Correlates of young physicians' support for unionization to maintain professional influence.

PURPOSE: A resolution in support of physicians' unionization was recently approved by the American Medical Association's House of Delegates. This study investigated the factors associated with young physicians' approval of unionization. METHOD: A survey was mailed to all 1987-1992 Jefferson Medical College graduates (n = 1,272); 835 (66%) responded. RESULTS: Of the respondents, 43% supported unionization, 31% did not support unionization, and 26% expressed no opinion. Surgeons, medical subspecialists, pediatricians, and hospital-based specialists were more likely to support unionization than were family physicians. Significant predictors of support for unionization were negative views of the changes in the health care system, negative perceptions of the quality of care provided by managed care, the belief that physicians' independence had been impaired by changes in the health care system, and the belief that physicians' personal satisfaction should take precedence over societal needs in determining the future of health care. Support for unionization correlated with physicians' perceptions that mental health patients should be referred to psychiatrists, physician-assisted suicide should be legalized, and the involvement of nurse practitioners in diagnosis and treatment could compromise the quality of care. CONCLUSIONS: Young physicians' support for unionization is a function of frustration with market-driven policies that compromise the quality of care and negatively affect physicians' autonomy and personal satisfaction.

Documenting and comparing medical students' clinical experiences.

CONTEXT: The decentralization of clinical teaching networks over the past decade calls for a systematic way to record the case-mix of patients, the severity of diseases, and the diagnostic procedures that medical students encounter in clinical clerkships. OBJECTIVE: To demonstrate a system that documents medical students' clinical experiences across clerkships. DESIGN AND SETTINGS: Evaluation of a method for recording student-patient clinical encounters using a pocket-sized computer-read patient encounter card at a US university hospital and its 16 teaching affiliates during academic years 1997-1998 through 1999-2000. PARTICIPANTS: A total of 647 third-year medical students who completed patient encounter cards in 3 clerkships: family medicine, pediatrics, and internal medicine. MAIN OUTCOME MEASURES: Number of patient encounters, principal and secondary diagnoses, severity of diseases, and diagnostic procedures as recorded on patient encounter cards; concordance of patient encounter card data with medical records. RESULTS: Students completed 86 011 patient encounter cards: 48 367 cards by 582 students in family medicine, 22 604 cards by 469 students in pediatrics, and 15 040 cards by 531 students in internal medicine. Significant differences were found in students' case-mix of patients, the level of disease severity, and the number of diagnostic procedures performed across the 3 clerkships. Stability of the findings within each clerkship across 3 academic years and the 77% concordance of students' reports of principal diagnosis with faculty's confirmation of diagnosis support the reliability and validity of the findings. CONCLUSIONS: An instrument that facilitates students' documentation of clinical experiences can provide data on important differences among students' clerkship experiences. Data from this instrument can be used to assess the nature of students' clinical education.

Attitudes toward physician-nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico.

BACKGROUND: Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior. OBJECTIVES: The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures. METHOD: The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design. RESULTS: Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed. CONCLUSIONS: Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.

Physicians' perceptions of the changing health care system: comparisons by gender and specialties.

This study was designed to investigate physicians' perceptions of changes in the United States health care system impacting academic medicine, quality of care, patient referrals, cost, ethical and sociopolitical aspects of medicine. A survey was mailed in 1998 to 1,272 physicians (graduates of Jefferson Medical (College between 1987 and 1992); 835 physicians (66%) responded. Results showed that a substantial majority (92%) believed that learning to work in a managed care environment should become an essential component of medical education. Physicians perceived that current changes impair physicians' autonomy (94%), and restrain physicians' freedom to provide optimal care (84%). A sizable majority (76%) endorsed patients' freedom to seek specialist care, and 55% believed that capitation reduces physicians' motivation for long-term monitoring of patients. The majority endorsed universal health coverage (80%), and agreed to support rather than resist the changes (62%). Only 18% hold a positive view of the changes in the future. The majority believed that medical education should prepare physicians to provide end-of-life care (92%), and that organized medicine should take a stand on social issues that can influence the well-being of society (79%). Only 34% endorsed the legalization of physician-assisted suicide. No gender differences were observed, but a few differences were found between generalists and specialists. Results can help in understanding physicians' perceptions of current changes in the United States health care system, and in providing guidelines for the development of educational programs to prepare physicians to face new challenges.

