Insurance acceptance and cash pay rates for psychotherapy in the US.

Cost and insurance coverage remain important barriers to mental health care, including psychotherapy and mental health counseling services ("psychotherapy"). While data are scant, psychotherapy services are often delivered in private practice settings, where providers frequently do not take insurance and instead rely on direct pay. In this cross-sectional analysis, we use a large national online directory of 175 083 psychotherapy providers to describe characteristics of private practice psychotherapy providers who accept and do not accept insurance, and assess self-reported private pay rates. Overall, about one-third of private practice psychotherapists did not accept insurance, with insurance acceptance varying substantially across states. We also found significant session rate differentials, with Medicaid rates being on average 40% lower than reported cash pay rates, which averaged $143.26 a session. Taken together, low insurance acceptance across a broad swath of mental health provider types means that access to care is disproportionately reliant on patients' ability to afford out-of-pocket payments-even when covered by insurance. While our findings are descriptive and may not be representative of all US psychotherapists, they add to scant existing knowledge about the cash pay market for an important mental health service that has experienced increased use and demand over time.

Building the private practice workforce in the Northern Territory: Barriers and facilitators for implementation of the allied health assistant role.

OBJECTIVE: To identify barriers and facilitators contributing to the successful implementation of the allied health assistant role in private disability practice to better meet population needs. DESIGN: A qualitative case study. SETTING: This study was completed with staff working in private disability practices in a regional context in the Northern Territory. PARTICIPANTS: Eight participants were interviewed, including three allied health assistants, three allied health professionals, and two managers with allied health backgrounds. RESULTS: More barriers were reported than facilitators, with four key themes identified. Financial risk was a barrier when employing allied health assistants. This risk was mediated by providing part-time employment or having allied health assistants in dual roles. Reduced confidence from allied health professionals and assistants to complete delegation work was the second barrier. A facilitator was increasing allied health assistants' task variation, which participants reported increased retention. Finally, a positive working relationship between allied health professionals and assistants facilitates delegation. CONCLUSION: This research offers private disability providers insight into the realities of employing an allied health assistant. It also suggests that formal training programs for both allied health assistants and professionals require increased focus on delegation in the private disability sector. On a government level, a review of the NDIS price guide for allied health assistant rates is needed if private providers are to better meet the requirements for NDIS participants in regional areas.

Regenerative medicine in Obstetrics & Gynecology: Current status under the Act on the Safety of Regenerative Medicine in Japan.

Introduction: While the provision of unapproved regenerative medicine has been problematic worldwide, few studies have examined the implementation status of regenerative medicine (RM) in the specific field. This study aimed to determine the current status of therapy and clinical research in the obstetrics and gynecology (OBGYN) in Japan under the Act on the Safety of Regenerative Medicine (RM Act). Methods: Detailed data were extracted from publicly available websites provided by the Ministry of Health, Labour, and Welfare. We extracted descriptive details, including risk classification of the RM Act, modality, target disease, locality, institution, and administration route. For therapy, the price for each modality was evaluated. Results: The total number of therapeutic provision plans in OBGYN (1.9% of RM in Japan) are classified as Class II (moderate) risk. Most were administered in clinics in urban areas for treating endometrial or ovarian infertility by locally administering platelet-rich plasma (PRP) or autologous mesenchymal stem cells (MSCs). The price using MSCs is approximately eight times more expensive that of those involving PRP (1832.1 ± 1139.8 vs 240.8 ± 106.5 thousand yen, p < 0.0001). Regarding research, four plans (2.2%) were submitted to target implantation failure and advanced gynecological cancer using autologous lymphocytes, dendritic cells, or MSCs. Conclusion: The RM Act permits knowledge of the current status of regenerative medicine even for unapproved uses in a specific clinical field. The study findings shall prompt a worldwide discussion regarding the required regulations for therapy and clinical research of RM.

[Ophthalmology telemedicine at Rennes University Medical Center: Evaluation of the secure platform OMNIDOC during its first year of use]. / Télé-expertise en ophtalmologie au centre hospitalier universitaire de Rennes : évaluation de la plateforme sécurisée OMNIDOC au cours de sa première année d'utilisation.

