An Analysis of the Characteristics and Trends in Practicing Plastic Surgeons in California.

BACKGROUND: Studies suggest an increasing trend of plastic surgeons choosing private practice after training, with up to 90% pursuing private practice without future fellowships.1 Previous data showed that 66.7% of graduates from plastic surgery residency programs chose to pursue private practice without future fellowship, while more recent studies estimate this statistic has risen close to 90%.1,2 The literature has yet to characterize the current plastic surgery workforce and changes in its composition over time. This study aims to analyze the characteristics and training of plastic surgeons in California through a comparative study with general surgeons. METHODS: Surgeon demographics were extracted from the Centers for Medicare and Medicaid Services open database. Urban/rural classification and academic affiliation were crosslinked from the Inpatient Prospective System database and sole proprietorship status was cross-linked from the NPI Registry. Summary statistics and logistic regressions with chi-squared analysis were analyzed using STATA/MP17. RESULTS: Our analysis consisted of 3871 plastic and general surgeons in California. Compared to general surgeons, plastic surgeons were less likely to be females (P < 0.000), and more likely to be sole proprietors (P < 0.000), and affiliated with a teaching hospital (P < 0.005). There was no statistically significant difference in the percentage of rural-practicing plastic and general surgeons (P = 0.590). More recent plastic surgery graduates were more likely to be affiliated with an academic hospital (P < 0.0000). The composition of females significantly increased from the older graduated cohort to the most recent one. There was no significant difference in sole proprietorship and rural practice status between the oldest and youngest graduating cohorts. CONCLUSIONS: Although the California plastic surgery workforce is gaining female plastic surgeons and shifting to academic institutions, significant progress in serving rural communities is yet to be made. Our study suggests that there may be a shift in the trend of plastic surgeons opting for private practice, possibly driven by a desire for more stable positions in academia. Continued improvement in diversity and training of future plastic surgeons is needed to alleviate the rural care gap.

Réplica al artículo «Comparación de datos demográficos, presentación clínica, tratamiento y desenlace de pacientes lúpicos tratados en un centro público y otro privado de salud en Santa Fe, Argentina» / Reply to the article “Comparing demographics, clinical presentation, treatments and outcome between sle patients treated in a public and private health system in Santa Fe, Argentina”

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Utilización de la sanidad privada por las embarazadas seguidas en un centro de salud público / Use of private health services by pregnant women followed up in a public health centre

Introducción. Nuestro objetivo fue conocer y analizar los motivos que conducen a las embarazadas, con cobertura sanitaria pública y seguidas en nuestro centro de salud, para utilizar además los servicios sanitarios privados durante el embarazo. Pacientes y métodos. Estudio cualitativo mediante cuestionario autoadministrado. Ámbito de atención primaria, centro de salud urbano. Embarazadas que parieron durante el año 2005 y que realizaron sesiones de educación maternal con la matrona (20 grupos). Se utilizaron las respuestas obtenidas de los cuestionarios cumplimentados. La saturación de la información se garantizó con el análisis por separado de los 20 grupos de participantes. Se realizó un análisis de contenido de las diferentes categorías. Resultados. Se construyeron 6 categorías (ecografías, tranquilidad y seguridad, seguimiento por el ginecólogo privado, el trato recibido, la comodidad y aspectos relacionados con el centro de salud). Los temas relacionados con las ecografías (número y calidad) y con el número de visitas subyacen en la mayoría de las respuestas. Las embarazadas consideran que deben realizarse más ecografías durante el seguimiento del embarazo. La atención recibida en el centro de salud es considerada de manera satisfactoria. Conclusiones. El número y la calidad de las ecografías son los principales motivos que inducen a las embarazadas a utilizar los servicios sanitarios privados. La seguridad y tranquilidad aparecen como motivos recurrentes. El seguimiento del embarazo por el médico de familia en atención primaria no aparece como motivo para utilizar la sanidad privada (AU)

Introduction. The objective of the study is to identify and analyse the reasons that lead pregnant women with public health cover and followed up in our public health clinic, to use private health services during pregnancy. Patients and methods. A qualitative study using a self-administered questionnaire completed during the year 2005. Setting: Urban Primary Care Health Centre. Pregnant women who delivered during 2005 and had maternal education sessions with the midwife (twenty groups). The responses from the questionnaires were analysed. Information saturation was ensured by the separate analysis of the 20 groups of participants. A content analysis was made of the different categories. Results. Six categories were constructed (ultrasound, tranquillity and safety, monitored by the private gynaecologist, the treatment, comfort and aspects relating to the ¿private? health centre). Issues related to ultrasound (number and quality) and the number of visits underlie most of the responses. Pregnant women believe there should be more follow-up ultrasound examinations during pregnancy. The care provided at the public health centre is considered satisfactory. Conclusions. The number and quality of the scans are the main reasons that lead pregnant women to use private health services. Safety and tranquillity appear as recurring themes. The monitoring of pregnancy by the family physician in primary care is not listed as a reason for using private healthcare (AU)

