Emergency medicine career change: associations with performances in medical school and in the first postgraduate year and with indebtedness

OBJECTIVE: Emergency medicine has been identified as the specialty that has gained the most young physicians who have changed their careers. To identify factors that may have contributed to such career changes, the authors compared the characteristics of three groups of physicians trained at their medical school: those who chose and stayed in emergency medicine, those who migrated into emergency medicine from other specialties, and those who moved out of emergency medicine. METHODS: A prospective longitudinal study was conducted. The sample consisted of physicians who chose emergency medicine as their careers at graduation and stayed in the specialty (n = 24), those who migrated from other specialties into emergency medicine (n = 51), and those who moved out of emergency medicine (n = 10). This sample was obtained from a total of 2,173 graduates of Jefferson Medical College between 1978 and 1987. The three groups of physicians were compared according to their academic performances both during medical school and after graduation. The dependent variables were freshmen and sophomore grade point averages (GPAs), written clinical examination scores, scores on National Board of Medical Examiners examination (Parts I, II, and III), and residency program directors' ratings. Age and indebtedness at medical school graduation and board certification status also were examined. RESULTS: Those physicians who stayed in emergency medicine and those who migrated from other specialties into emergency medicine had similar measures of academic performance, but both of these groups had higher academic performance measures and higher board certification rates than did the physicians who moved out of emergency medicine. Those who stayed in emergency medicine had the highest mean debt in the senior year of medical school. CONCLUSIONS: High academic performance and high indebtedness are factors associated with choosing or staying in the specialty of emergency medicine.     

Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty

BACKGROUND: Studies have found that female faculty publish less, have slower career progress, and generally have a more difficult time in academic careers than male faculty. The relation of family (dependent) responsibilities to gender and academic productivity is unclear. OBJECTIVE: To describe dependent responsibilities by gender and to identify their relation to the aspirations, goals, rate of progress, academic productivity, and career satisfaction of male and female medical school faculty. DESIGN: 177-item survey questionnaire. SETTING: 24 randomly selected medical schools in the contiguous United States. PARTICIPANTS: 1979 respondents from a probability sample of full-time academic medical school faculty. MEASUREMENTS: The main end point for measuring academic productivity was the total number of publications in refereed journals. Perceived career progress and career satisfaction were assessed by using Likert scales. RESULTS: For both male and female faculty, more than 90% of time devoted to family responsibilities was spent on child care. Among faculty with children, women had greater obstacles to academic careers and less institutional support, including research funding from their institutions (46% compared with 57%; P < 0.001) and secretarial support (0.68 full-time equivalents compared with 0.83 full-time equivalents; P = 0.003), than men. Compared with men with children, women with children had fewer publications (18.3 compared with 29.3; P < 0.001), slower self-perceived career progress (2.6 compared with 3.1; P < 0.001), and lower career satisfaction (5.9 compared with 6.6; P < 0.001). However, no significant differences between the sexes were seen for faculty without children. CONCLUSIONS: Compared with female faculty without children and compared with men, female faculty with children face major obstacles in academic careers. Some of these obstacles can be easily modified (for example, by eliminating after-hours meetings and creating part-time career tracks). Medical schools should address these obstacles and provide support for faculty with children.     

Effect of evaluator and resident gender on the American Board of Internal Medicine evaluation scores

OBJECTIVE: To examine the effects of resident and attending physician gender on the evaluation of residents in an internal medicine training program. DESIGN: Cross-sectional study. SETTING: Large urban academic internal medicine residency program. PARTICIPANTS: During their first 2 years of training, 132 residents (85 men, 47 women) received a total of 974 evaluations from 255 attending physicians (203 men, 52 women) from 1989 to 1995. MEASUREMENTS: The primary measurements were the numerical portions of the American Board of Internal Medicine evaluation form. Separate analyses were performed for each of the nine evaluation dimensions graded on a scale of 1 to 9. The primary outcome was the difference in the average scores received by each resident from male versus female attending physicians. RESULTS: Compared with female trainees, male residents received significantly higher scores from male attending physicians than from female attending physicians in six of the nine dimensions: clinical judgment, history, procedures, relationships, medical care, and overall. Similar trends, not reaching conventional levels of statistical significance, were observed in the other three categories: medical knowledge, physical exam, and attitude. These differences ranged from 0.24 to 0.60 points, and were primarily due to higher grading of male residents by male attending physicians than by female attending physicians. CONCLUSIONS: In one academic training program, we found a significant interaction in the grading process between the gender of internal medicine residents and the gender of their attending evaluators. This study raises the possibility that subtle aspects of gender bias may exist in medical training programs.     

