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Biomedical subjects

W D Marder

Publications and source records attributed to W D Marder.

At least 19 recordsLinked to original sources
PubMed2000

Cost implications for the use of inhaled anti-inflammatory medications in the treatment of asthma.

OBJECTIVE: To compare the expected costs of treating patients with asthma with versus without inhaled anti-inflammatory medications, adjusting for other factors that also influence medical care expenditures. DESIGN: Nonlinear exponential regression analyses were used to estimate relationships between medical care expenditures and treatment with inhaled corticosteroids, sodium cromoglycate (cromolyn) or nedocromil. The regressions adjusted for differences in patients' demographics, location, plan type and severity of illness. SETTING: Large, self-insured, corporate-sponsored medical plans represented in MarketScan database. PATIENTS AND PARTICIPANTS: 7466 continuously enrolled patients with asthma. INTERVENTIONS: Treatment with inhaled corticosteroids, sodium cromoglycate or nedocromil. MAIN OUTCOME MEASURES: (i) Total inpatient, outpatient and pharmaceutical expenditures; and (ii) asthma-related expenditures in the 1996 calendar year. RESULTS: If all patients had been treated with inhaled anti-inflammatory drugs, total expenditures would be expected to be about $US944.82 per patient lower, on average, than would be the case if no patients received these drugs. Asthma-related expenditures would be about $US498.74 per patient higher, on average, if all patients were treated with these drugs. CONCLUSIONS: Using inhaled anti-inflammatory agents would be associated with higher asthma-related expenditures but lower total expenditures. Treatment with inhaled anti-inflammatory drugs may represent an investment in better care that pays off with better health and lower total medical care expenditures.

Administration, Inhalation↗
PubMed1991

The supply of renal physicians: an analysis of data from the American Medical Association Physician Masterfile.

This study uses data from the American Medical Association (AMA) Physician Masterfile to describe current demographic trends among physicians specializing in adult and pediatric nephrology. The analysis shows that renal physicians are younger than the physician population as a whole. Compared with other specialty groups, renal physicians are less likely to be in patient-care activities and are more likely to be in research. In recent years, the population of renal physicians has grown at a much faster rate than the rest of the physician population. A projection analysis indicates that the adult nephrologist population will more than double in size between 1987 and 2010. Among adult nephrologists, the number of women is expected to grow much faster than the number of men. Rapid growth is expected in the older age categories, whereas the number of adult nephrologists 35 years of age and younger is expected to decrease slightly.

Adult↗
PubMed1991

Specialization among obstetrician/gynecologists. Another dimension of physician supply.

This study uses the Herfindahl index to investigate the specialization patterns of physicians. "Specialization" is defined as the degree to which an individual doctor concentrates his practice into a narrow range of disease categories. This application is the specialization pattern of office-based obstetrician/gynecologists in the United States. Physician's age and solo practice both exhibit a systematic negative effect on specialization. Both the age and type of practice effects reflect the tendency for younger and nonsolo obstetrician/gynecologists to gear relatively more of their practice into birth-related activities. The age effect is consistent with the hypotheses that either: (1) energy and/or skills for treating pregnancy become more scarce with age, or (2) there is a life-cycle pattern in the doctor/patient relationship with pregnancy serving as an entry point. Malpractice concerns may also contribute to this age effect. The nonsolo practitioner effect suggests the efficiency of multiple doctor practices for allocating physicians' time in activities with high hourly variability in demand. The method used to measure specialization can be extended to investigate other specialty categories and important issues regarding the future supply of physicians' services. These include the effects of an aging physician population and proposed changes in physician reimbursement.

Age Factors↗
PubMed1991

The role of local hospitals in physician rural location decisions.

This study has two objectives. First, it identifies how much the presence of community hospital beds adds to the stock of physicians practicing in nonmetropolitan counties. Second, it estimates the impact hospital closures or other reductions in beds have on the net flow of physicians into rural counties. The study relies primarily on data from the 1981 and 1986 Physician Masterfiles of the American Medical Association. We find that hospital bed reductions and closures essentially do not affect the availability of physicians--they have apparently already left by the time the downsizing occurs. Further, population change and the number of physicians already in the county determine for the most part the entry or exit of physicians.

Career Choice↗
PubMed1990

Physician contact with and attitudes toward HIV-seropositive patients. Results from a national survey.

The growing population of HIV-seropositives raises serious concerns about who will provide medical care to this group. This article presents the first national estimates of physician involvement in, and attitudes toward, the treatment of HIV-seropositive patients. Nearly 50% of the nonfederal patient care physicians in our nationally representative sample have treated at least one HIV patient, with an average of 6.7 such patients being treated per physician. Perceived responsibility to treat HIV-seropositive patients is uniformly strong across such physician and practice characteristics as specialty, years of experience, and practice type. However, there are pronounced differences in actual physician involvement along these dimensions.

Age Factors↗
PubMed1990

The growing proportion of female physicians: implications for US physician supply.

