Patients report high information coordination between rostered primary care physicians and specialists: A cross-sectional study.

Our study aimed to describe patient experience of information coordination between their primary care physician and specialists and to examine the associations between their experience and their personal and primary care characteristics. We conducted a cross-sectional study of Ontario residents rostered to a primary care physician and visited a specialist physician in the previous 12 months by linking population-based health administrative data to the Health Care Experience Survey collected between 2013 and 2020. We described respondents' sociodemographic and health care utilization characteristics and their experience of information coordination between their primary care physician and specialists. We measured the adjusted association between patient-reported measures of information coordination before and after respondents received care from a specialist physician and their type of primary care model. 1,460 out 20,422 (weighted 7.5%) of the respondents reported that their specialist physician did not have basic medical information about their visit from their primary care physician in the previous 12 months. 2,298 out of 16,442 (weighted 14.9%) of the respondents reported that their primary care physician seemed uninformed about the care they received from the specialist. Females, younger individuals, those with a college or undergraduate level of education, and users of walk-in clinics had a higher likelihood of reporting a lack of information coordination between the primary care and specialist physicians. Only respondents rostered to an enhanced fee-for-service model had a higher odds of reporting that the specialist physician did not have basic medical information about their visit compared to those rostered to a Family Health Team (OR 1.22, 95% Cl 1.12-1.40). We found no significant association between respondent's type of primary care model and that their primary care physician was uninformed about the care received from the specialist physician. In this population-based health study, respondents reported high information coordination between their primary care physician and specialists. Except for respondents rostered to an enhanced fee-for-service model of care, we did not find any difference in information coordination across other primary care models.

[Looking back on 100 years of board certification for urology in Germany : Formation of a medical subject in the context of specialization and professionalization]. / 100 Jahre Facharzt für Urologie : Zur Ausbildung eines medizinischen Faches im Kontext von Spezialisierung und Professionalisierung.

This article examines the development of urology as an independent medical discipline in Germany, with a particular focus on professionalization and specialization in the 19th and 20th centuries. Based on historical sources, the text illuminates the importance of the German medical profession's further training regulations as an instrument of medical self-administration and the classification of urology as a medical specialty in the Bremen guidelines of 1924, which established board certification in diseases of the urinary organs (urology).

Veterinary students' attitudes toward anesthesiology as a specialty.

OBJECTIVE: To identify the perceptions of veterinary students interested in specialization regarding veterinary anesthesiology. STUDY DESIGN: Cross-sectional, multi-institutional, voluntary, anonymous, nonrandomized survey. POPULATION: Veterinary students (303 of 557 total respondents) from 10 veterinary schools. METHODS: Quantitative data were obtained via 5-point Likert scale questions about anesthesia-related topics. Open-ended questions were used to obtain qualitative data. A multivariate logistic regression model assessed the likelihood of choosing a career as an anesthesiologist. Spearman's rank correlation coefficient was used to assess the relationship between 'anesthesia is interesting' and other variables. RESULTS: Of the respondents, 14 (6%) indicated veterinary anesthesia as their chosen specialty. There was a significant positive relationship between 'anesthesia is interesting' and the following variables: age, enjoyment in anesthesia class, belief in the importance of anesthesia for their career, belief in the importance of analgesia for their career, belief that anesthesia and analgesia have a large impact on patient care, interest in pharmacology, interest in physiology, interest in learning technical skills, belief that anesthesiologists are respected by their colleagues and belief that anesthesiologists are an important part of the health care team. More weeks on the anesthesia clinical rotation was positively and significantly associated with increased rotation enjoyment. Enjoyment in the anesthesia class [p = 0.001, Exp(ß) = 2.1, 95% confidence interval (CI): 1.3-3.4] and belief that anesthesia is interesting [p = 0.013, Exp(ß) = 2.6, 95% CI: 1.2-5.4] were predictors that respondents would be more likely to consider a career as a veterinary anesthesiologist. CONCLUSIONS: Those veterinary students with an interest in pharmacology and who enjoyed their anesthesia course were more likely to consider a career as a veterinary anesthesiologist. If students indicated no interest in specializing in veterinary anesthesia, they appreciated the value the specialty brings to animal care and believed that veterinary anesthesiologists are respected by their peers.

Pediatric subspecialty outreach clinics: reach and impact on access to care.

