Neurosurgical manpower: the physician's viewpoint

1982 ◽  
Vol 56 (5) ◽  
pp. 609-614
Author(s):  
Clark Watts ◽  
Robert C. Mendenhall ◽  
Stephen E. Radecki ◽  
Roger A. Girard
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
National Study ◽  
Content Type ◽  
Fine Print

✓ This paper reports a national study of physicians in 24 medical and surgical specialties, and reveals the opinions of neurosurgeons and their professional colleagues with regard to the adequacy of the supply of neurosurgical manpower. Among neurosurgeons, 30.4% believe the supply to be excessive, 60.1% think it is about right, 7.5% believe that there is a shortage, and 2.0% have no opinion. Neurologists' opinions do not differ significantly from those of neurosurgeons, but physicians and surgeons in 22 other specialties are significantly less likely to regard the supply as excessive, and are more likely to perceive a shortage. Primary care physicians, as a group, are most likely to perceive a shortage, and least likely to indicate an excess. Among the 24 specialties studied, 9.3% of physicians believe the supply of neurosurgeons to be excessive, 55.1% think it is about right, 22.9% believe that there is a shortage, and 12.8% have no opinion.

Neuroscience education of undergraduate medical students. Part II: outcome improvement

2000 ◽  
Vol 92 (4) ◽  
pp. 642-645 ◽  
Author(s):  
Daniel K. Resnick ◽  
Lincoln F. Ramirez
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Student Performance ◽  
Primary Care Physicians ◽  
Pressure Head ◽  
Rehabilitation Medicine ◽  
Spine Injury ◽  
Undergraduate Medical Students ◽  
Content Type ◽  
Fine Print

Object. Because of political and economic pressures, primary care physicians are now charged with greater responsibility for the care of patients with disease processes definitively managed by neurosurgeons. The goal of this study was to establish the feasibility and efficacy of a neurosurgical curriculum designed to teach future primary care physicians about these diseases.Methods. A compact, seven-lecture curriculum was developed to teach 3rd-year medical students about degenerative spine disease, stroke, tumor- and hydrocephalus-related raised intracranial pressure, head and spine injury, and subarachnoid hemorrhage. This curriculum was given as part of a 6-week pilot course that included neurology, neurosurgery, ophthalmology, and rehabilitation medicine components. This course was administered to two groups of 18 medical students, and an examination was administered at the end of the pilot course. The same examination was administered to an additional 19 students immediately after their completion of the neurology course currently required.Students enrolled in the pilot neuroscience course performed significantly better (p < 0.001) on the examination than those who had completed the standard neurology course. Striking improvements were noted in the recognition and management of head injury, hydrocephalus, and radiculopathy.Conclusions. Inclusion of a short neurosurgery-related curriculum in a combined neuroscience course significantly improved student performance on an examination focusing on the recognition and management of common neurosurgical disorders. Because primary care physicians are responsible for the initial recognition and management of these disorders, the knowledge gained may lead to improved patient care.

Neuroscience education of undergraduate medical students. Part I: role of neurosurgeons as educators

2000 ◽  
Vol 92 (4) ◽  
pp. 637-641 ◽  
Author(s):  
Daniel K. Resnick
Keyword(s):  
Primary Care ◽  
Medical Student ◽  
Medical Students ◽  
Primary Care Physicians ◽  
Carotid Artery Disease ◽  
Medical Student Education ◽  
Low Back ◽  
Content Type ◽  
Artery Disease ◽  
Fine Print

Object. Economic, demographic, and political pressures have mandated that medical schools increase the number of primary care physicians. The goal of this study was to determine the nature of the average medical student's exposure to neurosurgical issues.Methods. Surveys were sent to every neurosurgical program director in the United States and to the dean of every medical school in North America, querying the extent of neurosurgical involvement in medical student education. Specifically, the respondents were asked how medical students were educated about the management of low-back pain and radiculopathy, carotid artery disease, head and spine trauma, and headache.Survey results were obtained from 65 (67%) of 97 neurosurgery program directors and from 57 (40%) of 143 medical school deans. Only one program in North America reported having a required neurosurgical rotation for all medical students, and just over 50% (29 of 57 deans and 34 of 65 program directors) reported that neurosurgery was an option in a required neuroscience or surgical subspecialty course. Neurosurgeons were not listed among the top three sources for medical student education in the topics of low-back pain and radiculopathy or carotid artery disease. Neurosurgeons were the most frequently cited source of education regarding head and spinal injuries, despite the fact that the majority of medical schools do not have any required medical student exposure to neurosurgery.Conclusions. With rare exceptions, neurosurgeons are not significantly involved in the education of medical students concerning the management of common neurosurgical issues. As a result, most emerging primary care physicians are taught about these issues by other specialists or not at all. The implications of this situation are discussed.

Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care

2018 ◽  
Vol 32 (1) ◽  
pp. 39-55 ◽  
Author(s):  
Elizabeth Mansfield ◽  
Onil Bhattacharyya ◽  
Jennifer Christian ◽  
Gary Naglie ◽  
Vicky Steriopoulos ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Care Physicians ◽  
Pilot Project ◽  
Models Of Care ◽  
Structured Interviews ◽  
Pilot Projects ◽  
Additional Time ◽  
Content Type ◽  
The Impact

Purpose Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Quantitative comparisons of urgent care service providers

2015 ◽  
Vol 28 (6) ◽  
pp. 574-594 ◽  
Author(s):  
Hong Qin ◽  
Gayle L. Prybutok ◽  
Victor R. Prybutok ◽  
Bin Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Service Quality ◽  
Primary Care Physicians ◽  
Service Providers ◽  
Survey Instrument ◽  
Urgent Care ◽  
Emergency Rooms ◽  
Hospital Emergency ◽  
Content Type

Purpose – The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices. Design/methodology/approach – This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality. Findings – Primary care physicians’ offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions. Research limitations/implications – The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings. Practical implications – The patient’s choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape. Social implications – This work contributes to the understanding of how to provide cost effective and efficient UC services. Originality/value – This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.

Primary care physicians’ identifying abuse of older adults in the small island state of Trinidad and Tobago

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Camille Huggins ◽  
Akeem Modeste-James ◽  
Jennifer Rouse
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Trinidad And Tobago ◽  
Primary Care Physicians ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Small Island ◽  
Content Type ◽  
Island State ◽  
Small Island State

Purpose This study aims to examine primary care physicians who are in a tenable position to identify signs of abuse in older adults as well as provide an opportunity to safeguard them from abuse. Yet little is known about their clinical decision-making process during a clinic visit to detect abuse of older adults and provide adequate support in the Caribbean. Design/methodology/approach Fourteen primary care physicians working in a government operated free clinic were interviewed about their clinical decision-making process, in a narrative analysis format on the small island state of Trinidad and Tobago. Findings Primary care physicians expressed lack of knowledge about the primary health-care clinics’ protocols and procedures regarding abuse of older adults. Lack of attendance to educational in-service programs on recognizing and reporting abuse of older adults. A hands-off approach with non-medical abuse issues. Last there is no uniform assessments among the different types of physicians. Practical implications Although these findings are among primary care physicians located in Trinidad and Tobago, the context may be applied to primary care settings in other Caribbean islands. Major focus should be geared towards increasing awareness among the public and health-care professionals. Originality/value Sparse research on small island states regarding safeguarding policies for older adults who experience abuse.

Intraoperative complications in aneurysm surgery: a prospective national study

2002 ◽  
Vol 96 (3) ◽  
pp. 515-522 ◽  
Author(s):  
Steen Fridriksson ◽  
Hans Säveland ◽  
Karl-Erik Jakobsson ◽  
Göran Edner ◽  
Stefan Zygmunt ◽  
...  
Keyword(s):  
Blood Flow ◽  
Intraoperative Complications ◽  
Aneurysm Rupture ◽  
Arterial Blood Flow ◽  
National Study ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Poor Outcome ◽  
Arterial Blood ◽  
Fine Print

Object. With increasing use of endovascular procedures, the number of aneurysms treated surgically will decline. In this study the authors review complications related to the surgical treatment of aneurysms and address the issue of maintaining quality standards on a national level. Methods. A prospective, nonselected amalgamation of every aneurysm case treated in five of six neurosurgical centers in Sweden during 1 calendar year was undertaken (422 patients; 7.4 persons/100,000 population/year). The treatment protocols at these institutions were very similar. Outcome was assessed using clinical end points. In this series, 84.1% of the patients underwent surgery, and intraoperative complications occurred in 30% of these procedures. Poor outcome from technical complications was seen in 7.9% of the surgically treated patients. Intraoperative aneurysm rupture accounted for 60% and branch sacrifice for 12% of all technical difficulties. Although these complications were significantly related to aneurysm base geometry and the competence of the surgeon, problems still occurred apparently at random and also in the best of hands (17%). The temporary mean occlusion time in the patients who suffered intraoperative aneurysm rupture was twice as long as the temporary arrest of blood flow performed to aid dissection. Conclusions. The results obtained in this series closely reflect the overall management results of this disease and support the conclusion that surgical complications causing a poor outcome can be estimated on a large population-based scale. Intraoperative aneurysm rupture was the most common and most devastating technical complication that occurred. Support was found for a more liberal use of temporary clips early during dissection, regardless of the experience of the surgeon. Temporary regional interruption of arterial blood flow should be a routine method for aneurysm surgery on an everyday basis. A random occurrence of difficult intraoperative problems was clearly shown, and this factor of unpredictability, which is present in any preoperative assessment of risk, strengthens the case for recommending neuroprotection as a routine adjunct to virtually every aneurysm operation, regardless of the surgeon's experience.

