Richard P. Shugerman

The Work Lives of Women Physicians

AbstractOBJECTIVE: To describe gender differences in job satisfaction, work life issues, and burnout of U.S. physicians. DESIGN/PARTICIPANTS: The Physician Work life Study, a nationally representative random stratified sample of 5,704 physicians in primary and specialty nonsurgical care (N=2,326 respondents; 32% female, adjusted response rate=52%). Survey contained 150 items assessing career satisfaction and multiple aspects of work life. MEASUREMENTS AND MAIN RESULTS: Odds of being satisfied with facets of work life and odds of reporting burnout were modeled with survey-weighted logistic regression controlling for demographic variables and practice characteristics. Multiple linear regression was performed to model dependent variables of global, career, and specialty satisfaction with independent variables of income, time pressure, and items measuring control over medical and workplace issues. Compared with male physicians, female physicians were more likely to report satisfaction with their specialty and with patient and colleague relationships (P<.05), but less likely to be satisfied with autonomy, relationships with community, pay, and resources (P<.05). Female physicians reported more female patients and more patients with complex psychosocial problems, but the same numbers of complex medical patients, compared with their male colleagues. Time pressure in ambulatory settings was greater for women, who on average reported needing 36% more time than allotted to provide quality care for new patients or consultations, compared with 21% more time needed by men (P<.01). Female physicians reported significantly less work control than male physicians regarding day-to-day aspects of practice including volume of patient load, selecting physicians for referrals, and details of office scheduling (P<.01). When controlling for multiple factors, mean income for women was approximately

The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group.

22,000 less than that of men. Women had 1.6 times the odds of reporting burnout compared with men (P<.05), with the odds of burnout by women increasing by 12% to 15% for each additional 5 hours worked per week over 40 hours (P<.05). Lack of workplace control predicted burnout in women but not in men. For those women with young children, odds of burnout were 40% less when support of colleagues, spouse, or significant other for balancing work and home issues was present. CONCLUSIONS: Gender differences exist in both the experience of and satisfaction with medical practice. Addressing these gender differences will optimize the participation of female physicians within the medical workforce.

Prehospital endotracheal intubation of children by paramedics

AbstractOBJECTIVE: To describe gender differences in job satisfaction, work life issues, and burnout of U.S. physicians. DESIGN/PARTICIPANTS: The Physician Work life Study, a nationally representative random stratified sample of 5,704 physicians in primary and specialty nonsurgical care (N=2,326 respondents; 32% female, adjusted response rate=52%). Survey contained 150 items assessing career satisfaction and multiple aspects of work life. MEASUREMENTS AND MAIN RESULTS: Odds of being satisfied with facets of work life and odds of reporting burnout were modeled with survey-weighted logistic regression controlling for demographic variables and practice characteristics. Multiple linear regression was performed to model dependent variables of global, career, and specialty satisfaction with independent variables of income, time pressure, and items measuring control over medical and workplace issues. Compared with male physicians, female physicians were more likely to report satisfaction with their specialty and with patient and colleague relationships (P<.05), but less likely to be satisfied with autonomy, relationships with community, pay, and resources (P<.05). Female physicians reported more female patients and more patients with complex psychosocial problems, but the same numbers of complex medical patients, compared with their male colleagues. Time pressure in ambulatory settings was greater for women, who on average reported needing 36% more time than allotted to provide quality care for new patients or consultations, compared with 21% more time needed by men (P<.01). Female physicians reported significantly less work control than male physicians regarding day-to-day aspects of practice including volume of patient load, selecting physicians for referrals, and details of office scheduling (P<.01). When controlling for multiple factors, mean income for women was approximately

Teaching professionalism to residents.

22,000 less than that of men. Women had 1.6 times the odds of reporting burnout compared with men (P<.05), with the odds of burnout by women increasing by 12% to 15% for each additional 5 hours worked per week over 40 hours (P<.05). Lack of workplace control predicted burnout in women but not in men. For those women with young children, odds of burnout were 40% less when support of colleagues, spouse, or significant other for balancing work and home issues was present. CONCLUSIONS: Gender differences exist in both the experience of and satisfaction with medical practice. Addressing these gender differences will optimize the participation of female physicians within the medical workforce.

Misrepresentation of authorship by applicants to pediatrics training programs

STUDY OBJECTIVE To describe the experience of an emergency medical services system with the use of liberal indications for prehospital pediatric endotracheal intubation. METHODS We performed a retrospective review of prehospital and hospital patient records in an urban and suburban prehospital care system. The study included all children aged 15 years or younger who were intubated in the prehospital setting by King County paramedics from January 1, 1984, to December 31, 1990. RESULTS During the 7-year study period, 654 children were intubated, of which 355 (54%) were study patients. The median age of the patients was 3 years; 60% had an injury diagnosis. On arrival of the paramedics, 60% of the patients were in sinus rhythm, 62% had a systolic blood pressure of 70 mm Hg or greater, and 56% had a respiratory rate of 10 breaths per minute or greater. The Glasgow Coma Scale score was 8 or lower in 83% of the patients. Succinylcholine was used to facilitate intubation in 47% of patients. On arrival at the emergency department, 79% of the patients were in sinus rhythm; 75% had an adequate blood pressure (70 mm Hg or greater); 86% had a PaO2 value of 100 mm Hg or greater; and 74% had a PaCO2 value of 45 mm Hg or lower. Complications of intubation, more than half of which were classified as minor, were noted in 22.6% of patients. We were unable to determine the number of failed intubation attempts. Most of the patients (58%) survived to hospital discharge. Among cardiac arrest victims, only 12% survived. CONCLUSION In a setting where paramedics practice with close medical direction, applying liberal indications for pediatric intubation and permitting the use of succinylcholine allowed paramedics to intubate children of different ages and diagnoses.

