A randomized trial of the impact of certified mail on response rate to a physician survey, and a cost-effectiveness analysis.

This study's goals were to (a) determine whether sending a survey by certified mail results in a higher response rate from physicians compared to sending by first-class mail and (b) evaluate the cost-effectiveness of this method. The study sample was 409 physicians who were nonrespondents to two previous mailings of a medical specialty society survey. Eligible physicians were designated at random to receive a final mailing either by U.S. Postal Service certified mail including a return-receipt postcard or by first-class mail. There was a higher response rate from the certified mail group compared with the first-class mail group (41.3% versus 24.8%; relative risk = 1.66, 95% Confidence interval 1.25, 2.21). A cost-effectiveness analysis showed that the cost per respondent was higher using certified mail versus first-class mail in the third mailing ($2.77 versus $2.34). Thus, use of certified mail is effective in increasing survey response but more costly.

US neurologists: attitudes on the US health care system.

Because the American Academy of Neurology (AAN) exists to represent the views and needs of neurologists, a mailed survey to a randomly selected sample of 520 US-based, board-certified or board-eligible neurologist members was conducted in early 1995 to determine their attitudes in four key changing areas of the US health care system: (1) provision of neurologic care, (2) neurology workforce, (3) academic research, industry sponsorship, and pharmaceutical issues, and (4) health care delivery systems issues. Frequency distributions of degree of agreement and disagreement with 40 statements regarding issues in these four areas were tabulated for the entire group of 430 respondents (response rate = 83%). Associations between these attitudes and six demographic and practice variables (age, gender, board certification, practice type, degree of managed care, and geographical region) were evaluated in an exploratory analysis. The high response rate to the survey and the similarity in demographic and practice characteristics of respondents to the entire US-based, board-certified or -eligible AAN membership support that the attitudes that were measured are likely to be representative of US neurologists, excluding resident trainees. The survey results show that neurologists are deeply concerned that patients with chronic neurologic disorders are not receiving all the neurologic services they need. Respondent show uncertainty about whether there is a current oversupply of neurologists but generally agree that there are too many neurology residency positions. Neurologists support industry sponsorship of academic medical center research and new drug development. With respect to many of the current mechanisms for health care cost containment, respondents indicate they have little confidence that these strategies are in the best interests of patients or physicians. The survey results confirm that there is no consensus among US neurologists on how to improve today's health care delivery system, and the results suggest that certain attitudes are related to neurologists' demographic and practice characteristics. Since today's health care market is volatile, regular assessments of neurologists' attitudes will be needed to assure that their views are understood and clearly represented by the AAN.

Neurologists--1991 to 1992. Human Resources in Neurology Subcommittee of the American Academy of Neurology.

The American Academy of Neurology (AAN) membership survey was developed to define and monitor changing trends in the demography and practice profile of US neurologists. All 11,300 AAN members received a Demographic Information Form (DIF) and 2,600 members also received a Practice Profile Form (PPF) to gather this information. Response rates were 75% from the DIF group and 70% from those who received both. For responding members, age (median, 43 years), sex (83% male), race/ethnic origin (85% white), and medical schools (22% international medical graduates) are similar to those for other physicians in the United States. The ratio of neurologists to population ranges from a low of 1.3 per 100,000 in Wyoming to a high of 11.0 per 100,000 in the District of Columbia. One-fourth of neurologists complete at least one residency in addition to neurology and 39% complete a fellowship. Although nearly two-thirds (63%) of neurologists have a full-time or clinical academic appointment, 70% indicate patient care as their primary medical activity. The number of working hours and professional activities of neurologists vary with practice type. Neurologists perform numerous neurodiagnostic tests for reimbursement, particularly neurophysiologic studies and lumbar puncture. One-third of office-based neurologists have an ownership interest in an imaging facility. The most common payment sources for professional fees are commercial insurers (32%) and Medicare (29%), the latter reflecting the large proportion of disabled and elderly treated by neurologists. Office-based neurologists provide 5% charity care and write off an additional 13% of unpaid charges. The practice of neurology is constantly changing.(ABSTRACT TRUNCATED AT 250 WORDS)