BACKGROUND: Recent research highlighting a shortage of pediatric subspecialists in the United States has shown wide variations in the distance from children to the nearest subspecialists but has not accounted for subspecialty outreach clinics, in which specialists may improve access in rural areas by periodically staffing clinics there. This study aimed to determine the impact of pediatric subspecialty outreach clinics on the driving times to the nearest pediatric subspecialists for children in Maine. METHODS: This cross-sectional study utilized administrative data on the schedule and location of pediatric subspecialty clinics in Maine in 2022 to estimate the driving time from each ZIP-code tabulation area to the nearest subspecialist, with and without the inclusion of outreach clinics. Using 2020 census data, we calculated the median and interquartile ranges of driving times for the state's overall child population, as well as for children living in urban and rural areas. RESULTS: Of 207,409 individuals under 20 years old in Maine, 68% were located closer to an outreach location than to a clinical hub. Across the seven subspecialties offering outreach clinics, outreach clinics decreased median driving times to the nearest pediatric subspecialist by 5 to 26 minutes among all children, and by 16 to 46 minutes among rural children. CONCLUSIONS: Pediatric subspecialty outreach clinics can substantially reduce the driving time to the nearest pediatric subspecialist , especially for children living in rural areas. The use of outreach clinics should be accounted for in research describing the geographic access or barriers to care. Expanding the number of outreach clinics should be considered by policymakers hoping to improve access.

What medical specialists want to stay in remote areas of Indonesia: Discrete choice experiments.

INTRODUCTION: The equitable distribution of medical specialists in Indonesia's remote areas remains a challenge. This study investigated the preferences of medical specialists regarding retention programs aimed at addressing this issue. METHODS: A Discrete Choice Experiment (DCE) was utilized to collect stated preferences from 341 medical specialist working in district general hospitals across 10 Indonesian provinces. The DCE retention questionnaire focused on eight key characteristics: location, medical facilities, net income, continuing professional development program, security, length of commitment, source of incentives, and caseload. RESULTS: The study found that the most influential factors for retention in remote areas were security guarantees from the local government (OR = 6.11), fully funded continuing professional development programs (OR = 2.84), and access to advanced medical facilities (OR = 2.35). CONCLUSION: The findings indicate that a comprehensive intervention package, with a particular emphasis on security provisions, is necessary to retain medical specialists in remote areas. Financial incentives are also recommended to improve retention. However, it is crucial to acknowledge that no single intervention will suffice, as the factors influencing specialist retention in remote areas of Indonesia are complex and multifaceted.

Roles and Responsibilities of the Global Specialist Digital Health Workforce: Analysis of Global Census Data.

Background: The Global Specialist Digital Health Workforce Census is the largest workforce survey of the specialist roles that support the development, use, management, and governance of health data, health information, health knowledge, and health technology. Objective: This paper aims to present an analysis of the roles and functions reported by respondents in the 2023 census. Methods: The 2023 census was deployed using Qualtrics and was open from July 1 to August 13, 2023. A broad definition was provided to guide respondents about who is in the specialist digital health workforce. Anyone who self-identifies as being part of this workforce could undertake the survey. The data was analyzed using descriptive statistical analysis and thematic analysis of the functions respondents reported in their roles. Results: A total of 1103 respondents completed the census, with data reported about their demographic information and their roles. The majority of respondents lived in Australia (n=870, 78.9%) or New Zealand (n=130, 11.8%), with most (n=620, 56.3%) aged 35-54 years and identifying as female (n=720, 65.3%). The top four occupational specialties were health informatics (n=179, 20.2%), health information management (n=175, 19.8%), health information technology (n=128, 14.4%), and health librarianship (n=104, 11.7%). Nearly all (n=797, 90%) participants identified as a manager or professional. Less than half (430/1019, 42.2%) had a formal qualification in a specialist digital health area, and only one-quarter (244/938, 26%) held a credential in a digital health area. While two-thirds (502/763, 65.7%) reported undertaking professional development in the last year, most were self-directed activities, such as seeking information or consuming online content. Work undertaken by specialist digital health workers could be classified as either leadership, functional, occupational, or technological. Conclusions: Future specialist digital health workforce capability frameworks should include the aspects of leadership, function, occupation, and technology. This largely unqualified workforce is undertaking little formal professional development to upskill them to continue to support the safe delivery and management of health and care through the use of digital data and technology.

