RESUMEN
Over the course of the past twenty years, private equity (PE) has played a role in acquiring medical practices, hospitals, and nursing homes. More recently, PE has taken a greater interest in acquiring dental practices, but few data exist about the scope of PE activity within dentistry. We analyzed dentist provider data for the period 2015-21 to examine trends in PE acquisition of dental practices. The percentage of dentists affiliated with PE increased from 6.6 percent in 2015 to 12.8 percent in 2021. During this period, PE affiliation increased particularly among larger dental practices and among dental specialists such as endodontists, oral surgeons, and pediatric dentists. PE-affiliated dental practices were more likely to participate in Medicaid than practices not affiliated with PE. Future research should investigate whether PE's role in dentistry affects the affordability and quality of dental services.
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Odontólogos , Humanos , Estados Unidos , Odontólogos/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Sector Privado , Práctica Privada/estadística & datos numéricosRESUMEN
BACKGROUND: Nail excisions are indicated for onychocryptosis and nail spicules. They are technically demanding and require a refined skill set. We aimed to characterize practice patterns of US providers performing nail excisions. METHODS: We conducted a retrospective analysis of Medicare provider use and payment data, part D, for all claims of partial or complete nail/nail matrix excision with/without nail plate removal/destruction (current procedural terminology code 11750). High performers were defined as providers performing annual nail excisions 2 standard deviations above the mean. We analyzed demographic risk factors for nail excision high performers, including practice location, years of experience, household median income, practice type, and provider gender. Statistical analysis was conducted in SAS v9.4, with values of P < .05 considered statistically significant. RESULTS: Providers (n = 32,279) and high performers (n = 942) performed mean 34.7 and 173 nail excisions annually. Unsurprisingly, podiatrists constituted 99.7% of all nail excision performers. Providers in the South versus Midwest and Northeast were more often nail excision high performers (odds ratio [OR], 1.95; P < .0001, and OR, 1.46; P < .0001). Solo versus group practitioners were more likely, respectively, to be nail excision high performers (OR, 2.15; P < .0001). With linear regression analysis, for every 10-year increase in years of provider experience, there was an increase of 1.2 nail excisions annually per provider (P < .0001). For every $100,000 increase in household median income of practice location, there was a decrease of 9.9 nail excisions annually per provider. CONCLUSIONS: Southern podiatrists, podiatrists with more years of experience, solo practitioners, and those practicing in regions with lower household median incomes were more likely to perform higher numbers of nail excisions. Identifying performance trends among podiatrists can help podiatrists understand how their performance of nail excisions compares to other podiatrists across the country.
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Podiatría , Práctica Privada , Humanos , Estudios Retrospectivos , Masculino , Femenino , Estados Unidos , Práctica Privada/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Uñas/cirugía , Medicare , Uñas Encarnadas/cirugía , Competencia ClínicaRESUMEN
OBJECTIVES: The aim of this clinical audit was to assess patient demographics, outcomes and experience with care in patients who received acupuncture in a private practice setting in the United Kingdom. METHODS: Demographic and clinical data were extracted from patients' records over a 7-year period. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and an adapted Patient Global Impression of Change (PGIC) scale were used routinely to monitor patient outcomes over an 18-month period. Finally, a retrospective questionnaire was used to assess patient beliefs regarding treatment effectiveness, adverse events and overall experience with care. Patients not providing consent or known to be deceased were excluded. RESULTS: Data were collected for 306 patients presenting with 376 separate health complaints, 58% of which were musculoskeletal. Follow-up outcomes (MYMOP scores (n = 51) and PGIC scale responses (n = 50)) showed a clinically significant improvement compared to baseline for the majority of health complaints (93% of PGIC scores were 'improved' and 79% MYMOP demonstrated > 1 point change). Total mean MYMOP severity scores were reduced by almost 50% (p < 0.001) after 1-4 weeks, and this was sustained in the medium-to-long term. There was a strong negative correlation (r = -0.767, p < 0.001) between the MYMOP and PGIC scores. A total of 118 health complaints were reported by 85/255 patients who responded to a retrospective questionnaire. Over 84% of patients believed that the treatments they received were 'effective' at addressing their health complaints. Seven minor adverse events were reported and four patients experienced negative treatment outcomes. CONCLUSIONS: Although musculoskeletal conditions were the most common, this audit found that patients sought treatment for a wide range of predominantly chronic health complaints, for many of which there is a currently a lack of quality evidence to support the use of acupuncture. Overall, the small sample of patients who responded to outcome questionnaires reported clinically meaningful and sustained improvements.
