Objectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.Design Observational study.Setting US acute care hospitals.Participants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists.Main outcome measures 30 day mortality and readmissions and costs of care. Results 736 537 admissions managed by 18 854 hospitalist physicians (median age 41) were included. Patients' characteristics were similar across physician ages. After adjustment for characteristics of patients and physicians and hospital fixed effects (effectively comparing physicians within the same hospital), patients' adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%), 11.1% for physicians aged 40-49 (11.0% to 11.3%), 11.3% for physicians aged 50-59 (11.1% to 11.5%), and 12.1% for physicians aged ≥60 (11.6% to 12.5%). Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians. Similar patterns were observed among general internists and in several sensitivity analyses.Conclusions Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.
The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available.
Perhaps the only health policy issue on which Republicans and Democrats agree is the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs. In keeping with this notion of paying for value rather than volume, the Affordable Care Act (ACA) created the “value-based payment modifier,” or “value modifier,” a pay-for-performance approach for physicians who actively participate in Medicare. By 2017, physicians will be rewarded or penalized on the basis of the relative calculated value of the care . . .
To examine whether peppy comments from attending physicians increased the workload of residents working in the emergency department (ED).
Financial relationships between pharmaceutical manufacturers and health care professionals remain controversial. Some interactions, such as those involving research and exchange of expertise, promote the development and study of new drugs; by contrast, payments in the form of meals and continuing medical education (CME) programs have been criticized for being promotional and have been linked to non-evidence-based prescribing practices. The prevalence of these relationships has been estimated from national physician surveys, which found that, across seven specialties, about 83% of physicians received gifts from industry (excluding samples) in 2004. The prevalence has decreased slightly in recent years: a 2009 survey showed . . .
“Moving from volume to value” is health care reform’s latest mantra. Policymakers hope to replace fee-for-service systems with value-based approaches that reward improved outcomes achieved at lower cost. Ground zero in these efforts is the Medicare Physician Fee Schedule (MPFS). What payment reformers often fail to recognize is that the specific MPFS payment rates have important implications for Medicare and its beneficiaries. The relative payment levels for the thousands of service codes and the absence of payment for other activities powerfully influence how physicians spend their time - and their tendency to perform unneeded tests and procedures. The mix of . . .
Under the Physician Payments Sunshine Act, drug and device manufacturers and group purchasing organizations will report to the Centers for Medicare and Medicaid Services payments made to physicians and teaching hospitals, and the data will be posted on a public website.
To explore medical students' experiences working with frequently rotating pediatric inpatient attending physicians.
Laparoscopy simulation offers realistic complexity of tasks and required skills, and helps to develop competencies. However the relationship of stress to the experience has not been comprehensively explored. Objectives were: 1) To evaluate stress level before and during laparoscopy in surgery interns (PGY-1) and surgery residents (PGY-2); 2) To evaluate performance in simulated laparoscopy in both groups. 3) To study the correlation between stress pathways themselves and to study which factors mediate the relationship between stress and performance.
Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking.