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PURPOSE: Physician turnover is costly to health care systems and can affect patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and characteristics associated with turnover. DESIGN: A retrospective cross-sectional study. PARTICIPANTS: Actively practicing US ophthalmologists included in the Centers for Medicare & Medicaid Services (CMS) Physician Compare and Physician and Other Supplier Public Use File between 2014 and 2021. METHODS: Using two separate publicly available Medicare data sets, we collated data for ophthalmologists associated with practices in each year between 2014 and 2021. We calculated the rate of turnover as (1) annually in each year window and (2) cumulatively as the total proportion of 2014 practices separated by 2021. Multivariate logistic regression analysis was used to identify physician and practice characteristics associated with cumulative turnover. Additionally, we evaluated changes in annual turnover surrounding the Coronavirus disease 2019 pandemic. MAIN OUTCOME MEASURES: Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next. RESULTS: Of 13,264 ophthalmologists affiliated with 3,306 unique practices, 34.1% separated from at least one practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59, p<0.01), university-affiliation (aOR, 1.55, p<0.01), practice location in the Northeast (aOR 1.39, p<0.01), and practice size of 2-4 members (aOR, 1.21, p<0.01). Factors associated with decreased turnover included male gender (aOR, 0.87, p<0.01), and greater than 5 years of practice: 6-10 years (aOR, 0.63), 11-19 years (aOR, 0.54), 20-29 years (aOR, 0.36), and ≥30 years (aOR, 0.18) (p < 0.01 for all). In the initial year of the COVID-19 pandemic (2020), annual turnover grew from 7.8% to 11.0%, then fell to 8.7% in the pandemic post-vaccine period (2021). CONCLUSIONS: One-third of US ophthalmologists separated from at least one practice from 2014-2021. Turnover patterns differ by various physician and practice characteristics, the knowledge of which may prove useful when developing strategies to optimize future workforce stability. Because reasons for turnover cannot be solely determined using administrative data, further investigation is warranted given the potential clinical and financial implications.
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In the United States, medical schools are accredited by either the Liaison on Committee Medical Education (LCME) or the Commission on Osteopathic College Accreditation (COCA), which assesses the quality and standards of Doctor of Medicine (MD)-granting and Doctor of Osteopathic Medicine (DO)-granting institutions, respectively. Thereafter, new MD and DO physicians complete graduate medical education (GME) training. Historically, the two physician licensure pathways have been predominantly separate, but in 2020, the Accreditation Council for Graduate Medical Education and American Osteopathic Association finalized a single accreditation GME system. Now, other elements of MD and DO physician training that have traditionally remained separate, such as undergraduate medical education (UME), are increasingly being scrutinized. Since 2010, when the accreditation of UME was last qualitatively criticized, the standards and competencies set forth by LCME and COCA have converged. COCA, in particular, has updated its requirements to emphasize scholarly activity, improve inpatient clinical rotation requirements, engage medical students, and enhance clinical faculty qualifications. Such convergence brings to question the continuing need for two independent accreditation pathways and barriers that may prevent a single accreditation. We argue that although MD and DO physicians are unique, the natural confluence of UME accreditation represents an opportunity to simplify and improve physician training in the United States. Our analysis suggests the major barriers to implementing a single accreditation system surround the requirement of Osteopathic Manipulative Medicine (OMM)-focused faculty by COCA and the two separate licensing exams (USMLE (United States Medical Licensing Examination) and COMLEX (Comprehensive Osteopathic Medical Licensing Examination)). However, with a continuing decline in osteopathic physicians practicing OMM and growing debate over a new single licensing exam, a single accreditation UME system may be practically achieved.
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PURPOSE: To examine trends in ophthalmic trauma secondary to five major sports (baseball, soccer, tennis, football, basketball) and identify differences between patient characteristics and time period (pre-COVID vs COVID) of injury. METHODS: The National Electronic Injury Surveillance System was queried to extract cases related to the sports of interest from 2011-2020. Entries were analyzed by age, sex, diagnosis, location, and disposition, with narrative descriptions assessed to characterize the mechanism of injury and visual sequelae. National incidence was extrapolated and Pearson's ?2 and Fisher's exact tests were performed. RESULTS: Among 98,995 presentations, most involved male (83.5%) and pediatric patients (59.2%). Contusion/abrasion (57.3%) was the predominant diagnosis, with injuries primarily precipitated by contact with a ball (44.9%) and occurring in the recreational setting (49.0%). Visual sequelae were documented in 6.4% of injuries. Patients were commonly treated/examined and released (95.6%). Between sports, significant differences in diagnosis (p < .001), mechanism of injury (p < .001), location (p < .001), visual sequelae (p < .001), and disposition (p = .005) were observed. Stratification by age indicated significant differences in diagnosis, mechanism of injury, and location (all p < .001). Stratification by sex indicated significant differences in the mechanism of injury (p < .001) and visual sequelae (p = .04). Stratification by time period indicated significant differences in diagnosis (p = .002) and mechanism of injury (p = .001). CONCLUSION: There are notable differences in sports-related ocular injuries by patient characteristic, revealing important considerations for their clinical evaluation and the development of safety guidelines.
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Among many other things, the novel coronavirus pandemic of 2020 highlighted the significance of physician shortages in the United States. Current projections anticipate a national shortage of up to 122,000 physicians by 2032, with shortfalls in both primary care physicians and specialists. Yet while this figure highlights the magnitude of the problem, it does not capture the distributional aspect of American physician shortages. Though some specialties and geographic areas have a surplus of physicians, others have a chronic undersupply. Appropriately addressing the looming physician shortage therefore requires not only creating more physicians, but also ensuring that those physicians practice in the areas of greatest societal need. This review explores the nature of physician shortages in the United States, identifies the present bottleneck in physician training at the level of graduate medical education, and considers potential legislative and policy solutions to allow strategic and deliberate expansion of graduate medical education and physician practice.