This study analyzes how the growing proportion of women in the United States physician population will affect the amount and type of physician services available to the US population. Female physicians work fewer hours per week, are slightly less likely to be in patient care, and tend to enter different specialties than male physicians. Female physicians also have higher retirement rates than male physicians, but due to their lower mortality rates, have work lives nearly as long as male physicians. We examined how the changing composition of the physician population will affect the availability of physician services by comparing historical and projected trends for the number of active post-residency physicians with comparable trends for a full-time-equivalent measure of physician supply. The full-time-equivalent measure takes into account the different labor supply behavior of key subpopulations (e.g., women and graduates of US versus foreign medical schools). The results suggest that the changing composition of the physician population will reduce the growth of effective physician supply between 1986 and 2010 but only by four percentage points.

Adult↗
PubMed1986

Location of medical education and choice of location of practice.

The geographical distribution of physicians is affected by a number of factors, including the location of their medical education. The authors of the present paper examined the physicians' decisions on where to locate after they completed their training by determining where a state's practicing physicians come from and whether physicians who are trained in a state practice in that state or out of state. The results indicated a positive correlation between location of training and location of practice. Women physicians and general/family practitioners were most likely to remain in the state where they received their graduate medical education. The results also suggested that medical schools and graduate medical education programs are vehicles through which a state can attract physicians who will practice there.

Education, Medical↗
PubMed1985

Competition and medical groups. A survivor analysis.

This paper extends the survivor analysis of medical practice provided by Frech and Ginsburg (1974). Changes in the distribution of medical practice sizes are examined for the periods 1965-69, 1969-75, and 1975-80. Through 1975, we find that, almost uniformly, all sizes of medical groups were found to be optimal. In particular, the optimality of large (100 or more physicians) multi-specialty groups was strongly confirmed. Later data, however, suggest that the equilibrium size distribution may have shifted. For the 1975-80 period only large multi-specialty groups continue to be in the optimal size range. In addition, we find some evidence that suggests that solo practices may be optimal in some geographic regions.

Catchment Area, Health↗
PubMed1984

Changes in the hours worked by physicians, 1970-80.

The hours worked by physicians are affected by changes in a number of factors, including attitudes towards labor-leisure tradeoffs, the characteristics of the physician workforce, and the level of demand for medical services. This paper analyzes changes in the hours worked per week by office-based physicians over the decade 1970-80. Overall, there has been a statistically significant decline in hours of approximately 3 per cent, or 1.5 hours per week. This decline was fairly uniform across most physician characteristics, although the decline was greater for those in primary care specialties. Female physicians increased their average hours worked, although this increase was not statistically significant. In terms of the delivery of skilled medical services, the decline in total hours was largely offset by an increase in the percentage of total hours devoted to patient care. The question of whether these trends will continue has important implications for the validity of projections of a physician surplus in the near future.

Adult↗
PubMed1983

Waiting to see the doctor. The impact of organizational structure on medical practice.

In this article it is assessed whether or not the scheduling and office visit queues a patient faces depend upon the organizational structure of the physician's practice (i.e., does the physician practice in the fee-for-service system or in a health maintenance organization [HMO], and if in an HMO, in what type of an HMO). Data pooled from two national studies (N = 2448) reveal two major findings. First, although scheduling queues may be predicted from the organizational structure of physicians' practices and other factors, office queues appear to be more of a random phenomenon. Second, a distinct pattern emerges among the effects of the organizational structure of physicians' practices on patient queues, including 1) physicians in solo practice offer their patients the shortest queues, 2) physicians in group model HMOs maximize scheduling queues but minimize waiting room queues, 3) patient queues for physicians practicing in IPAs are no different from those of their counterparts in group-practice fee-for-service settings, and 4) patient queues for salaried physicians practicing in a predominantly salaried environment are among the longest. The implications of these findings are discussed with special reference to extent and future studies of the effects of organizational structure on medical practice.

Appointments and Schedules↗
PubMed1983

The organization of medical practice and primary care physician income.

This study investigates the effect of the organization of medical practice, e.g., solo, fee-for-service group, or health maintenance organization (HMO) settings, on primary care physicians' net incomes. Using pooled data on 2,372 primary care physicians, multivariate regression analysis is used to adjust physicians' 1979 net incomes for differences in medical specialty, workload, sex, and experience before estimating the effects of the organization of medical practice. Among HMO physicians, only those in staff model HMOs were found to have significantly lower net incomes than their fee-for-service group practice counterparts. Accordingly, there is little evidence to support the popular belief that physicians practicing in HMOs consistently earn less than their fee-for-service counterparts. (Am J Public Health 1983; 73:379-383.)

Humans↗
PubMed1982

State retention of medical school graduates.

State governments support medical schools in their states for various reasons. A major reason is the perception that graduates tend to practice in the state where they attend medical school. In a study reported here, the authors examined this assumption by investigating the experience of physicians currently active in medical practice. The entire population of active U.S. physicians who graduated from U.S. medical schools was examined, as well as four selected cohorts of U.S. medical school graduates, using the American Medical Associations' Physician Masterfile. The ability of states to retain their medical school graduates is related to physician characteristics (age, medical school, and practice specialty) as well as to state characteristics (population, physician-to-population ratio, and per capita income). The results indicate that, overall, the argument that states should support medical schools in order to ensure an adequate supply of physicians is less compelling than in the past, for reasons often beyond the control of the individual states.

Adult↗