Gender comparisons of income expectations in the USA at the beginning of medical school during the past 28 years.

This study was designed to investigate gender differences in the USA, in anticipated professional income. Participants were 5314 medical students (3880 men, 1434 women) who entered Jefferson Medical College between 1970 and 1997. The annual peak professional income estimated at the beginning of medical school was the dependent variable and gender within selected time periods was the independent variable. Results showed significant differences between men and women on their anticipated future incomes in different time periods. Women generally expected 23% less income than men. The effect size estimates of the differences were moderately high. The gender gap in income expectations was more pronounced for those who planned to pursue surgery than their counterparts who planned to practice family medicine or pediatrics. A unique feature of this study is that its outcomes could not be confounded by active factors such as experience, working hours, age and productivity. Findings suggest that social learning may contribute to gender gap in anticipated income.

A statewide system to track medical students' careers: the Pennsylvania model.

In 1994 the Commonwealth of Pennsylvania announced a statewide Generalist Physician Initiative (GPI) modeled after The Robert Wood Johnson Foundation's GPI. Three-year grants totaling more than $9 million were awarded to seven of Pennsylvania's medical schools, including two that had already received GPI grants from the foundation. Stimulated by these initiatives, the state's six allopathic and two osteopathic medical schools decided to work together to develop a collaborative longitudinal tracking system to follow the careers of all their students from matriculation into their professional careers. This statewide data system, which includes information for more than 18,000 students and graduates beginning with the entering class of 1982, can be used to evaluate the impact of the Pennsylvania GPI, and it also yielded a local longitudinal tracking system for each medical school. This paper outlines the concept of the system, its technical implementation, and the corresponding implications for other medical schools considering the development of similar outcomes assessment systems.

Who is a generalist? An analysis of whether physicians trained as generalists practice as generalists.

Accurate data on the number of generalist physicians are needed to monitor the physician workforce and to plan for future requirements in the changing health care system. This study assessed the relationship between two frequently used definitions of a generalist physician: completion of graduate medical education (GME) in only a generalist discipline and physician's self-report of practicing as a generalist. Data for 4,808 physician graduates from six Pennsylvania medical schools from 1986 to 1991 were analyzed using information from the GME tracking census of the Association of American Medical Colleges and the Physician Masterfile of the American Medical Association. Of 1,291 physicians trained in a generalist discipline, 1,205 (93%) reported practicing as generalists. Conversely, of the 3,517 not trained in a generalist discipline, 3,358 (95%) were not practicing as generalists. These results indicate GME training is a valid predictor of self-reported practice and provide baseline data to monitor future changes.

Assessment of physicians' interest in primary care training/retraining.

PURPOSE: To assess generalists and specialists interest in primary care training and the factors associated with this interest. METHOD: The study sample was drawn from the alumni of the Jefferson Medical College of Thomas Jefferson University (classes of 1970-1990) who were practicing in Pennsylvania. Family practitioners and general internists were defined as generalists; obstetrician-gynecologists (ob-gyns) and internal medicine subspecialists were defined as specialists. In 1995 a questionnaire was mailed consisting of 46 items assessing the physicians' interest in participating in primary care educational programs, reasons for any such interest, and preferences for content. Two items on the specialists' questionnaire asked about changing careers from specialist to generalist, and two items on the generalists' questionnaire asked about broadening the scope of their practices. RESULTS: The response rate was 54% (381/707). In all, 78% of the physicians expressed interest in primary care training. The generalists were more interested in primary care training than were the specialists (p < .001). The ob-gyns were more interested in primary care training than were the medical subspecialists (p = .01). Few of the medical subspecialists and no ob-gyns were influenced by plans to change careers to primary care. More of the ob-gyns than the medical subspecialists were motivated by plans to shift emphasis to provide more primary care. CONCLUSION: The results suggest (1) that although many specialists have an interest in primary care training, it is rarely motivated by plans to change to primary care practice, and (2) that generalists are very interested in expanding their abilities. Both of these findings should be considered in workforce planning.

