Cross-sectional survey of Good Samaritan behaviour by physicians in North Carolina.

OBJECTIVE: To assess the responses of physicians to providing emergency medical assistance outside of routine clinical care. We assessed the percentage who reported previous Good Samaritan behaviour, their responses to hypothetical situations, their comfort providing specific interventions and the most likely reason they would not intervene. SETTING: Physicians residing in North Carolina. PARTICIPANTS: Convenience sample of 1000 licensed physicians. INTERVENTION: Mailed survey. DESIGN: Cross-sectional study conducted May 2015 to September 2015. MAIN OUTCOME AND MEASURES: Willingness of physicians to act as Good Samaritans as determined by the last opportunity to intervene in an out-of-office emergency. RESULTS: The adjusted response rate was 26.1% (253/970 delivered). 4 out of 5 physicians reported previous opportunities to act as Good Samaritans. Approximately, 93% reported acting as a Good Samaritan during their last opportunity. There were no differences in this outcome between sexes, practice setting, specialty type or experience level. Doctors with greater perceived knowledge of Good Samaritan law were more likely to have intervened during a recent opportunity (p=0.02). The most commonly cited reason for potentially not intervening was that another health provider had taken charge. CONCLUSIONS: We found the frequency of Good Samaritan behaviour among physicians to be much higher than reported in previous studies. Greater helping behaviour was exhibited by those who expressed more familiarity with Good Samaritan law. These findings suggest that physicians may respond to legal protections.

Managing healthcare services in the global marketplace.

The world is getting "flatter"; people, information, technology, and ideas are increasingly crossing national borders. U.S. healthcare is not immune from the forces of globalization. Competition from medical tourism and the rapid growth in the number of undocumented aliens requiring care represent just two challenges healthcare organizations face. An international workforce requires leaders to confront the legal, financial, and ethical implications of using foreign-trained personnel. Cross-border institutional arrangements are emerging, drawing players motivated by social responsibility, globalization of competitors, growth opportunities, or an awareness of vulnerability to the forces of globalization. Forward-thinking healthcare leaders will begin to identify global strategies that address global pressures, explore the opportunities, and take practical steps to prepare for a flatter world.

Differential effectiveness in patient protection laws: what are the causes? An example from the drive-through delivery laws.

In the mid-1990s, many states as well as the federal government began to regulate early postpartum hospital discharge. Length-of-stay patterns changed markedly in response, but effects were much greater in some states than others. In particular, laws directly empowering patients appeared more effective than laws requiring providers to follow practice guidelines. In addition, the effectiveness of regulation could potentially be influenced by state environment, such as managed care penetration as well as exposure to media attention and public pressure on the issue, though these factors alone were insufficient to cause general behavior change. Furthermore, the 1996 federal law had little effect beyond state laws, suggesting that it did not provide substantial benefits to women in self-insured plans exempted from state law regulation by the Employee Retirement Income Security Act. Findings from this study could provide lessons for similar patient protection initiatives.

Exclusion of international medical graduates from federal health-care programs.

BACKGROUND: The professional standards of international medical graduates have been the subject of controversy, but empirical research on this topic has been limited. OBJECTIVES: This report considers whether international medical graduates are at greater risk than US medical graduates for exclusion by the federal government from federally funded programs, such as Medicare and Medicaid. RESEARCH DESIGN: The list of excluded physicians was merged with data regarding 87,729 family and general practice physicians from the American Medical Association Physician Masterfile, 555 of whom were currently excluded. Logistic regression was used to estimate the effect of international medical graduate status on the probability of exclusion, controlling for board-certification status and other physician characteristics. International medical graduates from high-income Organization for Economic Cooperation and Development (OECD) countries are distinguished from other international medical graduates. RESULTS: The adjusted exclusion rates of international medical graduates from OECD countries were similar to that of US medical graduates. Among board-certified physicians, the relative risk of exclusion of non-OECD international medical graduates was 2.19 (P <0.001) compared with US medical graduates. Board certification had an even stronger association: US medical graduates who had never been board certified had a relative risk of 4.12 (P <0.001) compared with board-certified US medical graduates. The never board-certified relative risk was 1.72 (P <0.001) among non-OECD international medical graduates compared with board-certified graduates. Among physicians who had never been board certified, rates of US and international medical graduates did not differ substantially. CONCLUSIONS: Further investigation is needed regarding the causal determinants of exclusion disparities. It is unclear to what extent these disparities may reflect differences in ethical conduct, quality of care, or prejudicial enforcement practices, and the extent to which board certification can causally reduce actions leading to exclusion.