INTRODUCTION: Ophthalmology as a specialty is a pioneer in the area of telemedicine. Remote consultation represents one of the 5 types of telemedicine services, with a growing volume of activity in university hospitals. In November 2020, the ophthalmology department of Rennes University Medical Center launched its remote consultation network with the secured platform OMNIDOC. The goal of this study was to assess its contribution during its first year of use. MATERIALS AND METHODS: Beginning in November 2020, ophthalmology consults at Rennes University Medical Center were directed towards the dedicated OMNIDOC network. Three-hundred and forty-one requests for remote consultation were received and analyzed between November 2020 and October 2021. We sent a satisfaction survey to both the requesting and consultant physicians to assess whether or not the network was beneficial. RESULTS: Three-hundred and twenty-seven remote consultations requested by 126 practitioners were included in the study. The median response time was 6hours. Every field of the specialty was involved, of which 22.3% were for pediatric patients under 6years of age. Among the requests, 89.7% were regional (Brittany) and came mostly from ophthalmologists (61.77%). Nearly one out of two patients did not require an in-person consultation at Rennes University Medical Center. DISCUSSION: The implementation of a remote consultation network allowed access to a rapid, facilitated medical ophthalmology consultation. Such a platform delivers safety and traceability of the interactions. It enhances and optimizes the patients' care pathway and encourages relationships with community physicians.

The Landscape of Pain Medicine for Women Physicians: A Perspective.

BACKGROUND: The gender bias in academic anesthesiology is well known. Women are not only a minority in the field but also underrepresented in leadership positions. Reported reasons for this underrepresentation include barriers to career advancement, lack of mentorship, and differences in compensation, among others. Interventional pain, a competitive procedural subspecialty of anesthesiology, sees the trickle-down effects of this disparity. According to a report from the ACGME that sorted medical subspecialties by number of female trainees, pain medicine ranked in the bottom quartile across all disciplines from 2008-2016. OBJECTIVES: To better understand the landscape for women physicians in the field of pain medicine, we undertook this investigation to review the knowledge about the topic and what questions remain unanswered. STUDY DESIGN: This study is a review of the current literature and aims to summarize and describe the landscape of pain medicine for women physicians. SETTING: All literature review and manuscript preparation took place at the Yale University School of Medicine. METHODS: We performed a comprehensive search using the PubMed, Scopus, and Cochrane databases for the combined terms "gender disparity," "pain medicine," and "anesthesiology," limiting our search to the year 2000 onward for the most recent literature on the topic. Our initial search retrieved 38 articles. All relevant articles pertaining to this perspective piece were collated. The available literature is discussed below. RESULTS: Women are underrepresented in interventional pain. The grim scarcity of female pain physicians is unlikely to improve soon, since while the number of Accreditation Council for Graduate Medical Education pain fellowship programs continues to grow, women trainees comprise only between 22-25% of all pain medicine fellows. Additionally, although studies have compared the numbers of male interventional pain faculty to their female counterparts in academic hospitals and shown the ratio to range from 71.84-82% to 18-28.52%, respectively, no studies have truly explored the landscape for women physicians in private practice. Patients prefer and have better experiences with physicians who are racially and ethnically like themselves. In fact, the preference for and the lack of female clinicians have been associated with delayed pursuit of care and adverse health outcomes. The consequences of the burnout and attrition caused by the gender disparity, especially in a field like pain medicine, cannot be understate. LIMITATIONS: The review might not have been comprehensive, and relevant studies might not have been included. CONCLUSION: While the gender disparity in academia is well documented for both anesthesiology and pain medicine, the reasons for this disparity have not been fully explored. Moreover, it is also unknown whether the minority of female physicians who select pain medicine as a subspecialty gravitate toward an academic or a private-practice path. To address the existing gender disparity, it is necessary to explore the landscape of interventional pain medicine in both academic and private practices and understand pain physicians' beliefs and sentiments regarding their subspecialty.

Key themes in periodontal treatment: Lessons learned from 40-year experiences.

