Providing 0.1 Full-Time Equivalent (FTE) Support to Fellowship Core Faculty Improves Faculty Involvement in Fellowship Education and Recruitment.

In 2022, the American Council for Graduate Medical Education (ACGME) recommended that core faculty (CF) in medical subspecialty fellowships receive at least 0.1 full-time equivalent (FTE) salary support, with plans to enforce compliance in July 2023. After early feedback raised concerns about potential unintended consequences, ACGME deferred enforcement to July 2024. Hence, there is an urgent need to understand the ramifications of providing FTE support for CF. In 2020, the Yale hematology and medical oncology (HO) fellowship program began providing 0.1 FTE support to all CF. Perceptions regarding this were assessed via surveys distributed to all CF in 2021 and 2022 and to all HO fellows in 2021. The vast majority (83.3%) of CF survey respondents reported improved job satisfaction and an increased sense of involvement in the fellowship program as a result of the new 0.1 FTE-supported CF program. Most CF increased attendance at fellowship conferences, devoted more time to mentorship, and increased participation in recruitment. In free text comments, CF respondents described that providing 0.1 FTE support made them "feel rewarded," gave them "a sense of commitment" to the fellowship, and helped "offset clinical requirements." HO fellows reported "a positive impact" of the new program with faculty being "more present at lectures." The median number of times faculty were available to interview fellowship applicants rose markedly after introduction of the program. The FTE-supported CF program was viewed enthusiastically by fellows and faculty, resulting in increased CF involvement in fellowship education and recruitment.

Surgeon compensation in academic medicine.

Academic surgery is the best career one could ever aspire to have; however, given the long duration of training and the anticipated education debt, surgeon compensation has not kept pace with the compensation of other comparable careers. As surgeon compensation has experienced increased downward pressure, it has become of growing importance to those in academic medicine/surgery. Competitive compensation is necessary, even if not sufficient, for successful faculty recruitment and retention. The optimal compensation system should encourage the best possible patient care, inspire teamwork, maximize the department's or physician practice's ability to recruit and retain faculty, support all missions, and be viewed as equitable and transparent. The goal of an optimal compensation system is to have faculty minds focused on things other than compensation-those elements of their job that are most important, such as career development, multidisciplinary clinical programs, research, and education. One way to ensure that compensation stays in the background for academic surgeons is for leadership to keep this front and center. Compensation plans can influence behavior and time management and affect the clinical, academic, and educational contributions of surgeons and physicians of all specialties. As we strive to optimize the productivity and engagement of a health system's most valuable resource-those who deliver surgical care and create new knowledge-compensation is an important variable in need of constant attention.

[The effect of industrial factors on health of crew members of bulk-oil fleet].

The negative effect of oil vapors and oil products on health of crew of tanker fleet is a large-scale problem of shipping since safety of life and health of seamen is declared as essential value in implementation of production activity. The inert gases emitted during handling and transportation of oil products, in view of their toxicity, may result not only in acute intoxication but also in development of chronic diseases when inhaling harmful substances in moderate concentrations. The article considers main professional industrial factors that affect crew members of bulk-oil fleet, symptomatology of intoxication and initial care of crew members, application of personal cover when working with this type of cargo. The special attention is paid to chronic diseases developing against the background of negative effect of oil products on health of seamen. The recommendations of prevention and timely detection of their development are proposed.

The hidden costs of the intercollegiate membership of the Royal College of surgeons examinations: Can trainees afford it?

BACKGROUND: The Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is a mandatory requirement for higher specialty surgical training in the UK. However, there is a significant economic impact on trainees which raises the question of whether the costs of this exam hinder surgical career progression. This study explores the burden of these exams on trainees. METHODS: A 37-point questionnaire was distributed to all trainees who were preparing for or have sat MRCS examinations. Univariate analyses included the cost of the preparatory resources, extra hours worked to pay for these and the examinations, and the number of annual leave (AL) days taken to prepare. Pearson correlation coefficients were used to identify possible correlation between monetary expenditure and success rate. RESULTS: On average, trainees (n â€‹= â€‹145) spent £332.54, worked 31.2 â€‹h in addition to their rostered hours, and used 5.8 AL days to prepare for MRCS Part A. For MRCS Part B/ENT, trainees spent on average £682.92, worked 41.7 extra hours, and used 5 AL days. Overall, the average trainee spent 5-9% of their salary and one-fifth of their AL allowance to prepare for the exams. There was a positive correlation between number of attempts and monetary expenditure on Part A preparation (r(109)=0.536, p â€‹< â€‹0.001). CONCLUSIONS: There is a considerable financial and social toll of the MRCS examination on trainees. Reducing this is crucial to tackle workforce challenges that include trainee retention and burnout. Further studies exploring study habits can help reform study budget policies to ease this pressure on trainees.

