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At least 19 recordsLinked to original sources
PubMed1979

Physician attitudes toward physician extenders: a comparison of nurse practitioners and physician assistants.

A survey of all physicians in the Eighth District Medical Society (Western New York) was conducted in 1975 to determine physician attitudes toward employment of and task delegation to nurse practitioners. The results of this study and one other similar study of nurse practitioners are compared to results of two previous studies examining physician attitudes toward physician assistants. It appears that physicians are somewhat more willing to employ and delegate tasks to a physician's assistant. Some correlates of physician attitudes toward each of the two types of physician extenders are also compared and discussed.

Attitude of Health Personnel↗
PubMed1979

The physician assistant in rural primary care practices: physician assistant activities and physician supervision at satellite and non-satellite practice sites.

Nineteen practice sites in Iowa were studied to determine the differences in the types of physician (MD) supervision the physician assistant (PA) received at work at satellite (separate from the major practice site of the supervising MD) and non-satellite practice sites. The MDs supervised PA functions in 12.9 per cent of the patients seen by the PAs at non-satellite and 15.9 per cent of patients they saw at satellite practice sites. All patients with presenting manifestations that suggested life-threatening conditions were seen by MDs at satellite and non-satellite sites. The MD spent 9.2 minutes per patient at satellite clinics, compared to 4.4 minutes per patient at non-satellite clinics. PAs working at satellite sites appeared to receive as much supervision as PAs working at non-satellite clinics.

Clinical Competence↗
PubMed1978

Physicians and non-physician health practitioners: the characteristics of their practices and their relationships.

Six primary care practices which utilize both physician and non-physician practitioner types were studied to measure differences between practitioner types in the care of patients. By chart review 1,369 patient-practitioner encounters were examined. Physicians identified less symptoms and signs in their patients and prescribed less non-drug therapies than did non-physicians. Likewise, at follow-up visits, physicians tended to document less follow-up of these types of problems and therapies than non-physicians. When examining the interaction between practitioners, the highest rates of follow-up of all types of problems and therapies were found when the same practitioner saw the patient at two successive visits to the same clinic. When a physician saw a patient following a previous visit to a nurse practitioner, there was a significant drop-off in the follow-up rate of problems and therapies. However, when a nurse practitioner saw the patient following a previous visit to a physician, the drop-off in follow-up rates was not as striking. These findings indicate that the skills of physician and nonphysician practitioners are potentially complementary. However, this potential is not fully exploited, particularly by physicians.

Diagnosis↗
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↗
PubMed1977

The supply of physicians and physicians' incomes: some projections.

This study identifies trends that will lead to a dramatic increase in the number of active physicians in the United States during the next decade. The supply of active medical doctors (MDs) and doctors of osteopathy (DOs) as well as active post-graduate MDs and DOs in the U.S. is projected to increase by approximately 50 percent in the decade ending in 1985. The number of active physicians per 100,000 population is similarly expected to increase by approximately one-third. The production of surgical specialists, in particular, appears to be excessive. In response, the average length of physician graduate training programs is anticipated to be shortened as more MD and DO graduates enter shorter, general practice residencies. The authors expect that the effects of this projected increase in the supply of physicians may relieve geographic disparities in physician distribution, rationalize the organization of medical practice, and reduce physicians' incomes relative to other professional groups and possibly in absolute terms. The projected increases in the supply of physicians will give the federal government much more flexibility and bargaining power should it choose to implement a national health insurance program with salaried physicians.

Economics, Medical↗
PubMed1978

Physician's assistants, their physician employers, and the problem of autonomy: consensus or conflict?

Do physician's assistants (PAs) and their physician employers disagree about levels of supervision and autonomy, and does level of physician's assistant autonomy relate in any way to other aspects of practice satisfaction? An indepth study of MD-PA teams in practice reveals that there is greater consensus than conflict concerning the autonomy of the physician's assistant; that the level of physician's assistant autonomy is not related to salary or to physician's assistant employment satisfaction; and that physician-employers who consider their physician's assistants to be more autonomous also tend to feel that the quality of their lives has improved as a result of hiring an assistant.

Conflict, Psychological↗
PubMedDate not supplied

Factors in the physician practice location puzzle: a survey of New York State residency-trained family physicians.