The feminization of the medical profession in Israel

Two factors have caused major changes in the gender composition of the Israeli medical profession in recent years: (i) a wave of immigration from the former USSR, which increased the doctor population by approximately 70% and which included a majority of women physicians, and (ii) the entry of more Israeli women into medical school. This report presents the current gender status of the Israeli medical profession, regarding students and physicians, and the choice of medical specialty and academic seniority, and compares gender differences in Israel with those in other countries. Traditional patterns of specialization persist in Israel, with women still concentrated in primary care (family medicine, paediatrics and psychiatry). In addition, women still face obstacles in entering the more prestigious (mainly surgical) specialties. Whilst the number of women in academic medicine has increased over the last decade, women are still concentrated in the lowest echelons of academic medicine. However, the steady trend towards the feminization of medicine will inevitably lead to an increase of women in all areas of the medical profession. Because cross-cultural studies have repeatedly revealed that women doctors have a more humanistic and personalized approach to patient care, a higher ratio of women in the profession should have a qualitative effect in this direction, despite the bureaucratic and fiscal constraints incumbent upon practising doctors. As more women become role models for medical students, their approach will influence the education of the doctors of the future.     

Departmental organization of health care institutions

The economic forces that are reshaping the practice of medicine and the funding of medical research will have great impact on clinical education and research in teaching hospitals and their associated medical schools. Changes in the setting of and approach to medical education will need to be made in order to continue to train physicians at the same high level as in the past and to maintain the productivity of our national biomedical research enterprise and its contributions to health. Academic leaders, such as department chiefs who have clinical service responsibilities, are finding it more and more difficult to manage simultaneously the demands of the clinical business, education, and research. In an effort to organize a teaching hospital and a medical school in a manner that would position them to maintain more effectively their common academic mission front and center with the clinical business, Harvard Medical School and the Beth Israel Hospital created a joint venture in 1996. The new nonprofit Institute for Education and Research has education and research as its top (and only) mission. It is designed to provide additional and specific academic leadership and to enable the joint venture to undertake strategic planning for the academic mission. In addition to the challenges it faces from changes in the external environment, the Institute for Education and Research will need to establish a new pattern of interactions internally within the parent institutions. Collaborations with department chairs and faculty are an essential ingredient for its success. It is hoped that this structure will prove to be a useful template for organizing other medical school-hospital collaborations on behalf of the academic mission.     

Preventive care for women. Does the sex of the physician matter?

BACKGROUND: Emphasis on ensuring women's access to preventive health services has increased over the past decade. Relatively little attention has been paid to whether the sex of the physician affects the rates of cancer screening among women. We examined differences between male and female physicians in the frequency of screening mammograms and Pap smears among women patients enrolled in a large Midwestern health plan. METHODS: We identified claims for mammography and Pap tests submitted by primary care physicians for 97,962 women, 18 to 75 years of age, who were enrolled in the health plan in 1990. The sex of the physician was manually coded, and the physician's age was obtained from the state licensing board. After identifying a principal physician for each woman, we calculated the frequency of mammography and Pap smears for each physician, using the number of women in his or her practice during 1990 as the denominator. Using unconditional logistic regression, we also calculated the odds ratio of having a Pap smear or mammogram for women patients with female physicians as compared with those with male physicians, controlling for the physician's and the patient's age. RESULTS: Crude rates for Pap smears and mammography were higher for the patients of female than male physicians in most age groups of physicians. The largest differences between female and male physicians were in the rates of Pap smears among the youngest physicians. For the subgroup of women enrolled in the health plan for a year who saw only one physician, after adjustment for the patient's age and the physician's age and specialty, the odds ratio for having a Pap smear was 1.99 (95 percent confidence interval, 1.72 to 2.30) for the patients of female physicians as compared with those of male physicians. For women 40 years old and older, the odds ratio for having a mammogram was 1.41 (95 percent confidence interval, 1.22 to 1.63). For both Pap smears and mammography, the differences between female and male physicians in screening rates were much more pronounced in internal medicine and family practice than in obstetrics and gynecology. CONCLUSIONS: Women are more likely to undergo screening with Pap smears and mammograms if they see female rather than male physicians, particularly if the physician is an internist or family practitioner.     

