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2.
JAMA Netw Open ; 4(1): e2026938, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33404616

RESUMO

Importance: Although there have been signs of increasing interest in entrepreneurship among physicians as well as claims of a paucity of entrepreneurial activity in health care in general, there is little systematic evidence of the extent, type, and characteristics of entrepreneurship by physicians. Physician involvement in entrepreneurship may result in more innovative and financially successful health care companies. Objective: To evaluate the proportion and characteristics of physicians who founded new businesses and the types of businesses that they started. Design, Setting, and Participants: This cross-sectional study was conducted by matching all 33 770 physicians holding a Massachusetts medical license in 2017 with the Massachusetts new business registration records from 1960 to 2017 to identify companies founded by physicians. Data were analyzed from September 2017 to December 2019. Main Outcomes and Measures: The number of physician-founded companies in Massachusetts and the types of businesses as characterized by the stated purpose at the time of founding. Results: Among the 33 770 physicians holding a Massachusetts license in 2017, 13 839 (41.0%) were women and 8029 (23.8%) were international medical graduates; the median year of graduation from medical school was 1994 (interquartile range, 1983-2004). A total of 6494 (19.2%) physicians had founded at least 1 new business, and 831 of the 2448 physicians (33.9%) who graduated from medical school between 1974 and 1978 had founded a business. A total of 9501 companies were founded, of which 6267 (66.0%) were clinical practice, real estate, or practice management companies; 703 companies (7.4%) were in the public interest, including advocacy, public health, and philanthropy; 533 (5.6%) were biotechnology, health care information technology, or medical device companies; and 1759 (18.5%) were other business pursuits. For physician entrepreneurs, the mean (SD) time from medical school graduation to company founding was 20.2 (9.8) years. Regression analysis suggested that female physicians founded companies at lower rates than male physicians (odds ratio [OR], 0.529; 95% CI, 0.494-0.567) and that there was an association between attending a top-10 medical school by National Institutes of Health research funding and starting a clinical practice (OR, 0.687; 95% CI, 0.616-0.766) or biotechnology company (OR, 4.326; 95% CI, 2.951-6.344). Conclusions and Relevance: The findings of this cross-sectional study suggest that physicians may be substantially involved in entrepreneurship, although there may be disparities by sex. Facilitation of physician entrepreneurship by policy makers, educators, and institutions may enhance medical innovation and public health.


Assuntos
Contrato de Risco , Médicos , Estudos Transversais , Contrato de Risco/organização & administração , Contrato de Risco/estatística & dados numéricos , Feminino , Setor de Assistência à Saúde , Humanos , Masculino , Massachusetts , Médicos/organização & administração , Médicos/estatística & dados numéricos
3.
Am J Manag Care ; 26(12): 499-500, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33315323

RESUMO

This article describes the tension that the coronavirus disease 2019 (COVID-19) pandemic brought up between administrators and physicians and offers a potential set of solutions to deal with it.


Assuntos
Pessoal Administrativo/organização & administração , Liderança , Médicos/organização & administração , Pessoal Administrativo/economia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Relações Comunidade-Instituição , Humanos , Satisfação no Emprego , Pandemias , Médicos/economia
6.
Emerg Med Clin North Am ; 38(3): 729-738, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616291

RESUMO

A variety of operational and administrative factors have the potential to decrease wellness and negatively impact emergency physicians, in terms of both their on-the-job performance and their long-term career satisfaction. Among these are the issues of workload balance, physiologic and circadian stresses, and larger issues of malpractice risk and institutional support. This overview covers both emerging research on how these problems affect emergency physicians and strategies to help mitigate these challenges.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Esgotamento Profissional/prevenção & controle , Humanos , Admissão e Escalonamento de Pessoal/organização & administração , Médicos/organização & administração , Médicos/psicologia
7.
BMC Public Health ; 20(1): 1099, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660464

RESUMO

BACKGROUND: This study aims to explore the effect of public hospital managers' risk and gain perception on their attitude towards physician dual practice (PDP). METHODS: A cross-sectional study enrolling 1513 managers from public hospitals in the East, Middle and West of China was conducted. Generalized linear mixed models (GLMM) were used to identify the determinants of managers' support for PDP. RESULTS: The rate of managers' support for allowing PDP or implementing PDP with restriction, was 94.3% (95% CI: 0.93, 0.95). The mean score of managers' risk perception was 67.7 ± 14.46, and the mean score of managers' gain perception was 24.0 ± 5.56. After controlling for individual and institutional characteristics, the GLMM presented the score for risk perception increased 1 score and the rate of managers' support for PDP decreased by 5% (OR = 0.95, 95% CI: 0.93, 0.97); while the score for gain perception increased 1 score and the rate of managers' support increased by 18% (OR = 1.18, 95% CI: 1.12, 1.24). CONCLUSIONS: Our data demonstrate that the majority of Chinese public hospital managers are in favor of allowing or implementing PDP with restrictions. Although gain perception is comparatively weaker than risk perception, a stronger influence in determining public hospital managers' support for PDP is demonstrated.


