Análisis de la actividad investigadora de los internistas gallegos a partir de los resultados de la oferta pública de empleo / Analysis of the investigation of the internists from the Public Bid of Employment in Galicia. Spain

Objetivo: Estudiar la actividad investigadora de los internistas respecto a los otros especialistas médicos a partir de los datos de la Oferta Pública de Empleo. Método: De la página web del Servicio Galego de Saude se han extraído los siguientes datos: especialidad, sexo, método de obtención del título de especialista, tesis doctoral y puntuación en lengua gallega, memoria profesional, experiencia profesional, docencia posgraduada y trabajos científicos. Resultados: Se presentaron 355 médicos (33,2% internistas, 66,8% de otras especialidades médicas). No hubo diferencias entre ellos en cuanto a sexo, obtención del título por vía MIR, tesis doctoral, y puntuación en idioma gallego, experiencia profesional y docencia postgraduada. El número de publicaciones fue significativamente inferior en los internistas (9,1 ± 9,6 vs. 15,7 ± 12,1, p < 0,0001), tanto de forma global como cuando se analizó por grupos según los años de experiencia profesional. La obtención del título vía MIR se asoció a mayor número de publicaciones (p < 0,001). La consecución de plaza se asoció a la puntuación de la memoria, la experiencia profesional y los trabajos publicados (p < 0,001). La realización de tesis doctoral se asoció a la obtención de plaza en hospitales universitarios (p < 0,005). Conclusión: Los internistas gallegos tienen menor actividad investigadora que los otros especialistas médicos. Es necesario, desde la medicina interna, promocionar la investigación y mejorar la formación de nuestros residentes en este aspecto

Objectives: The aim of the present study was to assess the investigative activity of the internists. Data were collected from the Public Bid of Employment (PBE) performed in Galicia in 2005, and compared with the rest of medical subspecialities. Methods: The results from the PBE related to internal medicine and medical subspecialities are available in the web page of the Galician Service of Health. The following data were studied: speciality, sex, method of attainment of the specialist degree, thesis, and scores obtained in Galician language exam, professional experience, professional report, postgraduate teaching and published scientific papers. Results: Data from 355 specialists were analyzed: 118 (33.2%) were internists, and 237 (66.8%) were medical subspecialists. There were no differences between internal medicine and the rest of subspecialities in terms of sex, method of attainment of the specialist degree, thesis, and scores obtained in Galician language exam, professional experience and postgraduate teaching. Internists presented fewer scientific papers than subspecialists, even when they were classified according to different levels of professional experience. Degrees obtained by the MIR system were associated with more publications (p < 0.001). The attainment of the job was associated to scores obtained in the professional report, professional experience, and published scientific papers (p < 0.001). The obtaining of the job was associated to the accomplishment of the doctoral thesis in the university teaching hospitals (A Coruña, Santiago y Vigo, p < 0.005). Conclusions: The investigative activity of the internists in Galicia is inferior to the rest of the medical subspecialists. It seems necessary to stimulate the internists to developing scientific investigation and to improve those skills of the internal medicine residents

Gastroenterology practice in 2006: challenges and opportunities.

Two main developments will dominate the future of gastroenterology in the United States. The first is changing demography, and the second is revolutionary change in the structure of health insurance, that is, the advent of consumer-driven health care. This article details some of the demographic and insurance changes that gastroenterologists will have to contend with in the future and outlines some of the opportunities and challenges that lie ahead.

The big squeeze. Insurers point to slower growth in premiums in past few years to show progress, but providers say they're paying the price.

While insurers last week were trumpeting the third straight year of slower growth in premiums, providers weren't exactly celebrating. That's because of huge mergers, which give insurers far more leverage and have led to reimbursements being cut back even more. "What's worrying us is that there's a growing segment (of insurers) that aren't going to budge an inch, no matter what," says Russ Weaver, left.

Turf wars in radiology: privileging and site accreditation programs--what they have accomplished for commercial health plans.

In recent years, some commercial health plans have instituted privileging and site accreditation programs for providers of diagnostic imaging. This article describes how these programs work and points out that they can help restrict self-referral and the overutilization that accompanies it. Another advantage is that they can help eliminate low-quality providers. Radiologists should encourage health plans in their area to develop and implement these measures.

Physician leaders of medical groups face increasing challenges.

Physician leadership has emerged as one of the biggest challenges and opportunities for medical group success. The environment for medical groups has become increasingly complex as the result of five major factors: 1) varying reimbursement methods, 2) growth in the size of groups, 3) technology investments, 4) sale and merger of groups, and 5) regulatory and legal issues. Striking the right balance between too little or too much physician involvement in leading medical groups is a key business decision. Most large, successful businesses view investment in their leaders as critical for success. Medical groups can learn from other businesses that investment in education, coaching, and succession planning for leaders is a key to long-term success.

Empiric examination of physician behavior in a changing healthcare market.

We hypothesized that, in the current healthcare environment, medical providers have strong economic incentives to introduce new technology and treat patients more extensively. We examined physician reimbursement for medical procedures in Utah in the early 1990s, a period of increasing utilization of managed care methods, using a cross-section time series and a supply side model to analyze how physician behavior changed during this period of time. Our findings suggest that physicians have acted to maintain their revenue by requesting reimbursement for more procedures as the reimbursement level per procedure decreased. We conclude that increased volatility in reimbursement levels and increased adjudication pressure from payers provide signals to physicians to act strategically to protect their revenue stream.

Responses to a payment policy denying professional charges for diagnostic imaging by nonradiologist physicians.

OBJECTIVE: To assess the impact of a payment policy denying reimbursement for the imaging-related professional services of nonradiologist physicians by comparing the use of and expenditures for diagnostic imaging examinations before and after implementation of the policy. DESIGN: Retrospective economic evaluation of claims and expenditures for diagnostic imaging examinations filed by physicians practicing in the 20 US counties having the greatest number of United Mine Workers of America Health and Retirement Funds (hereafter referred to as Funds) beneficiaries. SETTING: Insurance claims database of Funds beneficiaries, most of whom are elderly and live in rural communities and small towns. INTERVENTION: The January 1, 1993, implementation of a reimbursement policy denying payment of professional claims for diagnostic imaging of nonradiologist physicians. MAIN OUTCOME MEASURES: Numbers and types of eligible claims and Funds payments for diagnostic imaging examinations during the year before and after the intervention, normalized for changes in the number of beneficiaries. RESULTS: Despite the rejection of $811,466 in claims disallowed by the policy, the Funds paid 12% more for diagnostic imaging performed in the 20 counties we studied during 1993 than during 1992. The Funds reimbursed 41% more claims per beneficiary for diagnostic imaging in 1993 than in 1992 (t = -8.03, P < .0001). The absolute number of professional claims per beneficiary increased more than did technical or global claims. CONCLUSIONS: Despite a payment policy designed, in part, to reduce the Funds' imaging-related expenditures, the physicians we studied filed more claims, leading to greater expenditures. An increased number of self-referred technical claims and greater referral to hospital radiology departments likely account for most of the observed increases in utilization and costs.