The Diagnosis of Intussusception

The need to teach professionalism during residency has been affirmed by the Accreditation Council for Graduate Medical Education, which will require documentation of education and evaluation of professionalism by 2007. Recently the American Academy of Pediatrics has proposed the following components of professionalism be taught and measured: honesty/integrity, reliability/responsibility, respect for others, compassion/empathy, self-improvement, self-awareness/knowledge of limits, communication/collaboration, and altruism/advocacy. The authors describe a curriculum for introducing the above principles of professionalism into a pediatrics residency that could serve as a model for other programs. The curriculum is taught at an annual five-day retreat for interns, with 11 mandatory sessions devoted to addressing key professionalism issues. The authors also explain how the retreat is evaluated and how the retreats topics are revisited during the residency, and discuss general issues of teaching and evaluating professionalism.

Pediatrician workforce statement

PURPOSE: To determine whether applicants to pediatrics residency and fellowship programs misrepresented authorship of publications. METHOD: The authors sampled 1995 applications to the University of Washington School of Medicines pediatrics residency program and pediatrics pulmonary fellowship program. They submitted all publications claimed in the submitted applications to extensive efforts to authenticate both their existence and authorship. RESULTS: Among the 404 pediatrics residency program applications studied, 147 claimed authorship of publications; 29 (19.7%) of these contained at least one unverifiable publication. Of the 401 publications claimed in the 147 applications, 41 (10.2%) could not be confirmed. Among 31 fellowship applications, 14 claimed publications. At least one citation was unverifiable for each of the 14 applications. Of the total 77 publications claimed, 31 (40%) could not be confirmed. CONCLUSION: Misrepresentation occurs on graduate medical education applications; solutions are needed to address this problem.

Enhancing the diversity of the pediatrician workforce.

The aims of this study were to identify features in the history, physical examination, and radiologic studies that were associated with the diagnosis of intussusception and to determine if there was a subset of patients being evaluated for intussusception who can be spared from undergoing a contrast enema based on a combination of historical, clinical, and radiographic findings. A retrospective cohort study at a regional children’s hospital emergency department (ED) was conducted. Mean age was 1.2 years among both those with and without intussusception. Predictors of intussusception in the univariate analysis included history of vomiting (P=0.02), abdominal pain (P=0.1), and rectal bleeding (P=0.003); physical examination findings of abdominal mass (P<0.001), abdominal tenderness (P=0.02), and guiac positive stool (P=0.004); and plain radiograph finding of the absence of stool in the ascending colon (P<0.05). We were unable to develop a prediction model that would reliably identify all patients with the diagnosis of intussusception. Previously identified predictors of intussusception remain important in increasing suspicion of this important diagnosis. At this point there is no reliable prediction model that can accurately identify all patients with intussusception. A prospective study may aid in the development of a clinically more useful model.

Professionalism and the Match: A Pediatric Residency Program's Postinterview No-Call Policy and Its Impact on Applicants

This statement discusses the importance of pediatrician-workforce issues and their relevance to the provision of pediatric health care. It reviews previous work in the health policy arena on physician and pediatrician workforce. Key pediatrician-workforce trends are described, including the growth in the number of pediatricians in relation to the child population, the increase in the number of female pediatricians, the role of international medical graduates, the diversity of the pediatrician workforce, the contributions of internal medicine-pediatrics physicians, the increasing number of nonpediatrician providers of pediatric care, geographic distribution of physicians, and the future of pediatric subspecialists. Methods of influencing the pediatrician workforce are also considered. In the concluding series of recommendations, the statement identifies both overarching policy goals for the pediatrician workforce and implementation strategies designed to ensure that all of Americas infants, children, adolescents, and young adults have access to appropriate pediatric health care.

Risk factors for childhood sledding injuries: a case-control study.

This policy statement describes the key issues related to diversity within the pediatrician and health care workforce to identify barriers to enhancing diversity and offer policy recommendations to overcome these barriers in the future. The statement addresses topics such as health disparities, affirmative action, recent policy developments and reports on workforce diversity, and research on patient and provider diversity. It also broadens the discussion of diversity beyond the traditional realms of race and ethnicity to include cultural attributes that may have an effect on the quality of health care. Although workforce diversity is related to the provision of culturally effective pediatric care, it is a discrete issue that merits separate discussion and policy formulation. At the heart of this policy-driven action are multiorganizational and multispecialty collaborations designed to address substantive educational, financial, organizational, and other barriers to improved workforce diversity.