Full-time Work Rates of Physicians With Physician Spouses vs Nonphysician Spouses in Japan.
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ABSTRACT:
SUBMITTER: Miyawaki A
PROVIDER: S-EPMC9664262 | biostudies-literature | 2022 Nov
REPOSITORIES: biostudies-literature
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Full-time Work Rates of Physicians With Physician Spouses vs Nonphysician Spouses in Japan.
JAMA network open 20221101 11
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Project description:ImportancePatient experience and patient safety are 2 major domains of health care quality; however empirical data on the association of physician vs nonphysician chief executive officers (CEOs) with public and private quality measures are rare but critical to evaluate as hospitals increasingly seek out physician CEOs.ObjectivesTo evaluate whether there is an association of CEO background with hospital quality and to investigate differences in hospital characteristics between hospitals with a physician CEO vs those with a nonphysician CEO.Design, setting, and participantsThis cross-sectional study used 2019 data from 3 sources (ie, the American Hospital Association [AHA] Annual Survey, the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS], and the Leapfrog Hospital Safety Grades) to identify statistical differences in hospital characteristics and outcomes. Data were analyzed from April to December 2021 .Main outcomes and measuresMultivariable ordinal logistic regression was used to examine the association of physician CEOs with hospital quality assessment outcomes while controlling for other confounding factors. Characteristics from the AHA Annual Survey database were assessed as potential confounders, including hospital control, bed size, region, teaching status, and patient volume.ResultsThe AHA database contained 6162 hospitals; 1759 (29%) had HCAHPS ratings, 1824 (30%) had Leapfrog grades, and 383 (6%) had physician CEOs. A positive Spearman correlation coefficient was found between physician CEOs and HCAHPS patient willingness to recommend the hospital (ρ = 0.0756; P = .002), but the association between CEO medical background and Leapfrog safety grades or HCAHPS ratings did not reach a level of significance in the multivariable ordinal logistic regression models.Conclusions and relevanceIn this study, a positive correlation was found between physician CEOs and HCAHPS patient willingness to recommend the hospital, but the multivariable analysis did not find an association between hospital physician CEOs and the examined quality and safety outcomes.
| S-EPMC9561952 | biostudies-literature
Project description:BACKGROUND: Physician job satisfaction is reportedly associated with interpersonal quality of care, such as patient satisfaction, but its association with technical quality of care, as determined by whether patients are offered recommended services, is unknown. OBJECTIVE: We explored whether the job satisfaction of hospital-employed physicians in Japan is associated with the technical quality of care, with an emphasis on process qualities as measured by quality indicators. DESIGN: Cross-sectional study linking data from physician surveys with data abstracted from outpatient charts. PARTICIPANTS: A total of 53 physicians working at 13 hospitals in Japan participated. Medical records covering 568 patients were reviewed. MEASUREMENTS: Disease-specific indicators related to the care of patients with hypertension, type 2 diabetes, and asthma, as well as disease-independent measures of the process of care were abstracted. We analyzed the association between the quality of care score for individual physicians, which is defined as the percentage of quality indicators satisfied among the total for which their patients were eligible, and physician job satisfaction, which was measured by a validated scale. RESULTS: No statistically significant association between physician job satisfaction and quality of care was observed. A 1-standard deviation (SD) increment in the physician job satisfaction scale was associated with an increase of only 0.3% for overall quality (P = 0.85), -3.0% for hypertension (P = 0.22), 2.5% for type 2 diabetes (P = 0.44), 8.0% for asthma (P = 0.21), and -0.4% for cross-cutting care (P = 0.76). CONCLUSION: Contrary to the positive association reported between physician job satisfaction and high quality of interpersonal care, no association was seen between physician job satisfaction and the technical quality of care.
