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Author Interviews, Cost of Health Care, JAMA / 19.12.2022

Physician Weekly Work Hours Fall Especially for Doctor Fathers

MedicalResearch.com Interview with: Anna L Goldman, MD, MPH, MPA Assistant Professor of Medicine Boston Medical Center MedicalResearch.com: What is the background for this study? Response: Experts on the healthcare labor market have long debated the existence and magnitude of a physician shortage. Physician work hours are a major contributor to physician supply issues, but little research is available on recent trends in work hours by physicians. In addition, no available studies have rigorously estimated changes in the physician workforce size during the pandemic. MedicalResearch.com: What are the main findings? Were there gender differences in hours worked? Response: The average hours worked per week by physicians decreased 7.6% in the two decades between 2001 and 2021. On average, physicians worked 52.6 hours per week in 2001-2003 and 48.6 hours per week in 2019-2021. This decrease did not appear to be caused by the COVID-19 pandemic, as the trend continued on the same steady trajectory that was present prior to the pandemic. The observed decreases were driven by reduced work hours among male physicians, full-time physicians, and younger physicians. Male physicians decreased work hours twice as much as female physicians. Physician mothers were the only group to increase weekly work hours, with a 3% increase over 20 years. Physician fathers, by contract, decreased work hours by 12%. The number of part-time physicians remained flat throughout the study period. Broadly decreasing trends in work hours were similarly present among non-physician holders of doctoral degrees, suggesting a broader trend among highly-educated professionals in their approach to work hours. The physician workforce grew by 32.9% over two decades, but then fell by 6.7% during the COVID-19 pandemic, or a drop of 1 in 14 physicians. The physicians who left the workforce during the pandemic were disproportionately white and from rural areas. Work hours generated by the physician workforce, as a whole, grew 7% over the study period, which was about half the rate of population growth in the same period (16.6%). This sluggish growth in physician workforce hours was entirely offset by large increases in the work hours contributed by nurse practitioners and physician assistants. When the clinician workforce was assessed as a whole (combining hours from physicians, nurse practitioners, and physician assistants), growth in total workforce hours was 21.4%, exceeding the population growth rate. MedicalResearch.com: What should readers take away from your report? • Physician weekly work hours fell 8% from 2001-2021, with a particularly large drop for physician fathers (-12%) vs. a small increase for physician mothers (+3%). • Because of this decline in hours, total weekly hours contributed by the physician workforce lagged far behind US population growth, an increase of 7% in work hours vs. 16.6% increase in US population. This gap was entirely offset by a large increase in nurse practitioner and physician assistant hours. • From 2019 to 2021, the physician workforce fell by 7%, which represents 1 in 14 physicians leaving the workforce during the COVID-19 pandemic. MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: Research on work hours in individual physician specialties is needed to better understand the distribution of work hour changes across the spectrum of physician types. Measurement of these trends can help predict burnout in specialties where hours may be lengthening vs. shortages in fields with rapidly decreasing work hours. MedicalResearch.com: Is there anything else you would like to add? Any disclosures? Response: Our findings may shed light on the high rates of burnout that has been identified among physician-mothers in other research. While increasing work hours among mothers may indicate progress on gender parity in terms of career engagement, this change may not have been sufficiently offset by a reduction in domestic responsibility. Further research should examine the balance of household duties as physician mothers spend an increasing amount of time at work. No disclosures. Citation: Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

MedicalResearch.com Interview with: Anna L. Goldman, M.D., M.P.A., M.P.H Assistant Professor of Medicine General Internal Medicine Boston University Chobanian & Avedisian School of Medicine MedicalResearch.com: What is the background for this study? Response: Experts on the healthcare labor market have long debated the existence and magnitude of a physician shortage. Physician work hours are a major contributor to physician supply issues, but little research is available on recent trends in work hours by physicians. In addition, no available studies have rigorously estimated changes in the physician workforce size during the pandemic. (more…)

Author Interviews, JAMA, Race/Ethnic Diversity / 16.05.2022

Mistreatment of Physicians in the Health Care Workplace

Susannah G. Rowe, MD, MPH Office of Equity, Vitality and Inclusion Boston University Medical Group Boston Medical Center Boston University School of Medicine Boston, Massachusetts

