Publications
1.
Khullar, Dhruv; Young, Dannagal G.
Misinformation, Identity, and the Basis of Belief Journal Article
In: Annals of Internal Medicine , vol. 0, iss. 0, 2024.
Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Misinformation, Identity, and the Basis of Belief},
author = {Dhruv Khullar and Dannagal G. Young},
url = {https://www.acpjournals.org/doi/10.7326/ANNALS-24-02844},
year = {2024},
date = {2024-12-31},
journal = {Annals of Internal Medicine },
volume = {0},
issue = {0},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
2.
Casalino, Lawrence P.; Karig, Shachar; Markovits, Daniel; Fisman, Raymond; Li, Jing
Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits Journal Article
In: JAMA Health Forum, vol. 5, no. 10, 2024.
Abstract | Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits},
author = {Lawrence P. Casalino and Shachar Karig and Daniel Markovits and Raymond Fisman and Jing Li},
url = {https://edhub.ama-assn.org/jn-learning/audio-player/18918894 },
doi = {10.1001/jamahealthforum.2024.3383},
year = {2024},
date = {2024-10-11},
urldate = {2024-10-11},
journal = {JAMA Health Forum},
volume = {5},
number = {10},
abstract = {Importance
Altruism—putting the patient first—is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending.
Objective
To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results.
Design, Setting, and Participants
This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024.
Exposure
Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic.
Main Measures
Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending.
Results
In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, −16.24% to −2.27%; P = .01).
Conclusions and Relevance
This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
Importance
Altruism—putting the patient first—is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending.
Objective
To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results.
Design, Setting, and Participants
This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024.
Exposure
Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic.
Main Measures
Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending.
Results
In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, −16.24% to −2.27%; P = .01).
Conclusions and Relevance
This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.
Altruism—putting the patient first—is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending.
Objective
To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results.
Design, Setting, and Participants
This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024.
Exposure
Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic.
Main Measures
Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending.
Results
In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, −16.24% to −2.27%; P = .01).
Conclusions and Relevance
This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.
3.
Bond, Amelia M.; Casalino, Lawrence P.; Tai-Seale, Ming; Unruh, Mark Aaron; Zhang, Manyao; Qian, Yuting; Kronick, Richard
Physician Turnover in the United States Journal Article
In: Annals of Internal Medicine, vol. 176, iss. 7, pp. 896-903, 2023.
Abstract | Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Physician Turnover in the United States},
author = {Amelia M. Bond and Lawrence P. Casalino and Ming Tai-Seale and Mark Aaron Unruh and Manyao Zhang and Yuting Qian and Richard Kronick},
doi = {https://doi.org/10.7326/M22-2504},
year = {2023},
date = {2023-07-11},
urldate = {2023-07-11},
journal = {Annals of Internal Medicine},
volume = {176},
issue = {7},
pages = {896-903},
abstract = {Background: Medical groups, health systems, and professional associations are concerned about potential increases in physician turnover, which may affect patient access and quality of care.
Objective: To examine whether turnover has changed over time and whether it is higher for certain types of physicians or practice settings.
Design: The authors developed a novel method using 100% of traditional Medicare billing to create national estimates of turnover. Standardized turnover rates were compared by physician, practice, and patient characteristics.
Setting: Traditional Medicare, 2010 to 2020.
Participants: Physicians billing traditional Medicare.
Measurements: Indicators of physician turnover—physicians who stopped practicing and those who moved from one practice to another—and their sum.
Results: The annual rate of turnover increased from 5.3% to 7.2% between 2010 and 2014, was stable through 2017, and increased modestly in 2018 to 7.6%. Most of the increase from 2010 to 2014 came from physicians who stopped practicing increasing from 1.6% to 3.1%; physicians moving increased modestly from 3.7% to 4.2%. Modest but statistically significant (P < 0.001) differences existed across rurality, physician sex, specialty, and patient characteristics. In the second and third quarters of 2020, quarterly turnover was slightly lower than in the corresponding quarters of 2019.
Limitation: Measurement was based on traditional Medicare claims.
Conclusion: Over the past decade, physician turnover rates have had periods of increase and stability. These early data, covering the first 3 quarters of 2020, give no indication yet of the COVID-19 pandemic increasing turnover, although continued tracking of turnover is warranted. This novel method will enable future monitoring and further investigations into turnover.