| S-EPMC2642562 | biostudies-other
Project description:ImportanceDespite known benefits, electronic health records (EHRs) have had drawbacks for daily practice and the physician experience. There is evidence that physicians practicing in solo or physician-owned practices are more likely to be satisfied with the EHR and experience lower burnout than those practicing in other ownership arrangements; however, it is unclear how practice ownership patterns interact with physicians' experiences with the EHR and documentation in the EHR now that use of these systems is widespread.ObjectiveTo examine the association between practice ownership and physician perceptions of the EHR.Design, setting, and participantsThis cross-sectional study included non-federally employed physicians who provided office-based patient care in 2019 and completed the 2019 National Electronic Health Records Survey. The 2019 survey sample consisted of 1524 eligible responses (41.0% unweighted response rate representing 301 603 physicians); of those, 1368 physicians who reported having an EHR and answered questions regarding location ownership were included in the analysis. Data for the 2019 National Electronic Health Records Survey were collected by RTI International from June 14 to December 11, 2019; the current cross-sectional analysis was conducted from October 1 to November 30, 2021.Main outcomes and measuresSatisfaction with the EHR, perceptions of time spent on clinical documentation, and presence of staff support for documentation.ResultsAmong 1368 respondents (weighted, 270 813 respondents) included in the analysis, 960 respondents (weighted: 185,385 respondents [68.5%]) were male, and 951 respondents (weighted: 200,622 respondents [74.1%]) were over 50 years of age; 766 respondents (weighted, 161 226 respondents [59.5%]) were working in a practice owned by a physician or physician group, and 700 respondents (weighted, 131 284 respondents [48.5%]) were primary care physicians. A total of 602 respondents (weighted, 109 587 physicians [40.5%]) were working in a non-physician-owned practice. Overall, 529 respondents (weighted, 108 093 respondents [68.1%]) working in physician-owned practices reported being satisfied with their EHR vs 320 respondents (weighted, 63 988 respondents [58.5%]) working in non-physician-owned practices (P = .03). Among those working in physician-owned practices, perceptions that time spent on documentation was appropriate (328 physicians [weighted, 71 827 physicians (44.8%)] vs 191 physicians [weighted, 35 447 physicians (32.4%)]; P = .005) and that staff support for documentation was available (289 physicians [weighted, 57 702 physicians (36.0%)] vs 146 physicians [weighted, 29 267 physicians (26.7%)]; P = .02) were significantly higher compared with those working in non-physician-owned practices. Physicians' perceptions of the appropriateness of time spent and the availability of staff support only partially explained the association between practice ownership type and EHR satisfaction.Conclusions and relevanceThe results of this nationally representative cross-sectional study suggest that physicians working in physician-owned practices are more likely to be satisfied with the EHR, to have positive perceptions of time spent on documentation, and to have staff support for documentation compared with their counterparts working in non-physician-owned practices. The workflow and cultural forces underlying these differences are important to understand in the setting of known differences in burnout by practice ownership type and ongoing physician group consolidation and acquisition by health care systems.
| S-EPMC9024386 | biostudies-literature
Project description:ImportanceDespite the growing number of physicians who reduce clinical time owing to research, administrative work, and family responsibilities, the quality of care provided by these physicians remains unclear.ObjectiveTo examine the association between the number of days worked clinically per year by physicians and patient mortality.Design, setting, and participantsThis cross-sectional analysis was completed on a 20% random sample of Medicare fee-for-service beneficiaries 65 years and older who were admitted to the hospital with an emergency medical condition and treated by a hospitalist in 2011 through 2016. Because hospitalists typically work in shifts, hospitalists' patients are plausibly quasirandomized to hospitalists based on the hospitalists' work schedules (natural experiment). The associations between hospitalists' number of days worked clinically per year and 30-day patient mortality and readmission rates were examined, adjusting for patient and physician characteristics and hospital fixed effects (effectively comparing physicians within the same hospital). Data analysis was conducted from July 1, 2020, to July 2, 2021.ExposuresPhysicians' number of days worked clinically per year.Main outcomes and measuresThe primary outcome was 30-day patient mortality, and the secondary outcome was 30-day patient readmission.ResultsAmong 392 797 hospitalizations of patients treated by 19 170 hospitalists (7482 female [39.0%], 11 688 male [61.0%]; mean [SD] age, 41.1 [8.8] years), patients treated by physicians with more days worked clinically exhibited lower mortality. Adjusted 30-day mortality rates were 10.5% (reference), 10.0% (adjusted risk difference [aRD], -0.5%; 95% CI, -0.8% to -0.2%; P = .002), 9.5% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001), and 9.6% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001) for physicians in the first (bottom), second, third, and fourth (top) quartile of days worked clinically, respectively. Readmission rates were not associated with the numbers of days a physician worked clinically (adjusted 30-day readmissions for physicians in the bottom quartile of days worked clinically per year vs those in the top quartile, 15.3% vs 15.2%; aRD, -0.1%; 95% CI, -0.5% to 0.3%; P = .61).Conclusions and relevanceIn this cross-sectional study, hospitalized Medicare patients treated by physicians who worked more clinical days had lower 30-day mortality. Given that physicians with reduced clinical time must often balance clinical and nonclinical obligations, improved support by institutions may be necessary to maintain the clinical performance of these physicians.
