Quantifying and Predicting Surgeon Work Effort for Primary and Revision Total Knee Arthroplasty.

BACKGROUND: The objectives of this study were to quantify increased utilization of resources in revision total knee arthroplasty (TKA) compared with primary TKA, determine preoperative factors that predict outcome measures, and compare Medicare reimbursement for each procedure. METHODS: Seventy-eight revision TKA patients were compared with 80 primary TKA patients. Outcomes measured were surgical time, estimated blood loss, length of stay, and complications. RESULTS: Revision TKA showed 49% increased surgical time compared with primary TKA. Estimated blood loss was increased 91%. Tibial and femoral bone loss was associated with increased surgical time as was use of longer stemmed tibial components. Average Medicare hospital payment increased 29% ($13,464 for primary, $17,331 for revision). Average physician reimbursement represented a 36% increase. Relative value units were increased to 31%. CONCLUSION: There was substantial increase in work effort not commensurate with current Medicare reimbursement, which may limit patient access to revision TKA.

Housework, children, and women's wages across racial-ethnic groups.

Motherhood affects women's household labor and paid employment, but little previous research has explored the extent to which hours of housework may explain per child wage penalties or differences in such penalties across racial-ethnic groups. In this paper, I use longitudinal Panel Study of Income Dynamics (PSID) data to examine how variations in household labor affect the motherhood penalty for White, Black, and Hispanic women. In doing so, I first assess how children affect hours of household labor across these groups and then explore the extent to which this household labor mediates the relationship between children and wages for these women. I find that household labor explains a portion of the motherhood penalty for White women, who experience the most dramatic increases in household labor with additional children. Black and Hispanic women experience slight increases in housework with additional children, but neither children nor housework affects their already low wages.

Relation between work hours, work control, work stress, and quality of life in persons with spinal cord injury.

BACKGROUND: Work participation is related to a better quality of life (QoL) for people with spinal cord injury (SCI), however, the specific work characteristics that are related to QoL in people with SCI are largely unknown. OBJECTIVES: To investigate which work characteristics are related to QoL in people with SCI. METHODS: Cross-sectional survey of people with SCI in the Netherlands. The survey consisted of demographic, SCI-related, and work-related items. Work control was measured with the short Job Content Questionnaire and work stress with the effort-reward imbalance (ERI). People of working age with at least 1 h of paid work per week were included. Hierarchical regression analysis was performed to examine the contribution of work characteristics to QoL while controlling for potential clinical and demographic confounders. RESULTS: The study included 169 persons with SCI (74.6 % male, 47.8 ± 9.3 years, time since injury 18.9 ± 11.1 years). The final hierarchical regression model explained 31 % of the variance in QoL. The number of SCI-related health complications contributed the strongest to QoL (ß = -.36), followed by work hours (ß = .24), and work stress (ß = .24). However, work control did not contribute significantly to QoL in our final model. CONCLUSION: Work hours and work stress contributed to QoL in people with SCI, but the number of SCI-related health complications was the strongest contributor. Future research and vocational rehabilitation should be directed to both medical and work-related variables to enhance the QoL of working people with SCI.

PROTOCOL: Employee work motivation, effort, and performance under a merit pay system: A systematic review.

This is the protocol for a Campbell systematic review. The objectives are as follows: One goal of this systematic review is to identify whether merit pay predicts employee work motivation, effort, and performance; a second goal is to determine whether the association between merit pay and subsequent employee work motivation, effort, and performance is stronger depending on the actual relationship between the performance ratings and merit increases received, as well as on the perceived relationship by employees between their performance and their pay; a third goal is to identify whether the association between merit pay and subsequent employee motivation depends on what type of motivation is measured (i.e., intrinsic vs. extrinsic/general work motivation).

Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study.

