Amy E. Wallace

Racial, Socioeconomic, and Rural–Urban Disparities in Obesity-Related Bariatric Surgery

BackgroundMorbid obesity is associated with serious health and social consequences, high medical costs and is increasing in the USA, particularly among rural, socioeconomically disadvantaged populations. Bariatric surgery more often provides significant long-term weight loss than traditional weight loss treatments. We examined the likelihood of bariatric surgery among morbidly obese patients across rural/urban locales, racial/ethnic groups, insurance categories, socioeconomic, and comorbidity levels.MethodsWe examined 159,116 records representing 774,000 patients with morbid obesity from the 2006 Nationwide Inpatient Sample. We determined the likelihood, expressed in odds ratios, of bariatric surgery associated with each patient characteristic using survey-weighted univariate logistic regression. We also performed multivariate logistic regression, assuming all patient factors were independent.ResultsAfter adjusting for patient-level characteristics, the most rural residents were 23% less likely to receive bariatric surgery than urban residents. Other demographic features associated with significantly lower odds ratios for bariatric surgery included minority status, male gender, lower income, older age, non-private insurance status, and higher comorbidity. Rural-dwelling patients who are non-white, male, poorer, older, sicker, and non-privately insured almost never received bariatric surgery (OR = 0.0089).ConclusionsThough obesity is more prevalent among middle-aged, rural, economically disadvantaged, and racial/ethnic minority populations, these patients are unlikely to access bariatric surgery. Because obesity is a leading cause of preventable morbidity and mortality in the USA, effective treatments should be made available to all patients who might benefit. Current Medicare/Medicaid policies that reimburse only high volume centers may effectively deny rural residents who rely on these insurance programs for bariatric surgery.

The more things change: revisiting a comparison of educational costs and incomes of physicians and other professionals.

The authors previously compared the 1990 educational costs and incomes of physicians and other professional groups. Since then, there have been dramatic changes in the market for the groups examined. This article reports their update of the previous analysis, using 1997 data. For this update, the authors applied standard financial techniques to expected incomes and educational costs to determine the return on educational investment over the working lifetime for five professional groups: primary care physicians, procedure-based physicians, dentists, attorneys, and graduates of the top 20 business schools. The hours-adjusted net present values of the educational investments for attorneys (

Readability of British and American medical prose at the start of the 21st century

10.73) and procedure-based physicians (

Long-term financial implications of specialty training for physicians

10.40) are considerably higher than those for dentists (

Return on Educational Investment in Geriatrics Training

8.90) and businessmen (

Tort Claims Analysis in the Veterans Health Administration for Quality Improvement

8.27); the return for primary care physicians (

Race and gender differences in general internists' annual incomes.

5.97) remains much lower than all others. Primary care physicians have an hours-adjusted internal rate of return on their educational investment equal to 16%, compared with 18% for procedure-based medicine, 22% for dentistry, 23% for law, and 26% for business. Although it remains the lowest of all professional groups examined, primary care medicine has made the largest percentage gain in net present value of all groups. Although anticipated changes in physician incomes have occurred, the standing of physicians relative to other professional groups has not changed. Students can still anticipate relatively poorer returns on their educational investment when they choose a career in primary care medicine as compared with careers in procedure-based medicine or surgical specialties, business, law, or dentistry.

Comparing the Characteristics, Utilization, Efficiency, and Outcomes of VA and Non-VA Inpatient Care Provided to VA Enrollees : A Case Study in New York

Articles published in the BMJ and JAMA are available on the internet, albeit for a fee in the case of JAMA . We wanted to determine whether the materials published by these two pre-eminent journals, while physically accessible to a broad population, are likely to be comprehensible to them. We obtained electronic versions of articles from the BMJ and JAMA published in the first six months of 2001. We limited our analysis to articles that were published as “Papers” in the BMJ or “Original Papers” in JAMA , had structured abstracts, and had first authors with either British or US institutional affiliations. The BMJ published 42 such articles and JAMA 68. For each article, we noted the national affiliation of the first listed author. We used Readability Calculations software from Micro Power and …

Rural Veterans and Access to High-Quality Care for High-Risk Surgeries

PURPOSE Given the recent changes in physician reimbursement and managed care penetration, we examined the financial returns that might be anticipated when considering different medical careers. METHODS We used survey data from the American Medical Association and standard financial techniques to calculate the return on educational investment (as the discounted, annual hours-adjusted, net present value of additional training) over a working lifetime for six different specialties (family practice, pediatrics, general internal medicine, gastroenterology, cardiology, and general surgery). RESULTS From 1992 to 1998, the annual yield on specialty training (hours-adjusted internal rate of return) declined for all specialty groups, especially for primary care specialties. The difference in the average income between a given specialty and general practice decreased for general internal medicine, from

Thiamine treatment of chronic hepatitis B infection

5400 (95% confidence interval [CI]: