scholarly journals HIV Care by Early-Career Family Physicians

2021 ◽  
Vol 53 (9) ◽  
pp. 760-765
Author(s):  
Kento Sonoda ◽  
Zachary J. Morgan ◽  
Lars E. Peterson
Keyword(s):  
Family Medicine ◽  
Family Physicians ◽  
Personal Characteristics ◽  
Female Gender ◽  
Hiv Prevalence ◽  
Early Career ◽  
Hiv Care ◽  
Graduate Survey ◽  
Practice Characteristics ◽  
Current Provision

Background and Objectives: Antiretroviral treatment has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Prior research demonstrated a discrepancy between preparation to provide HIV care and current provision among recent residency graduates. Our study aimed to describe characteristics related to preparedness and provision of HIV care, and to identify the associations between physician and practice characteristics with current provision of HIV care among those prepared. Methods: We obtained data from the 2016 through 2019 American Board of Family Medicine (ABFM) National Family Medicine Graduate Survey. Our main outcome was self-reported provision of HIV care. Bivariate statistics compared differences in personal and practice characteristics with self-reported preparation for HIV care, then among those prepared, provision of HIV care. We used logistic regression to determine associations between HIV care, among those prepared, with practice and personal characteristics. Results: The response rate was 68.7% and our final sample size was 6,740 respondents. Only 25% of respondents reported preparedness in residency, and 44% of them reported current provision. Among those prepared, female gender (OR=0.604; 95% CI, 0.494-0.739) was associated with lower odds of practicing HIV care. Those working in high HIV prevalence areas (OR=1.718; 95% CI, 1.259-2.344) and in Northeast census region (OR=1.557; 95% CI, 1.137-2.132) had higher odds of providing HIV care. Conclusions: Fewer than half of those prepared in residency reported currently providing HIV care. Working in a high HIV prevalence area was associated with higher odds of providing HIV care, which suggests early-career family physicians are responding to community needs.

scholarly journals The Impact of Practicing Obstetrics on Burnout Among Early-Career Family Physicians

2020 ◽  
Vol 52 (6) ◽  
pp. 408-413
Author(s):  
Tyler W. Barreto ◽  
Aimee Eden ◽  
Audrey Brock
Keyword(s):  
Family Medicine ◽  
Family Physicians ◽  
The United States ◽  
Early Career ◽  
Residency Programs ◽  
Complex Patients ◽  
Semistructured Interviews ◽  
Administrative Tasks ◽  
The Impact ◽  
The Relationship

Background and Objectives: According to a previous study, obstetric deliveries may be protective against burnout for family physicians. Analyses of interviews conducted during a larger qualitative study about the experiences of early-career family physicians who intended to include obstetric deliveries in their practice revealed that many interviewees discussed burnout. This study aimed to understand the relationship between practicing obstetrics and burnout based on an analysis of these emerging data on burnout. Methods: We conducted semistructured interviews with physicians who graduated from family medicine residency programs in the United States between 2013 and 2016. We applied an immersion-crystallization approach to analyze transcribed interviews. Results: Fifty-six early-career family physicians participated in interviews. Burnout was an emerging theme. Physicians described how practicing obstetrics can protect from burnout (eg, brings joy to practice, diversity in practice), how it can contribute to burnout (eg, time demands, increased stress), how it can do both simultaneously and the importance of professional agency (ie, the capacity to make own free choices), and other sources of burnout (eg, administrative tasks, complex patients). Conclusions: This study identifies a family medicine-obstetric paradox wherein obstetrics can simultaneously protect from and contribute to burnout for family physicians. Professional agency may partially explain this paradox.

scholarly journals Scope of Practice and Patient Panel Size of Family Physicians Who Work With Nurse Practitioners or Physician Assistants

2019 ◽  
Vol 51 (4) ◽  
pp. 311-318 ◽  
Author(s):  
Mingliang Dai ◽  
Richard C. Ingham ◽  
Lars E. Peterson
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Nurse Practitioners ◽  
Family Physicians ◽  
Physician Assistants ◽  
Scope Of Practice ◽  
Certification Examination ◽  
Panel Size ◽  
Practice Characteristics ◽  
Number Of Patients

Background and Objectives: Little is known about how the presence of nurse practitioners (NPs) and physician assistants (PAs) in a practice impacts family physicians’ (FPs’) scope of practice. This study sought to examine variations in FPs’ practice associated with NPs and PAs. Methods: We obtained data from American Board of Family Medicine practice demographic questionnaires completed by FPs who registered for the Family Medicine Certification Examination during 2013-2016. Scope of practice score was calculated for each FP, ranging from 0-30 with higher numbers equating to broader scope of practice. FPs self-reported patient panel size. Primary care teams were classified into NP only, PA only, both NP and PA, or no NP or PA. We estimated variation in scope and panel size with different team configurations in regression models. Results: Of 27,836 FPs, nearly 70% had NPs or PAs in their practice but less than half (42.5%) estimated a panel size. Accounting for physician and practice characteristics, the presence of NPs and/or PAs was associated with significant increases in panel sizes (by 410 with PA only, 259 with NP only and 245 with both; all P<0.05) and in scope score (by 0.53 with PA only, 0.10 with NP only and 0.51 with both; all P<0.05). Conclusions: We found evidence that team-based care involving NPs and PAs was associated with higher practice capacity of FPs. Working with PAs seemed to allow FPs to see a greater number of patients and provide more services than working with NPs. Delineation of primary care team roles, responsibilities and boundaries may explain these findings.