Transformational, transactional, and laissez-faire leadership styles: A meta-analysis comparing women and men.

A meta-analysis of 45 studies of transformational, transactional, and laissez-faire leadership styles found that female leaders were more transformational than male leaders and also engaged in more of the contingent reward behaviors that are a component of transactional leadership. Male leaders were generally more likely to manifest the other aspects of transactional leadership (active and passive management by exception) and laissez-faire leadership. Although these differences between male and female readers were small, the implications of these findings are encouraging for female leadership because other research has established that all of the aspects of leadership style on which women exceeded men relate positively to leaders' effectiveness whereas all of the aspects on which men exceeded women have negative or null relations to effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of outpatient diagnostic imaging. Does the physician's gender play a role?

OBJECTIVE: To examine physician and patient characteristics related to the ordering of imaging studies in a general medicine practice and to determine whether physician gender influences ordering patterns. DESIGN: Retrospective cohort study. SETTING: Hospital-based academic general medicine practice of 29 attending physicians. PATIENTS: All 8,203 visits by 5,011 patients during a 6-month period. METHODS: For each visit the following variables were abstracted from the electronic patient record: patient age, patient gender, visit urgency, visit type, and physician seen. All diagnostic imaging studies performed within 30 days of each outpatient visit were identified from the hospital's Radiology Information System. Screening mammography was not included in the analysis. Physician variables included gender and years since medical school graduation. Logistic regression analysis was used to evaluate the effect of various patient, physician, and visit characteristics on the probability of a diagnostic imaging study being ordered. RESULTS: Patient age, urgent visits, visit frequency, and the gender of the physician were all significantly related to the ordering of an imaging study. Correcting for all other factors, the ordering of an imaging study during an outpatient medical visit was 40% more likely if the physician was female (odds ratio = 1.40; 95% confidence interval [CI] 1.01, 1.95). Female physicians were 62% more likely (95% CI 0.99, 2.64) than male physicians to order an imaging study for a male patient and 21% more likely (95% CI 0.87, 1.69) to order an imaging study for a female patient. CONCLUSIONS: Physician gender is a predictor of whether an outpatient medical visit generates an imaging study. Reasons for this observation are unclear, but may be the result of different practice styles of male and female physicians or unmeasured patient characteristics.     

Dynein inner arm heavy chain identification in cAMP-activated flagella using class-specific polyclonal antibodies

In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.     

Gender, quality of life, and mental disorders in primary care: results from the PRIME-MD 1000 study

BACKGROUND: Recently there has been increased interest in the special mental health needs of women. We used data from the PRIME-MD 1000 study to assess gender differences in the frequency of mental disorders in primary care settings, and to explore the potential impact of these differences on health-related quality of life (HRQL). SUBJECTS AND METHODS: One thousand primary care patients (559 women) were interviewed during the PRIME-MD study, which was conducted at four primary care clinics affiliated with university hospitals throughout the eastern United States. Patients completed a one-page questionnaire in the waiting room prior to being seen by the physician; patients and physicians then completed together a clinician evaluation guide that used DSM-III-R algorithms to diagnose mood, anxiety, somatoform, eating, and alcohol related disorders. Health-related quality of life was assessed with the Medical Outcomes Study SF-20 General Health Survey. RESULTS: Women were more likely than men to have at least one mental disorder (43% versus 33%, P < 0.05). Higher rates were particularly prominent for mood disorders (31% of women versus 19% of men, odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.4 to 2.6), anxiety disorders (22% versus 13%, OR = 1.9, CI = 1.3 to 2.8), and somatoform disorders (18% versus 9%, OR = 2.2, CI = 1.5 to 3.4). Psychiatric comorbidity was also more common in women (26% of women had two or more mental disorders versus 15% of men, P < 0.05). Unadjusted HRQL scores, ranging from 0 to 100, with 100 = best health, were all significantly lower in women than in men (eg, physical function = 67 in women versus 76 in men, P < 0.0001; mental health = 69 in women versus 76 in men, P < 0.0001). Many HRQL differences persisted after controlling for age, education, ethnicity, marital status, and number of physical disorders; however, differences in HRQL were eliminated in 5 of 6 domains after controlling for number of mental disorders. When compared with female patients of male physicians, female patients of female physicians demonstrated similar satisfaction with care, health care utilization, HRQL, and recognition rate of mental disorders. CONCLUSIONS: In the 1,000 patients of the PRIME-MD study, mood, anxiety, and somatoform disorders and psychiatric comorbidity were all significantly more common in women than men. The HRQL scores were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders. These data suggest that one of the most important aspects of a primary care physician's care of female patients is to screen for and treat common mental disorders.     

