Differences in Hospitalization Outcomes of Kidney Disease between Patients Who Received Care by Nephrologists and Non-Nephrologist Physicians: A Propensity-Score-Matched Study

The influence of physician specialty on the outcomes of kidney diseases (KDs) remains underexplored. We aimed to compare the complications and mortality of patients with admissions for KD who received care by nephrologists and non-nephrologist (NN) physicians. We used health insurance research data in Taiwan to conduct a propensity-score matched study that included 17,055 patients with admissions for KD who received care by nephrologists and 17,055 patients with admissions for KD who received care by NN physicians. Multivariable logistic regressions were conducted to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for 30-day mortality and major complications associated with physician specialty. Compared with NN physicians, care by nephrologists was associated with a reduced risk of 30-day mortality (OR 0.29, 95% CI 0.25–0.35), pneumonia (OR 0.82, 95% CI 0.76–0.89), acute myocardial infarction (OR 0.68, 95% CI 0.54–0.87), and intensive care unit stay (OR 0.78, 95% CI 0.73–0.84). The association between nephrologist care and reduced admission adverse events was significant in every age category, for both sexes and various subgroups. Patients with admissions for KD who received care by nephrologists had fewer adverse events than those who received care by NN physicians. We suggest that regular nephrologist consultations or referrals may improve medical care and clinical outcomes in this vulnerable population.

Awareness, Attitude, and Current Practices Toward Influenza Vaccination Among Physicians in India: A Multicenter, Cross-Sectional Study

Background: Although annual influenza vaccination is recommended for healthcare providers (HCPs), vaccination rate among HCPs in India is generally low. This cross-sectional survey was conducted to evaluate physicians' awareness, attitude, and current practices toward influenza vaccination in high-risk groups in India.Methods: The survey was performed in June–July 2020, wherein consulting physicians, pulmonologists, diabetologists, obstetricians/gynecologists, or cardiologists across 14 cities completed a 39-item questionnaire consisting of 3 sections, one each on awareness, attitude, and practice patterns. Descriptive statistics were used to summarize the study results. Statistical analysis was performed for comparison of subgroups by physician specialty, city of practice (metro/non-metro), and zone of practice (north/south/east/west). Level of statistical significance was set at p < 0.05.Results: In all, 780 physicians completed the survey. Of these, 3.97, 53.08, and 42.95% had high, medium, and low level of awareness about influenza/influenza vaccination, respectively. Statistically significant (p < 0.05) between-group differences were found by physician specialty and zone of practice. In terms of attitude toward vaccination of high-risk group subjects, only 0.9% physicians were “extremely concerned,” while the majority (92.56%) were “quite concerned” and 6.54% were a “little concerned,” with no reported significant differences between different subgroups. With regard to practice patterns, 82.82% of physicians offered influenza vaccines to their patients, 32.69% vaccinated 10–25% of patients per month, and 38.85% required and offered the vaccine to their office staff. Physicians' reasons for not prescribing influenza vaccines to patients included fear of side effects (16.54%), cost (15.64%), lack of awareness about availability (15.38%), absence of belief that it is beneficial (14.36%), history of side effects (13.46%), and patients' fear of needles (11.28%).Conclusion: These findings suggest the need to implement educational strategies among physicians to enhance their awareness about influenza vaccination and improve their attitudes and current practices toward influenza vaccination especially in high-risk groups in India.

Physician Gender, Patient Risk and Online Reviews: A Longitudinal Study of the Relationship between Physicians’ Gender and Their Online Reviews (Preprint)

BACKGROUND Online reviews of physicians have become exceedingly popular among healthcare consumers since the early 2010s. A factor that can potentially influence these reviews is the gender of the physician since the physician's gender has been found to influence patient-physician communication. When studying the direct relationship between the gender of physicians and their online reviews, it is important to account for clinical characteristics, such as the patient risk, associated with a physician to isolate the direct effect of a physician’s gender on their online reviews. It is also important to account for temporal factors that can influence physicians and their online reviews. Our study is among the first to conduct rigorous longitudinal analysis to study the effects of the gender of physicians on their reviews after accounting for several important clinical factors, including patient risk, physician specialty, as well as temporal factors using time fixed-effects. This study is also among the first ones to study the possible gender bias in online reviews using statewide data from Alabama. OBJECTIVE This study conducts a longitudinal empirical investigation of the relationship between the gender of physicians and their online reviews using data across the state of Alabama after accounting for patient risk and temporal effects. METHODS We created a unique dataset by combining data from online physician reviews from a popular physician review website RateMDs and clinical data from the Center for Medicare and Medicaid Services (CMS) for the state of Alabama. We utilized longitudinal econometric specifications to conduct the econometric analysis and controlled for several important clinical and review characteristics, including patient risk, physician specialty and latent topics embedded in the textual comments of the online reviews. We utilized the four rating dimensions (helpfulness, knowledge, staff, and punctuality) and overall rating from RateMDs as the dependent variables and gender of the physicians as the key explanatory variable in our panel regression models. RESULTS The panel used to conduct most of the analysis had approximately 1093 physicians. After controlling for clinical factors such as Medicare patient risk, number of Medicare beneficiaries, number of services provided, and physician specialty, review factors such as latent topics embedded in the review comments, and number of words in the comments and year fixed effects, the physician random-effects specifications showed that male physicians receive better online ratings than female physicians. The coefficients and the corresponding standard errors, P values of the binary variable GenderFemale (1 for female physicians and 0 otherwise) with different rating variables as outcomes are as follows: OverallRating (Coefficient: -0.194, Std. Error: 0.060, P=.001), HelpfulnessRating (Coefficient: -0.221, Std. Error: 0.069, P=.001), KnowledgeRating (Coefficient: -0.230, Std. Error: 0.065, P<.001), StaffRating (Coefficient: -0.123, Std. Error: 0.062, P=.049) and PunctualityRating (Coefficient: -0.200, Std.Error: 0.067, P=.003). CONCLUSIONS This study finds that female physicians do indeed receive lower online ratings than male physicians, and this finding is consistent even after accounting for several clinical characteristics associated with the physicians and temporal effects. Even though the magnitude of the coefficients of GenderFemale is relatively small, they are statistically significant. The findings of this study provide support to the findings on gender bias in the existing healthcare literature. We contribute to the existing literature by conducting a study using data across the state of Alabama and utilizing a longitudinal econometric analysis along with incorporating important clinical and review controls associated with the physicians.