| S-EPMC8438618 | biostudies-literature
Project description:BackgroundLittle is known about how physicians spend their work time.ObjectiveTo determine how physicians in outpatient care spend their time at work, using an innovative method: ecological momentary assessment (EMA).DesignPhysician activity was measured via EMA, using a smartphone app.ParticipantsTwenty-eight practices across 16 US states. Sixty-one physicians: general internal medicine, family medicine, non-interventional cardiology, orthopedics.Main measuresProportions of time spent on 14 activities within 6 broad categories of work: direct patient care (including both face-to-face care and other patient care-related activities), electronic health record (EHR) input, administration, teaching/supervising, personal time, and other.Key resultsAfter excluding personal time, physicians spent 66.5% of their time on direct patient care (23.6% multitasking with use of the EHR and 42.9% without the EHR), 20.7% on EHR input alone, 7.7% on administrative activities, and 5.0% on other activities (0.6% using the EHR). In total, physicians spent 44.9% of their time on the EHR.LimitationsUnable to measure time spent at home on the EHR or other work tasks; participating physicians were not a random sample of US physicians.ConclusionsThe efficiency of highly trained professionals spending only two-thirds of their time on direct patient care may be questioned. EHR use continues to account for a large proportion of physician time. Further attempts should be made to redesign both EHRs and physician work processes.
| S-EPMC7661623 | biostudies-literature
Project description:BackgroundPhysicians are expected to perform three unique roles as a clinician, educator, and researcher in university hospitals. However, the actual practices of physicians performing different duties are relatively unknown. Therefore, the authors conducted an observational study at a university hospital to examine physicians' work activities.MethodsBetween 2011 and 2013, ten observers shadowed 20 physicians from different specialties for a day at the Tokyo Women's Medical University Hospital. Observers recorded physicians' activities every 30 seconds that were subsequently categorized into work types. The number of work types and activity changes performed by a physician in one observational period were counted.ResultsAuthors categorized physicians' work activities into five groups: patient care (direct and indirect), education, research, professional development, and administration. All physicians performed at least one type of activity in addition to patient care. Activity change occurred 1.86 times per hour, on average. The median time-distribution of 20 physicians was 173.8 minutes, 213.8 minutes, 3.3 minutes, 5.0 minutes, 0 minutes, and 0.8 minutes for direct patient care, indirect patient care, education, research, professional development, and administration, respectively.ConclusionJapanese hospital physicians performed multiple work duties including professional development and administrative activities in addition to triple duties.
| S-EPMC4262132 | biostudies-literature
Project description:ImportanceBurnout is a pervasive, unrelenting problem among health care workers (HCWs), with detrimental impact to patients. Data on the impact of burnout on workforce staffing are limited and could help build a financial case for action to address system-level contributors to burnout.ObjectiveTo explore the association of burnout and professional satisfaction with changes in work effort over 24 months in a large cohort of nonphysician HCWs.Design, setting, and participantsThis longitudinal cohort study was conducted in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; Jacksonville, Florida; and community-based hospitals and health care facilities in the Midwest among nonphysician HCWs who responded to 2 surveys from 2015 to 2017. Analysis was completed November 25, 2020.ExposuresBurnout, as measured by 2 items from the Maslach Burnout Inventory, and professional satisfaction.Main outcomes and measuresThe main outcome was work effort, as measured in full-time equivalent (FTE) units, recorded in payroll records.ResultsData from 26 280 responders (7293 individuals aged 45-54 years [27.8%]; 20 263 [77.1%] women) were analyzed. A total of 8115 individuals (30.9%) had worked for the organization more than 15 years, and 6595 individuals (25.1%) were nurses. After controlling for sex, age, duration of employment, job category, baseline FTE, and baseline burnout, overall burnout (odds ratio [OR], 1.53; 95% CI, 1.38-1.70; P < .001), high emotional exhaustion at baseline (OR, 1.54; 95% CI, 1.39-1.71; P < .001), and high depersonalization at baseline (OR, 1.40; 95% CI, 1.21-1.62; P < .001) were associated with an HCW reducing their FTE over the following 24 months. Conversely, satisfaction with the organization at baseline was associated with lower likelihood of reduced FTE (OR, 0.73; 95% CI, 0.65-0.83; P < .001). Findings were similar when emotional exhaustion (OR per 1-point increase, 1.12; 95% CI, 1.10-1.16; P < .001), depersonalization (OR per 1-point increase, 1.10; 95% CI, 1.06-1.14; P < .001) and satisfaction with the organization (OR per 1-point increase, 0.83; 95% CI, 0.79-0.88; P < .001) were modeled as continuous measures. Nurses represented the largest group (1026 of 1997 nurses [51.4%]) reducing their FTE over the 24 months.Conclusions and relevanceThis cohort study found that burnout and professional satisfaction of HCWs were associated with subsequent changes in work effort over the following 24 months. These findings highlight the importance of addressing factors contributing to high stress among all HCWs as a workforce retention and cost reduction strategy.