Work absenteeism, disability, and lost wages among patients with acute myeloid leukemia and their caregivers: a cohort study using US administrative claims and productivity data.

OBJECTIVE: We describe the impact of acute myeloid leukemia (AML) diagnosis on workplace absenteeism and disability days among patients and their caregivers. METHODS: This retrospective study included adults with newly diagnosed AML (2009-2019) and adult caregivers of patients with newly diagnosed AML, identified from the US Merative™ MarketScan® Commercial Database. The Merative MarketScan Health and Productivity Management Database provided linked patient-level records of workplace absence and short-term (STD) and long-term disability (LTD) data. Endpoints included workplace absence, STD and LTD for patients and caregivers during 12 months pre-AML (baseline) and ≤3 years' follow-up, and corresponding cost of work loss. RESULTS: Patient workplace absence decreased in the months post-AML diagnosis, but the number of STD and LTD leave days claimed increased significantly by sixfold and fourfold, respectively. The proportion of patients making STD leave claims increased within 4-5 months of diagnosis, while the proportion making LTD leave claims increased significantly starting from month 5. Caregiver workplace absence peaked in the first 2 months post-diagnosis and remained elevated versus baseline throughout the study. CONCLUSION: AML diagnosis leads to workplace absenteeism and increased economic burden for patients with AML and their caregivers.

Perceived Implications of Compensation Structure for Academic Surgical Practice: A Qualitative Study.

This qualitative study examines how incentive-based and salary-only compensation models affect academic surgeons.

Impact of the minimum wage increase on smoking behaviour: A quasi-experimental study in South Korea.

BACKGROUND: While there's a growing body of research studying the health effects of minimum wage increases, evidence of its impact on smoking is inconsistent. Using nationally representative statistics, our quasi-experimental study examines the impacts of South Korea's 2018 minimum wage increase on smoking patterns, offering a distinctive context due to the significant wage growth and the country's permissive smoking culture. METHODS: Using the Korean Welfare Panel Study (KOWEPS), we conducted a difference-in-differences analysis using two-way fixed effect (TWFE) and Callaway and Sant'Anna Difference-in-differences (CSDID) methods. The study sample (n = 3494) included individuals aged 19-64 at baseline in 2016, and employed in the entire study period (2016-2019). RESULTS: The model results suggest a roughly 2% increase in the probability of current smoking with an insignificant impact on average daily cigarette consumption following the 2018 minimum wage increase in Korea. These effects were most pronounced among men and age groups (45-64). We also found policy effects on those earning up to 150% of the minimum wage. CONCLUSION: In a culture with widespread acceptance of smoking, an exogenous increase in disposable income due to elevated minimum wage might enhance vulnerability to societal pressure to smoke. Although TWFE and CSDID both suggest the same overall trend, the latter approach allows a more detailed examination by acknowledging heterogeneous treatment effects. These results could guide policymakers to contemplate the potential for increased smoking resulting from minimum wage hikes in societies where tobacco use is common, and accordingly strategize anti-smoking public health initiatives.

From Debt to Dollars: Assessing a General Surgeon's Career Value.

INTRODUCTION: Surgical residents make decisions that may have a dramatic impact on career earnings based off conceptions regarding future income potential. This study examines the effect of debt burden, repayment plan, and practice setting on a general surgeon's career value. METHODS: Debt levels, repayment plans, and practice setting were considered to model a surgeon's career value using net present value (NPV) across 35 scenarios. The NPV was calculated using salary, education debt, yearly spending, and a discount rate of 5%. Salary data were obtained from the Medical Group Management Association, student debt information from the Association of American Medical Colleges, and tax and household spending data from U.S. government records. Assumptions included no gaps in training, no prior debt, single-person household, and career duration of 35 y. RESULTS: A general surgeon's salary adequately repays debt burdens from $100,000-$300,000 over 10-25 y, regardless of repayment plan or practice setting. Practice setting decreased career value for academic surgeons when debt burden and repayment plan were held constant: the NPV for an academic surgeon was $382,000 compared to $500,000 for a nonacademic surgeon with the same debt and repayment plan. Debt burden repaid through unsubsidized and income-based repayment plans reduced NPV for all surgeons, while subsidized plans increased NPV. The projected NPV for all scenarios ranged $2.35M-$2.87 M. CONCLUSIONS: Though the modeled scenarios do not account for prior debt burden, major expenditures, or increases in yearly household spending beyond national averages, surgery residents should be aware that general surgery remains a financially feasible career.