Primary Funding Source: The Physicians Foundation Center for the Study of Physician Practice and Leadership.},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
Background: Medical groups, health systems, and professional associations are concerned about potential increases in physician turnover, which may affect patient access and quality of care.
Objective: To examine whether turnover has changed over time and whether it is higher for certain types of physicians or practice settings.
Design: The authors developed a novel method using 100% of traditional Medicare billing to create national estimates of turnover. Standardized turnover rates were compared by physician, practice, and patient characteristics.
Setting: Traditional Medicare, 2010 to 2020.
Participants: Physicians billing traditional Medicare.
Measurements: Indicators of physician turnover—physicians who stopped practicing and those who moved from one practice to another—and their sum.
Results: The annual rate of turnover increased from 5.3% to 7.2% between 2010 and 2014, was stable through 2017, and increased modestly in 2018 to 7.6%. Most of the increase from 2010 to 2014 came from physicians who stopped practicing increasing from 1.6% to 3.1%; physicians moving increased modestly from 3.7% to 4.2%. Modest but statistically significant (P < 0.001) differences existed across rurality, physician sex, specialty, and patient characteristics. In the second and third quarters of 2020, quarterly turnover was slightly lower than in the corresponding quarters of 2019.
Limitation: Measurement was based on traditional Medicare claims.
Conclusion: Over the past decade, physician turnover rates have had periods of increase and stability. These early data, covering the first 3 quarters of 2020, give no indication yet of the COVID-19 pandemic increasing turnover, although continued tracking of turnover is warranted. This novel method will enable future monitoring and further investigations into turnover.
Primary Funding Source: The Physicians Foundation Center for the Study of Physician Practice and Leadership.
Objective: To examine whether turnover has changed over time and whether it is higher for certain types of physicians or practice settings.
Design: The authors developed a novel method using 100% of traditional Medicare billing to create national estimates of turnover. Standardized turnover rates were compared by physician, practice, and patient characteristics.
Setting: Traditional Medicare, 2010 to 2020.
Participants: Physicians billing traditional Medicare.
Measurements: Indicators of physician turnover—physicians who stopped practicing and those who moved from one practice to another—and their sum.
Results: The annual rate of turnover increased from 5.3% to 7.2% between 2010 and 2014, was stable through 2017, and increased modestly in 2018 to 7.6%. Most of the increase from 2010 to 2014 came from physicians who stopped practicing increasing from 1.6% to 3.1%; physicians moving increased modestly from 3.7% to 4.2%. Modest but statistically significant (P < 0.001) differences existed across rurality, physician sex, specialty, and patient characteristics. In the second and third quarters of 2020, quarterly turnover was slightly lower than in the corresponding quarters of 2019.
Limitation: Measurement was based on traditional Medicare claims.
Conclusion: Over the past decade, physician turnover rates have had periods of increase and stability. These early data, covering the first 3 quarters of 2020, give no indication yet of the COVID-19 pandemic increasing turnover, although continued tracking of turnover is warranted. This novel method will enable future monitoring and further investigations into turnover.
Primary Funding Source: The Physicians Foundation Center for the Study of Physician Practice and Leadership.
4.
Khullar, Dhruv
Burnout, Professionalism, and the Quality of US Health Care Journal Article
In: JAMA Health Forum , vol. 4, iss. 3, 2023.
Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Burnout, Professionalism, and the Quality of US Health Care},
author = {Dhruv Khullar },
doi = {10.1001/jamahealthforum.2023.0024},
year = {2023},
date = {2023-03-24},
journal = {JAMA Health Forum },
volume = {4},
issue = {3},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
5.
Casalino, Lawrence P.
Primary Care-Specialist Relationships, Intrinsic Motivation, and Patient Experience of Care Journal Article
In: JAMA Internal Medicine, vol. 183, iss. 2, pp. 132-133, 2023.
Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Primary Care-Specialist Relationships, Intrinsic Motivation, and Patient Experience of Care},
author = {Lawrence P. Casalino},
doi = {https://doi.org/10.1001/jamainternmed.2022.6000},
year = {2023},
date = {2023-02-01},
urldate = {2023-02-01},
journal = {JAMA Internal Medicine},
volume = {183},
issue = {2},
pages = {132-133},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
6.