| S-EPMC8379653 | biostudies-literature
Project description:Although the adverse effect of burnout on physicians has been widely documented, studies have shown an inconsistent relationship between burnout and the quality of patient care. We hypothesized that physician burnout will have an inverse relationship with the time spent at the bedside by physicians. In a cross-sectional study, we surveyed patients on their perception of the time spent by their physician on the day of the survey (4 categories: 0-5, 6-10, 11-15, >15 minutes). Oldenburg Burnout Inventory was used to assess physician burnout; burnout was defined as high levels of both exhaustion (≥2.25) and disengagement (≥2.10). Among the 1374 patients, the most commonly reported time spent at bedside category was 6-10 minutes (n=614, 45%). Among the 95 physicians who saw these patients, burnout was present in 44 (46%), with a higher prevalence in women (61% vs 39%; P=0.04). Using ordered logistic regression, we found no relationship between physician burnout and patient's perception of bedside time spent, without adjustment (odds ratio: 0.86, 95% CI: 0.65-1.16) or with adjustment (odds ratio: 0.85, 95% CI: 0.64-1.12) for potential confounders. Although physician burnout is not associated with patient perception of time spent at bedside, it may be associated with other patient outcomes that require further research.
| S-EPMC7834173 | biostudies-literature
Project description:BackgroundNonphysicians are expanding practice into specialty medicine. There are limited studies on patient and physician perspectives as well as safety outcomes regarding the nonphysician practice of cosmetic procedures.ObjectiveTo identify the patient (consumer) and physician perspective on preferences, adverse events, and outcomes following cosmetic dermatology procedures performed by physicians and nonphysicians.Materials and methodsInternet-based surveys were administered to consumers of cosmetic procedures and physician members of the American Society for Dermatologic Surgery. Descriptive statistics and graphical methods were used to assess responses. Comparisons between groups were based on contingency chi-square analyses and Fisher exact tests.ResultsTwo thousand one hundred sixteen commenced the patient survey with 401 having had a cosmetic procedure performed. Fifty adverse events were reported. A higher number of burns and discoloration occurred in the nonphysician-treated group and took place more often in a spa setting. Individuals seeing nonphysicians cited motivating factors such as level of licensure (type) of nonphysician, a referral from a friend, price, and the location of the practitioner. Improper technique by the nonphysician was cited most as a reason for the adverse event. Both groups agree that more regulation should be placed on who can perform cosmetic procedures. Recall bias associated with survey data.ConclusionPatients treated by nonphysicians experienced more burns and discoloration compared with physicians, and they are encountering these nonphysicians outside a traditional medical office, which are important from a patient safety and regulatory standpoint. Motivating factors for patients seeking cosmetic procedures may also factor into the choice of provider.Key pointsBoth patients and physicians think more regulation should be in place on who can perform cosmetic procedures. More adverse events such as burns and discolorations occurred with patients seeing nonphysicians compared with those seeing physicians. In addition, for those seeing nonphysicians, a majority of these encounters took place in spa settings. Patient safety is of utmost concern when it comes to elective cosmetic medical procedures. More adverse events and encounters occurring outside traditional medical settings when nonphysicians performed these procedures call into question the required training and oversight needed for such procedures.
| S-EPMC6450566 | biostudies-literature
Project description:ObjectiveTo study the effects of payment timing, form of payment, and requiring a social security number (SSN) on survey response rates.Data sourceThird-wave mailing of a U.S. physician survey.Study designNonrespondents were randomized to receive immediate U.S.$25 cash, immediate U.S.$25 check, promised U.S.$25 check, or promised U.S.$25 check requiring an SSN.Data collection methodsPaper survey responses were double entered into statistical software.Principal findingsResponse rates differed significantly between remuneration groups (χ(3) (2) = 80.1, p<.0001), with the highest rate in the immediate cash group (34 percent), then immediate check (20 percent), promised check (10 percent), and promised check with SSN (8 percent).ConclusionsImmediate monetary incentives yield higher response rates than promised in this population of nonresponding physicians. Promised incentives yield similarly low response rates regardless of whether an SSN is requested.
| S-EPMC3034272 | biostudies-literature