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Terapia por Acupuntura , Práctica Privada , Humanos , Femenino , Masculino , Reino Unido , Persona de Mediana Edad , Adulto , Anciano , Encuestas y Cuestionarios , Estudios Retrospectivos , Práctica Privada/estadística & datos numéricos , Resultado del Tratamiento , Satisfacción del Paciente , Adulto Joven , Auditoría Clínica , Adolescente , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Studies suggest an increasing trend of plastic surgeons choosing private practice after training, with up to 90% pursuing private practice without future fellowships.1 Previous data showed that 66.7% of graduates from plastic surgery residency programs chose to pursue private practice without future fellowship, while more recent studies estimate this statistic has risen close to 90%.1,2 The literature has yet to characterize the current plastic surgery workforce and changes in its composition over time. This study aims to analyze the characteristics and training of plastic surgeons in California through a comparative study with general surgeons. METHODS: Surgeon demographics were extracted from the Centers for Medicare and Medicaid Services open database. Urban/rural classification and academic affiliation were crosslinked from the Inpatient Prospective System database and sole proprietorship status was cross-linked from the NPI Registry. Summary statistics and logistic regressions with chi-squared analysis were analyzed using STATA/MP17. RESULTS: Our analysis consisted of 3871 plastic and general surgeons in California. Compared to general surgeons, plastic surgeons were less likely to be females (P < 0.000), and more likely to be sole proprietors (P < 0.000), and affiliated with a teaching hospital (P < 0.005). There was no statistically significant difference in the percentage of rural-practicing plastic and general surgeons (P = 0.590). More recent plastic surgery graduates were more likely to be affiliated with an academic hospital (P < 0.0000). The composition of females significantly increased from the older graduated cohort to the most recent one. There was no significant difference in sole proprietorship and rural practice status between the oldest and youngest graduating cohorts. CONCLUSIONS: Although the California plastic surgery workforce is gaining female plastic surgeons and shifting to academic institutions, significant progress in serving rural communities is yet to be made. Our study suggests that there may be a shift in the trend of plastic surgeons opting for private practice, possibly driven by a desire for more stable positions in academia. Continued improvement in diversity and training of future plastic surgeons is needed to alleviate the rural care gap.
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Cirugía Plástica , Humanos , California , Cirugía Plástica/educación , Cirugía Plástica/tendencias , Cirugía Plástica/estadística & datos numéricos , Femenino , Masculino , Práctica Privada/estadística & datos numéricos , Práctica Privada/tendencias , Selección de Profesión , Cirujanos/estadística & datos numéricos , Cirujanos/tendencias , Adulto , Persona de Mediana EdadRESUMEN
BACKGROUND: Studies demonstrating the potential utility of reflectance confocal microscopy (RCM) have been performed under experimental conditions. OBJECTIVE: To provide an overview of RCM practice in real-life. METHODS: A multicenter, prospective study carried out in 10 university dermatology departments in France. RESULTS: Overall, 410 patients were enrolled. One-half of the patients (48%) were referred by private practice dermatologists. They were referred for diagnosis (84.9%) or presurgical mapping (13%). For diagnosis, the lesions were located on the face (62%), arms and legs (14.9%), and trunk (13.6%), and presurgical mapping was almost exclusively on the face (90.9%). Among those referred for diagnosis, the main indication was suspicion of a skin tumor (92.8%). Of these, 50.6% were spared biopsies after RCM. When RCM indicated surgery, histology revealed malignant lesions in 72.7% of cases. The correlation between RCM and histopathology was high, with a correlation rate of 82.76% and a kappa coefficient of 0.73 (0.63; 0.82). LIMITATIONS: This study was performed in the settings of French tertiary referral hospitals. CONCLUSION: This study shows that in real-life RCM can be integrated into the workflow of a public private network, which enables a less invasive diagnostic procedure for patients.