[What about extending Specialised Health Training to architecture and engineering?] / ¿Y si ampliamos la Formación Sanitaria Especializada para la arquitectura e ingeniería?

Projects and construction management in healthcare facilities are usually assigned to architectural firms and engineering companies with previous experience. However, there is no evaluation system to ensure their level of competence in the healthcare sector. In the past, this was also the case for clinicians when they were self-appointed specialists without any supervision. Currently, the Specialised Health Training (SHT) programme in Spain is the only official specialisation pathway and consists of a period that combines training and paid healthcare practice. Similarly, but from Argentina, hospital residencies in architecture have been carried out for specialised postgraduate training. The aim of this article was to show the experience in Argentina and to propose the extension of the SHT in Spain. Our proposal consists of a programme of residencies in architecture and engineering to be developed in healthcare centres. We believe that this initiative has great potential to address health from its multiple disciplines and to reinforce the maturity of a National Health System in constant change.

Los proyectos y la dirección de obras en los centros sanitarios se suelen asignar a estudios de arquitectura y empresas de ingeniería con experiencia previa. Sin embargo, no hay un sistema de evaluación que asegure su nivel de competencia en el sector sanitario. Antiguamente, esta situación también se daba en los profesionales clínicos, cuando se autotitulaban especialistas sin ningún tipo de supervisión. En la actualidad, el programa de Formación Sanitaria Especializada (FSE) en España es la única vía de especialización oficial y consiste en un periodo que aúna formación y práctica asistencial remunerada. De manera similar, pero desde Argentina, se llevan realizando unas residencias hospitalarias de arquitectura para la formación especializada de posgrado. El objetivo de este artículo fue mostrar la experiencia en Argentina y proponer la ampliación de la FSE en España. Nuestra propuesta consiste en un programa de residencias en arquitectura e ingeniería a desarrollar en centros sanitarios. Consideramos que esta iniciativa tiene un gran potencial para abordar la salud desde sus múltiples disciplinas y reforzar la madurez de un Sistema Nacional de Salud en constante cambio.

Mixed practice was my plan then cattle health specialisation caught my attention.

Gaining experience in mixed practice was the starting point for Nicola Gladden, then locuming and travel gave her the space to decide which career route to follow next, choosing a residency pathway.

The COVID-19 Pandemic Led To A Large Decline In Physician Gross Revenue Across All Specialties In 2020.

US health care use declined during the initial phase of the COVID-19 pandemic in 2020. Although utilization is known to have recovered in 2021 and 2022, it is unknown how revenue in 2020-22 varied by physician specialty and practice setting. This study linked medical claims from a large national federation of commercial health plans to physician and practice data to estimate pandemic-associated impacts on physician revenue (defined as payments to eligible physicians) by specialty and practice characteristics. Surgical specialties, emergency medicine, and medical subspecialties each experienced a greater than 9 percent adjusted gross revenue decline in 2020 relative to prepandemic baselines. By 2022, pathology and psychiatry revenue experienced robust recovery, whereas surgical and oncology revenue remained at or below baseline. Revenue recovery in 2022 was greater for physicians practicing in hospital-owned practices and in practices participating in accountable care organizations. Pandemic-associated revenue recovery in 2021 and 2022 varied by specialty and practice type. Given that physician financial instability is associated with health care consolidation and leaving practice, policy makers should closely monitor revenue trends among physicians in specialties or practice settings with sustained gross revenue reductions during the pandemic.

Characterizing physician directory data quality: variation by specialty, state, and insurer.

BACKGROUND: As U.S. legislators are urged to combat ghost networks in behavioral health and address the provider data quality issue, it becomes important to better characterize the variation in data quality of provider directories to understand root causes and devise solutions. Therefore, this manuscript examines consistency of address, phone number, and specialty information for physician entries from 5 national health plan provider directories by insurer, physician specialty, and state. METHODS: We included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state. RESULTS: Of 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state. CONCLUSIONS: In evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information.

Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health.

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.

Trauma-informed training as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists.