Cancer Screening after the Adoption of Paid-Sick-Leave Mandates.

BACKGROUND: By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS: We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS: Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS: In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).

Geographic Trends in General Surgery Resident Compensation Across the United States.

OBJECTIVE: To examine the effect of cost of living on general surgery resident salaries and identify factors associated with greater incomes and availability of housing stipends. DESIGN: Retrospective cross-sectional analysis of Fellowship and Residency Electronic Interactive Database (FREIDA), institutional websites, and Doximity. Program characteristics were compared through Kruskal-Wallis tests, ANOVA, and χ2 tests. Multivariable linear mixed modeling and multivariable logistic regression were utilized to determine factors associated with higher salary and availability of housing stipend, respectively. SETTING: Three-hundred fifty-one general surgery residency programs in the United States. PARTICIPANTS: Three-hundred-seven general surgery residency programs with available salary data for the 2022 to 2023 academic year. RESULTS: The average postgraduate year 1 resident annual salary was $59,906.00 (standard deviation [SD] ± $5051.97). After adjustment for the cost of living, the average annual income surplus was $22,428.42 (SD ± $4848.64). Cost of living and resident remuneration varied substantially across regions (p < 0.001). Annual income surplus was the highest for programs in the Northeast when compared to other regions (p < 0.001). Resident annual income increased by $510 (95% confidence interval [CI] $430-$590) for each $1000 increase in the cost of living and $150 (95% CI $80-$210) for each 10-rank increase in Doximity general surgery program reputation ranking. An increased cost of living was associated with a higher likelihood of housing stipend availability (odds ratio 1.17, 95% CI 1.07-1.28). CONCLUSIONS: General surgery residents are inadequately compensated for the cost of living, indicating the potential for increased compensation to alleviate economic strain of surgical trainees. As financial stress can have implications for mental and physical well-being, further discussion of current resident salaries and benefits is warranted.

Orthopaedics and the gender pay gap: A systematic review.

AIMS: Gender pay gaps are present in a wide range of industries, with the medical profession being no exception. The aim of this systematic review was to analyse the peer-reviewed literature to identify whether there is a gender pay gap in orthopaedics. METHODS: A systematic review was conducted by searching the following databases: MEDLINE, Health & Medical Collection, Nursing & Allied Health Database, Publicly Available Content Database, Consumer Health Database and Healthcare Administration Database. Original research papers pertaining to the earnings of male and female orthopaedic surgeons were included for review. RESULTS: Of 745 papers acquired through the database search, 12 were eligible for inclusion. These were published in the USA, Canada and Taiwan. 6 looked at the relationship between sex and annual income, 4 studied industry payments, one analysed hourly earnings and one compared payments per case between males and females. Men were found to earn significantly higher annual incomes than women, even when confounding factors such as rank, practice setting and subspeciality were accounted for. Men also receive significantly higher payments from industry, and earn more per hour than women. CONCLUSION: This systematic review has demonstrated that there is a gender pay gap in orthopaedics, with women commonly earning significantly less than their male colleagues. The reasons for this, however, remain unclear, and deserve further investigation. It is incumbent upon orthopaedic departments, healthcare providers and orthopaedic associations to raise awareness and ensure that men and women are paid the same for equal work.

Estimating Effects of Wages on Smoking Prevalence Using Labor Unions as Instrumental Variables.

OBJECTIVES: To test for the effects of wages on smoking using labor unions as instrumental variables. METHODS: We analyzed four waves of the Panel Study of Income Dynamics (2013 to 2019 alternate years). The overall sample included workers aged 18 to 70 years in 2013 and subsamples within blue + clerical/white-collar and private/public sector jobs (N = 37,117 to 8446 person-years). We used two instrumental variables: worker's union membership and states' right-to-work laws. RESULTS: $1 (2019 US dollars) increases in wages-per-hour resulted in 1.3 ( P < 0.001) percentage point decreases in smoking prevalence (8.2% decreases at the smoking mean). Larger effect sizes and strong statistical significance were found for blue-collar + clerical and private-sector subsamples; smaller sizes and insignificance were found for public-sector and white-collar subsamples. CONCLUSIONS: Unions increase wages, and higher wages, in turn, reduce smoking. Wages and labor unions are underappreciated social determinants of health.

Translating the Value of the Academic Surgeon Into Salary, Time, and Resources.