Ryskina, Kira L.; Unruh, Mark Aaron; Qian, Yuting; Jung, Hye-Young
US Generalist Physicians and Groups that Focused Practice in a Single Care Setting: 2014-2017 Journal Article
In: Medical Care , vol. 60, iss. 11, pp. 831-838, 2022.
Abstract | Links | BibTeX | Tags: Corporatization and Consolidation, Medical Professionalism and Physician Well-being
@article{nokey,
title = { US Generalist Physicians and Groups that Focused Practice in a Single Care Setting: 2014-2017},
author = {Kira L. Ryskina and Mark Aaron Unruh and Yuting Qian and Hye-Young Jung},
doi = {https://doi.org/10.1097/mlr.0000000000001778},
year = {2022},
date = {2022-11-01},
urldate = {2022-11-01},
journal = {Medical Care },
volume = {60},
issue = {11},
pages = {831-838},
abstract = {Background: Some generalist physicians whose training prepared them for primary care practice increasingly practice in a facility (eg, hospitals, nursing homes); however, whether this trend was accompanied by a complimentary rise in generalist physicians who focused their practice on office-based care is unknown.
Objectives: Our objective in this study was to examine trends in the prevalence of generalist physicians and physician groups that practice in a single setting.
Research design: This was a retrospective cross-sectional study of generalist physicians trained in family medicine, internal medicine, or geriatrics. We used 2014-2017 billing data for Medicare fee-for-service beneficiaries to measure the proportion of all patient visits made by physicians in the following care settings: office, outpatient hospital department, inpatient hospital, and other sites.
Results: From 2014 to 2017, the proportion of generalist physicians who narrowed their practice to a single setting increased by 6.69% (from 62.80% to 67.00%, p for trend <0.001). In 2017, 4.63% of physician groups included more than 1 type of setting-based physicians.
Conclusions: Generalist physicians treating older adults increasingly narrowed their practice focus to a single type of health care setting. This trend was not accompanied by growth among physician groups that included different types of setting-based physicians. Further evaluation of the consequences of these trends on the fragmentation of primary care delivery across different health care settings and primary care outcomes is needed.},
keywords = {Corporatization and Consolidation, Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
Background: Some generalist physicians whose training prepared them for primary care practice increasingly practice in a facility (eg, hospitals, nursing homes); however, whether this trend was accompanied by a complimentary rise in generalist physicians who focused their practice on office-based care is unknown.
Objectives: Our objective in this study was to examine trends in the prevalence of generalist physicians and physician groups that practice in a single setting.
Research design: This was a retrospective cross-sectional study of generalist physicians trained in family medicine, internal medicine, or geriatrics. We used 2014-2017 billing data for Medicare fee-for-service beneficiaries to measure the proportion of all patient visits made by physicians in the following care settings: office, outpatient hospital department, inpatient hospital, and other sites.
Results: From 2014 to 2017, the proportion of generalist physicians who narrowed their practice to a single setting increased by 6.69% (from 62.80% to 67.00%, p for trend <0.001). In 2017, 4.63% of physician groups included more than 1 type of setting-based physicians.
Conclusions: Generalist physicians treating older adults increasingly narrowed their practice focus to a single type of health care setting. This trend was not accompanied by growth among physician groups that included different types of setting-based physicians. Further evaluation of the consequences of these trends on the fragmentation of primary care delivery across different health care settings and primary care outcomes is needed.
Objectives: Our objective in this study was to examine trends in the prevalence of generalist physicians and physician groups that practice in a single setting.
Research design: This was a retrospective cross-sectional study of generalist physicians trained in family medicine, internal medicine, or geriatrics. We used 2014-2017 billing data for Medicare fee-for-service beneficiaries to measure the proportion of all patient visits made by physicians in the following care settings: office, outpatient hospital department, inpatient hospital, and other sites.
Results: From 2014 to 2017, the proportion of generalist physicians who narrowed their practice to a single setting increased by 6.69% (from 62.80% to 67.00%, p for trend <0.001). In 2017, 4.63% of physician groups included more than 1 type of setting-based physicians.