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Microscopía Confocal , Neoplasias Cutáneas , Humanos , Estudios Prospectivos , Francia , Microscopía Confocal/métodos , Microscopía Confocal/estadística & datos numéricos , Femenino , Masculino , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/diagnóstico , Persona de Mediana Edad , Anciano , Adulto , Anciano de 80 o más Años , Adulto Joven , Adolescente , Práctica Privada/estadística & datos numéricos , Enfermedades de la Piel/patología , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/diagnóstico por imagen , Derivación y Consulta/estadística & datos numéricos , Biopsia/estadística & datos numéricos , Dermatología/métodos , Dermatología/estadística & datos numéricosRESUMEN
OBJECTIVE: Characterizing access to sudden sensorineural hearing loss (SSNHL) care at private practice otolaryngology clinics of varying ownership models. STUDY DESIGN: Cross-sectional prospective review. SETTING: Private practice otolaryngology clinics. METHODS: We employed a Secret Shopper study design with private equity (PE) owned and non-PE-owned clinics within 15 miles of one another. Using a standardized script, researchers randomly called 50% of each clinic type between October 2021 and January 2022 requesting an appointment on behalf of a family member enrolled in either Medicaid or private insurance (PI) experiencing SSNHL. Access to timely care was assessed between clinic ownership and insurance type. RESULTS: Seventy-eight total PE-owned otolaryngology clinics were identified across the United States. Only 40 non-PE clinics could be matched to the PE clinics; 39 PE and 28 non-PE clinics were called as Medicaid patients; 39 PE and 25 non-PE clinics were called as PI patients; 48.7% of PE and 28.6% of non-PE clinics accepted Medicaid. The mean wait time to new appointment ranged between 9.55 and 13.21 days for all insurance and ownership types but did not vary significantly (P > .480). Telehealth was significantly more likely to be offered for new Medicaid patients at non-PE clinics compared to PE clinics (31.8% vs 0.0%, P = .001). The mean cost for an appointment was significantly greater at PE clinics than at non-PE clinics ($291.18 vs $203.75, P = .004). CONCLUSIONS: Patients seeking SSNHL care at PE-owned otolaryngology clinics are likely to face long wait times prior to obtaining an initial appointment and reduced telehealth options.
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Accesibilidad a los Servicios de Salud , Pérdida Auditiva Sensorineural , Otolaringología , Humanos , Estados Unidos , Pérdida Auditiva Sensorineural/terapia , Pérdida Auditiva Sensorineural/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Estudios Transversales , Estudios Prospectivos , Otolaringología/economía , Medicaid , Pérdida Auditiva Súbita/terapia , Pérdida Auditiva Súbita/economía , Propiedad , Práctica Privada/economía , Práctica Privada/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Instituciones de Atención Ambulatoria/economía , Instituciones de Atención Ambulatoria/estadística & datos numéricosRESUMEN
OBJECTIVE: To quantify the proportion of annual assisted reproductive technology (ART) cycles performed at private equity-affiliated fertility practices and to test for differences in services and success rates between private equity-affiliated and nonaffiliated practices. DESIGN: Cross-sectional analysis of national data set. SETTING: Not applicable. PATIENT(S): None. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): The primary outcome measures were the volume of ART cycles performed, the percentage of retrievals resulting in live births, and the percentage of transfers resulting in live births. The secondary outcomes included the median income of the practice location, the use of preimplantation genetic testing, the clinical service availability, and the patient reasons for seeking treatment. RESULT(S): Of the practices listed on the Centers for Disease Control's 2018 Fertility Clinic Success Rates Report, 14.7% had a private equity affiliation. Of the 305,883 ART cycles performed in 2018, 29.3% (89,535) occurred at private equity-affiliated practices. Patients at private equity-affiliated practices were 6.75% (95% confidence interval [CI], -10.15%, -3.36%) less likely to initiate a cycle due to male factor infertility, and 10.60% (95% CI, 3.49, 17.76) more likely to use preimplantation genetic testing before embryo transfer. No statistically significant differences were found in success rates among women aged <35 years. The average median household income (standard error) in zip codes with private equity-affiliated practices compared with nonaffiliated practices was $83,610 ($35,990) and $72,161 ($32,314), respectively. CONCLUSION(S): A major portion of fertility practices in the United States are private equity-affiliated, and these practices perform an even greater portion of ART cycles in the United States each year. Fertility appears to be the medical specialty with the greatest market share owned by private equity. Our findings corroborate preliminary research, which forecasts the increasing involvement and consolidation by private equity in fertility. Future research should continue monitoring for differences in outcomes, financing, case mix, service use, and accessibility.