Medical research at Norwegian universities

This study shows that Norwegian medical research suffers from lack of both public funds and recruitment, as well as being affected by the following major factors. Norway uses less of its GNP on R&D than other Western countries and less than the OECD average. Medical research in particular receives less financial support than in any of the other Nordic countries. Norwegian medical researchers publish less material and are cited less often than their colleagues in comparable countries. More than half of the medically trained scientific staff in Norway's four medical faculties will retire during the next decade and today there are many vacant positions in academic medicine because there are not enough competent applicants to fill them. The percentage of M.D.s among professors and lecturers has fallen, and a continued decline in preclinical and laboratory medicine and in public health is predicted. This percentage has also decreased among Ph.D. students, while the age at which medical doctors dissertate has increased and is higher than for other Ph.D.s. The number of medical students doing research has fallen in recent years, and the number of doctoral theses has not increased as much in medicine as in other fields. There are significant differences between the salaries paid in medical science and those paid in clinical medicine. Lack of resources and low salaries keep doctors from pursuing a career in academic medicine. In conclusion, if Norway is to be visible in the field of international medical science, this negative trend must be reversed and medical research and academic medicine revitalised.     

Epidemiology and economic impact of heart failure in France

There are little epidemiological data available about heart failure in France, despite its considerable impact on the system of health care and the fact that this problem will become even more acute in the future. Here are some important statistics: in France, there are about 500,000 people suffering from heart failure with about 120,000 new cases every year. The incidence increases from 4% in men and 3% in women of 55 to 64 years of age to 50% in men and 85% in women of 85 to 94 years of age. The average age of diagnosis is 73.5 years: two thirds of patients are over 70 years of age. There are about 3.5 million consultations and 150,000 hospital admissions for heart failure per year. The average length of hospital stay is 11 days. There are more than 32,000 deaths per year from heart failure. The cost of treating heart failure represents more than 1% of total medical expenses. Heart failure is a major problem of public health which is on the increase. This should incite physicians to provide optimal treatment for those affected and to place greater emphasis on preventive measures.     

Gender and the evaluation of leaders: A meta-analysis.

[Correction Notice: An erratum for this article was reported in Vol 112(3) of Psychological Bulletin (see record 2008-10512-001). Some of the numbers in the Value columns of Table 1, page 11, were aligned incorrectly. The corrected version of Table 1 is provided in the erratum.] Reviews research on the evaluation of women and men that occupy leadership roles. While holding the characteristics, except for sex, constant and varying the sex of the leader, these experiments investigated whether people are biased against female leaders and managers. Although this research showed only a small overall tendency for Ss to evaluate female leaders less favorably than male ones, this tendency was more pronounced under certain circumstances. Specifically, women in leadership positions were devalued relative to their male counterparts when leadership was carried out in stereotypically masculine styles, especially when this style was autocratic or directive. Also, the devaluation of women was greater when leaders occupied male-dominated roles and when the evaluators were men. Findings are interpreted from a perspective that emphasizes the influence of gender roles within organizational settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Application of heparin-coated PCPS for traumatic cardiac rupture: report of a case

OBJECTIVES: This study examined whether primary care physicians provide education and counselling on head injury prevention as part of their routine health care discussions with patients. METHODS: A preventive health care practices survey was distributed to 678 physicians in the Central Virginia area. Data regarding respondents' age, gender, medical specialty, patient population and counselling practices were obtained. RESULTS: Fifty-one per cent of those surveyed responded. Ninety-five per cent of physicians reported providing health care counselling 'in most cases' or 'commonly'. Less than half (46%) of physicians discussed head injury prevention with their patients. In contrast, almost all respondents (97%) discussed smoking. Physician age, specialty, and patient population did not affect head injury counselling practices. CONCLUSIONS: Prevention strategies for head injury are discussed much less frequently than other health risks such as heart disease and cancer in the primary care setting. Strategies for educating primary care physicians on head injury should be considered in order to increase their efforts toward prevention.     

