The Conundrum of Medical Licensure for Physician Leaders.

This article discusses the dichotomy between the need for physician leaders and the need for alternative pathways for medical licensure for nonpracticing physicians who seek leadership roles, including the possibility of a national solution to the problem. Currently, no nationwide licensing standards or requirements exist for clinically inactive physician leaders, and states have different requirements and procedures for licensure. In many states, physician leaders who no longer practice medicine may be held to the same standards of medical licensure as practicing physicians, which may require board recertification or enrollment in formal "reentry" programs and other activities that may seem unreasonable or irrelevant to the roles and responsibilities of physicians in leadership positions. Physicians interested in leaving practice for leadership opportunities in industry and other sectors of medicine should always maintain an active medical license. Those seeking employment in a state other than the one(s) in which they are currently licensed should not make any job commitments based on expectation of licensure until they are actually licensed.

The Value of Physician Leaders to Nonphysician Coworkers.

With few exceptions, physician leaders are perceived as valuable to their organizations, helping to define goals, set priorities, and plan future direction. In some cases, however, physician leaders are misunderstood or devalued by senior business leaders. There could be several reasons for this observation: (1) the roles and responsibilities of physician leaders may be unclear to business leaders; (2) nonmedical leaders may question the business relevance of the activities performed by physician leaders; and (3) some business executives may believe (erroneously) that the activities performed by physician leaders are nonessential, or could be performed equally well by lesser trained healthcare professionals. Under such circumstances, physicians may become demoralized and indignant, but they should never lose sight of their importance to the everyday coworkers who are the most valuable asset of any organization.

Traumatized by practice: PTSD in physicians.

Posttraumatic stress disorder (PTSD) is underrecognized in physicians, even though it may be more prevalent in physicians than in the general population in the United States. Five types of physicians appear to be particularly prone to developing PTSD: (1) emergency physicians; (2) physicians practicing in underserved and remote areas; (3) physicians in training (i.e., medical residents); (4) physicians involved in malpractice litigation; and (5) physicians who are "second victims" in the sense that they are indirectly exposed to trauma. In addition to experiencing trauma, the cumulative stress of practice may cause PTSD. The road to recovery for physicians with PTSD entails proper diagnosis and treatment, which includes maintaining a high index of suspicion for the occurrence of PTSD in predisposed physicians, and individual or group therapy. Physicians in leadership positions should advocate for effective support programs for their colleagues with PTSD.

Can we talk? The search for common ground in the doctor-patient relationship.

Communication is an essential component of providing quality care. Proper communication incorporates the use of plain language and culturally sensitive information in oral, written, and nonverbal communication to patients. Plain language explains medical concepts and conditions in understandable terms without "talking down" to patients or coming across as erudite or condescending. Timing and delivery are also important. Patients are less likely to retain information under stressful circumstances. Bad news should be delivered compassionately and disclosed according to the patient's knowledge and understanding of the situation. Physicians need to individualize their communication to patients based on patients' needs and desires. Online communication to patients needs to clearly focus on medical issues, separating personal and professional content.

The potholed path to becoming a physician executive.

This article discusses evolving career pathways for physician executives--pathways that take physicians out of primarily patient care roles and into management activities. The discussion is textured with "how-to" advice for readers who may have aspirations of becoming physician managers and executives. The advice stems from my own experiences in the pharmaceutical industry and other healthcare sectors. Specific topics addressed include: attending business school, gaining management experience, working in large corporations, dealing with job loss, acquiring both hard and soft skills, cultivating mentors, and developing leadership competencies. Physician executives must demonstrate strong leadership abilities and learn how to tactfully confront difficult people and problems.

Efficacy of extended release quetiapine fumarate monotherapy in patients with major depressive disorder: a pooled analysis of two 6-week, double-blind, placebo-controlled studies.

Prospectively planned pooled analysis evaluating the efficacy of quetiapine extended release (XR) monotherapy in major depressive disorder (MDD). Data were pooled from two 6-week, randomized, double-blind, placebo-controlled studies of quetiapine XR in outpatients with MDD. The primary endpoint was Montgomery-Åsberg Depression Rating Scale (MADRS) total score change from randomization at week 6. Other evaluations were MADRS response/remission, Hamilton Rating Scale for Anxiety, and subgroup analyses. A total of 968 patients were randomized to quetiapine XR, 150 mg/day (n=315), 300 mg/day (n=323), or placebo (n=330). The mean MADRS total score reductions from randomization were significant at week 6 with quetiapine XR, 150 mg/day (-14.7; P<0.001) and 300 mg/day (-14.7; P<0.001) versus placebo (-11.1), with significant reductions versus placebo from week 1 onward. Response rates (week 6): 52.7% (P<0.001) quetiapine XR 150 mg/day and 49.5% (P<0.001) quetiapine XR 300 mg/day versus placebo (33.0%). MADRS remission (score≤8; week 6): 23.5% (P=0.208) quetiapine XR 150 mg/day and 28.8% (P<0.01) quetiapine XR 300 mg/day versus placebo (19.4%). Quetiapine XR (both doses) significantly improved eight of 10 MADRS items versus placebo at week 6. The therapeutic effect of quetiapine XR was neither limited to nor driven by factors such as sex, age, or severity of depression. In patients with MDD, quetiapine XR (150 and 300 mg/day) monotherapy reduced depressive symptoms, with significant improvements compared with placebo from week 1 onward.

How can physicians break through job boredom?

Physicians are not immune to job boredom, which may be brought on by lack of a stimulating job; a job that provides little opportunity for personal growth, development, or advancement; and work settings that are poorly matched to physicians' skills, interests, and capabilities. Common remedies include switching specialties, practicing concierge medicine, and taking locum tenens assignments. Some physicians counter boredom by leaving practice for jobs in the pharmaceutical and managed care industries, as well as other types of medical organizations. A small percentage of exceptional physicians pursue unique opportunities based on individual talents and interests that may or may not be related to their medical training and background.