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Clínicas de Fertilidad/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Práctica Privada/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Índice de Embarazo , Embarazo Múltiple/estadística & datos numéricos , Prevalencia , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To determine characteristics of providers marketing vasectomy reversal (VR) online, degree of information available online, the ease with which patients can compare providers, and the differences in VR practice patterns between academic and private practices. MATERIALS AND METHODS: We identified VR practices operating within the top 50 most populous metropolitan areas in the US. Practice websites were reviewed to obtain information such as provider educational background, level of magnification, ability to perform vasoepididymostomy, surgical volume, and cost. Based on information available, providers were assigned a novel REVERSAL score created by the authors. Descriptive statistics were used to compare results. RESULTS: Of the 107 providers identified (29 academic, 78 private), the majority were male urologists with a Doctor of Medicine degree. Academic providers were more likely to have fellowship training than private practice providers, 96.6 vs 43.6%, respectively (P = 0.00001). Compared to non-urologists, urologists were less likely to purchase online ads or disclose cost. Non-urologists charged significantly less than urologists, $3,584 ± 1,554 and $6,591 ± 1,518, respectively (P = 0.00001). Only one provider provided complete information as defined by REVERSAL score of 12, with the majority (61.7%) of providers achieving score ≤6. CONCLUSION: There is significant lack of transparency in publicly available information from VR practices. Practices should implement measures to improve dissemination of information to the public, so that patients can more easily compare providers and make informed decisions regarding VR.
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Comercialización de los Servicios de Salud/estadística & datos numéricos , Urólogos/estadística & datos numéricos , Urólogos/normas , Vasovasostomía , Adulto , Ciudades , Honorarios y Precios , Becas/estadística & datos numéricos , Femenino , Humanos , Práctica Institucional/estadística & datos numéricos , Internet , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Práctica Privada/estadística & datos numéricos , Estados Unidos , Urólogos/economía , Urólogos/educación , Vasovasostomía/economíaRESUMEN
OBJECTIVE: To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS: Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS: QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION: QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.
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Seguridad del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad/estadística & datos numéricos , Urólogos/estadística & datos numéricos , Urología/estadística & datos numéricos , Adulto , Anciano , Educación Médica Continua/estadística & datos numéricos , Femenino , Humanos , Práctica Institucional/organización & administración , Práctica Institucional/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Práctica Privada/organización & administración , Práctica Privada/estadística & datos numéricos , Factores Raciales , Factores Sexuales , Encuestas y Cuestionarios , Estados Unidos , Urólogos/educación , Urología/educaciónRESUMEN
BACKGROUND: Rising health care costs and the high number of uninsured Americans has led to the increasing popularity of a single payer alternative. While opinions of physicians at large have been studied, we present the first data examining the views of United States (U.S.) board-certified plastic surgeons on a single payer health care system and its implications for patients and practice. METHODS: A total of 3,431 US plastic and reconstructive surgeons were sent a 25-item Qualtrics survey and responses collected from September 1 to November 1, 2019. Independent variables included surgeon sociodemographic characteristics. The association between these and a preference for a single payer was evaluated using the logistic regression. RESULTS: There was a 11% response rate (nâ¯=â¯383). The majority of respondents were in private practice (64.5%). Forty-four percent believed that it is the government's responsibility to ensure care is provided for all; 34% were willing to give up income in exchange for reduced paperwork and administrative burden. Sixty-three percent would not work the same number of hours under single payer. Private practice plastic surgeons were significantly less likely to favor single payer (95% CI: 0.19 and 0.76). Among academic plastic surgeons, 24% would consider leaving if single payer were enacted and 60% would decrease the reconstructive portion of their practice. CONCLUSIONS: Most U.S. plastic and reconstructive surgeons do not support a single payer health care system. Its enactment could have sweeping implications for plastic surgeons nationwide, among the most significant being a shift from academic to private practice with a potential reduction in patient access to complex reconstructive procedures.
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Actitud del Personal de Salud , Médicos , Procedimientos de Cirugía Plástica/economía , Sistema de Pago Simple , Cirugía Plástica/economía , Adulto , Anciano , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Práctica Institucional/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Práctica Privada/estadística & datos numéricos , Encuestas y Cuestionarios , Estados UnidosRESUMEN
The SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) was first reported in December 2019, then its rapid spread around the world caused a global pandemic in March 2020 recording a high death rate. The epicenter of the victims moved from Asia to Europe and then to the United States. In this Pandemic, the different governance mechanisms adopted by local health regional authorities made the difference in terms of contagiousness and mortality together with a community strong solidarity. This document analyzes the andrological urgencies management in public hospitals and in private practice observed in Italy and in particular in the most affected Italian Regions: Emilia-Romagna and Marche.
