Optimising the educational value of indirect patient care.

INTRODUCTION: Indirect patient care activities (IPCA) such as documentation, reviewing investigations and filling out forms require an increasing amount of physician time. While an essential part of patient care, rising rates of IPCA work correspond with increases in physician burnout and job dissatisfaction. It is not known how best to prepare residents in IPCA-heavy specialties (e.g. family medicine) for this aspect of their career. This study investigates how educators and residency programmes can optimise IPCA work during residency to best prepare residents for future practice. METHODS: Using Constructivist Grounded Theory, we conducted focus groups and individual interviews with 42 clinicians (19 family medicine residents, 16 family physicians in the first 5 years of practice and 7 family physician educators). All participants were connected to one family medicine residency programme. We analysed interview data iteratively, using a staged approach to constant comparative analysis. RESULTS: While residents, early career physicians and educators perceived the educational value of IPCAs differently, they all reported IPCAs as a necessary weight that family physicians carry throughout their career. Some residents described IPCAs as a burden, creating inequities in workload and interfering with other learning and personal opportunities. In contrast, educators conceptualised IPCAs as an opportunity to build and develop the skills required to carry the weight of IPCAs throughout their career. We make specific recommendations for helping residents recognise this educational opportunity, such as clarifying expectations, navigating equity, understanding purpose and maintaining consistency when teaching IPCAs. CONCLUSION: IPCAs are a key competency for many medical residents but require explicit pedagogical attention. If the educational opportunities are not made explicit, residents may miss the opportunity to develop strategies for practice management, professional boundaries, and administrative efficiencies.

The gender earnings gap in medicine: Evidence from Canada.

Despite the gender gap in physician earnings being of concern to many in Canada, its existence is far from universally accepted and there are no studies covering all physicians/regions or addressing earnings rather than billings. This may explain the lack of serious consideration or remedial action by medical associations and governments in negotiations, or tariff and compensation processes. Our study employs 2016 Canadian Census data linked to Canada Revenue Agency taxation records. Rather than focusing on gross billings, we model physician net earnings (after overhead expenses and controlling for hours/weeks of work) including dividends from corporations. Using OLS, and unconditional quantile regression to document the gap across the earnings distribution, we observe that Canadian female physicians, on average, earn 9.3% less than their male counterparts. The average adjusted gap is slightly smaller for family physicians (8.5%) than other specialists (10.2%). Beyond averages, at the top of the income distribution the gap is double that at the median for both family physicians and other specialists. The gap also varies across provinces, from 6.6% in Quebec to 19.8% in Manitoba. Although our results yield somewhat smaller estimates than those from studies using billings/self-reported income, the magnitudes remain appreciable. The findings substantiate the claim that the gender pay gap in Canadian medicine is pervasive.

Clinician responses to legal requests for hastened death: a systematic review and meta-synthesis of qualitative research.

BACKGROUND: The legalisation of medical assistance in dying in numerous countries over the last 20 years represents a significant shift in practice and scope for many clinicians who have had little-to-no training to prepare them to sensitively respond to patient requests for hastened death. AIMS: Our objective was to review the existing qualitative literature on the experiences of healthcare providers responding to requests for hastened death with the aim of answering the question: how do clinicians make sense of, and respond to patients' expressed wishes for hastened death? METHODS: We performed a systematic review and meta-synthesis of primary qualitative research articles that described the experiences and perspectives of healthcare professionals who have responded to requests for hastened death in jurisdictions where MAiD (Medical Assistance in Dying) was legal or depenalised. A staged coding process was used to identify and analyse core themes. RESULTS: Although the response to requests for hastened death varied case-by-case, clinicians formulated their responses by considering seven distinct domains. These include: policies, professional identity, commitment to patient autonomy, personal values and beliefs, the patient-clinician relationship, the request for hastened death and the clinician's emotional and psychological response. CONCLUSION: Responding to a request for hastened death can be an overwhelming task for clinicians. An approach that takes into consideration the legal, personal, professional and patient perspectives is required to provide a response that encompasses all the complexities associated with such a monumental request.