BACKGROUND: Periodontitis is one of the most prevalent oral diseases with significant implications for systemic health. This study aims to explore themes influencing successful long-term outcomes in periodontal treatment through a historical lens, focusing on various factors influencing the longevity of periodontal health and dentition stability. METHODS: Utilizing an inductive qualitative thematic analysis approach, this study utilized a retrospective chart review of 19 patient records spanning, on average, 40 years. RESULTS: Four major themes contributing to periodontal stability were identified: (1) adequate patient plaque control; (2) regular periodontal maintenance; (3) collaboration between hygienists and periodontists; and (4) the application of various periodontist/dentist-performed procedures. CONCLUSION: Current findings underscore the importance of these factors in preserving patients' periodontal health by emphasizing conservative treatment approaches in the maintenance and retention of the natural dentition. KEY POINTS: Adequate patient plaque control is essential for maintaining a patient's periodontal health and dentition long-term. A regular periodontal maintenance schedule should be assigned and modified as necessary for each individual patient's care. Collaborative care with hygienist colleagues and ensuring there are flexible treatment options for patients can lead to successful treatment outcomes when hygiene alone is not sufficient. PLAIN LANGUAGE SUMMARY: Periodontitis is a widespread oral disease with significant systemic health implications. This study examined patient records to identify factors contributing to long-term periodontal stability and maintenance of teeth. By analyzing 19 patient charts over an average of 40 years using a qualitative approach, four key themes were identified in successful patient treatments: effective patient plaque control, regular periodontal maintenance, collaboration between dental hygienists and periodontists, and the addition of other approaches by periodontists and dentists when necessary. The study underscores the importance of these factors in preserving periodontal health and retaining natural teeth with conservative treatment approaches. This research highlights the critical role of sustained, multifaceted dental care and professional collaboration in achieving successful long-term oral and systemic health outcomes.

Exploring the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business: a hermeneutic phenomenological study.

AIM: To explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business. DESIGN: A hermeneutic phenomenological approach. PARTICIPANTS: Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. METHODS: In-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed. RESULTS: Three interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff. CONCLUSIONS: Private practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. CONTRIBUTION OF THE PAPER.

Findings and Challenges in Replacing Traditional Uterine Cervical Cancer Diagnosis with Molecular Tools in Private Gynecological Practice in Mexico.

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol.

Incorporating Dermatologic Clinical Research Into Private Practice: A Review.

Clinical research is beneficial for the continued progression of medicine and the larger body of scientific knowledge. Clinical research can be incorporated into a range of settings, ranging from larger learning institutions to small private practices. With the need for continued advancement of the development of pharmaceutical interventions as well as other forms of clinical understanding, it is advantageous to create an environment where smaller, private practices feel comfortable and guided in establishing clinical research. It can be difficult to find the best methods to incorporate in-house clinical research. This review aims to address this gap in the literature, making the establishment of clinical trials, specifically clinical drug trials, more accessible in dermatology for private practices.

Private practice dietetics: A scoping review of the literature.

AIM: Private practice is one of the most rapidly growing, but under-researched employment sectors for graduate dietitians in Australia, limiting evidence-based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities. METHODS: The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports, statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research. RESULTS: A total of 72 peer-reviewed and grey literature sources were included, with 65% of the studies being Australian-based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners. CONCLUSIONS: The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced-based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.

Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study.

BACKGROUND: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. OBJECTIVE: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. METHODS: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). RESULTS: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). CONCLUSIONS: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients.

The Decline of Small Practice in Colorectal Surgery: Practice Consolidation From 2015-2022.

INTRODUCTION: Physicians have gravitated toward larger group practice arrangements in recent years. However, consolidation trends in colorectal surgery have yet to be well described. Our objective was to assess current trends in practice consolidation within colorectal surgery and evaluate underlying demographic trends including age, gender, and geography. METHODS: We performed a retrospective cross-sectional study using the Center for Medicare Services National Downloadable File from 2015 to 2022. Colorectal surgeons were categorized by practice size and by region, gender, and age. RESULTS: From 2015 to 2022, the number of colorectal surgeons in the United States increased from 1369 to 1621 (+18.4%), while the practices with which they were affiliated remained relatively stable (693-721, +4.0%). The proportion of colorectal surgeons in groups of 1-2 members fell from 18.9% to 10.7%. Conversely, those in groups of 500+ members grew from 26.5% to 45.2% (linear trend P < 0.001). The midwest region demonstrated the highest degree of consolidation. Affiliations with group practices of 500+ members saw large increases from both female and male surgeons (+148.9% and +86.9%, respectively). New surgeons joining the field since 2015 overwhelmingly practice in larger groups (5.3% in groups of 1-2, 50.1% in groups of 500+). CONCLUSIONS: Colorectal surgeons are shifting toward larger practice affiliations. Although this change is happening across all demographic groups, it appears unevenly distributed across geography, gender, and age. New surgeons are preferentially joining large group practices.

Promoting access to care in pyometra treatment: pathways to collaboration between high-quality, high-volume spay-neuter clinics and private practices.

