The Cost of a Locum: A Simulation to Determine When You Are Paying Too Much for Your Anesthesia Locum Tenens Coverage.

BACKGROUND: Current research on locum tenens physicians has primarily focused on their safety, reliability, and patient outcomes, leaving a significant gap in understanding the financial implications of their employment in health systems. Amidst a persistent shortage of physicians across specialties, healthcare organizations have increasingly relied on locum tenens to meet the rising demand for clinical services. This study aims to bridge the knowledge gap by evaluating the financial feasibility of employing locum tenens physicians compared to full-time anesthesiologists, given the context of growing physician shortages and increasing healthcare demands. METHODS:  We developed a Python simulation model to compare the costs of hiring locum tenens versus full-time anesthesiologists. The model inputs included hourly rates for both locum tenens and full-time anesthesiologists and the upfront hiring costs for full-time physicians. By plotting these costs against each other, the model identifies the breakeven point: the number of working hours at which the cost of employing a locum tenens physician equals that of hiring a full-time physician. Utilizing Monte Carlo simulations with data from the Northeastern United States, we assessed the variability and determined an average breakeven point across different scenarios. RESULTS:  The Monte Carlo simulation, based on 10,000 iterations, revealed an average breakeven point of 665 hours, corresponding to just over 11 weeks of 60-hour workweeks. This suggests that for any locum tenens engagement exceeding this duration, hiring a full-time anesthesiologist becomes more cost-effective for the healthcare institution. The simulation also showed that 28% of scenarios had a breakeven point below 60 days, highlighting the financial dynamics and decision-making complexities in employing locum tenens versus full-time physicians. CONCLUSIONS:  The findings indicate that employing locum tenens physicians for durations shorter than 665 hours remains financially viable compared to the option of hiring full-time anesthesiologists. However, the significant variability observed in the simulations underscores the importance of context in making staffing decisions. Healthcare organizations must consider the specific needs and circumstances of their operations when deciding between hiring locum tenens and full-time physicians, especially for longer-term coverage requirements.

Investor initiatives program: Public-private partnerships to expedite commercialization for NCI-funded small business entrepreneurs.

The National Cancer Institute's Small Business Innovation Research Development Center (NCI SBIR) provides federal research and development funding and commercialization resources to more than 400 small businesses each year developing novel technologies to prevent, diagnose, and treat cancer. Although federal funding is vital for life science startups at the early stage of development, it is often insufficient to translate the technology from discovery to commercial product. Early-stage startups must connect to follow-on capital and resources to bring NCI-funded technologies to patients. Most startups face challenges in securing additional funding due to lack of access to investors and strategic partners and the ability to effectively pitch their technology. In 2015, the NCI SBIR started the Investor Initiatives program to connect funded small businesses with targeted investors and strategic partners to address the aforementioned obstacles. This program leverages an extensive network of investors and partners to conduct business-focused reviews and provide pitch coaching. The program incentivizes earlier collaborations between NCI-funded companies and private investors through various channels. The program has supported 117 companies from years 2016-2019 to attend 27 investor showcase events. Follow-up surveys show that the program and the assistance offered by NCI SBIR have contributed to a total of 32 completed deals as of April 29, 2020. This paper will discuss the Investor Initiatives program and its outcomes from 2016 to 2019 and demonstrate the effectiveness of a federal program that leverages public-private partnerships to assist portfolio companies with raising follow-on funding to accelerate the translation of research into clinical practice.

What Can Be Learned from Health-Related Tensions and Disparities in Ultra-Orthodox Jewish Families?

Promoting healthy lifestyle from early childhood is a key objective in public health, yet health behaviors are often culturally driven, especially in closed-religious communities. This study aims to reveal key cultural-religious aspects of attitudes and behaviors regarding lifestyle in one such closed community-the ultra-orthodox Jewish community. In-depth interviews were conducted with 20 participants: religious leaders, educational figures, psycho-medical professionals from two major ultra-orthodox communities in Israel. A thematic analysis was used to reveal key themes in the interviews. We found tensions between conflicting themes in the parenting, nutrition and physical activity domains, while the sleep domain illustrated cultural solution for a tension. By illuminating the perceptional components of lifestyle, the study contributes to better foundations of health promotion in closed-religious communities.

How can medical schools contribute to bringing about health equity?

The role of medical schools is in a process of change. The World Health Organization has declared that they can no longer be ivory towers whose primary focus is the production of specialist physicians and cutting edge laboratory research. They must also be socially accountable and direct their activities towards meeting the priority health concerns of the areas they serve. The agenda must be set in partnership with stakeholders including governments, health care organisations and the public. The concept of social accountability has particular resonance for the Bar Ilan Faculty of Medicine in the Galilee, Israel's newest medical school, which was established with a purpose of reducing health inequities in the Region. As a way of exploring and understanding the issues, discussions were held with international experts in the field who visited the Galilee. A symposium involving representatives from other medical schools in Israel was also held to extend the discourse. Deliberations that took place are reported here. The meaning of social accountability was discussed, and how it could be achieved. Three forms of action were the principal foci - augmentation of the medical curriculum, direct action through community engagement and political advocacy. A platform was set for taking the social accountability agenda forward, with the hope that it will impact on health inequalities in Israel and contribute to discussions elsewhere.