Diez años de psicología clínica infantil y de adultos en un centro privado / Ten years of clinical infantile psychology and of adults in a private center

En el presente artículo se muestra el resultado de diez años de trabajo en psicología clínica infantil y de adultos en un centro privado desde una perspectiva descriptiva.Hemos destacado desde el principio el crecimiento de la actividad y la aceptación por parte de los usuarios de la necesidad de atención psicológica. Este proceso lo hemos vividenciado y, echando la vista átras, planteamos este estudio co el objetivo de determinar la evolución de nuestro trabajo tanto en las técnicas como en los resultados obtenidos. Exponemos aquí el análisis de los datos conseguidos en los 595 sujetos que hemos introducido en el estudio, cuyos resultados indican que el proceso terapéutico llevado es satisfactorio(AU)

In the present article there appears the result of ten years of work in clinical infantile psychology and of adults in a center deprived from a descriptive perspective. We have emphasized from the beginning the growth of the activity and the acceptance on the part of the users of the need of psychological attention. This process it is vividenciado and, throwing the sight átras, raises this study co the aim to determine the evolution of our work both in the technologies and in the obtained results. We expose here the analysis of the information obtained in 595 subjects that we have introduced in the study, which results indicate that the therapeutic taken process is satisfactory(AU)

La sanidad privada en el Sistema Nacional de Salud. Perspectivas de futuro / Private Health Care in the National Health Care System. Future perspectives

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Incorporaçäo das práticas de saúde do sistema tradicional pelo sistema institucional

O presente trabalho realizou estudos sobre a incorporaçäo das práticas de saúde da Medicina Tradicional Comunitária pela Medicina Institucional. Foram levantadas as Instituiçöes Tradicionais Comunitárias que desenvolvem atividades de cura em Belo Horizonte e as Instituiçöes Oficiais que däo assistência à populaçäo na área da saúde. Seis Instituiçöes Tradicionais Comunitárias, foram selecionadas para identificaçäo das práticas de saúde utilizadas e para estudar a populaçäo que se serve das fontes do sistema tradicional comunitário segundo os problemas de saúde e as características individuais de idade, sexo, renda familiar e instruçäo. Durante o estudo identificamos que, a populaçäo que tem mais acesso ao sistema tradicional comunitário é aquela situada na faixa etária de 40 anos e mais, do sexo feminino, com renda familiar de 0 a 3 salários mínimos, exclusive, e grau de instruçäo no nível primário; identificamos ainda que, o problema de saúde que mais levou a populaçäo ás referidas instituiçöes foi "Ataque de Nervos", e o "Passe" foi a prática tradicional mais indicada para a populaçäo solucionar o seu problema de saúde. No campo das Instituiçöes Oficiais selecionamos 100 das 234 existentes para identificar a participaçäo dos praticantes tradicionais nos programas oficiais de saúde

Survey of patient care in Barbadian family practice - abstract

A survey to establish the use of standard procedures in patient care was undertaken by 19 (31 percent) of the family physicians in Barbados. Seven physicians in the government service and 14 in private practice (2 physicians worked both in the government service and in private practice) recorded information on their management of each encounter over a 6-week period from November 11, 1982. There were 7,303 encounters, and in 5,525 (75.6 percent) of these a prescription was given. Drugs prescribed in order of frequency were anti-infective agents (39.7 percent), analgesics (34.7 percent), anti-hypertensive agents (17.7 percent), and cough preparations (15.4 percent). Of the total number 4,248 (77 percent) were short term management of less than two weeks, 595 (10.8 percent) were for 2 to 4 weeks' therapy and 670 *12.2 percent) were for long term therapy. Family practitioiner in the Government services wrote 2,008 prescriptions in 2,299 encounters, while those in private practice wrote 3,517 in 5,004 encounters. This difference was significant at the p<0.001 level. Physicians in practice for less than 5 years wrote fewer single drug prescriptions and more 2 to 5 drug prescriptions than their colleagues with 5 to 14 years' and 15+ years' experience. These differences were statistically significant (p<0.001). In 2,922 (40 percent) encounters, management entailed patient education or psychotherapeutic counselling. Minor operative procedures were carried out in 1,161 (16.2 percent) encounters, clinical observation in 686 (9.4 percent) and certification in 685 (9.4 percent). Drug prescribing was the most frequent method of patient care by family physicians and variations in this, according to the experience of the doctor and conditions of his employment, are important in further development of patient care. The relative infrequency of counselling and observation are surprising findings in a discipline where the emphasis is on health promotion, and where much of the morbidity is either self limiting or seen in the early stages of development (AU)