BACKGROUND: Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT) code 62380. However, no work relative value units (RVUs) are currently assigned to the procedure. An international team of endoscopic spine surgeons conducted a study, endorsed by several spine societies, analyzing the learning curve, difficulty, psychological intensity, and estimated work RVUs of endoscopic lumbar spinal decompression compared with other common lumbar spine surgeries. METHODS: A survey comparing CPT 62380 to 10 other comparator CPT codes reflective of common spine surgeries was developed to assess the work RVUs in terms of learning curve, difficulty, psychological intensity, and work effort using a paired Rasch method. RESULTS: The survey was sent to 542 spine specialists. Of 322 respondents, 150 completed the survey for a 43.1% completion rate. Rasch analysis of the submitted responses statistically corroborated common knowledge that the learning curve with lumbar endoscopic spinal surgery is steeper and more complex than with traditional translaminar lumbar decompression surgeries. It also showed that the psychological stress and mental and work effort with the lumbar endoscopic decompression surgery were perceived to be higher by responding spine surgeons compared with posterior comparator decompression and fusion surgeries and even posterior interbody and posterolateral fusion surgeries. The regression analysis of work effort vs procedural difficulty showed the real-world evaluation of the lumbar endoscopic decompression surgery described in CPT code 62380 with a calculated work RVU of 18.2464. CONCLUSION: The Rasch analysis suggested the valuation for the endoscopic lumbar decompression surgery should be higher than for standard lumbar surgeries: 111.1% of the laminectomy with exploration and/or decompression of spinal cord and/or cauda equina (CPT 63005), 118.71% of the laminectomy code (CPT 63047), which includes foraminotomy and facetectomy, 152.1% of the hemilaminectomy code (CPT 63030), and 259.55% of the interlaminar or interspinous process stabilization/distraction without decompression code (CPT 22869). This research methodology was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the Mexican Society of Spinal Surgeons (AMCICO), the International Society For Minimally Invasive Spine Surgery (ISMISS), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Surgery (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS). CLINICAL RELEVANCE: This study provides an updated reimbursement recommendation for endoscopic spine surgery. LEVEL OF EVIDENCE: Level 3.

The effects of work alienation on organisational commitment, work effort and work-to-family enrichment.

AIM: The aim of this study was to analyse the effects of work alienation on organisational commitment, work effort and work-to-family enrichment. BACKGROUND: There is substantial research on the effects of work alienation on passive job performance, such as organisational commitment. However, studies analysing work alienation on active performance, such as work effort, and outside work, such as work-to-family enrichment, are scarce. METHOD: Two dimensions of work alienation are considered: powerlessness and meaninglessness. Hypotheses are tested using surveys collected among a national sample of midwives in the Netherlands (respondents: 790, response rate 61%). RESULT: the findings indicate that work alienation (powerlessness and meaninglessness) influence organisational commitment, work effort and--to a lesser extent--work-to-family enrichment. High work meaninglessness, in particular, has negative effects on these outcomes. CONCLUSION: When people feel that they have no influence in their work (hence, when they feel 'powerless') and especially when the feel that their work is not worthwhile (when they feel 'meaningless') this has substantial negative effects. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should increase the meaningfulness that people attach to their work, thereby maintaining a high-quality workforce. Possible strategies include: (1) improving person-job fit, (2) developing high-quality relationships, (3) better communicating the results people help to deliver.

Association Between Commute Duration and Sickness Absence in the Context of China: Mechanism and Heterogeneous Effects.

Background: Most employees in urban China have experienced a heavy commuting burden, which has become an urgent issue that should be solved in the new urbanization strategy process. However, the exploration of the relationship between the commute duration and sickness absence remains scant in China, and no direct discussion has been done to analyze the mechanism linking commute duration and sickness absence. Methods: Using a unique dataset of the 2013 China Matched Employer-Employee Survey, the present study applies a two-level random-intercept Poisson model to explore this association. Results: A long commute is significantly related with increased sickness absence. A longer commute is associated with poorer self-rated health status and a higher degree of psychological depression, and it is also highly related with a decrease in sleeping time. Moreover, an increased commuting duration is associated with lower work effort (working hours). Conclusion: Longer commute duration induces lower productivity through increased sickness absence, and the potential link of commute duration and sickness absence is mainly transmitted through health-related outcomes and work effort.

Gender Differences in Modality Interpretation Among Radiologists: An Exploratory Study of Occupational Horizontal Segregation.