Conclusions: Generalist physicians treating older adults increasingly narrowed their practice focus to a single type of health care setting. This trend was not accompanied by growth among physician groups that included different types of setting-based physicians. Further evaluation of the consequences of these trends on the fragmentation of primary care delivery across different health care settings and primary care outcomes is needed.
7.
Li, Jing; Casalino, Lawrence P.; Fisman, Raymond; Kariv, Shachar; Markovits, Daniel
Experimental evidence of physician social preferences Journal Article
In: PNAS, vol. 119, iss. 28, 2022.
Abstract | Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Experimental evidence of physician social preferences},
author = {Jing Li and Lawrence P. Casalino and Raymond Fisman and Shachar Kariv and Daniel Markovits
},
doi = {10.1073/pnas.2112726119},
year = {2022},
date = {2022-07-12},
urldate = {2022-07-12},
journal = {PNAS},
volume = {119},
issue = {28},
abstract = {Physicians' professional ethics require that they put patients' interests ahead of their own and that they should allocate limited medical resources efficiently. Understanding physicians' extent of adherence to these principles requires understanding the social preferences that lie behind them. These social preferences may be divided into two qualitatively different trade-offs: the trade-off between self and other (altruism) and the trade-off between reducing differences in payoffs (equality) and increasing total payoffs (efficiency). We experimentally measure social preferences among a nationwide sample of practicing physicians in the United States. Our design allows us to distinguish empirically between altruism and equality-efficiency orientation and to accurately measure both trade-offs at the level of the individual subject. We further compare the experimentally measured social preferences of physicians with those of a representative sample of Americans, an "elite" subsample of Americans, and a nationwide sample of medical students. We find that physicians' altruism stands out. Although most physicians place a greater weight on self than on other, the share of physicians who place a greater weight on other than on self is twice as large as for all other samples-32% as compared with 15 to 17%. Subjects in the general population are the closest to physicians in terms of altruism. The higher altruism among physicians compared with the other samples cannot be explained by income or age differences. By contrast, physicians' preferences regarding equality-efficiency orientation are not meaningfully different from those of the general sample and elite subsample and are less efficiency oriented than medical students.},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
Physicians' professional ethics require that they put patients' interests ahead of their own and that they should allocate limited medical resources efficiently. Understanding physicians' extent of adherence to these principles requires understanding the social preferences that lie behind them. These social preferences may be divided into two qualitatively different trade-offs: the trade-off between self and other (altruism) and the trade-off between reducing differences in payoffs (equality) and increasing total payoffs (efficiency). We experimentally measure social preferences among a nationwide sample of practicing physicians in the United States. Our design allows us to distinguish empirically between altruism and equality-efficiency orientation and to accurately measure both trade-offs at the level of the individual subject. We further compare the experimentally measured social preferences of physicians with those of a representative sample of Americans, an "elite" subsample of Americans, and a nationwide sample of medical students. We find that physicians' altruism stands out. Although most physicians place a greater weight on self than on other, the share of physicians who place a greater weight on other than on self is twice as large as for all other samples-32% as compared with 15 to 17%. Subjects in the general population are the closest to physicians in terms of altruism. The higher altruism among physicians compared with the other samples cannot be explained by income or age differences. By contrast, physicians' preferences regarding equality-efficiency orientation are not meaningfully different from those of the general sample and elite subsample and are less efficiency oriented than medical students.
8.
Casalino, Lawrence P.; Li, Jing; Peterson, Lars E.; Rittenhouse, Diane R.; Zhang, Manyao; O'Donnell, Eloise; Jr, Robert L. Phillips
Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex. Journal Article
In: Health Affairs, vol. 41, iss. 4, pp. 549-556, 2022.