MedicalResearch.com Interview with: Susannah G. Rowe, MD, MPH Office of Equity, Vitality and Inclusion Boston University Medical Group Boston Medical Center Boston University School of Medicine Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: We wanted to learn how frequently mistreatment occurs for clinicians at work and how it impacts their occupational well-being. We began to see more anecdotal reports of workplace mistreatment of clinicians even before the pandemic. In the extraordinarily stressful environment we are currently experiencing, with people feeling exhausted and emotionally threadbare on some level, the problem appears to be growing. We also predicted that the burden of mistreatment would not borne be equally. It has often been said that we are all in the same storm but in different boats – some of us are riding out the storm in comfortable ocean liners, while others are paddling in canoes without life jackets. What we are learning, though, is that we are not in fact experiencing the same storm. For example, the increasing intolerance and erosion of public civility we have seen in recent years might show up as minor annoyances for some of us, and actual threats of violence for others depending in large part on our gender and racialized identities. Our relationship to privilege and oppression affects our experiences, creating protections or additional burdens, so when studying clinician occupational well-being, it seemed important to consider how these disparities play out in the workplace. (more…)

Author Interviews, Dermatology, Race/Ethnic Diversity / 28.04.2022

Tinted Sunscreens: Consumer Preferences Based on Light, Medium, and Dark Skin Tones

“Sunscreen” by Tom Newby is licensed under CC BY 2.0

MedicalResearch.com Interview with: Dr. Neelam Vashi MD Director of the Boston University Center for Ethnic Skin Dermatologist at Boston Medical Center, and Dr. Henriette De La Garza MD Research fellow Boston University School of Medicine MedicalResearch.com: What is the background for this study? Response: The COVID-19 pandemic abruptly shifted many of our daily activities to an online world, dramatically increasing the use of electronic devices. Although visible light exposure from screens is small compared with the amount of exposure from the sun, there is concern about the long-term effects of excessive screen time. Recent studies have demonstrated that exposure to light emitted from electronic devices, even for as little as 1 hour, may cause reactive oxygen species generation, apoptosis, collagen degradation, and necrosis of skin cells. Visible light increases tyrosinase activity and induces immediate erythema in light-skinned individuals and long-lasting pigmentation in dark-skinned individuals. In recent years, tinted sunscreens have been rising in popularity because they are an effective and convenient way to protect against high-energy visible light while providing cosmetic benefits. The purpose of this analysis was to study current available options and product factors that may influence consumer preference when choosing a tinted sunscreen so dermatologists can improve their familiarity with available products and tailor their recommendations to patients with all skin tones. (more…)

Author Interviews, BMC, Breast Cancer, Brigham & Women's - Harvard, Cancer Research, Diabetes, Nutrition / 10.12.2020

Breast Cancer: Diabetes Risk Reduction Diet Linked to Improved Survival

MedicalResearch.com Interview with: Tengteng Wang, PhD, MSPH, MBBS Postdoctoral Research Fellow Department of Epidemiology Harvard T.H. Chan School of Public Health Channing Division of Network Medicine Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Type 2 diabetes (T2D) has been associated with poor progression of breast cancer. Moreover, having a breast cancer diagnosis may also increase the risk of developing T2D. Therefore, identifying strategies for T2D prevention among breast cancer survivors may play a key role in improving their survival outcomes. One approach may be through a diabetes risk reduction diet (DRRD), a dietary pattern comprised of 9 components that has been associated with 40% lower T2D risk in a previous Nurses’ Health Study publication.1 However, no studies to date have evaluated the association between adherence to the DRRD (as measured by the DRRD score) and survival outcomes following breast cancer. In this prospective cohort study among 8,320 breast cancer survivors, we found that greater adherence to the diabetes risk reduction diet after diagnosis was associated with a statistically significant 31% lower risk of overall mortality. Reduced breast cancer-specific mortality was also observed, which was more pronounced (20% lower risk) among those who improved adherence after diagnosis compared to women with consistently low DRRD adherence before and after diagnosis. (more…)

Author Interviews, BMC, Cost of Health Care, Diabetes, Yale / 28.09.2019

Study Finds Need For Increased Diabetes Screening in Rural Communities

MedicalResearch.com Interview with: Phoebe Tran Doctoral Student Department of Chronic Disease Epidemiology Yale School of Medicine MedicalResearch.com: What is the background for this study? Response: As the prevalence of diabetes risk factors such as obesity, high blood pressure, high cholesterol, and physical inactivity are considerably higher in US individuals residing in rural areas compared to their urban counterparts, rural residents face increased risk of developing diabetes. Diabetes screening is a useful tool that can be used to identify people with newly developed type 2 diabetes and offer them early treatment. In this study, we examined whether there are differences in diabetes screening levels between rural and urban areas across the US using nationally representative survey data from 2011, 2013, 2015, and 2017. (more…)

Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Health Care Systems, Hospital Acquired, JAMA, Urinary Tract Infections / 06.02.2019

Federal Incentives Did Not Reduce Catheter Infections in Hospitals

Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118

MedicalResearch.com Interview with: Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings? Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015. Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown. Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example. We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals. (more…)

