Kathleen E. Ellsbury

Gender Differences in Practice Characteristics of Graduates of Family Medicine Residencies.

A survey of 310 graduates of eight university-affiliated family medicine residencies in the northwestern United States conducted in 1985 revealed several significant differences between male and female graduates. The female graduates were significantly (p less than .05) more likely than male graduates to practice in urban settings, taking salaried positions, and work in nonprivate practice. With regard to practice content the women spent significantly (p less than .01) more time in the office setting, worked fewer hours per week in direct patient care, and reported doing fewer complex procedures in their practice than did the men. The women were more satisfied than the men with their income but equally satisfied as the men with their professional and personal lives. There were no significant gender differences with regard to concerns about liability and hospital privileges. The women felt significantly (p less than .05) less well prepared in several subject areas, especially surgical areas; hierarchical multiple-regression analysis showed that this difference persisted when analysis controlled for community size and practice setting. Possible explanations and implications are proposed.

Perceptions of Practice Among Rural Family Physicians—Is There a Gender Difference?

Background: Women physicians are relatively less likely to practice in rural areas. The purpose of this study was to describe differences in perceptions of rural practice between male and female physicians currently in rural practice. Methods: A questionnaire was developed from interviews with rural family physicians and mailed to 118 randomly selected board-certified family physicians in rural towns of the northwestern United States. Results: Responses from 63 physicians were analyzed quantitatively and qualitatively. Female family physicians were more likely than their male counterparts to agree they had been attracted by the availability of part-time work and by opportunities for their personal partner. Compared with men, women were more likely to expect to earn less in rural than in urban practice. On open-ended questions analyzed using qualitative methods, women were more likely to report discouragement by professional isolation and by potential lack of privacy in rural areas. Conclusions: These responses suggest that during recruitment efforts rural communities might be able to attract more female physicians by offering flexible schedules, spouse or partner opportunities, role boundaries, and professional or personal support networks.

The shift to primary care: emerging influences on specialty choice.

No abstract available.

A survey of the attitudes of physician specialists toward capitation-based health plans with primary care gatekeepers.

A survey of 414 Washington state physicians board certified in one of seven non-primary care specialties (gastroenterology, cardiology, dermatology, otolaryngology, orthopedics, psychiatry, and general surgery) assessed physician attitudes towards capitation-based health plans with primary care gatekeepers. Responses indicated significant differences in attitude according to specialty. Negative attitudes were more prevalent among physicians in solo practices and those practicing in smaller communities and were related to quality of care provided, lack of information regarding benefits, loss of physician autonomy, and heavy administrative demands in these plans. Although most respondents disapproved of capitation-based health plans, a significant number agreed that gatekeeper-based plans serve to increase public awareness about health care costs as well as to control health care costs.

Competing professionalism values among community-based family physicians.

Background Professionalism has received considerable attention in recent years, mostly within academic settings. Little attention has been given to the perspectives of practicing physicians on professionalism. This study was designed to determine whether prevailing definitions of and guidelines for professionalism accurately reflect the perspectives and experiences of practicing community-based family physicians. Method Eighteen practicing family physicians in Seattle were recruited from nonacademic settings to participate in focus groups during 2003. Transcripts were analyzed for content themes related to professionalism. Results Analysis revealed several tensions among values that the physician participants described balancing in their practices. Balancing organizational expectations and individual physician or patient values was a major source of tension. Conclusions Practicing family physicians describe various tensions as they attempt to balance their own values with competing values of their patients, the organizations for which many work, and stated values of their profession. Such tensions among values have seldom been described in past literature and should be considered in designing medical curricula at all levels.

Lay Opinions Regarding Capitation-Based Health Care Plans

Capitation-based health care plans typically pay health care providers a fixed amount per enrollee per month to provide needed health care. Cited benefits of such plans include the reduction of unnecessary medical interventions, better coordination of patient care, and increased provider awareness of costs.1,2 Physicians in past studies have expressed concerns about capitation-based plans limiting patient access to care, reducing physician autonomy, threatening the physicianpatient relationship, and decreasing the quality of health care.1-5 To our knowledge, the depth of understanding and the beliefs of the lay population regarding the concept of capitation have not been published. Given the importance placed on capitation-based reimbursement in health care reform proposals, lay population views about the concept of capitation deserve attention. The hypotheses tested in this study were, first, that the lay population would be largely unaware of the nature of capitation-based plans and, second, that they would hold a generally negative view of the concept of capitation.

The Economic Impact of a Primary Care Clinic-Reply

In Reply.— The issue raised by Dr Kolodzik is most appropriate and we appreciate the opportunity to respond. Indeed, the actual revenues derived from billings are dependent on the patients insurance coverage, or lack thereof. The declining reimbursement levels for government-sponsored insurance programs, especially Medicaid, certainly affect the collection rate. At the time of the study, the overall collection rates, including contractual allowances, for hospital charges and professional fees were 86% and 60%, respectively. The issue of reimbursement notwithstanding, the article points out that a family practice (primary care) clinic can provide medical care at relatively lower cost and at the same time be a source of patients and revenues for the sponsoring hospital and its subspecialty consultants. In other words, it illustrates in concrete terms the value of a primary care referral base.