RATIONALE AND OBJECTIVES: Occupational "horizontal segregation," defined as disparity in the distribution of responsibilities between genders, could discourage women from seeking careers in radiology, as well as impact women within radiology in terms of compensation, promotion, and career advancement. We aimed to explore the existence of horizontal workplace segregation in radiology, as potentially manifested as intergender differences in the distribution of clinical work effort among imaging modalities for radiologists. MATERIALS AND METHODS: Medicare-participating general radiologists, neuroradiologists, abdominal, cardiothoracic, and musculoskeletal radiologists were identified from the 2016 Medicare Physician and Other Supplier Public Use File. Work effort in radiography, ultrasound, CT, and MRI was stratified by gender. Univariable and multivariable analyses were performed. RESULTS: 22,445 radiologists were included (19.0% female; 19.6% in academic practices). At univariable analysis, female (vs. male) generalists had lower work effort in MRI (10.2% vs. 13.2%) (p < 0.001); abdominal radiologists had higher work effort in ultrasound (27.1% vs. 21.9%), with lower work effort in CT (53.7%. vs. 56.0%) and MRI (8.1%. vs. 9.4%) (p < 0.001); and musculoskeletal radiologists had higher work effort in radiography (41.6% vs. 34.8%) and less in MRI (44.8% vs. 49.6%) (p = 0.007). In multivariable analyses, female gender was independently associated with lower work effort in advanced imaging (CT and MRI) for generalists (coefficient, -0.020; p < 0.001), abdominal radiologists (coefficient, -0.042; p < 0.001), and neuroradiologists (coefficient -0.010; p = 0.035). CONCLUSION: Horizontal occupational segregation exists in radiology with female radiologists devoting lower work effort to advanced imaging modalities. Further investigation is warranted to better understand the sources and downstream implications of such variation.

Effort-Reward Imbalance and Overcommitment at Work: Associations With Police Burnout.

The present study examined associations of effort-reward imbalance (ERI) and over-commitment at work with burnout among police officers using data from 200 (mean age = 46 years, 29% women) officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study. ERI and overcommitment were assessed using Siegrist's "effort/reward" questionnaire. The Maslach Burnout Inventory-General Survey was used to assess burnout and its three subscales (exhaustion, cynicism, and professional efficacy). Analysis of covariance was used to examine mean values of burnout scores across quartiles of ERI and overcommitment. Linear regression was used to test for linear trend. ERI and overcommitment were positively and significantly associated with cynicism and exhaustion (trend p value < .001), while professional efficacy showed an inverse association with overcommitment (p = .026). Cynicism and exhaustion scores were significantly higher in officers who reported both overcommitment and ERI compared with their counterparts (p < .001). The results suggest that ERI and overcommitment at work are determinants of higher cynicism and exhaustion. The inverse association of overcommitment with professional efficacy (an indicator of engagement at work) suggests that extreme involvement in work may negatively affect efficacy. Overcommitment may be related to a need for approval and inability of officers to withdraw from work, even in an off-duty status. Police agencies should consider organizational remedies to maintain acceptable levels of commitment by officers. In addition, there is a need to monitor and improve effort-reward imbalance experienced by officers.

"I Can Only Work So Hard Before I Burn Out." A Time Sensitive Conceptual Integration of Ideological Psychological Contract Breach, Work Effort, and Burnout.

Employees often draw meaning from personal experiences and contributions in their work, particularly when engaging in organizational activities that align with their personal identity or values. However, recent empirical findings have demonstrated how meaningful work can also have a negative effect on employee's well-being as employees feel so invested in their work, they push themselves beyond their limits resulting in strain and susceptibility to burnout. We develop a framework to understand this "double edged" role of meaningful work by drawing from ideological psychological contracts (iPCs), which are characterized by employees and their employer who are working to contribute to a shared ideology or set of values. Limited iPC research has demonstrated employees may actually work harder in response to an iPC breach. In light of these counterintuitive findings, we propose the following conceptual model to theoretically connect our understanding of iPCs, perceptions of breach, increases in work effort, and the potential "dark side" of repeated occurrences of iPC breach. We argue that time plays a central role in the unfolding process of employees' reactions to iPC breach over time. Further, we propose how perceptions of iPC breach relate to strain and, eventually, burnout. This model contributes to our understanding of the role of time in iPC development and maintenance, expands our exploration of ideology in the PC literature, and provides a framework to understanding why certain occupations are more susceptible to instances of strain and burnout. This framework has the potential to guide future employment interventions in ideology-infused organizations to help mitigate negative employee outcomes.

Components of responsibility in estimating relative value units: How do dentists value their work?