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Andrología/estadística & datos numéricos , COVID-19 , Infertilidad Masculina/terapia , Pandemias , Manejo de la Enfermedad , Hospitales Públicos/estadística & datos numéricos , Humanos , Italia , Masculino , Práctica Privada/estadística & datos numéricos , Enfermedades Urológicas/terapiaAsunto(s)
Carcinoma Basocelular/prevención & control , Carcinoma de Células Escamosas/prevención & control , Fármacos Dermatológicos/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/prevención & control , Acitretina/uso terapéutico , Humanos , Práctica Institucional/estadística & datos numéricos , Queratosis Actínica/prevención & control , Cirugía de Mohs , Niacinamida/uso terapéutico , Práctica Privada/estadística & datos numéricos , Encuestas y Cuestionarios , Complejo Vitamínico B/uso terapéuticoRESUMEN
PURPOSE: To determine the effects of knowledge and practice variations on prescribing patterns of systemic corticosteroids (SC) for acute upper respiratory tract infections (URTI). MATERIALS AND METHODS: A cross-sectional evaluation of practicing otolaryngologists in the United States through the use of a 16-question Knowledge, Attitude, and Practice survey. The survey was self-administered through email delivery to practicing members of the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS: Of 349 respondents, the majority were attending physicians in private practice and used SC 25% to 50% of the time. There was a higher rate of SC use by clinicians in the Southeast United States (adjusted odds ratio [aOR], 2.10; 95% confidence intervals [95% CI], 1.18-3.72) and by those in private practice (aOR, 2.67; 95% CI, 1.63-4.37). Levels of SC knowledge did not vary across respondents; however, knowledge was associated with increased use of SC. Only 62.8% of respondents answered all 4 Knowledge questions correctly and this was associated with a 3.5-fold decrease in SC use (aOR, 0.29; 95% CI, 0.19-0.44). Attitudes toward SC use reflected prescribing practices and were also linked to levels of knowledge, as respondents with less knowledge were more likely to have a favorable outlook toward use of SC. CONCLUSION: Use of SC for treatment of acute URTI is associated with clinician demographics and knowledge. Otolaryngologists are more likely to use SC for acute URTI in the Southeast United States and in private practice. Knowledge and provider education are key factors in prescribing patterns.
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Corticoesteroides/administración & dosificación , Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Otorrinolaringólogos/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Estudios Transversales , Síndrome de Guillain-Barré , Humanos , Práctica Privada/estadística & datos numéricos , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaAsunto(s)
Cirugía de Mohs/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Grabación en Video/estadística & datos numéricos , Congresos como Asunto , Femenino , Humanos , Práctica Institucional/estadística & datos numéricos , Masculino , Cirugía de Mohs/educación , Práctica Privada/estadística & datos numéricos , Procedimientos de Cirugía Plástica , Factores Sexuales , Colgajos Quirúrgicos , Encuestas y Cuestionarios , Enseñanza , Factores de Tiempo , Estados Unidos , Técnicas de Cierre de HeridasRESUMEN
AIM: This paper outlines the results of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology (FRO) 2018 workforce census. Here we report the responses of New Zealand radiation oncologists and trainees in order to understand characteristics of the New Zealand radiation oncology workforce. METHOD: The workforce census was conducted online during July-September 2018. Distribution was by Survey Monkey to all radiation oncologists (fellows, life members, educational affiliates, retired) and trainees on the RANZCR membership database, including members from Australia, New Zealand and Singapore. All responses were aggregated for analysis. This paper addresses only responses from New Zealand members. The census was designed to explore issues relevant to the New Zealand workforce, and questions from previous workforce censuses were repeated in order to monitor trends. RESULTS: The response rate for New Zealand radiation oncologists was 73.3% (44/60). The majority (67%) were male. The average age was 50.8 years. Three-fifths (59.5%) reported New Zealand ethnicity. One-third obtained their specialist qualifications outside of Australia and New Zealand. Most worked in the public sector only (63.4%), with only two in exclusive private practice. Most radiation oncologists attained a consultant post immediately on completion of training, but there were 26 who pursued an overseas fellowship. Most worked one full-time equivalent or greater (FTE), with 17.5% working less than 1.0 FTE. Radiation oncologists reported working a median of 50.0 hours per week, with half working over 10 hours above their contracted hours. Most time was spent on clinical duties with minimal time spent on research. Radiation oncologists reported seeing an average of 235 new patients per year (median: 230). Leadership positions were held by 21/43 respondents. Within 15 years, 55% of the current workforce reported an intention to retire, including 30% of those currently practising highly specialised