Facilitators and barriers to physicians’ entrepreneurial ventures in major Japanese cities: A qualitative study

Background The Japanese healthcare system currently faces numerous challenges, including a super-aging society and an excessive burden on medical workers; therefore, the need for innovative solutions from healthcare ventures to tackle these issues has increased. Meanwhile, as physicians play important roles in healthcare ventures, the need for Japanese physician entrepreneurs is more important than ever. Given the lack of research examining barriers to physicians starting ventures and what skills, knowledge, and surrounding environments act as facilitators, this study aimed to identify the facilitators and barriers faced by physicians to start ventures. Methods Between September and November 2019 and in May 2021, qualitative interviews were conducted with 33 participants, which included eight physician entrepreneurs; two administrative officers at the Ministry of Health, Labour and Welfare and the Ministry of Economy, Trade and Industry; three faculty members at Tokyo Medical and Dental University (in-depth interviews); and 20 medical students (focus group discussions). The interviews were deductively coded based on the social ecological model. The inductive approach was applied to coding any knowledge necessary to start a business. We conducted member checking with three physician entrepreneurs and seven medical students to improve our results’ credibility. Results The factors influencing a physician’s decision to launch a new business include their willingness to contribute to society, the unique environment in which an individual is placed while in medical school and afterward, negative aspects of the lack of diversity in physicians’ careers, the financial stability provided by a medical license, and self-efficacy. Conclusions Our study revealed facilitators and barriers to physicians’ entrepreneurial ventures. Knowledge about these factors might be useful in supporting physicians to launch or become involved in healthcare ventures.

Characteristics and Outcomes of Individuals Engaging in USMLE Irregular Behavior, 2006–2015

ABSTRACT Medical licensing authorities and other entities utilize and rely on the United States Medical Licensing Examination (USMLE) as a standardized, valid and reliable tool to assess physicians’ knowledge and skills. As such, engaging in irregular behavior during the USMLE process can have a broad and damaging impact on an individual’s ability to complete the USMLE sequence and subsequently obtain a medical license in the United States. While there are also repercussions for the USMLE program and entities overseeing medical students and physicians, the risk to the public of being cared for by someone who did not pass a medical licensing examination by his or her own merit is of great concern. This study reviews data about individuals who engaged in irregular behavior, common sanctions taken against them and their ability to ultimately practice medicine in the United States. Using data from the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), individuals with findings of irregular behavior as part of the USMLE application and/or testing process between 2006 to 2015 were identified, along with their corresponding demographic, examination, sanction and licensure outcome data. A total of 165 individuals were found to have engaged in 170 incidents of irregular behavior. The majority of individuals were male (63%, n = 101), international medical graduates (69%, n = 112) and had a mean age of 33 years old (SD = 8 years, n = 161) at the first incident or finding of irregular behavior. The two most common types of irregular behavior were falsified information (31%, n = 53) and security violations (27%, n = 46). Most incidents (86%, n = 146) were reported to the FSMB Physician Data Center (PDC) and 68% (n = 116) involved a bar from taking the USMLE for a period of time. Only 26% (n = 43) of individuals ultimately passed the entire USMLE sequence and 16% (n = 27) obtained a full, unrestricted medical license in the U.S. by 2019. To help maintain the integrity of a key component for initial licensure in the United States, there is a continued need for rigorous enforcement and safeguarding of USMLE examination applications, content, testing conditions and score reports. Individuals who plan on taking the USMLE should become familiar with USMLE rules and penalties regarding irregular behavior, including the serious implications of such behavior that can severely diminish their ability to practice medicine in the United States. Entities using USMLE information for licensure or admission into medical-related programs need to diligently ensure authentication of USMLE documents and carefully consider if individuals who have engaged in irregular behavior are qualified to practice medicine.