OBJECTIVES: Responsibility weights can translate services into a common scale of work effort (relative value units). The aims were to describe the responsibility weights for main areas of dental services and assess associations of ratings of the importance of the components of responsibility with responsibility weights. METHODS: Mailed questionnaires were used to collect responsibility weights and components of responsibility from a random sample of Australian dentists who were randomly assigned into panels. Across the panels, weights were elicited for 299 service items from 9 service areas. Data were weighted to the age and sex distribution of the workforce. Ordered logit regression models assessed differences in weights by ratings of importance of the 8 components of responsibility. RESULTS: Responses were collected from 846 dentists (response rate = 37%). Adjusted models showed that, with the exception of general/miscellaneous services, all remaining service areas were associated with between 3 and 7 components. Preventive weights were associated with dexterity and mental effort but negatively with perception. Diagnostic weights were associated with knowledge, judgement, experience, perception, physical and mental effort, and negatively with dexterity. Ratings of components of responsibility were associated with responsibility weights and showed varying patterns across service areas. Mental effort, invasiveness, dexterity, experience and knowledge were associated with responsibility weights in the majority of service areas. CONCLUSIONS: The observed variation in weights across service areas showed that dentists discriminated between services in a systematic and cognizant manner and so provided broad validation of weights assigned by dentists.

Healthy working days: The (positive) effect of work effort on occupational health from a human capital approach.

The neoclassic economic rationale has taken for granted that the effect of effort on health is negative. However, several studies in the field of occupational health and medicine claim that working is clearly better for health than non-working or being unemployed, as some psychological and physical condition may improve with work effort. This paper analyzes the effect of work effort on occupational health. The proposed human capital approach builds upon the classic economic perspective, that assumes a negative effect of effort on health, and extends it by allowing positive effects, as suggested by occupational researchers. Using a sample from 2010 of 20,000 European workers we find that, under adequate working conditions, the level of effort (measured in working hours) at which health starts to deteriorate is very high (120 h per week). However, if working conditions are not adequate, even a moderate effort (35 h per week) can harm workers health.

Creating One's Reality: The Interaction of Politics Perceptions and Enactment Behavior.

The current study investigated the previously unexamined relationship between politics perceptions and employee enactment behavior. Consistent with previous job stress and sense-making research, we hypothesized that individuals reporting low levels of enactment behaviors would be more adversely affected by politics perceptions than those who engaged in high levels of enactment behavior. Results across two samples provided strong support for the hypothesized relationships. Specifically, employees who reported low levels of enactment behavior experienced less satisfaction, less person-environment fit, and reported lower levels of effort when faced with highly political environments. Conversely, levels of satisfaction and person-environment fit perceptions of individuals reporting high levels of enactment behaviors were largely unaffected by highly political contexts. Implications of these findings, strengths and limitations, and avenues for future research are provided.

How Much Work Effort is Involved in Minimally Invasive Sacroiliac Joint Fusion?

BACKGROUND: Minimally invasive sacroiliac joint fusion is increasing significantly. Starting January 1, 2015, it has a category I CPT code. The current RVU for this procedure is not equal to the amount of work involved. There is not a published RUC validated survey to establish the work effort of MI SI fusion. Our hospital system has been doing this procedure for 4 years and has been tracking surgeon time through a commercial tracking system (Navicare). Our study looks at time utilization for performance of MI SI joint fusion and a comparator of primary lumbar discectomy (PLD), presumably similar in time and work effort. METHODS: This study was a retrospective review of prospectively collected data using Navicare. The data for 3 surgeons who perform MI SI joint fusion and lumbar discectomies from January 1, 2013 through November 30, 2014 was retrieved. Surgeon room time was identified as the time the patient entered the OR to the time they exited the OR. This was used as opposed to skin to skin time seen in similar studies as it was more accurately and consistently recorded in the medical record. Mean and standard deviations were then compared using student's t-test. RESULTS: In 50 primary MI SI joint fusions, the average in-room time was 112 minutes (SD=23). In 89 cases of PLD, the average in-room time was 119 minutes (SD=26). When comparing mean in-room times, MI SI and PLD were not statistically significantly different (p=0.135, 2-tailed t-test). Post-operative work effort was found to be greater for MI SI joint fusion than PLD. CONCLUSIONS / LEVEL OF EVIDENCE: Surgical time was found to be comparable between MI SI joint fusion and PLD, while work effort was found to be greater for MI SI joint fusion. This signifies at a minimum an equal RVU for PLD should be used for MI SI joint fusion. This study was approved by the Institutional Review Board at the University of Minnesota. LEVEL OF EVIDENCE: 3.