brachytherapy. Females in the workforce were less likely to work fulltime and spent less time in research and management activities. All trainees reported full-time work, although 50% expressed a desire for part-time training. Half of the trainees reported working 6-10 hours on call, and 60% reported two or less hours of protected teaching per week. Despite this, 90% of trainees were satisfied with their career choice. CONCLUSIONS: Radiation oncology is a small specialty in New Zealand, with a significant reliance on overseas-trained specialists. The specialty continues to work significant overtime hours while time spent on research and non-clinical duties remains low. The growth in staffing between the 2014 and 2018 census has been low. Trainee numbers do not appear sufficient to meet the demand for replacing staff, due to retirements and the reduction of hours. Radiation intervention rates are low in New Zealand, but growth would be reliant on an expansion of the workforce beyond simply replacing staff losses. The radiation oncology workforce in New Zealand remains vulnerable, and careful consideration must be given to expansion and retention to ensure a viable workforce for the future.
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Fuerza Laboral en Salud/estadística & datos numéricos , Oncólogos de Radiación/estadística & datos numéricos , Oncología por Radiación/educación , Oncología por Radiación/estadística & datos numéricos , Adulto , Braquiterapia/estadística & datos numéricos , Censos , Empleo/estadística & datos numéricos , Becas/estadística & datos numéricos , Femenino , Humanos , Internado y Residencia/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Práctica Privada/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Oncólogos de Radiación/provisión & distribución , Jubilación/estadística & datos numéricos , Factores Sexuales , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Chronic kidney disease remains highly prevalent and exerts a heavy economic burden. The practice of nephrology has come a long way in managing this disease, though there remains room for improvement. The private domain, where more than half of the adult nephrology workforce operates, faces serious challenges. Interest has decreased in the field, leading to diminished recruitment. There has been a reduction in both reimbursement rates and revenues. We discuss the current state of private practice nephrology and strategies to reinvigorate our discipline. There needs to be a focus on preparing fellows during training not only for academic careers, but also for effective functioning in the environment of private practice and development of pathways for growth. We believe that private practice nephrology must expand its frontiers to be fulfilling professionally, challenging academically, and successful financially. The United States government has recently announced the Advancing American Kidney Health Executive Order which seeks to prioritize optimal treatments for patients with kidney disease. We are optimistic that there is a renaissance afoot in nephrology and that our field is in the process of rediscovering itself, with its best days yet to come.
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Nefrología/tendencias , Práctica Privada/tendencias , Movilidad Laboral , Predicción , Humanos , Nefrología/estadística & datos numéricos , Práctica Privada/organización & administración , Práctica Privada/estadística & datos numéricos , Estados UnidosRESUMEN
BACKGROUND: This is the first study to explore workforce data from the Podiatrists Board of New Zealand. The study analysed data from an online survey which New Zealand podiatrists complete as part of their application for an Annual Practising Certificate. METHODS: Survey responses between 2015 and 2019 were analysed. Data was related to work setting, employment status, work hours, location, professional affiliations, and number of graduates entering practice. Survey data was downloaded by a second party who provide data security for the Podiatrists Board of New Zealand workforce data. All data supplied for analysis were deidentified and could not be re-linked to an individual practitioner. RESULTS: In 2019 there were 430 podiatrists who held an Annual Practising Certificate. Eighty percent of podiatrists who work in New Zealand are in private practice, with 8% employed in the public health sector. Podiatrist's work is a mix of general podiatry, diabetes care and sports medicine. The majority are self-employed (40%) or business owners (19%). Approximately 40% work between 31 to 40 h per week and 46 to 50 weeks per year. The majority are female (67%) with most practising in the North Island (69%) and located in the Auckland region (33%). On average 76% of new graduates were issued an Annual Practising Certificate between 2015 and 2019. CONCLUSION: The New Zealand podiatry profession is small and growing at a slow rate, consequently there is evidence of a workforce shortage. To maintain a per-capita ratio of podiatrists approximate to Australia and the United Kingdom an additional 578 podiatrists are required in the New Zealand workforce. There are not enough new graduate practitioners entering the workforce and once practising, the majority enter private practice in the face of limited public health employment opportunities.