BACKGROUND: For the past 5 years fewer medical students have selected primary care specialties, and one-third of all physicians have indicated they will move in the next 5 years. These two factors make family physicians one of the most recruited specialties in medicine. METHODS: A questionnaire about practice profiles and factors that have an impact on a physician's location decision was mailed to all physicians who graduated from New York State family medicine residencies between 1970 and 1989. Data from completed responses were analyzed by year of graduation from residency, community size, and whether the responder remained in New York State or chose to locate outside New York State. RESULTS: There were 711 (46 percent) physicians who responded. The number of minorities remained stable at 14 percent during these years, but women graduates increased from 12 percent to 21 percent. The graduates in the 1980s, when compared with those in the 1970s, were more likely to be salaried, make less money, and to believe employment for the physician's spouse to be important in practice location. The 38 percent of responders from communities of fewer than 25,000 were less likely to be salaried, were more likely to practice in a group, worked more hours, offered a broader range of services including obstetrics, made less money, and placed less importance on availability of hospital consultants. Extended family, previous negotiated obligations, and geographic or climate issues were the reasons 64 percent of out-of-state responders gave for leaving New York. Spouse's opinion, hospital consultants, hospital services, colleague interaction, and after-hours coverage were most frequently rated as important factors for family physician practice location. CONCLUSIONS: Factors important in attracting new physicians to a community include the spouse's opinion, institutional and colleague support, and lifestyle issues.

Adult↗
PubMed1977

Physicians, physicians' assistants, and the social characteristics of patients in southern Appalachia.

A focus on health care delivery systems and the emergence of New Health Practitioners, particularly Physicians' Assistants (PAs), represents one of the more significant nonbiomedical developments in American medicine since World War II. Much discussion about PAs revolves around the kinds of illnesses they are qualified to treat which then permits physicians to concentrate on patients with other types of illnesses. Ignored in this focus on illness characteristics is the possibility that physicians and PAs may treat patients with different social characteristics. That issue is the topic of this paper. Differences between the status characteristics of physician and PA patients are reported for a rural community where PAs and physicians work side by side in the same offices. The relationships observed in this rural community suggest that the higher a patient's socioeconomic status, the more likely (s)he is to be treated by the physician.

Age Factors↗
PubMed1977

The effectiveness and cost of acute respiratory illness medical care provided by physicians and algorithm-assisted physicians' assistants.

The medical management of patients with acute respiratory illnesses was analyzed at two different clinics during a 14- to 21-month period. Patients received care from either physicians or physician-supervised physician's assistants (PA). The PAs used respiratory illness clinical algorithms to guide their choice of diagnostic tests and treatment. Illness outcome, patient satisfaction, and medical care cost data were obtained for all patients approximately two weeks after the index illness. Despite significant differences in patient population characteristics, illness outcomes were similar, regardless of the provider's educational background. Medical care costs, however, were highest for the physician's patients. For all patients, diagnostic tests contributed about one-third of the total direct costs, mainly because of chest x-ray and throat culture use. Sixty to eighty per cent of medication costs were due to nonprescription drugs used principally for symptom relief. The data demonstrate that the medical care delivered by these physician's assistants was as effective and less costly than the care provided by physicians. Reducing chest x-ray and throat culture use would have a significant economic impact, without adversely affecting medical care effectiveness.

Acute Disease↗
PubMed1992

Evaluating acute hand injuries in the emergency department: a comparison of physicians with varying postgraduate training backgrounds. St Louis Emergency Physicians' Association Research Group.

This study compared the quality of the history, physical examination, and treatment of patients with hand injuries performed by emergency physicians with varied training backgrounds. Four hundred ninety-seven patients with isolated hand injuries were evaluated by 97 physicians, who were classified into four groups: (1) emergency medicine board certified, (2) primary care specialty board certified, (3) non-board certified, and (4) moonlighting residents. The history and physical examination were separated into several variables to define deficiencies. Adequacy of treatment were determined by two emergency physicians and an orthopedic surgeon. Significant differences were found in five categories. Group no. 4 documented the history and followed the Centers for Disease Control tetanus prophylaxis guidelines better than did groups no. 1 or 2. Group no. 1 obtained x-rays less often than any other group and had a better treatment score, but the latter did not reach statistical significance. Physicians of lesser training are more meticulous about documenting a history and following treatment protocols than are residency-trained or boarded emergency physicians, but order more tests and are less likely to document adequate treatment.

