Ed Baker

Association of “Grit” and Satisfaction in Rural and Nonrural Doctors

Background: One potential psychological construct, grit, may help to explain the non-cognitive traits that account for both rural physician satisfaction and retention. We investigated (1) the psychological construct grit among rural and non-rural primary care/specialty care physicians, (2) satisfaction levels and (3), the relationship between the psychological construct grit and satisfaction across combinations of rural/non-rural and primary care/specialty care physicians. Methods: We mailed a cross-sectional questionnaire to 2126 active members of the Idaho Medical Association and Idaho Academy of Family Physicians measuring their self-reported level of grit, satisfaction level and area of specialty. Results: We received responses from 564 physicians (26.5%). Idaho physicians have relatively uniform levels of grit independent of specialty or practice location. Specialty care physicians reported significantly higher levels of ambition, regardless of practice location. Most physicians were satisfied with their practice (91.7%). Specialty care physicians reported a significantly higher difference in their levels of satisfaction with their practice compared to primary care physicians. Conclusions: Idaho primary care and specialty care physicians in both rural and non-rural settings reports themselves as individuals who work hard, persevere despite setbacks, and are ambitious. Furthermore, Idaho physicians are satisfied with their current practices.

Preventing Employee Injury: Implementation of a Lift Team

A lift team was implemented at an urban medical center in the Pacific Northwest to reduce employee injuries. The lift team consisted of a lift technician and a nursing assistant both trained in lifting techniques. The trial lasted 1 year. Data on employee injuries and day versus night injuries before and during lift team implementation are presented. Results do not show the same reduction in employee injuries described by previous authors. Possible explanations are related to the use of the lift team and policy development.

Investigating Carbon Monoxide Exposure on Denali

Abstract Objective.—This exploratory study assessed a potential relationship between elevated carboxyhemoglobin (COHb) levels and acute mountain sickness (AMS) at 4300 m on Denali. Additional analysis assessed the relationship among COHb levels, AMS, and climber characteristics and behaviors. Methods.—Participants were screened for AMS with the Lake Louise Self-Report questionnaire and answered questions focusing on AMS symptoms, prevention, and previous altitude illness. Levels of COHb were measured by serum cooximetry. Additional questions assessed stove practices, climbing practices, and climber behaviors. Nonparametric statistical analyses were performed to examine potential relationships among COHb levels, AMS symptoms, and climber behaviors. Results.—A total of 146 climbers participated in the study. Eighteen climbers (12.5%) were positive for carbon monoxide (CO) exposure and 20 (13.7%) met criteria for AMS. No significant relationship was observed between positive CO exposure and positive criteria for AMS. Climbers descending the mountain were 3.6 times more likely to meet the study criteria for positive CO exposure compared with those ascending the mountain (P = .42). In addition, COHb levels were significantly higher for those descending the mountain (P = .012) and for those taking prophylactic medications (P = .010). Climbers meeting positive criteria for AMS operated their stoves significantly longer (P = .047). Conclusions.—No significant relationship between AMS symptoms and CO exposure was observed. This may have been affected by the low percentage of climbers reporting AMS symptoms, as well as limited power. Descending climbers had a 3.6 times increased risk of CO exposure compared with ascending climbers and had significantly higher COHb scores. Increased hours of stove operation was significantly linked to climbers who also met criteria for AMS.

Carbon Monoxide Exposure on Denali: Comparing the 2004 and 2005 Climbing Seasons

Abstract Objective.—This study assessed a potential relationship between elevated carboxyhemoglobin (COHb) levels and the presence of acute mountain sickness (AMS) at 4300 m on Denali and evaluated the relationship between COHb levels, AMS, and climber characteristics and behaviors. Building on our research done in 2004, in this article we report further data gathered during the 2005 climbing season and evaluate the combined results. Methods.—Participants were screened for AMS using the Lake Louise Self-Report Questionnaire and answered questions focusing on AMS symptoms, AMS prevention, and previous history of altitude illness. Carboxyhemoglobin levels were measured by serum co-oximetry. Additional questions assessed stove practices, climbing practices, and climber behaviors. Nonparametric statistical analyses were performed to examine potential relationships between COHb levels, AMS symptoms, and climber behaviors across the 2 years and with years combined. Results.—Overall, 317 climbers participated in the 2-year study. As in 2004, the combined data demonstrated no relationship between positive carbon monoxide (CO) exposure and positive criteria for AMS (P = .276). Climbers in 2005 were 1.92 times more likely to meet positive criteria for AMS, compared to climbers in 2004 (P = .028). On the contrary, climbers in 2004 were 3.93 times more likely to be CO exposed than climbers in 2005 (P = .003). Overall, climbers descending the mountain were more likely to be positive for CO exposure (5.56 times more likely than ascending climbers, P = .002) and to have higher overall mean COHb levels (2.26% descending vs 0.93% ascending, P = .006). The previous association between increased stove use and climbers who met positive criteria for AMS was not observed in the 2005 or in the combined data (P = .715). A relationship was observed between increased hours of operating stoves and increased COHb levels (P = .002). Female climbers were 2.041 times more likely to meet criteria for AMS (P = .043). Conclusions.—No relationship between AMS symptoms and CO exposure was observed. As found in our initial study, descending climbers had higher overall COHb levels and an increased risk of CO exposure (COHb of >3% in nonsmokers and >10% in smokers). Also, increased hours of stove operation was linked to climbers who had elevated COHb levels.

Assessing Idaho Rural Family Physician Scope of Practice Over Time

CONTEXT An important consideration determining health outcomes is to have an adequate supply of physicians to address the health needs of the community. PURPOSE The purpose of this investigation was to assess scope of practice factors for Idaho rural family physicians in 2012 and to compare these results to findings from a 2007 study. METHODS The target population in this study was rural family physicians in Idaho counties with populations of fewer than 50,000. Identical surveys and methods were utilized in both 2007 and 2012. RESULTS The physician survey was mailed to 252 rural physicians and was returned by 89 for a response rate of 35.3%. Parametric and nonparametric statistical analyses were conducted to analyze the 2012 results and to assess changes in scope of practice across the time periods. DISCUSSION The percentage of rural family physicians in Idaho in 2012 who provided prenatal care, vaginal deliveries, and nursing home care was significantly lower than the results from the 2007 survey. Female physicians were more likely to provide prenatal care and vaginal deliveries than males in 2012. Male physicians were more likely to provide emergency room coverage and esophagogastroduodenoscopy or colonoscopy services than females in 2012. Younger physicians were found to be more likely to provide inpatient admissions and mental health services in 2012 than older physicians. Employed physicians were more likely to provide cesarean delivery, other operating room services and emergency room coverage in 2012 than nonemployed physicians. Further research is needed to assess the root causes of these changes.