Assuntos
Administradores Hospitalares/psicologia , Hospitais Públicos/organização & administração , Médicos/organização & administração , Setor Privado , Setor Público , Adulto , Atitude , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Medição de Risco
8.
Rev Med Suisse ; 16(697): 1210-1213, 2020 Jun 10.
Artigo em Francês | MEDLINE | ID: mdl-32520461

RESUMO

Polypharmacy is common in patients with a chronic disease. It is appropriate when both the patient and the physician discuss the goal of each prescribed medication with a motivated patient capable of managing his/her medication. It can however be inappropriate when treatment becomes too complex for the frail patient. The risk is non-adherence to therapy, which often results in an intensification of treatment due to unmet therapeutic goals. Collaboration between physicians and pharmacists is therefore essential for the educational support of patients with polypharmacy. In this article, we review the studies examining the impact of a physician-pharmacist collaboration on the medication adherence of diabetic patients with renal impairment.


Assuntos
Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/psicologia , Adesão à Medicação , Farmacêuticos/organização & administração , Médicos/organização & administração , Humanos , Polimedicação
10.
Clin Med (Lond) ; 20(4): 442-444, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32591338

RESUMO

Final-year medical students in the UK have been allowed to voluntarily apply for early provisional registration in response to the COVID-19 pandemic, allowing these foundation interim year-1 (FiY1) doctors to assist in service provision in hospitals where resources and staffing may be strained. The authors, as recently qualified foundation year-1 (FY1) doctors, use this article to draw on their own experiences, and those of their colleagues, to provide advice on key topics that may not have been covered, or not covered sufficiently, in medical education, such as prescribing, rotas, wellbeing, and useful apps and websites.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Educação Médica , Pandemias , Médicos/organização & administração , Pneumonia Viral/epidemiologia , Comunicação , Prescrições de Medicamentos , Nível de Saúde , Humanos , Internet , Aplicativos Móveis , Relações Médico-Enfermeiro , Ensino , Reino Unido
11.
PLoS One ; 15(6): e0234879, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542030

RESUMO

Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. A multivariable regression analysis was performed to determine whether there is a difference in patients' length of ICU stay for two years before and after CNS as ICU head nurse and an intensivist started collaborating. The patients' diagnosis, age, gender, scheduled/emergency admission, surgical history, length of ICU stay, usage of ventilator, and details of ICU treatment were collected from the institution's electronic medical records. During the study period (April 2015 to March 2019), 3,135 patients were admitted to ICU, with 1,471 in the before collaboration group and 1,664 in the after-collaboration group. Collaboration between the CNS as head nurse and intensivists was significantly associated with shorter length of ICU stay (coefficient -0.03 [95% CI, -0.05-0.01], p < 0.001, t-statistic -3.29). Our main finding illustrates that in low-intensity ICUs, collaboration between CNSs as head nurses and intensivists may reduce patients' length of ICU stay.


Assuntos
Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Enfermeiras Especialistas/organização & administração , Médicos/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Hospitais com Baixo Volume de Atendimentos/organização & administração , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Supervisão de Enfermagem/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Adulto Jovem
12.
J Prev Med Public Health ; 53(3): 175-177, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32498141

RESUMO

Public health doctors of Korea contributed significantly to massive coronavirus disease 2019 (COVID-19) testing. They were immediately dispatched to epicenters of the COVID-19 pandemic, and have run tests at screening centers, airport quarantines and hospitals. However, their expertise from in-field experience has been often neglected. It is time to reorganize public health doctor system to better prepare for future epidemics. Transforming and strengthening their roles as public health experts through systematic training is crucial.


Assuntos
Infecções por Coronavirus/epidemiologia , Papel do Médico , Médicos/organização & administração , Pneumonia Viral/epidemiologia , Prática de Saúde Pública , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Planejamento em Desastres/organização & administração , Humanos , Capacitação em Serviço , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , República da Coreia/epidemiologia
13.
Croat Med J ; 61(2): 100-106, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32378376

RESUMO

AIM: To predict the future supply and age distribution of physicians with a simulation model, which can be used as an advising tool for policymakers who decide on enrollment and specialization training (ST) quotas at the national level. METHODS: A simulation model was created using the system dynamics (SD) method. Changes in the number of physicians and their age distribution were projected in the context of the expected future changes of the Croatian population under different scenarios covering the period from 2017 to 2041. RESULTS: The two scenarios showed that Croatia would not face physician shortage in the future. The scenario 1 projected that Croatia would certainly reach the current European Union (EU) average of 360 physicians per 100 000 inhabitants by 2021, and that this figure would increase to 430 per 100 000 inhabitants by 2041. The scenario 2 suggested a similar trend, with Croatia reaching the current EU average by 2021 and the number of physicians increasing to 451 per 100 000 inhabitants by 2041. Both scenarios indicated that the Croatian physicians' age distribution will recover in favor of younger age groups of specialists. CONCLUSION: There is no need to increase the enrollment into the medical schools to ensure sufficient number of physicians per capita in Croatia, but it is necessary to keep the recently reached level of 550 licenses for ST per year. The developed dynamic model is available online and can be adapted to the analysis of different scenarios in different health care systems.