Leading with love: learning and shared accountability

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Peter Pronovost ◽  
Todd M. Zeiger ◽  
Randy Jernejcic ◽  
V. George Topalsky
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health System ◽  
Management System ◽  
Primary Care Physicians ◽  
Peer Learning ◽  
Illustrative Case ◽  
Learning Networks ◽  
Improve Performance ◽  
Content Type

PurposeTo describe peer learning and shared accountability and their use within our management system to improve the rate of patient annual wellness visits completed by primary care physicians.Design/methodology/approachOur management system implements programs to improve performance on a measure, initially declaring the goal, roles and responsibilities. In the illustrative case in this article, primary care physicians are assigned the goal of completing annual wellness visits for 65% of their patients by the end of 2021. To support physicians, peer learning networks are established, connecting teams, physicians and others to broadly share best practices and support better performance. Shared accountability means higher-level leaders in the organization need to first set lower-level leaders up to succeed before holding lower-level leaders accountable for achieving the declared goal. Our shared accountability model describes processes of the higher-level leader to ensure lower-leader success. The accountability process if a lower-level leader does not improve performance involves 3 steps: (1) a letter; (2) meeting with hospital executives for peer review; (3) review for sanctions/disciplinary action.FindingsIn quarter 1 of calendar year 2021, we identified 30 physicians that were behind pace for reaching the 65% goal of AWVs with patients for 2021 and also had not achieved the 2020 60% goal. After step 1, 22 of 30 (73%) physicians were on target for the goal. After step 2, 3 of 8 physicians were on target for the goal.Originality/valuePeer learning and shared accountability are underdeveloped in health care, and often viewed as at odds with each other. In our framework we integrate them. Thus, we formed learning networks, connecting every level of the organization and branching out across the health system to share ideas and build capability. Our shared accountability model removes the punitive connotation often connected to accountability by aligning higher and lower-level leaders to work together as a team. This model is improving personal performance among primary care physicians, and now being used for all quality and value efforts in our health system. We believe if broadly applied, this model could help improve value in health care.

Post-traumatic stress disorder in primary-care settings: prevalence and physicians' detection

2001 ◽  
Vol 31 (3) ◽  
pp. 555-560 ◽  
Author(s):  
O. TAUBMAN-BEN-ARI ◽  
J. RABINOWITZ ◽  
D. FELDMAN ◽  
R. VATURI
Keyword(s):  
Primary Care ◽  
Psychological Distress ◽  
Primary Care Physicians ◽  
Demographic Data ◽  
National Sample ◽  
Self Report ◽  
National Study ◽  
Post Traumatic Stress ◽  
Primary Care Settings ◽  
General Psychological Distress

Background. Little is known about the prevalence of PTSD in primary-care settings and regarding the ability of primary-care physicians to detect PTSD. The current study examines prevalence of PTSD in a national sample of primary-care attenders and primary-care physicians' detection of PTSD and general psychological distress in PTSD patients.Methods. Data are from a national study of 2975 primary-care attenders in Israel. Demographic data, responses to the GHQ-28, PTSD Inventory and physicians' diagnoses were examined.Results. Twenty-three per cent of all patients who attended clinics (N=684) reported traumatic events, 39% of whom (males 37%, females 40%) met criteria for PTSD on the PTSD Inventory. Eighty per cent of the males and 92% of the females with PTSD were distressed according to the GHQ. According to physicians, 37% of persons who reported trauma (40% of the women, 32% of the men) suffered from psychological distress. Only 2% of patients meeting PTSD criteria on the self-report measure were given a diagnoses of PTSD by physicians.Conclusions. Many primary-care patients suffer from PTSD, which is usually accompanied by major psychological distress. Attention by primary-care physicians to a history of trauma could improve physicians' detection of this disabling disorder.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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