Abstract | Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex.},
author = {Lawrence P. Casalino and Jing Li and Lars E. Peterson and Diane R. Rittenhouse and Manyao Zhang and Eloise O'Donnell and Robert L. Phillips Jr},
doi = {10.1377/hlthaff.2021.00440},
year = {2022},
date = {2022-04-04},
urldate = {2022-04-04},
journal = {Health Affairs},
volume = {41},
issue = {4},
pages = {549-556},
abstract = {Despite reports of a physician burnout epidemic, there is little research on the relationship between burnout and objective measures of care outcomes and no research on the relationship between burnout and costs of care. Linking survey data from 1,064 family physicians to Medicare claims, we found no consistent statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care-sensitive admissions, ambulatory care-sensitive emergency department visits, readmissions, or costs. The coefficients for ambulatory care-sensitive admissions and readmissions for all burnout levels, compared with never being burned out, were consistently negative (fewer ambulatory care-sensitive admissions and readmissions), suggesting that, counterintuitively, physicians who report burnout may nevertheless be able to create better outcomes for their patients. Even if true, this hypothesis should not indicate that physician burnout is beneficial or that efforts to reduce physician burnout are unimportant. Our findings suggest that the relationship between burnout and outcomes is complex and requires further investigation.},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
Despite reports of a physician burnout epidemic, there is little research on the relationship between burnout and objective measures of care outcomes and no research on the relationship between burnout and costs of care. Linking survey data from 1,064 family physicians to Medicare claims, we found no consistent statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care-sensitive admissions, ambulatory care-sensitive emergency department visits, readmissions, or costs. The coefficients for ambulatory care-sensitive admissions and readmissions for all burnout levels, compared with never being burned out, were consistently negative (fewer ambulatory care-sensitive admissions and readmissions), suggesting that, counterintuitively, physicians who report burnout may nevertheless be able to create better outcomes for their patients. Even if true, this hypothesis should not indicate that physician burnout is beneficial or that efforts to reduce physician burnout are unimportant. Our findings suggest that the relationship between burnout and outcomes is complex and requires further investigation.
9.
Jung, Hye-Young; Qian, Yuting; Katz, Paul R.; Casalino, Lawrence P.
The Characteristics of Physicians Who Primarily Practice in Nursing Homes Journal Article
In: JAMDA, vol. 22, iss. 2, pp. 468-469, 2020.
Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = { The Characteristics of Physicians Who Primarily Practice in Nursing Homes},
author = {Hye-Young Jung and Yuting Qian and Paul R. Katz and Lawrence P. Casalino},
doi = {https://doi.org/10.1016/j.jamda.2020.10.006},
year = {2020},
date = {2020-11-21},
urldate = {2020-11-21},
journal = {JAMDA},
volume = {22},
issue = {2},
pages = {468-469},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
10.
Unruh, Mark Aaron; Qian, Yuting; Casalino, Lawrence P.; Katz, Paul R.; Ryskina, Kira L.; Jung, Hye-Young
The Prevalence and Characteristics of Clinicians Who Provide Care in Assisted Living Facilities, 2014-2017 Journal Article
In: JGIM, vol. 36, iss. 8, pp. 2514-2516, 2020.
Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = { The Prevalence and Characteristics of Clinicians Who Provide Care in Assisted Living Facilities, 2014-2017},
author = {Mark Aaron Unruh and Yuting Qian and Lawrence P. Casalino and Paul R. Katz and Kira L. Ryskina and Hye-Young Jung},
doi = {https://doi.org/10.1007/s11606-020-06163-9},
year = {2020},
date = {2020-09-01},
urldate = {2020-09-01},
journal = {JGIM},
volume = {36},
issue = {8},
pages = {2514-2516},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
11.
Toscano, Fabrizio; O'Donnell, Eloise; Broderick, Joan E.; May, Marcella; Tucker, Pippa; Unruh, Mark Aaron; Messina, Gabriele; Casalino, Lawrence P.
How Physicians Spend Their Work Time: an Ecological Momentary Assessment Journal Article
In: Journal of General Internal Medicine, vol. 35, iss. 11, pp. 3166-3172, 2020.
Abstract | Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {How Physicians Spend Their Work Time: an Ecological Momentary Assessment},
author = {Fabrizio Toscano and Eloise O'Donnell and Joan E. Broderick and Marcella May and Pippa Tucker and Mark Aaron Unruh and Gabriele Messina and Lawrence P. Casalino },
doi = {https://doi.org/10.1007/s11606-020-06087-4},
year = {2020},
date = {2020-08-07},
urldate = {2020-08-07},
journal = {Journal of General Internal Medicine},
volume = {35},
issue = {11},
pages = {3166-3172},
abstract = {Background: Little is known about how physicians spend their work time.
Objective: To determine how physicians in outpatient care spend their time at work, using an innovative method: ecological momentary assessment (EMA).
Design: Physician activity was measured via EMA, using a smartphone app.