scholarly journals Opportunities and Barriers for Family Physician Contribution to the Maternity Care Workforce

2019 ◽  
Vol 51 (5) ◽  
pp. 383-388 ◽  
Author(s):  
Tyler W. Barreto ◽  
Aimee Eden ◽  
Elizabeth Rose Hansen ◽  
Lars E. Peterson
Keyword(s):  
Family Medicine ◽  
Family Physicians ◽  
Early Career ◽  
Certification Examination ◽  
Obstetrical Care ◽  
New Graduates ◽  
Middle Atlantic ◽  
South Central ◽  
Central Regions ◽  
Recent Graduates

Background and Objectives: The number of family physicians providing obstetric deliveries is decreasing, but high numbers of new graduates report they intend to include obstetric deliveries in their practices. The objective of this study was to understand barriers to providing obstetrical care faced by recent family medicine residency graduates who intended to provide obstetrical care at graduation. Methods: Email surveys were sent to graduating family medicine residents who indicated intention to include obstetrics in their practice on the American Board of Family Medicine (ABFM) Certification Examination Registration Survey (2014-2016). We used descriptive and bivariate statistics to analyze the data. Results: Of our sample of 2,098 early career family physicians, 1,016 (48.4%) responded. Seven hundred (68.9%) currently include obstetrics in their practices. Those currently including obstetrics were more likely to practice in a small rural or isolated (15.4% vs 5.2% and 4.6% vs 1.7%, P<0.001) community and report credentialing was easy (85.2% and 26.5%, respectively, P<0.001). Physicians not currently including obstetrics in their practice reported “found a job without OB” and “lifestyle concerns” as the most significant barriers. Respondents living in the Middle Atlantic and West South Central regions were least likely to provide obstetric deliveries, with fewer than 50% doing so. Conclusions: Among recent graduates who intended to practice obstetrics, finding a job without obstetrics and lifestyle concerns were the most significant barriers to realizing the scope of practice they intended.

scholarly journals Mindsets of Early-Career Family Physicians Trained in Competency-Based Education

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Mao Ding ◽  
Sudha Koppula ◽  
Olga Szafran ◽  
Lillian Au ◽  
Oksana Babenko
Keyword(s):  
Clinical Practice ◽  
Family Medicine ◽  
Family Physicians ◽  
Well Being ◽  
Early Career ◽  
Survey Study ◽  
Competency Based Education ◽  
Competency Based ◽  
Over Time ◽  
Family Medicine Residents

Introduction: The objective of this study was to examine the mindsets (mastery, performance approach, performance avoidance) of early-career family physicians following graduation from a competency-based education residency program. Methods: This was a longitudinal, cohort, survey study of family medicine residents at a large Canadian university. The 2015-2017 cohort of family medicine residents was surveyed at three time points: (1) at the end of residency training; (2) at 1 year in clinical practice; and (3) at 3 years in clinical practice. We used Baranik et al’s instrument to measure three types of mindsets. We performed descriptive and multivariate analyses using SPSS 26.0 software. Results: Irrespective of the time in practice, mean scores were the highest on the mastery mindset and the lowest on the performance avoidance mindset measures (P<.001). Over time, the mastery mindset scores tended to decrease (P=.04). Conclusion: Family physicians trained in competency-based education continued to be mastery-oriented in the first 3 years of clinical practice. This finding is reassuring given that the mastery mindset is associated with professional well-being and long-term success. Nonetheless, because mastery mindset scores appeared to decrease over time, residency programs need to ensure graduating residents are equipped with knowledge and tools to remain mastery-oriented throughout the course of their professional careers.

scholarly journals Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania

2021 ◽  
Author(s):  
Clare Bristow ◽  
Grace George ◽  
Grace Hillsmith ◽  
Emma Rainey ◽  
Sarah Urasa ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
High Standard ◽  
Female Gender ◽  
Screening Tools ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Diagnostic Tools ◽  
Clinical Frailty Scale ◽  
Frailty Phenotype ◽  
Sub Saharan

Abstract There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.

