Kristie Keeton

Predictors of physician career satisfaction, work-life balance, and burnout

OBJECTIVE: To explore factors associated with physician career satisfaction, work–life balance, and burnout focusing on differences across age, gender, and specialty. METHODS: A cross-sectional, mailed, self-administered survey was sent to a national sample of 2,000 randomly-selected physicians, stratified by specialty, age, and gender (response rate 48%). Main outcome measures included career satisfaction, burnout, and work–life balance. Scales ranged from 1 to 100. RESULTS: Both women and men report being highly satisfied with their careers (79% compared with 76%, P<.01), having moderate levels of satisfaction with work–life balance (48% compared with 49%, P=.24), and having moderate levels of emotional resilience (51% compared with 53%, P=.09). Measures of burnout strongly predicted career satisfaction (standardized β 0.36–0.60, P<.001). The strongest predictor of work–life balance and burnout was having some control over schedule and hours worked (standardized β 0.28, P<.001, and 0.20–0.32, P<.001, respectively). Physician gender, age, and specialty were not strong independent predictors of career satisfaction, work–life balance, or burnout. CONCLUSION: This national physician survey suggests that physicians can struggle with work–life balance yet remain highly satisfied with their career. Burnout is an important predictor of career satisfaction, and control over schedule and work hours are the most important predictors of work–life balance and burnout. LEVEL OF EVIDENCE: II

Indications for induction of labour: a best‐evidence review

Background  Rates of labour induction are increasing.

Methods of induction of labour: A systematic review

BackgroundRates of labour induction are increasing. We conducted this systematic review to assess the evidence supporting use of each method of labour induction.MethodsWe listed methods of labour induction then reviewed the evidence supporting each. We searched MEDLINE and the Cochrane Library between 1980 and November 2010 using multiple terms and combinations, including labor, induced/or induction of labor, prostaglandin or prostaglandins, misoprostol, Cytotec, 16,16,-dimethylprostaglandin E2 or E2, dinoprostone; Prepidil, Cervidil, Dinoprost, Carboprost or hemabate; prostin, oxytocin, misoprostol, membrane sweeping or membrane stripping, amniotomy, balloon catheter or Foley catheter, hygroscopic dilators, laminaria, dilapan, saline injection, nipple stimulation, intercourse, acupuncture, castor oil, herbs. We performed a best evidence review of the literature supporting each method. We identified 2048 abstracts and reviewed 283 full text articles. We preferentially included high quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised or quasi-randomised trials.ResultsWe included 46 full text articles. We assigned a quality rating to each included article and a strength of evidence rating to each body of literature. Prostaglandin E2 (PGE2) and vaginal misoprostol were more effective than oxytocin in bringing about vaginal delivery within 24 hours but were associated with more uterine hyperstimulation. Mechanical methods reduced uterine hyperstimulation compared with PGE2 and misoprostol, but increased maternal and neonatal infectious morbidity compared with other methods. Membrane sweeping reduced post-term gestations. Most included studies were too small to evaluate risk for rare adverse outcomes.ConclusionsResearch is needed to determine benefits and harms of many induction methods.

The impact of medical legal risk on obstetrician-gynecologist supply.

OBJECTIVE: To evaluate the effects of medical legal risk on practice location of obstetrician–gynecologists. METHODS: We used the American College of Obstetricians and Gynecologists (ACOG) Membership Record to determine the number of Fellows and Junior Fellows by state. We obtained state malpractice premiums from the Medical Liability Monitor and state birth rates from the National Center for Health Statistics. The American Medical Association (AMA) “Crisis” and ACOG “Red Alert” designations, as well as state malpractice premium levels, were used to approximate malpractice risk. We examined the changes in state births to obstetrician–gynecologist rates from 1995 to 2003 by using the Student t test and Mann-Whitney tests. Comparisons were made between states of different risk levels. RESULTS: We found no significant difference in the percentage changes in births per Fellow or births per Junior Fellow between AMA “Crisis” and remaining states, nor between ACOG “Red Alert” and Safe states. The percentage changes in births per Fellow were similar in the 10 highest-premium states and the 10 lowest-premium states. The percentage increase in births per Junior Fellow in the 10 highest-premium states was significantly greater than the 10 lowest-premium states (median 28.5% versus 5.0%, P = .03). CONCLUSION: Malpractice premiums appear to influence practice location of new obstetrician–gynecologists. Neither the AMA designation of “Crisis” nor the ACOG designation of “Red Alert” had supply implications in the analysis. More research on the interaction of malpractice rates and obstetrician–gynecologist supply is needed for informed decisions regarding malpractice premium management. LEVEL OF EVIDENCE: II-3

The Effect of the Family Case Management Program on 1996 Birth Outcomes in Illinois

OBJECTIVES The purpose of this study was to determine if birth outcomes for Medicaid recipients were improved with participation in the Illinois Family Case Management Program. METHODS Health program data files were linked with the 1996 Illinois Vital Records linked birth-death certificate file. Logistic regression was used to characterize the variation in birth outcomes as a function of Family Case Management participation while statistically controlling for measurable factors found to be confounders. RESULTS Results of the logistic regression analysis show that women who participated in the Family Care Management Program were significantly less likely to give birth to very low birth weight infants (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.75, 0.99) and low birth weight infants (OR = 0.83, CI = 0.79, 0.89). For infant mortality, however, the adjusted OR (OR = 0.98, CI = 0.82, 1.17), although under 1, was not statistically significant. CONCLUSIONS These results suggest that the Family Case Management Program may be effective in reducing very low birth weight and low birth weight rates among infants born to low-income women.