Acute Disease↗
PubMed1992

Aid-in-dying: should we decriminalize physician-assisted suicide and physician-committed euthanasia?

Recent news stories, medical journal articles, and two state voter referenda have publicized physicians' providing their patients with aid-in-dying. This Note distinguishes two components of aid-in-dying: physician-assisted suicide and physician-committed voluntary active euthanasia. The Note traces these components' distinct historical and legal treatments and critically examines arguments for and against both types of action. This Note concludes that aid-in-dying measures should limit legalization initiatives to physician-assisted suicide and should not embrace physician-committed voluntary active euthanasia.

Ethics, Medical↗
PubMed1992

The physician's physician: latent duties to protect third persons.

It is apparent from a growing body of court decisions that physician-patient confidentiality has been limited in those circumstances where society has a need to know certain specific information. The treating physician's duty to breach confidentiality and to warn third parties of a patient's dangerousness because of violent intent, effects of medication or dangerous health condition encompasses a duty to report previously undisclosed impairment of a fellow physician who is in treatment. The alternative is to convince the impaired colleague to withdraw from practice until the impairment is remedied. Thus, a physician collegially providing care of a colleague shoulders a particular responsibility when the physician patient is found to manifest professional impairment. This article presents a development of this thesis based upon common law and legislation in the United States.

Confidentiality↗
PubMed1992

Factors affecting physician loyalty and exit: a longitudinal analysis of physician-hospital relationships.

This article examines forces that influence physicians to change the percentage of their admissions to a hospital (loyalty) and to cease admitting patients to a hospital altogether (exit). Because physicians are both members of a hospital and consumers of its services, their admitting patterns can be described using models of employee commitment and consumer buying behavior. We test several hypotheses drawn from these literatures using data on physician admissions at hospitals over a two-year period. Results indicate that admitting patterns are explained primarily by convenience and inertia processes characteristic of consumer behavior. On the other hand, factors believed to influence organizational commitment (e.g., decision-making involvement, conflict, economic investments) have little effect on loyalty and exit. The findings question the utility of hospital strategies to improve the climate of physician-hospital relations, and suggest several qualifications for research on the commitment of professionals.

Age Factors↗
PubMed1992

CompreLink--a physician to physician communication network.

The Cleveland Clinic Foundation has developed a physician to physician communication network designed to meet the needs of their affiliate physicians--physicians who do not have admitting privileges at the Cleveland Clinic Hospital. This paper provides an overview of the CompreLink network as it exists today, as well as a glimpse into some of their plans for network expansion and development.

Group Practice↗
PubMed1992

Physician attitudes toward confidentiality of treatment for adolescents: findings from the Upper Midwest Regional Physicians Survey.

The provision of confidential medical services to adolescents is an enduring health policy issue in the United States, and the focus of policy statements by several professional medical organizations. Physician attitudes toward confidential service provision to teenagers were examined in the Upper Midwest Regional Physician Survey, a representative sample of community-based pediatricians and family physicians. Overall, three-quarters of participants favored confidential service provision for youths. Multivariate analysis revealed that the most salient reasons for favoring confidentiality were perception of unique needs among adolescents, year of licensure, high self-assessed competency in addressing sexual concerns of adolescence, adequacy of training in interpersonal and sexual issues, frequency of addressing interpersonal issues, and lower self-assessed adequacy of training in traditional medical problems of youths. Implications for state and federal legislation are discussed.

Adolescent↗
PubMed1978

Geographic variation in physicians' fees. Payments to physicians under Medicare and Medicaid.

To study geographic differences in physician fees recognized by the Medicare and Medicaid programs, we analyzed physician reimbursement rates at the national, regional, state, and county levels. The results indicate that nationally, Medicaid specialist fees are 77% of Medicare specialist fees. Meidcare specialist fees in metropolitan areas are 23% higher than those in nonmetropolitan areas, but there are no differences under Medicaid. State Medicare specialist fees varied from 73% to 132% of the national Medicare average, while Medicaid specialist fees ranged from 49% to 179% of the national Medicaid average. State Medicaid fees for specialists ranged from 39% to 100% of Medicare specialist fees. These results indicate that under national health insurance, fees set at national or statewide levels could have notable effects on physician remuneration in some localities.

Fee Schedules↗