OBJECTIVE: Aim: To determine the conditions for the implementation of trauma-informed training as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists. PATIENTS AND METHODS: Materials and Methods: 1,100 students studying in the conditions of martial law took part in the experimental work. RESULTS: Results: As a result of the negative impact of the stressful and destructive factors of the war on the inner world, the future specialists the following manifestations of the deterioration of the health were established: depression (99%), sudden change of mood (92%), worsening of well-being during sudden changes in the weather (66%), irritability (52%), aggressiveness (11%), anger (7%). It was found that future specialists wanted to postpone completing the educational task until later, as they perceived it as very difficult (79%). CONCLUSION: Conclusions: The conditions for the implementation of trauma-informed studying were formulated as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists. 1. During the organization of learning, teachers take into account the fact that psycho-traumas, which are caused by stressful and destructive factors of war, disturb students until they experience them. 2. Teachers take into account the traumatic experience of future specialists. 3. The teachers' actions aim to restore future professionals' sense of security, reestablish contact with other study participants, and regain control over their own lives and studies.

Comparative analysis of carotid artery stenting practice and outcomes across operator specialties: insights from a prespecified subanalysis of a large real-world patient cohort (ROADSAVER Study).

BACKGROUND: In contemporary clinical practice, carotid artery stenting (CAS) is increasingly becoming a multispecialty field, joining operators of various training backgrounds, which bring forth their unique expertise, patient management philosophies, and procedural preferences. The best practices and approaches, however, are still debated. Therefore, real-world insights on different operator preferences and related outcomes are of utmost value, yet still rather scarce in the available literature. METHODS: Using the data collected in the ROADSAVER observational, European multicenter CAS study, a prespecified comparative analysis evaluating the impact of the operator's specialization was performed. We used major adverse event (MAE) rate at 30-day follow-up, defined as the cumulative incidence of any death or stroke, and its components as outcome measures. RESULTS: A total of 1965 procedures were analyzed; almost half 878 (44.7%) were performed by radiologists (interventional/neuro), 717 (36.5%) by cardiologists or angiologists, and 370 (18.8%) by surgeons (vascular/neuro). Patients treated by surgeons were the oldest (72.9±8.5), while radiologists treated most symptomatic patients (58.1%) and more often used radial access (37.2%). The 30-day MAE incidence achieved by cardiologists/angiologists was 2.0%, radiologists 2.5%, and surgeons 1.9%; the observed differences in rates were statistically not-significant (P=0.7027), even when adjusted for baseline patient/lesion and procedural disparities across groups. The corresponding incidence rates for death from any cause were 1.0%, 0.8%, and 0.3%, P=0.4880, and for any stroke: 1.4%, 2.3%, and 1.9%, P=0.4477, respectively. CONCLUSIONS: Despite the disparities in patient selection and procedural preferences, the outcomes achieved by different specialties in real-world, contemporary CAS practice remain similar when using modern devices and techniques.

Sources of specialist physician fee variation: Evidence from Australian health insurance claims data.

This study explores the variation in specialist physician fees and examines whether the variation can be attributed to patient risk factors, variation between physicians, medical specialties, or other factors. We use health insurance claims data from a large private health insurer in Australia. Although Australia has a publicly funded health system that provides universal health coverage, about 44 % of the population holds private health insurance. Specialist physician fees in the private sector are unregulated; physicians can charge any price they want, subject to market forces. We examine the variation in fees using two price measures: total fees charged and out-of- pocket payments. We follow a two-stage method of removing the influence of patient risk factors by computing risk-adjusted prices at patient-level, and aggregating the adjusted prices over all claims made by each physician to arrive at physician-level average prices. In the second stage, we use variance-component models to analyse the variation in the physician-level average prices. We find that patient risk factors account for a small portion of the variance in fees and out-of-pocket payments. Physician-specific variation accounts for the bulk of the vari- ance. The results underscore the importance of understanding physician characteristics in formulating policy efforts to reduce fee variation.

Factors associated with medical students' career choice in different specialties: a multiple cross-sectional questionnaire study at a German medical school.