Assuntos
Distribuição por Idade , Médicos , Adulto , Simulação por Computador , Croácia , Previsões , Humanos , Pessoa de Meia-Idade , Médicos/organização & administração , Médicos/estatística & dados numéricos , Médicos/provisão & distribução
14.
Recenti Prog Med ; 111(5): 295-296, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32448878

RESUMO

Italy is one of the most affected countries by the new coronavirus (CoViD-19) pandemic. In the country, there are an estimated 49,000-52,000 homeless people. People experiencing homelessness are among the potentially most vulnerable groups to the CoViD-19. Despite this, in Italy there is a worrying delay in implementation of a national coordinated strategy to protect homeless people from the potentially devastating effects caused by CoViD-19. In order to contain the epidemic among the most vulnerable people, we propose a short operational agenda based on the field experience of the medical-humanitarian organization Medici per i Diritti Umani (Doctors for Human Rights, Italy - MEDU) as well as on the example of initiatives taken by other countries.


Assuntos
Infecções por Coronavirus/epidemiologia , Pessoas em Situação de Rua/estatística & dados numéricos , Médicos/organização & administração , Pneumonia Viral/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Direitos Humanos , Humanos , Itália/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Socorro em Desastres
17.
Can J Anaesth ; 67(10): 1417-1423, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32394338

RESUMO

Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Anestesiologistas/organização & administração , Anestesiologistas/normas , Competência Clínica , Infecções por Coronavirus/mortalidade , Cuidados Críticos/normas , Humanos , Cuidados Paliativos/organização & administração , Pandemias , Médicos/organização & administração , Médicos/normas , Pneumonia Viral/mortalidade , Assistência Terminal/normas , Suspensão de Tratamento
19.
BMJ ; 369: m1505, 2020 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-32461201

RESUMO

OBJECTIVE: To investigate the nature and extent of financial relationships between leaders of influential professional medical associations in the United States and pharmaceutical and device companies. DESIGN: Cross sectional study. SETTING: Professional associations for the 10 costliest disease areas in the US according to the US Agency for Healthcare Research and Quality. Financial data for association leadership, 2017-19, were obtained from the Open Payments database. POPULATION: 328 leaders, such as board members, of 10 professional medical associations: American College of Cardiology, Orthopaedic Trauma Association, American Psychiatric Association, Endocrine Society, American College of Rheumatology, American Society of Clinical Oncology, American Thoracic Society, North American Spine Society, Infectious Diseases Society of America, and American College of Physicians. MAIN OUTCOME MEASURES: Proportion of leaders with financial ties to industry in the year of leadership, the four years before and the year after board membership, and the nature and extent of these financial relationships. RESULTS: 235 of 328 leaders (72%) had financial ties to industry. Among 293 leaders who were medical doctors or doctors of osteopathy, 235 (80%) had ties. Total payments for 2017-19 leadership were almost $130m (£103m; €119m), with a median amount for each leader of $31 805 (interquartile range $1157 to $254 272). General payments, including those for consultancy and hospitality, were $24.8m and research payments were $104.6m-predominantly payments to academic institutions with association leaders named as principle investigators. Variation was great among the associations: median amounts varied from $212 for the American Psychiatric Association leaders to $518 000 for the American Society of Clinical Oncology. CONCLUSIONS: Financial relationships between the leaders of influential US professional medical associations and industry are extensive, although with variation among the associations. The quantum of payments raises questions about independence and integrity, adding weight to calls for policy reform.


Assuntos
Conflito de Interesses/economia , Indústrias/economia , Médicos/economia , Sociedades Científicas/economia , Consultores/estatística & dados numéricos , Estudos Transversais , Indústria Farmacêutica/economia , Equipamentos e Provisões/economia , Humanos , Indústrias/ética , Indústrias/organização & administração , Liderança , Avaliação de Resultados em Cuidados de Saúde , Médicos/ética , Médicos/organização & administração , Sociedades Científicas/organização & administração , Sociedades Científicas/tendências , Estados Unidos/epidemiologia , United States Agency for Healthcare Research and Quality/organização & administração
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