Foundation rotations in medical training: is it love at first sight?

Purpose of studyFactors influencing physician specialty choice is a prominent topic given the recruitment challenges faced by various specialties. We aimed to assess whether specialty exposure in the first foundation year was a positive predictive factor for permanent career choice.Study designA questionnaire-based study was distributed online using a survey tool. Questions recorded the foundation rotations of participants as well as their chosen medical specialty.Results1181 responses were included in the analysis. 23% of respondents had undertaken a Foundation Year 1 (F1) rotation in their career specialty. Having undertaken a foundation rotation in anaesthetics, cardiology, emergency medicine, endocrinology, gastroenterology, genito-urinary medicine, intensive care, obstetrics and gynaecology, oncology, paediatrics, palliative care, psychiatry, radiology, respiratory and rheumatology was found to be statistically significantly linked to choosing that specialty as a career (p<0.01). There was a significant correlation between the second foundation rotation and career choice (p=0.02).ConclusionsFor many specialties, direct experience within foundation training has a positive effect on later career choice.

The burden of waiting: wait times for pediatric surgical procedures in Quebec and compliance with national benchmarks

Background: Wait time information and compliance with national guidelines are limited to a few adult conditions in the province of Quebec. We aimed to assess compliance with Paediatric Canadian Access Targets for Surgery (P-CATS) guidelines and determine the burden incurred due to waiting for 3 common elective surgical conditions (inguinal hernia, cryptorchidism and hypospadias) in a pediatric population. Methods: We carried out a population-based retrospective cohort study of randomly selected children residing in Quebec without complex chronic medical conditions, using administrative databases belonging to the Régie de l’assurance maladie du Québec for the period 2010–2013. Disability-adjusted life years (DALYs) were calculated to measure the burden due to waiting. Multivariate forward regression identified risk factors for compliance with national guidelines. Results: Surgical wait time information was assessed for 1515 patients, and specialist referral wait time was assessed for 1389 patients. Compliance with P-CATS benchmarks was 76.6% for seeing a specialist and 60.7% for receiving surgery. Regression analysis identified older age (p < 0.0001) and referring physician specialty (p = 0.001) as risk factors affecting specialist referral wait time target compliance, whereas older age (p = 0.040), referring physician specialty (p = 0.043) and surgeon specialty (p = 0.002) were significant determinants in surgical wait time compliance. The total burden accrued due to waiting beyond benchmarks was 35 DALYs. Conclusion: Our results show that provincial compliance rates with wait time benchmarks are still inadequate and need improvement. Patient age and physician specialty were both found to have significant effects on wait time target compliance.

Physician perceptions of documentation methods in electronic health records

This study sought to determine physician, specialty and practice factors influencing choice of method for electronic health record (EHR) documentation: direct typing (DT), electronic transcription (ET), human transcription (HT), and scribes. A survey assessing physician documentation practices was developed and distributed online. The primary outcome was the proportion of physicians using each method. Secondary outcomes were provider-rated accuracy, efficiency, and ease of navigation on a 1-5 Likert scale. Means were compared using linear mixed models with Bonferroni adjustment. The 818 respondents were mostly outpatient (46%) adult (79%) physicians, practiced for a mean 15.8 years, and used DT for EHR documentation (72%). Emergency physicians were more likely to use scribes ( p < 0.0001). DT was rated less efficient than all other methods ( p < 0.0001). ET was rated less accurate than DT ( p < 0.001) and HT ( p < 0.001). HT was rated less easy to navigate than DT ( p = 0.002) and scribe ( p < 0.001), and ET less than scribe ( p = 0.002). Two hundred and forty-three respondents provided free-text comments that further described opinions. DT was the most commonly used EHR method but rated least efficient. Scribes were rated easy to navigate and efficient but infrequently used outside of emergency settings. Further innovation is needed to design systems responsive to all physician EHR needs.