Diffuse near-infrared spectroscopy prediction of healing in diabetic foot ulcers: a human study and cost analysis.

Wound size reduction has been the standard benchmark for determination of efficacy for diabetic ulcer treatments but due to interclinician error and difficulty measuring irregular wound shapes, this method is unreliable with a positive predictive value of less than 60%. Diffuse near-infrared spectroscopy (DNIRS) uses 70-MHz modulated light in the diagnostic window (650-900 nm) noninvasively to quantify levels of oxy- and deoxy-hemoglobin in the wound bed, which when measured over time, can show a trend toward or away from healing based on the changes in oxy-hemoglobin concentration from week to week. In this study, DNIRS was used to monitor 24 human diabetic foot ulcers longitudinally over the course of 20 weekly or biweekly measurement sessions. In just 4 weeks, the DNIRS system has an 82% positive predictive value (sensitivity of 0.9 and specificity of 0.86; p < 0.002). These data indicate that it could be possible to predict healing in 4 weeks using DNIRS, which can provide objective guidance toward the continuation of costly treatments. Discontinuing ineffective treatments after 4 weeks could have potentially saved over $12,600 per patient, based on the treatment regimen of patients in this study.

Near infrared wound monitor helps clinical assessment of diabetic foot ulcers.

BACKGROUND: The efficacy of using diffuse near infrared spectroscopy (NIRS) in predicting wound healing in diabetic foot ulcers was demonstrated by conducting a pilot human study. METHOD: Sixteen chronic diabetic wounds were followed and assessed for subsurface oxyhemoglobin concentration using the NIRS device. Weekly measurements were conducted until there was wound closure, limb amputation, or 20 completed visits without healing. Wound size and degree of wound contraction were measured by image analysis of digital photographs, and results were compared to NIRS results. RESULTS: In the 16 patients followed, seven wounds healed, six limbs were amputated, and three wounds remained opened after 20 visits. Initial values of subsurface hemoglobin concentration, in all wounds, were higher than in nonwound control sites. Healed wounds exhibited a consistent reduction of hemoglobin concentration several weeks prior to closure, and the absolute hemoglobin concentration approached the value at the control site. In wounds that did not heal or ended in amputations, the hemoglobin concentration remained elevated throughout the study. A negative slope for the rate of change of hemoglobin concentration was indicative of healing across all wounds. CONCLUSIONS: Evaluation of diabetic foot ulcers using NIRS may provide an effective and more complete measurement of wound healing compared to current clinical approaches.

Noninvasive assessment of diabetic foot ulcers with diffuse photon density wave methodology: pilot human study.

A pilot human study is conducted to evaluate the potential of using diffuse photon density wave (DPDW) methodology at near-infrared (NIR) wavelengths (685 to 830 nm) to monitor changes in tissue hemoglobin concentration in diabetic foot ulcers. Hemoglobin concentration is measured by DPDW in 12 human wounds for a period ranging from 10 to 61 weeks. In all wounds that healed completely, gradual decreases in optical absorption coefficient, oxygenated hemoglobin concentration, and total hemoglobin concentration are observed between the first and last measurements. In nonhealing wounds, the rates of change of these properties are nearly zero or slightly positive, and a statistically significant difference (p<0.05) is observed in the rates of change between healing and nonhealing wounds. Differences in the variability of DPDW measurements over time are observed between healing and nonhealing wounds, and this variance may also be a useful indicator of nonhealing wounds. Our results demonstrate that DPDW methodology with a frequency domain NIR device can differentiate healing from nonhealing diabetic foot ulcers, and indicate that it may have clinical utility in the evaluation of wound healing potential.

Performance assessment of community-based physicians: evaluating the reliability and validity of a tool for determining CME needs.

PURPOSE: To evaluate the reliability, validity, and feasibility of the Physician Assessment in Medical Practice (PAMP) as a means of determining the CME needs of practicing, community-based physicians. METHOD: A group of 45 randomly selected community-based physicians (19 certified family physicians and 26 general practitioners) affiliated with the Department of Family Medicine at Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel, volunteered to participate in the study, conducted in 1997. All participants took a ten-station, performance-based examination designed to closely represent the physicians' work settings. At each station, a different medical problem was presented by a standardized patient. Physician-candidates' performances were assessed by physician-examiners using global ratings. The following performance domains were assessed: information gathering, diagnosis and management plan, and communication skills. A CME needs assessment score was determined for each of the participants and a CME level to meet the needs of the physician was recommended. RESULTS: Overall reliability of the examination was high (.87), with domain reliabilities ranging from.76 to.87. Reliability of the examiners' judgments of the physicians' competence was.66. All the stations' validity scores were significant, and differences in performances between family physicians and general practitioners demonstrated construct validity of the test results. Overall, the cost of running the examination was U.S. $250 per physician-candidate. CONCLUSIONS: Using the PAMP to determine CME needs of community-based physicians was found to reliable, valid, and feasible, and the cost per physician-candidate was not excessive. Performance results provided indepth information for use by both the individual physician and providers of CME programs.