BACKGROUND: Given the shortage and unequal distribution of physicians across specialties, we aimed to evaluate factors associated with medical students' career choices, including background, personality traits, educational experience, personal interests, lifestyle considerations, and the awareness of work requirements. METHODS: We conducted multiple cross-sectional surveys of students; a 159-item online questionnaire was designed and students from three different stages of the six-year medical degree course (outset, clinical phase, and on graduation) were invited to complete the survey. Data were collected between May 2021 and April 2023. RESULTS: The questionnaire was sent to 1406 students, of whom 683 replied (49%); 481 respondents were female (70%). The top specialty choices across the respondents were internal medicine, surgery, and general practice, with anaesthesiology, paediatric and adolescent medicine (ranging 11-15%), and obstetrics and gynaecology also receiving interest, with 6% undecided. In particular, female students lost interest in surgery during the course of study in favour of the other options. The choice of general practice was associated with more vocational training, prior positive experiences with the specialty, and lower grades in the university entry examination. Clinical clerkships in a specific (freely chosen) specialty aligned with career choice, while the final practical year did not have an impact on career decision-making. All students highly desired regulated working hours and work-life-balance; however, students choosing surgery rated these items as less important. Willingness to work in a hospital environment was highly associated with choosing anaesthesiology and surgery, whereas rural areas and practices were associated with general practice. Higher scores at agreeableness were associated with choosing paediatric and adolescent medicine by more female students, whereas lower neuroticism values were associated with the choice of anaesthesiology. CONCLUSIONS: The results highlight the intricate nature of decision-making and shed light on various aspects that contribute to the process of selecting a specialty. By identifying and addressing influencing factors, we can develop targeted interventions and policies to enhance diversity and distribution across medical specialisations and to aim for high-quality and equitable healthcare that matches the specific needs of both individuals and the population as a whole.

Influence of a rural Longitudinal Integrated Clerkship on medical graduates' geographic and specialty decisions: a constructivist grounded theory study.

BACKGROUND: Like many countries, Australia is suffering from a longstanding and persistent medical workforce maldistribution with fewer doctors per capita in rural locations and a trend towards sub-specialisation. Longitudinal Integrated Clerkships (LIC), a medical education model, are more likely than other clerkship models to produce graduates who work rurally, in communities of increasing remoteness and in primary care. While this quantitative data is essential, there has been a dearth of program-specific evidence explaining this phenomenon. METHODS: To address this knowledge gap, a constructivist qualitative grounded theory approach was employed to identify how the Deakin University comprehensive rural LIC influences graduates' (2011-2020) career decisions in terms of both medical specialty and geographic practice location. RESULTS: Thirty-nine graduates participated in qualitative interviews. The Rural LIC Career Decision Making Framework was developed, postulating that an alignment of personal and program factors under the central concept of 'choosing to participate' can influence graduates' geographic and specialist career decisions, both individually and symbiotically. Once embedded in the clerkship, participation was augmented by the concepts of learning design affordance and learning in place, providing the participants with longitudinal opportunities to experience and compare medical disciplines in an integrated manner. CONCLUSIONS: The developed framework presents contextual elements of the program that were deemed influential on graduates' subsequent career decisions. The alignment of these elements with the program's mission statement has the capacity to enhance the program's rural workforce goals. Regardless of graduates' willingness to participate in the program, a transformation occurred. Transformation occurs through reflection, either challenging or confirming the graduate's pre-conceived ideas about career decisions and in turn influencing professional identity formation.

Specialist care visits outside the hospital by South Australian older adults.

BACKGROUND: Limited access to specialist medical services is a major barrier to healthcare in rural areas. We compared rural-urban specialist doctor consultations outside hospital by older adults (≥ 60 years) across South Australia. METHODS: Cross-sectional data were available from the South Australia's Department of Health. The Modified Monash Model (MM1-7) of remoteness was used to categorize data into rural (MM 3-4), remote (MM5-7), and urban (MM1-MM2) of participants in urban and non-urban South Australia. The analysis was conducted on older adults (n = 20,522), self-reporting chronic physical and common mental health conditions. RESULTS: Specialist doctor consultation in the past 4 weeks was 14.6% in our sample. In multivariable analysis, increasing age (odds ratio 1.3, 95% CI: 1.2-1.4), higher education (odds ratio 1.5, 95% CI: 1.3-1.9), physical health conditions [diabetes (odds ratio 1.2, 95% CI: 1.1-1.3); cancer (odds ratio1.8, 95% CI: 1.7-2.0); heart disease (odds ratio 1.9, 95% CI: 1.6-2.1)], and common mental disorders [depression (odds ratio 1.3, 95% CI: 1.1-1.5); anxiety (odds ratio 1.4, 95% CI: 1.1-1.6)] were associated with higher specialist care use. Specialist care use among rural (odds ratio 0.8, 95% CI: 0.6-0.9), and remote (odds ratio 0.8, 95% CI: 0.7-0.9) older people was significantly lower than their urban counterparts after controlling for age, education, and chronic disease. CONCLUSION: Our findings demonstrate a disparity in the use of out of hospital specialist medical services between urban and non-urban areas.