A comparative study on self-medication practice of analgesics among MBBS students of Dr. B. R. Ambedkar Medical College, Bengaluru

Background: Self-medication with analgesics is prevalent worldwide among medical students due to easy availability of drugs and may lead to irrational usage of drugs. To assess knowledge, attitude, practice and perception of self-medication of analgesics.Methods: A comparative study on self-medication of analgesics was conducted on 3rd and 5th term Bachelor of medicine and Bachelor of Surgery (MBBS) students of Dr. B. R. Ambedkar Medical College, Bengaluru in November 2019. A pre-designed questionnaire was used to collect information on self-medication with analgesics.Results: 74.5% of 3rd term and 65.5% of 5th term MBBS students practiced self-medication with analgesics. Majority of students in both groups had some knowledge on self-medication with analgesics. Common condition for using analgesic self-medication was headache (75.8%, 59.7%, p=0.0172) and non-steroidal anti-inflammatory drugs (80.6%, 90%, p=0.0780) were commonly used analgesics. Analgesics were used for quick relief (67.7%, 73.3%, p=0.4512) and students in group II referred medical textbooks as a source of information for practicing self-medication with analgesics (22.5%, 61.6%, p<0.001). Students agreed that self-medication is acceptable for medical students (45.8%, 43%, p=0.045) and medical license is required for better administration of drugs (51.3%, 63.2%, p=0.225).Conclusions: This study has found that self-medication with analgesics was common among MBBS students for minor illness. It is necessary to create awareness and educate students regarding the hazards of self-medication.

The Medical Community Perspectives Regarding the Egyptian Medical License Exam: Mixed-Method Study

Background: Although National Licensing Examinations (NLEs) may be a costly process, they can predict better performance for many following years. The current licensing requirements will not entail and new requirements will be requested. Therefore, this study suggests a framework for the development of the Medical Licensing Exam by exploring the opinions of Egyptian medical practitioners and educators regarding the exam format and criteria. Objective and methods: to describe the needed steps to develop the EMLE through a two-phase exploratory mixed-method study that had been conducted among the Egyptian medical sectors: medical practitioners and educators. Results: There were 50 clinical and academic educators shared in the online discussion about EMLE development. Then, a survey was carried out on 266 participants with various working places in which 198 of the participants were staff in the Higher Education Ministry and 68 physicians in the Ministry of Health. The input from both had contributed to the development of the following framework that is divided into two main sections; the Exam Logistics and the Exam Set up. The exam Logistics included the exam committee, prerequisites for the exam, the admission criteria and fees, and the validity of the license. While the Exam Set up included exam setting, structure, standard-setting, pass marks and reset policy. Conclusion: A Multidisciplinary team resources for the exam setting. Fairness and objectivity were highlighted through several factors; development of the exam blueprint, types of assessment methods, post-exam analysis, and standard-setting. Finally, the reset policy, fees, and validity of the license were recommended with a student-centered perspective that was suggested for the exam committee.

Why Otolaryngologists Get Excluded From Medicare and Medicaid

The List of Excluded Individuals and Entities (LEIE) is a federally updated and available list of providers who have been excluded from participating from federal healthcare programs. With over 40 year’s worth of exclusion history, we were able to isolate and identify otolaryngologists who were excluded and the most common cause, albeit exceptionally rare, was revocation of their medical license due to negligence.

Substance Use Disorder in Physicians after Completion of Training in Anesthesiology in the United States from 1977 to 2013

Background Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence and outcomes of substance use disorder that resulted in either a report to a certifying body or death in physicians after the completion of anesthesiology training. Methods Physicians who completed training in U.S. anesthesiology residency programs from 1977 to 2013 and maintained at least one active medical license were included in this retrospective cohort study (n = 44,736). Substance use disorder cases were ascertained through records of the American Board of Anesthesiology and the National Death Index. Results Six hundred and one physicians had evidence of substance use disorder after completion of training, with an overall incidence of 0.75 per 1,000 physician-years (95% CI, 0.71 to 0.80; 0.84 [0.78 to 0.90] in men, 0.43 [0.35 to 0.52] in women). The highest incidence rate occurred in 1992 (1.79 per 1,000 physician-years [95% CI, 1.12 to 2.59]). The cumulative percentage expected to develop substance use disorder within 30 yr estimated by Kaplan–Meier analysis equaled 1.6% (95% CI, 1.4 to 1.7%). The most common substances used by 353 individuals for whom information was available were opioids (193 [55%]), alcohol (141 [40%]), and anesthetics/hypnotics (69 [20%]). Based on a median of 11.1 (interquartile range, 4.4 to 19.8) yr of follow-up, the cumulative proportion of survivors estimated to experience at least one relapse within 30 yr was 38% (95% CI, 31 to 43%). Of the 601 physicians with substance use disorder, 114 (19%) were dead from a substance use disorder–related cause at last follow-up. Conclusions A substantial proportion of anesthesiologists who develop substance use disorder after the completion of training die of this condition, and the risk of relapse is high in those who survive. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New