Academic surgeons provide tremendous value to institutions including notoriety, publicity, cutting-edge clinical advances, extramural funding, and academic growth and development. In turn, these attributes may result in improved reputation scores and hospital or medical center rankings. While many hospital systems, schools of medicine, and departments of surgery claim to have a major commitment to academic surgery and research, academic surgeons are often undercompensated compared to clinically focused counterparts. Existing salary benchmarks (e.g., the Medical Group Management Association (MGMA) or the Association of American Medical Colleges (AAMC)) are often used but are imperfect. Thus, the value proposition for academic surgeons goes beyond compensation and often includes protected time for academic pursuit, nonsalary financial support, and other intangible benefits to being associated with a major academic center (e.g., abundance of scientific collaborators, infrastructure for grant management). As a result, institution-specific practices have developed and academic surgeons are left to negotiate salary support including bonus structures, protected time, and recruitment packages on a case-by-case basis without a clear roadmap. A diverse panel representing a range of academic surgical experiences was convened at the 2022 Academic Surgical Congress to illuminate this complex, often stress-inducing, aspect of an academic surgeon's professional career.

American College of Radiology Paid Family/Medical Leave Policy: A Call to Action for the House of Medicine.

The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that "diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed." The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.

Gender Disparities in Physician Assistant Educator Promotion and Compensation: A Mixed Methods Approach.

INTRODUCTION: The gender wage gap is well documented in many industries. A disparity in salary between female and male physician assistant (PA) educators has been demonstrated, but disparities in academic rank have not been shown. The purpose of this study was to re-examine gender disparities in compensation to PA educators and to explore whether gender-based disparities exist in promotion to higher academic rank in this field. METHODS: An explanatory sequential mixed-methods design was used to determine differences in salary and rank by gender. PA Education Association Faculty and Directors Survey data from 2014, 2017, and 2019 were analyzed. A focus group was conducted to explain the findings and understand the barriers to promotion for female faculty. RESULTS: Female PA faculty members earn $7573 less than their male colleagues when controlling for all other variables. Female faculty members have an increased likelihood (RR 1.150) for being in early career stage versus late career stage. Obtaining a doctoral degree decreased the risk for being in an early career stage (RR 0.567) with men twice as likely to have a doctoral degree as women. DISCUSSION: Rank and salary disparities exist in PA faculty by gender. Female faculty are less likely to hold doctoral degrees or to be promoted to higher academic ranks, and they earn less than men. Degree level and career track are themes unique to the PA education profession, and further research is needed to understand their impact. With more women entering PA education, pay equity and promotion need to be addressed.

[How much does a specialized medical consultation cost for families of pediatric patients in the Brazilian Unified National Health System?] / Quanto custa uma consulta médica especializada para as famílias de pacientes pediátricos no Sistema Único de Saúde?

In this study, we investigated the costs of transportation for each outpatient consultation in patients referred to specialized surgical evaluation in a tertiary hospital in Rio de Janeiro, Brazil. Descriptive study with guardians of pediatric patients scheduled for pediatric surgery, questioning transportation cost, and opportunity costs (loss of remuneration, food, payment of caregivers for other children, expenses for other companions). About half patients were aged up to five years; about two thirds had diseases of simple and definitive surgical resolution; and 181 families (89.17%) presented monthly family income up to BRL 1,999.00. The proportion of families that benefited from free transportation ranged from 4.26% to 15.56% for patients living up to 100 km away from the hospital (45.83% for patients living more than 100 km away from the institution). A total of 176 (87.13%) guardians reported expenses buying food, 12 (5.94%) paid caregivers to the other children on the day of the consultation, and 80 (39.6%) reported loss of remuneration for the working day. Among the high complexity cases, 9.33% of the mothers have given up their regular paid employment. Transportation expenses for a pediatric surgery consultation at a reference hospital in Rio de Janeiro cost about 4.42% of the current minimum wage, spending around 217.32 minutes of displacement/consultation. Expenses with food and loss of remuneration due to absence at work also entail significant financial charges or loss of remuneration for the patient at each consultation.