Tuberculin positivity and patient contact in healthcare workers in the urban United States.

We performed tuberculin and anergy testing in 91 healthy volunteer employees from the patient transport and housekeeping units at an urban tertiary-care hospital, stratifying results by the risk factor of patient contact. Tuberculin positivity was highly prevalent in this group; patient contact was not a predictor of tuberculosis infection risk, and anergy was rare.

A national study of the factors influencing men and women physicians' choices of primary care specialties.

BACKGROUND: Despite a recent increase in the percentage of graduating U.S. medical students planning to pursue generalist careers, interest in primary care among students is still far below what it was in the early 1980s and falls well short of the stated goal of the Association of American Medical Colleges that half of all graduates should choose generalist careers. Also during the past decade, the number of women students and physicians has increased. Given the importance of concerns regarding the primary care work force, it is timely to examine the relationship between gender and other factors that influence the decision to enter primary care. METHOD: Totals of 1,038 (65%) men and 558 (35%) women primary care physicians selected from the 1983 and 1984 graduates of all allopathic U.S. medical schools were surveyed in early 1993. Gender comparisons were made on the 19 variables that influenced the physicians' decisions to enter primary care specialties and on the six factor scores derived from a factor analysis of these 19 variables. Also included in the gender comparisons were characteristics of practice, populations served, timing of making the decision to enter primary care, and personal demographic information. RESULTS: Men, more than women, were influenced to become primary care physicians by early role models. Women, more than men, were influenced by personal and family factors. Overall, medical school experience and personal values are two important factors that explained the largest variances of the 19 predictor variables influencing the physicians' choices of primary care disciplines. There was no gender difference in place of origin, family income as a child, timing of the decision to become a primary care physician, or the amount of debt upon graduation. CONCLUSION: This nationwide study of primary care physicians indicates that men and women physicians differ in their perceptions of the relative importances of factors influencing the choice of a primary care specialty. Gender-specific factors should receive more attention in the development of successful strategies to attract more medical students into primary care specialties.

Percutaneous injuries on the "front line": a survey of housestaff and nurses.

Our objective was to assess the frequency of work-related percutaneous injuries in two high-risk groups and to compare patterns of injury and reporting in these groups. Data were collected through an anonymous, self-administered survey distributed to all full-time nurses and housestaff. The survey results were compared to Employee Health Service records. Surveys were returned by 258 of 330 housestaff and 455 of 593 nurses for a response rate of 77% (housestaff = 78%; nurses = 76%). The respondents were highly representative of the nursing divisions and residency programs surveyed. The percentage of nurses who had ever sustained percutaneous injuries was 64.7%; for housestaff it was 74.1% (prevalence difference = -9.4%, 95% confidence interval [CI] = -16.4%, -2.4%). The percentage of nurses who had sustained recent injuries was 34.6%; for housestaff it was 43.0% (prevalence difference = -8.4%, 95% CI = -15.9%, -0.9%). Injuries with syringe needles were the most common, followed by injuries with suture needles, scalpels, and then a variety of other sharp objects and instruments. The nurses were more likely to seek care as directed by hospital policy at the Employee Health Service (reporting difference = 29.7%, 95% CI = 19.5%, 39.9%) or the Emergency Room (reporting difference = 11.9%, 95% CI = 8.1%, 20.0%). Knowledge of policy increased the probability of reporting by nurses. The housestaff were more likely to evaluate injuries themselves (reporting difference = -16.7%, 95% CI = -26.8%, -6.6%).(ABSTRACT TRUNCATED AT 250 WORDS)