Psychosocial Beliefs of Medical Students Planning to Specialize in Family Medicine

1997 ◽  
Vol 80 (3) ◽  
pp. 987-992 ◽  
Author(s):  
Fred W. Markham ◽  
James J. Diamond
Keyword(s):  
Internal Medicine ◽  
Medical Students ◽  
Family Medicine ◽  
Family Physicians ◽  
Female Students ◽  
Further Training ◽  
Senior Year ◽  
Family Doctors ◽  
Fourth Year Medical Students ◽  
Belief Scale

The psychosocial orientation of fourth-year medical students planning careers in family medicine was compared to those selecting other specialities using the Physician Belief Scale. This scale has shown that practicing family physicians have a greater psychosocial orientation than those in other specialities such as internal medicine. The current study was done to see whether students choosing family medicine already have this greater orientation before they begin training as residents. 664 fourth-year medical students received surveys during their senior year and 378 (57%) returned completed surveys. Female students had a significantly greater psychosocial orientation than their male peers, but there were no significant differences between students planning residencies in family medicine and those selecting other residencies. The greater orientation of family doctors would appear to be a product of further training and experience either during residency or later during the actual practice of family medicine.

scholarly journals Emergency medicine training demographics of physicians working in rural and regional southwestern Ontario emergency departments

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 449-452 ◽  
Author(s):  
Munsif Bhimani ◽  
Gordon Dickie ◽  
Shelley McLeod ◽  
Daniel Kim
Keyword(s):  
Emergency Medicine ◽  
Family Medicine ◽  
Residency Training ◽  
Emergency Departments ◽  
Training Programs ◽  
Family Physicians ◽  
Demographic Information ◽  
Trauma Resuscitation ◽  
Curriculum Content

ABSTRACT Objectives: We sought to determine the emergency medicine training demographics of physicians working in rural and regional emergency departments (EDs) in southwestern Ontario. Methods: A confidential 8-item survey was mailed to ED chiefs in 32 community EDs in southwestern Ontario during the month of March 2005. This study was limited to nonacademic centres. Results: Responses were received from 25 (78.1%) of the surveyed EDs, and demographic information on 256 physicians working in those EDs was obtained. Of this total, 181 (70.1%) physicians had no formal emergency medicine (EM) training. Most were members of the College of Family Physicians of Canada (CCFPs). The minimum qualification to work in the surveyed EDs was a CCFP in 8 EDs (32.0%) and a CCFP with Advanced Cardiac and Trauma Resuscitation Courses (ACLS and ATLS) in 17 EDs (68.0%). None of the surveyed EDs required a CCFP(EM) or FRCP(EM) certification, even in population centres larger than 50 000. Conclusion: The majority of physicians working in southwestern Ontario community EDs graduated from family medicine residencies, and most have no formal EM training or certification. This information is of relevance to both family medicine and emergency medicine residency training programs. It should be considered in the determination of curriculum content and the appropriate number of residency positions.

scholarly journals Strengthening the Somaliland health system by integrating public and private sector family medicine

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Muna M. Mahfud ◽  
Fathia M. Nour ◽  
Hodan J. Abdi ◽  
Sabah M. Muse ◽  
Tim Fader
Keyword(s):  
Family Medicine ◽  
Private Sector ◽  
Health System ◽  
Healthcare System ◽  
Clinical Care ◽  
Family Physicians ◽  
Public Private Partnerships ◽  
Specialty Training ◽  
Public And Private ◽  
Public And Private Sector

Four family physicians, who received their specialty training at Amoud University in Somaliland, organised a practice together that uses informal public–private partnerships to optimise their clinical care and teaching. Their experience offers insights into public–private partnerships that could strengthen the country’s healthcare system.

scholarly journals Factors Associated with Choice of Career in Family Medicine Among Junior Doctors in Oman

2020 ◽  
Vol 20 (3) ◽  
pp. 337
Author(s):  
Asma Ali Al-Salmani ◽  
Asma Al-Shidhani ◽  
Najlaa Jaafar ◽  
Abdulaziz Al-Mahrezi
Keyword(s):  
Family Medicine ◽  
Career Choice ◽  
Family Physicians ◽  
Medical Specialty ◽  
World Health ◽  
Junior Doctors ◽  
Myers Briggs Type Indicator ◽  
Factors Influencing ◽  
Type Indicator ◽  
Myers Briggs

Objectives: The number of family physicians in Oman is far below that recommended by the World Health Organization. This study aimed to determine factors influencing junior doctors’ choice of a career in family medicine. Methods: This cross-sectional study was conducted between March and June 2018 and targeted applicants to Oman Medical Specialty Board residency programmes during the 2018–2019 academic year. Applicants were grouped according to their choice of either family medicine (n = 64) or other specialities (n = 81). A self-administered questionnaire was utilised to compare the applicants’ sociodemographic characteristics, factors influencing their choice of career and their Myers-Briggs Type Indicator® (MBTI) personality traits. Results: A total of 52 family medicine and 43 other residency applicants participated in the study (response rates: 81.3% and 53.1%, respectively). Most family medicine applicants were female (86.5%), married (65.4%) and resided in rural areas (73.1%); moreover, 19.2% were ≥30 years of age. Overall, emphasis on continuity of care, opportunity to deal with a variety of medical problems, the ability to use a wide range of skills and knowledge, early exposure to the discipline, opportunity to teach and perform research and the influence of family or friends were important factors in determining choice of a career in family medicine. Moreover, the MBTI analysis revealed that family medicine applicants were commonly extroverted-sensing-thinking-judging personality types. Conclusion: Knowledge of the factors influencing career choice among junior doctors may be useful in determining future admission policies in order to increase the number of family physicians in Oman.Keywords: Career Choice; Internship and Residency; Medical Specialty; Family Practice; Family Physicians; Myers-Briggs Type Indicator; Oman.

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