Participants: Twenty-eight practices across 16 US states. Sixty-one physicians: general internal medicine, family medicine, non-interventional cardiology, orthopedics.
Main Measures: Proportions of time spent on 14 activities within 6 broad categories of work: direct patient care (including both face-to-face care and other patient care-related activities), electronic health record (EHR) input, administration, teaching/supervising, personal time, and other.
Key Results: After excluding personal time, physicians spent 66.5% of their time on direct patient care (23.6% multitasking with use of the EHR and 42.9% without the EHR), 20.7% on EHR input alone, 7.7% on administrative activities, and 5.0% on other activities (0.6% using the EHR). In total, physicians spent 44.9% of their time on the EHR.
Limitations: Unable to measure time spent at home on the EHR or other work tasks; participating physicians were not a random sample of US physicians.
Conclusions: The efficiency of highly trained professionals spending only two-thirds of their time on direct patient care may be questioned. EHR use continues to account for a large proportion of physician time. Further attempts should be made to redesign both EHRs and physician work processes.},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}
Background: Little is known about how physicians spend their work time.
Objective: To determine how physicians in outpatient care spend their time at work, using an innovative method: ecological momentary assessment (EMA).
Design: Physician activity was measured via EMA, using a smartphone app.
Participants: Twenty-eight practices across 16 US states. Sixty-one physicians: general internal medicine, family medicine, non-interventional cardiology, orthopedics.
Main Measures: Proportions of time spent on 14 activities within 6 broad categories of work: direct patient care (including both face-to-face care and other patient care-related activities), electronic health record (EHR) input, administration, teaching/supervising, personal time, and other.
Key Results: After excluding personal time, physicians spent 66.5% of their time on direct patient care (23.6% multitasking with use of the EHR and 42.9% without the EHR), 20.7% on EHR input alone, 7.7% on administrative activities, and 5.0% on other activities (0.6% using the EHR). In total, physicians spent 44.9% of their time on the EHR.
Limitations: Unable to measure time spent at home on the EHR or other work tasks; participating physicians were not a random sample of US physicians.
Conclusions: The efficiency of highly trained professionals spending only two-thirds of their time on direct patient care may be questioned. EHR use continues to account for a large proportion of physician time. Further attempts should be made to redesign both EHRs and physician work processes.
Objective: To determine how physicians in outpatient care spend their time at work, using an innovative method: ecological momentary assessment (EMA).
Design: Physician activity was measured via EMA, using a smartphone app.
Participants: Twenty-eight practices across 16 US states. Sixty-one physicians: general internal medicine, family medicine, non-interventional cardiology, orthopedics.
Main Measures: Proportions of time spent on 14 activities within 6 broad categories of work: direct patient care (including both face-to-face care and other patient care-related activities), electronic health record (EHR) input, administration, teaching/supervising, personal time, and other.
Key Results: After excluding personal time, physicians spent 66.5% of their time on direct patient care (23.6% multitasking with use of the EHR and 42.9% without the EHR), 20.7% on EHR input alone, 7.7% on administrative activities, and 5.0% on other activities (0.6% using the EHR). In total, physicians spent 44.9% of their time on the EHR.
Limitations: Unable to measure time spent at home on the EHR or other work tasks; participating physicians were not a random sample of US physicians.
Conclusions: The efficiency of highly trained professionals spending only two-thirds of their time on direct patient care may be questioned. EHR use continues to account for a large proportion of physician time. Further attempts should be made to redesign both EHRs and physician work processes.
12.
Khullar, Dhruv; Marchalik, Daniel
Scientific collaboration in Michael Lewis's The Undoing Project Journal Article
In: The Lancet, vol. 393, iss. 10170, pp. 397, 2019.
Links | BibTeX | Tags: Medical Professionalism and Physician Well-being
@article{nokey,
title = {Scientific collaboration in Michael Lewis's The Undoing Project},
author = {Dhruv Khullar and Daniel Marchalik},
doi = {https://doi.org/10.1016/s0140-6736(19)30110-2},
year = {2019},
date = {2019-02-02},
urldate = {2019-02-02},
journal = {The Lancet},
volume = {393},
issue = {10170},
pages = {397},
keywords = {Medical Professionalism and Physician Well-being},
pubstate = {published},
tppubtype = {article}
}