in comparison to program dropouts. Graduates were more likely to be abstinent and less likely to fully relapse or be incarcerated at 6-month followup. Further research is needed to discern optimal treatment length-that which maximizes both length of stay and completion rates, while optimizing use of limited treatment resources.

Female↗
PubMed2004

Changes in authorship patterns in prestigious US medical journals.

To improve identification of contributors to manuscripts, editors of medical journals have developed authorship responsibility criteria. Some have specified an acceptable number of authors per manuscript. We wanted to examine changes in patterns of authorship in the context of the development of these specifications. Therefore, we used a retrospective cohort design to calculate the average number of authors per manuscript and the prevalence of group and corporate authorship between 1980 and 2000 for original, scientific, non-serial articles published in four prestigious medical journals: the Annals of Internal Medicine, Archives of Internal Medicine, Journal of the American Medical Association, and the New England Journal of Medicine. Group authorship identifies individual authors in the byline who are writing for a group; in corporate authorship, contributors are not individually listed in the byline. We found that the number of authors per article increased dramatically over time in each journal, from an average of 4.5 in 1980 to 6.9 in 2000 across journals. As a proportion of published manuscripts, group authorship (authors listed in the byline) increased from virtually zero to over 15%, while corporate authorship (authors not listed in the byline) remained rare and stagnant. Manuscripts published by single authors all but vanished. Group authorship was most prevalent in journals that limited the acceptable number of authors per manuscript. These findings suggest that the number of authors per manuscript continues to grow. The growth in the number of authors on bylines and the proportion of group-authored manuscripts is likely to reflect the increasing complexity of medical research.

Authorship↗
PubMed2004

Return on educational investment in geriatrics training.

The graying of America will increase demand for specialists in geriatric medicine, but the proportion of filled fellowship positions in geriatric medicine has been falling recently. The objective of this study was to examine the financial return of additional training in geriatric medicine for general internists by using survey data from the American Medical Association and standard financial techniques. The return on educational investment over a working lifetime for a third-year resident in internal medicine who was considering specialty training in geriatric medicine between 1993 and 1999 was calculated. Physicians self-identified as geriatricians had lower incomes and lower incomes per hour than age-matched general internists, although the disparities decreased somewhat over the period examined. Regression modeling suggested that incomes for geriatricians are lower than expected and that this disparity increased in the last 2 years of the study. Some of the income disparities may be attributable to the fact that geriatricians obtain a greater proportion of their total revenue from Medicare than is optimal in the generalist setting. Returns on educational investment for geriatrics training were negative, although less so in recent years. Analysis suggests that the pursuit of additional specialty training in geriatric medicine has a negative financial return. Financial returns and the incentives they create should be carefully considered in meeting the anticipated geriatrics workforce needs of the nation.

Economics, Medical↗
PubMed2003

Time and money: a retrospective evaluation of the inputs, outputs, efficiency, and incomes of physicians.

BACKGROUND: Physicians' concerns with the health care system focus on having less time with their patients and needing to work harder to maintain incomes. We sought to determine whether physicians are working longer hours and whether their incomes are declining. METHODS: Using survey data, we conducted a retrospective analysis of physician inputs, outputs, efficiency, and incomes for generalists, general internists, general surgeons, pediatricians, and obstetrician-gynecologists from 1987 to 1998. RESULTS: Physician inputs (as measured by the average hours worked in professional activities) showed little absolute change across specialties over time. Outputs (as measured by the total number of patient visits per week) decreased between 9% and 28%, depending on the specialty. Efficiency (the proportion of time spent in direct patient care and the amount of time spent during a typical office visit) remained stable over the time examined. Consumer price index inflation-adjusted annual incomes increased considerably over the time period examined (42% for general internists, 28% for pediatricians, 13% for generalists, and 8% for general surgeons); only obstetricians-gynecologists showed a net loss of annual income when adjusting for inflation (a 6% loss). CONCLUSIONS: Our findings do not confirm the prevailing concern that physicians are working harder or longer or that their incomes are declining, but they offer an explanation of how physicians are maintaining incomes without increasing work inputs. There is a great deal of dissatisfaction with the health care system among physicians; exploration of perceptual reasons for that dissatisfaction may outline a course of action needed to resolve it.

American Medical Association↗
PubMed2002

Long-term financial implications of specialty training for physicians.

PURPOSE: Given the recent changes in physician reimbursement and managed care penetration, we examined the financial returns that might be anticipated when considering different medical careers. METHODS: We used survey data from the American Medical Association and standard financial techniques to calculate the return on educational investment (as the discounted, annual hours-adjusted, net present value of additional training) over a working lifetime for six different specialties (family practice, pediatrics, general internal medicine, gastroenterology, cardiology, and general surgery). RESULTS: From 1992 to 1998, the annual yield on specialty training (hours-adjusted internal rate of return) declined for all specialty groups, especially for primary care specialties. The difference in the average income between a given specialty and general practice decreased for general internal medicine, from $5400 (95% confidence interval [CI]: $5000 to $5800) in 1992 to $1180 (95% CI: $1160 to $1205) in 1998, and became negative for family practice (from $5200 [95% CI: $1000 to $9500] to -$2500 [95% CI: -$5800 to $800]) and pediatrics (from $4000 [95% CI: $1200 to $6800] to -$6300 [95% CI: -$9700 to -$2900]). Values for surgery decreased from $33,100 (95% CI: $29,400 to $36,400) in 1992 to $27,200 (95% CI: $21,700 to $32,100) in 1998, whereas there were increases for cardiology, from $35,100 (95% CI: $30,000 to $39,700) to $36,700 (95% CI: $26,500 to $45,700), and for gastroenterology, from $30,000 (95% CI: $21,800 to $37,200) to $34,700 (95% CI: $22,700 to $45,300). CONCLUSION: Our analysis suggests that recent efforts to use financial incentives to make primary care fields more attractive have not been effective. Financial returns and the incentives they create should be carefully considered as part of health care reform.

Adult↗
PubMed2002

Relations between brain pathology and temporal lobe epilepsy.

Temporal lobe epilepsy, the most common type of epilepsy in adult humans, is characterized clinically by the progressive development of spontaneous recurrent seizures of temporal lobe origin and pathologically by hippocampal neuronal loss and mossy fiber sprouting. In this study, we sought to test the prominent hypothesis that neuronal loss and mossy fiber sprouting play a critical role in the genesis and progression of temporal lobe epilepsy. Rats receiving a single kainic acid injection experienced a single sustained episode of epileptic status with massive neuronal loss and mossy fiber sprouting, whereas rats receiving triple kainic acid injections experienced two priming episodes and one sustained episode of epileptic status with no detectable neuronal loss and mossy fiber sprouting. Early in the process of chronic seizure development, primed rats that failed to show detectable neuronal loss and mossy fiber sprouting exhibited a starting date and a frequency of spontaneous recurrent seizures similar to those of nonprimed rats that showed massive neuronal loss and mossy fiber sprouting. However, nonprimed rats displayed significantly prolonged episodes of spontaneous recurrent seizures over the whole process of chronic seizure development and more frequent severe seizures later in the process. Similar results were observed in both Fischer-344 and Wistar rats as well as in the rat pilocarpine preparation of temporal lobe epilepsy. These results fail to reveal a relation between neuronal loss-mossy fiber sprouting and the genesis of temporal lobe epilepsy but suggest that neuronal loss, mossy fiber sprouting, or both contribute to the intensification of chronic seizures.

Animals↗