Nesta pesquisa, estudamos os custos de transporte por consulta ambulatorial em pacientes referenciados para avaliação cirúrgica especializada em um hospital terciário no Rio de Janeiro, Brasil. Trata-se de um estudo descritivo com responsáveis por pacientes pediátricos agendados para consulta de cirurgia pediátrica, questionando fatores ligados ao custo de transporte e de oportunidade (perda de remuneração, alimentação, pagamento de cuidadores para outros filhos, despesas para outros acompanhantes). Aproximadamente metade dos pacientes tinham até 5 anos de idade, cerca de 2/3 apresentavam doenças de resolutividade cirúrgica simples e definitiva e 181 famílias (89,17%) contavam com renda familiar mensal de até R$ 1.999,00. A proporção de famílias beneficiadas por transporte gratuito variou entre 4,26-15,56% para pacientes morando até 100km de distância do hospital (45,83% para pacientes com residência a mais de 100km da instituição). Dos responsáveis, 176 (87,13%) relataram despesas para alimentação, 12 (5,94%) pagavam cuidadores para os outros filhos no dia da consulta e 80 (39,6%) referiram perda do pagamento do dia de trabalho. Dos casos de alta complexidade, 9,33% das mães entrevistadas abriram mão de exercer atividade remunerada regular. As despesas com transporte para uma consulta em cirurgia pediátrica em um hospital de referência do Rio de Janeiro custam em média 4,42% do salário mínimo vigente, com uma média de 217,32 minutos de deslocamento por consulta. Despesas com alimentação e perda de remuneração pela ausência no trabalho também implicam encargos financeiros ou perda de remuneração significativos para o paciente em cada consulta.

En esta investigación se estudiaron los costes de transporte por visita ambulatoria en pacientes remitidos para evaluación quirúrgica especializada en un hospital de atención terciaria en Río de Janeiro, Brasil. Es un estudio descriptivo con responsables de pacientes pediátricos programados para consulta de cirugía pediátrica, en el que se cuestionaron factores relacionados con el coste del transporte y los costes de oportunidad (pérdida de remuneración, alimentación, pago de cuidadores de otros niños, gastos de otros cuidadores). Aproximadamente la mitad de los pacientes tenían hasta 5 años de edad; cerca de 2/3 presentaban enfermedades de resolución quirúrgica simple y definitiva, 181 familias (89,17%) con renta familiar mensual de hasta BRL 1.999,00. La proporción de familias que se benefician de transporte gratuito varía entre el 4,26% y el 15,56% para los pacientes que viven hasta a 100 km del hospital (45,83% para los pacientes que viven a más de 100 km de la institución). Ciento setenta y seis (87,13%) cuidadores declaran gastos de alimentación, 12 (5,94%) pagan a los cuidadores de sus otros hijos en el día de la consulta y 80 (39,6%) declaran pérdida de salario por la jornada laboral. De los casos de alta complejidad, el 9,33% de las madres entrevistadas habían abandonado su actividad remunerada habitual. Los gastos de transporte para una consulta de cirugía pediátrica en un hospital de referencia de Río de Janeiro cuestan de media el 4,42% del salario mínimo vigente, con una media de 217,32 minutos de tiempo de viaje/consulta. Los gastos de alimentación y la pérdida de salario por ausencia en el trabajo también implican una importante carga económica o pérdida de salario para el paciente en cada cita.

Gender Related Differences in Surgeon Compensation: Survey Results from the American Society of Colon and Rectal Surgeons.

OBJECTIVE: We sought to understand the effect of sex on compensation among colorectal surgeons and to determine which factors contribute to gender-based differences in compensation. SUMMARY OF BACKGROUND DATA: The sex-based wage gap in the medical profession is among the most pronounced wage gaps in the U.S. Data regarding the wage gap among colorectal surgeons and the underlying reasons for this disparity remain unclear. METHODS: The Healthcare Economics Committee of the American Society of Colon and Rectal Surgeons conducted a survey to evaluate surgeon demographics, compensation, and practice characteristics. To evaluate the effect of sex on compensation, we performed multivariable linear regression with backward selection. We used a two-sided P -value with a significance threshold <0.05. RESULTS: The mean difference in normalized total compensation between men and women was $46,250, and when salary was adjusted for FTEs, the difference was $57,000. Women were more likely to perform anorectal surgery, less likely to perform general surgery and less likely to hold positions in leadership. After adjustments, women reported significantly lower compensation (aOR, 0.88; 95% CI, 0.80-0.97). Time spent doing abdominal surgery (aOR, 1.13; 95% CI 1.03-1.23), professor status (aOR, 1.17; 95% CI, 1.03-1.32) and instructor status (aOR, 1.49; 95% 1.28-1.73) were independently associated with compensation. CONCLUSIONS: We found a 12% adjusted sex wage gap among colorectal surgeons. Gender-based differences in leadership positions and allocation of effort may contribute. Further research will be necessary to clarify sources of wage inequalities. Still, our results should prompt expedient actions to support closing the gap.