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Fuerza Laboral en Salud/estadística & datos numéricos , Podiatría/estadística & datos numéricos , Práctica Privada/estadística & datos numéricos , Adulto , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Podiatría/organización & administración , Encuestas y CuestionariosRESUMEN
PURPOSE: The COVID-19 pandemic has led to an urgent reorganisation of the healthcare system to prevent hospitals from overflowing and the virus from spreading. Our objective was to evaluate the socioeconomic and psychological impact of the COVID-19 outbreak on radiologists. MATERIAL AND METHODS: French radiologists were invited to answer an online survey during the pandemic through mailing lists. The questionnaire was accessible for nine days. It covered socio-demographic information, exposure to COVID-19 at work and impact on work organisation, and included the Insomnia Severity Index and Hospital Anxiety and Depression Scale. Outcomes were moderate to severe insomnia, definite symptoms of depression or anxiety. Risk and protective factors were identified through multivariate binary logistic regression. RESULTS: 1515 radiologists answered the survey. Overall, 674 (44.5 %) worked in a highCOVID-19 density area, 671 (44.3 %) were women, and 809 (53.4 %) worked in private practice. Among responders, 186 (12.3 %) expressed insomnia, 222 (14.6 %) anxiety, and 189 (12.5 %) depression symptoms. Lack of protective equipment, increased teleradiology activity and negative impact on education were risk factors for insomnia (respectively OR [95 %CI]:1.7[1.1-2.7], 1.5[1.1-2.2], and 2.5[1.8-3.6]). Female gender, respiratory history, working in COVID-19 high density area, increase of COVID-19 related activity, and impacted education were risk factors for anxiety (OR[95 %CI]:1.7[1.2-2.3], 2[1.1-3.4], 1.5[1.1-2], 1.2[1-1.4], and 2.1[1.5-3]). Conversely, working in a public hospital was a protective factor against insomnia, anxiety, and depression (OR[95 %CI]:0.4[0.2-0.7], 0.6[0.4-0.9], and 0.5[0.3-0.8]). CONCLUSIONS: During COVID-19 pandemic, many radiologists expressed depression, anxiety and insomnia symptoms. Working in a public hospital was a protective factor against every psychological symptom. Socio-economic impact was also major especially in private practice.
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Infecciones por Coronavirus/economía , Infecciones por Coronavirus/psicología , Hospitales Públicos/economía , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/psicología , Práctica Privada/economía , Radiólogos/economía , Radiólogos/psicología , Factores Socioeconómicos , Adulto , Betacoronavirus , COVID-19 , Femenino , Francia , Hospitales Públicos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Práctica Privada/estadística & datos numéricos , Radiólogos/estadística & datos numéricos , Factores de Riesgo , SARS-CoV-2 , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To compare treatments for localised prostate cancer for men diagnosed in private and public health services in Victoria. DESIGN: Retrospective analysis of Victorian Cancer Registry data linked to population-based administrative health datasets. SETTING, PARTICIPANTS: 29 325 Victorian men diagnosed with prostate cancer during 2011-2017. MAIN OUTCOME MEASURES: Proportions of men in private and public health services receiving radical prostatectomy (with or without curative radiation therapy) or curative external beam radiation therapy alone within 12 months of diagnosis. RESULTS: After adjusting for age, tumour classification and comorbidity, men diagnosed in private health services received radical treatment more frequently than men diagnosed in public health services (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.31-1.49). The proportion of private patients who underwent radical prostatectomy was larger than that for public patients (44% v 28%; OR, 2.28; 95% CI, 2.13-2.44) and the proportion of private patients who received curative external beam radiation therapy alone (excluding brachytherapy) was smaller (9% v 19%; OR, 0.45; 95% CI, 0.42-0.49). These differences were apparent for all International Society of Urological Pathology (ISUP) tumour grades. The magnitude of the difference for prostatectomy was greater for men aged 70 years or more; for radiation therapy alone, it was larger for those diagnosed before age 70. The differences between private and public services narrowed during 2011-2017 for men with ISUP grade 1 disease, but not ISUP grade 2-5 tumours. CONCLUSION: Prostate cancer treatment choices differ substantially between men diagnosed in private and public health services in Victoria. These differences are not explained by disease severity or comorbidity.