"Gender and the evaluation of leaders: A meta-analysis": Correction to Eagly et al.

Reports an error in "Gender and the evaluation of leaders: A meta-analysis" by Alice H. Eagly, Mona G. Makhijani and Bruce G. Klonsky (Psychological Bulletin, 1992[Jan], Vol 111[1], 3-22). Some of the numbers in the Value columns of Table 1, page 11, were aligned incorrectly. The corrected version of Table 1 is provided in the erratum. (The following abstract of the original article appeared in record 1992-16290-001.) Reviews research on the evaluation of women and men that occupy leadership roles. While holding the characteristics, except for sex, constant and varying the sex of the leader, these experiments investigated whether people are biased against female leaders and managers. Although this research showed only a small overall tendency for Ss to evaluate female leaders less favorably than male ones, this tendency was more pronounced under certain circumstances. Specifically, women in leadership positions were devalued relative to their male counterparts when leadership was carried out in stereotypically masculine styles, especially when this style was autocratic or directive. Also, the devaluation of women was greater when leaders occupied male-dominated roles and when the evaluators were men. Findings are interpreted from a perspective that emphasizes the influence of gender roles within organizational settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician attitudes toward managing obesity: differences among six specialty groups

BACKGROUND: The Healthy People 2000 report recommended that physicians more actively address obesity, but little is known about current attitudes and practices of physicians, particularly across specialty areas relevant to obesity as a medical risk factor. METHODS: A mail survey of 1,222 physicians from six specialties (family practice, internal medicine, gynecology, endocrinology, cardiology, and orthopedics) investigated beliefs, attitudes, and practices regarding obesity in relation to medical risk, management, and interest in training and other resources. RESULTS: Specialty groups shared high concern for the health risks of moderate and morbid obesity, but distinct attitudes and patterns of practice emerged. For example, family practitioners, internists, and endocrinologists reported treating obesity themselves in about 50% of obese patients, which correlated with reported use of more active treatment approaches (r = 0.62, P < 0.0001). Other groups reported intervening with 5 to 29% of patients, but expressed greater interest in making referrals. Physicians reporting "any specialty training related to ... obesity" ranged from 4.5% of family practitioners to 36.4% of endocrinologists. CONCLUSIONS: Physicians express high concern with management of obesity but variable interest in assuming this role themselves. Mild obesity may be particularly undertreated. Research is critically needed to assess effective physician roles in weight management and to support the development of physician guidelines.     

Patients in Norwegian hospitals. Length of stay and patterns of use

All 633,987 periods of admission to Norwegian general hospitals in 1991 were analyzed. The length of stay increases considerably with the patient's age. 80-year old patients stay three times as long in hospital as five-year old patients. The typical surgical patient requires 56% more resources than the typical medical patient. For surgical patients, the mean length of stay was 7.2 days, and for medical patients it was 6.8 days. Patients in the age group 70-79 years require almost twice as much resources as the youngest patients. Patients up to the age of 65 who live in a municipality where there is a hospital stay in hospital just as long as corresponding patients from municipalities without a hospital. For older patients there are significant differences in length of stay for these two categories of patients. The discharge rate for men of 70 years and older is significantly higher than the rate for women in the same age group, but the women stay longer in hospital.     

Physician practice styles and patient outcomes: differences between family practice and general internal medicine

OBJECTIVES: This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine. METHODS: New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self-reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured. RESULTS: There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation. CONCLUSIONS: There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.     

Professional conditions and satisfaction in general practice in 1993. Practice profile of Norwegian primary physicians

European study of General Practice (GP) task profiles was carried out in 30 European countries in 1993. We analyzed the Norwegian results. 164 primary care physicians, 51% of a random sample, answered a questionnaire. 147 kept a diary on their practice for one week. Compared with results from two earlier studies performed 15 years ago, the proportion of female GPs had doubled to 25%, there were more group practices, more time was spent on vocational training and continuous education, and night service was less frequent than in 1978. 45% were specialists in general practice and 7% in community medicine. Job satisfaction was high, and highest for women, fee-for-service GPs on contract, and GPs who cooperated with other health professionals.