OBJECTIVE: To compare results from 2 previously published surveys aimed at determining how pyometra is treated in high-quality, high-volume spay-neuter clinics (HQHVSNCs) and private practices (PPs), with a specific focus on identifying opportunities for partnership between the clinic types to improve access to care in pyometra treatment. SAMPLE: Responses from 123 PPs and 87 HQHVSNCs. METHODS: A previously published survey of PPs conducted from June to July 2021 and a similar previously published survey of HQHVSNCs conducted from June to July 2020 were compared regarding demographics, pyometra treatment availability, estimated outcome, alternative outcome, disruption, cost, and protocol between HQHVSNCs and PPs. A comparison was also run of the surveys' responses regarding referral of a pyometra to an HQHVSNC by a PP. RESULTS: Although PPs estimated that economic euthanasia is the most likely alternative outcome for 13% of patients unable to access care at their practice, 80% would be reluctant to refer to an HQHVSNC. The 3 primary reasons indicated by PPs with a reluctance to refer were a perceived lack of prompt appointment availability (20%), lack of aftercare (18%), and lack of adequate equipment (14%). In contrast, most HQHVSNCs estimated that they generally accept referrals the same day (50%) or the next day (30%) and 95% of HQHVSNCs reported having the resources needed to treat most pyometras. CLINICAL RELEVANCE: There are several opportunities for partnership between PPs and HQHVSNCs in the treatment of pyometra. The most frequent concerns expressed by PPs regarding referral to HQHVSNCs were not shared by HQHVSNCs or could be ameliorated by referral to an HQHVSNC for surgery and transfer back to the PP for aftercare.

[Respiratory physiotherapy in private practice: Interest and prescription modalities]. / Kinésithérapie respiratoire libérale : intérêts et modalités de prescription.

INTRODUCTION: Respiratory diseases represent a major public health issue and impact both quality of life and life expectancy of the patients. STATE OF ART: Several interventions used in respiratory physiotherapy have been shown to reduce dyspnoea, improve quality of life and reduce hospitalisation in many respiratory diseases. However, respiratory physiotherapy remains poorly known to the medical community and may be under-prescribed. PERSPECTIVES: In order to improve the interdisciplinarity around the patient with respiratory impairment, we describe the interests and prescription modalities of liberal respiratory physiotherapy. In the context of respiratory physiotherapy acts, the precision of drafting prescription directly conditions the means implemented by the physiotherapist regarding care provided to the patient. CONCLUSION: The increased knowledge of prescribers, both concerning the prescription methods and the precise content of the rehabilitation sessions is one of the keys to their success.

Access to Sudden Sensorineural Hearing Loss Care at Private Equity-Owned Otolaryngology Clinics.

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.

Rapid adoption of penoscrotal decompression for ischemic priapism in private practice.

Refractory ischemic priapism is a difficult to treat clinical entity for which there are a host of shunt procedures identified, but no singular agreed upon technique for surgical therapy. Recent literature describes success using a penoscrotal decompression technique that uses a similar dissection of a penoscrotal penile prosthesis placement. We demonstrate that this technique is easily applicable in the private practice setting as it uses a familiar setup to most general urologists in our case report.

Clinicopathological, dermoscopic features and circumstances of diagnosis of amelanotic or hypomelanotic melanoma: A prospective multicentric study in the French private medical sector.

BACKGROUND: Amelanotic or hypomelanotic melanomas (AHM) are difficult to diagnose, and are often diagnosed late, with a high Breslow index and a poor prognosis. PATIENTS AND METHODS: A total of 226 volunteer dermatologists consulting in private practice in France completed an online form for each new histologically proven case of melanoma diagnosed at their clinic in 2020. This anonymised survey collected data on the clinical, dermoscopic, and histological features of melanoma, as well as the circumstances of diagnosis and initial management. A group of 145 AHM was single out and compared to the 1503 pigmented melanomas (PM) from the same cohort. RESULTS: 1503 pigmented melanomas (PM) and 145 AHM (8.8% of these melanomas) were identified and included. In the AHM group, the mean age at diagnosis was 65 ±â€¯16 years, with no significant difference from the PM control group. AHM were not predominantly on the face and neck area, and there were no differences based on gender. Warning signs (local progression and bleeding) were significantly more frequent in the AHM group than in the PM group. AHM were more frequently ulcerated and nodular, with a higher median Breslow thickness than in the PM group (1.56 vs. 0.5 mm), and mitoses were more frequent. Dermoscopy was widely used and proved useful for distinguishing benign lesions, and for highlighting the vascular polymorphous pattern of malignant lesions. Patients noticed the suspicious lesion themselves in most cases of AHM (73.2%), as opposed to their general practitioner (17.2%) or entourage (9.5%). A total body skin examination enabled detection of 19.3% of AHM and 21.3% of PM where the patient consulted for another lesion, or for an unrelated reason. CONCLUSION: AHM are difficult to diagnose for the clinician because of the paucity or absence of pigmentary criteria. Knowledge of dermoscopic vascular patterns is critical and could help reduce the median Breslow index of AHM at the time of detection. Self-examination of the skin should be encouraged, and simple algorithms for earlier detection of skin cancers should be promoted among health professionals and the general population.

A comparison of career plans of gastroenterology fellows compared to fellows in other internal medicine subspecialties.

Background: The career trajectory of medical professionals, particularly in specialized fields like gastroenterology, can significantly impact healthcare and research. This study aimed to analyze career choices among gastroenterology fellows in the US and investigate the factors influencing these choices. Methods: We utilized data from the American Medical Association on internal medicine subspecialty fellows. The study examined career plans of gastroenterology fellows and compared them with those of other subspecialties. A chi-square test was performed to assess differences in career choices and practice settings. Results: Among gastroenterology fellows, 46% opted for private practice, 28% pursued further training, and 26% chose academia. Notably, gastroenterology fellows were more inclined toward private practice than their counterparts in other subspecialties (46.3% vs 38.4%) and were less likely to pursue academic careers (25.6% vs 30.7%). Conclusion: This study highlights a concerning trend among recent gastroenterology fellowship graduates favoring private practice over academic careers or additional training. To sustain and strengthen academic medicine in gastroenterology, interventions such as scholarships, mentorship programs, and loan repayment initiatives tailored to academic pursuits could play a crucial role.

Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia.

OBJECTIVES: To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems. METHODS: A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines. RESULTS: We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities. CONCLUSIONS: These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

RESUMEN: OBJETIVOS: Explorar las percepciones que tienen los colombianos sobre los planes de seguro de salud privados voluntarios (VPHI) en el sistema de salud para identificar las tensiones que existen entre los sistemas público y privado. MéTODOS: Un estudio cualitativo de caso con 46 entrevistas semiestructuradas a pacientes, trabajadores de la salud, administradores de salud, tomadores de decisiones y ciudadanos. Las entrevistas se grabaron, transcribieron y almacenaron de manera anónima. El análisis se hizo siguiendo conceptos de la teoría fundamentada. RESULTADOS: Desarrollamos una matriz paradigmática que explora cómo, en un contexto mediado tanto por la mercantilización de la salud como por la estratificación social, las percepciones sobre las fallas en el sistema de salud público relacionadas con la falta de atención oportuna, procedimientos administrativos extensos y la búsqueda de atención privilegiada llevaron a posicionar los VPHI como una solución a estas fallas. Los entrevistados identificaron tres consecuencias del uso de los VPHI: primero, el empeoramiento de los problemas de acceso oportuno a la atención en el sistema público; segundo, mayores costos para los ciudadanos, traducidos en un pago doble por tecnologías y servicios a los que tienen derecho; tercero, el aumento de las brechas de equidad en el acceso a los servicios de salud entre personas con necesidades similares pero diferentes capacidades de pago. CONCLUSIONES: Estos hallazgos pueden ayudar a los tomadores de decisiones a comprender las percepciones de los ciudadanos sobre las implicaciones que el VPHI puede tener en el empeoramiento de las brechas de equidad en el sistema de salud colombiano. También muestra cómo el VPHI se percibe como un pago doble por servicios cubiertos dentro de los planes de seguridad social y sugiere que la falta percibida de acceso oportuno a la atención en los sistemas públicos y el miedo que los ciudadanos tienen por sí mismos o por sus familiares cuando utilizan una atención sanitaria subóptima son factores importantes para adquirir estos seguros privados.

A Practical Guide to Clinical Studies in Veterinary Oncology.

This article explains the authors' experiences about opportunities, perspectives, and considerations required to initiate clinical studies in a veterinary oncology practice. These details include the infrastructure required for appropriate study training for all staff. Negotiation of scope of work and fees for service with study sponsors is also discussed. Finally, although generally similar, the article also describes management of clinical studies in academic and private practice settings.