Addiction, Author Interviews, Cocaine, Opiods, Primary Care / 03.01.2019

Urine Tests Useful in Primary Care Monitoring of Opioid and Cocaine Use

Sarah M. Bagley MD, MSc Assistant Professor of Medicine and Pediatrics Director, CATALYST Clinic Boston University School of Medicine/Boston Medical Center Boston, MA

MedicalResearch.com Interview with: Sarah M. Bagley MD, MSc Assistant Professor of Medicine and Pediatrics Director, CATALYST Clinic Boston University School of Medicine/Boston Medical Center Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Urine drug testing is a routine part of the management of primary care patients with opioid use disorder treated with medications such as buprenorphine. In addition, most providers also ask patients about recent drug use. The point of this study was to see the agreement between the urine drug testing and what patients told a nurse and whether that changed the longer a patient was in treatment. We found that truthful disclosure of opioid and cocaine use increased with time in treatment and that urine drug tests are a useful tool to monitor patients. (more…)

Author Interviews, Nutrition, Pediatrics / 12.11.2018

Lower SNAP Participation by Immigrant Mothers With Young Children

MedicalResearch.com Interview with: Allison Bovell-Ammon, M.Div. Deputy Director of Policy Strategy Children's HealthWatch MedicalResearch.com: What is the background for this study? Response: Children’s HealthWatch was founded in 1998 by pediatric providers treating children with failure to thrive in six US cities across the country. They began their research on the health impacts of economic hardships like food insecurity in response to the 1996 welfare reform legislation after witnessing deteriorating health among young children in their clinics as a result of welfare sanctions on families. Over the years, the scope of the research has expanded to include research on food insecurity, housing instability, energy insecurity, health care hardships, and child care constraints. Through our current network of pediatricians and public health researchers in five US cities (Boston, Baltimore, Little Rock, Minneapolis, and Philadelphia), we seek to improve the health and well-being of children under age 4 and their families by informing policies that address and alleviate economic hardships. Our ongoing data collection in emergency departments and primary care clinics enables us to rapidly respond to emerging public health issues as policies and economic conditions change. While we have produced other papers and analyses specifically addressing health and economic disparities relevant to immigrant families, we were specifically interested in exploring this topic because the clinicians in our group as well as national media began anecdotally reporting that immigrants were forgoing accessing critical public health programs like SNAP out of fear. (more…)

Author Interviews, JAMA, Opiods, Pediatrics / 26.10.2018

The US Opioid Crisis is Expanding and Worse Among Young People

Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine

MedicalResearch.com Interview with: Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Massachusetts has been particularly hard hit by the opioid epidemic despite lower opioid prescribing rates, near universal health insurance, and availability of opioid treatment. That said, it is difficult to estimate the population with or at-risk for opioid use disorder. It is generally a highly stigmatized disease and typical methods to estimate of opioid use disorder relay on contact with the healthcare system and/or patient reporting. We used a unique and powerful methodology coupled with a first-in-the-nation linked database in Massachusetts to obtain both an accurate count of people with opioid use disorder who are known to the healthcare system and estimate the number who are out there but not yet known to the system. We found that more than 275,000 people – or 4.6 percent of people over the age of 11 in Massachusetts– have opioid use disorder, a figure nearly four times higher than previous estimates based on national data. In 2011 and 2012, the prevalence of opioid use disorder in Massachusetts for those over the age of 11 was 2.72 percent and 2.87 percent, respectively. That increased to 3.87 percent in 2013, and even more, to 4.6 percent in 2015. Those between the ages of 11 and 25 experienced the greatest increase in prevalence of all age groups. The number of “known” persons increased throughout the study period – from 63,989 in 2011 to 75,431 in 2012, and 93,878 in 2013 to 119,160 in 2015. (more…)

Addiction, Author Interviews, JAMA, Opiods, Pediatrics / 10.09.2018

Adolescents Face Large Addiction-Treatment Gap

Scott E. Hadland, MD, MPH, MS Assistant Professor of Pediatrics Boston Medical Center / Boston University School of Medicine

MedicalResearch.com Interview with: Scott E. Hadland, MD, MPH, MS Assistant Professor of Pediatrics Boston Medical Center / Boston University School of Medicine MedicalResearch.com: What is the background for this study? Response: Amidst a worsening overdose epidemic in the United States, adolescents and young adults have not been spared. Although evidence-based medications like buprenorphine, naltrexone, and methadone are recommended for adolescents and young adults, the extent to which youth receive these medications — and whether these medications help retain youth in addiction treatment — isn’t yet known. (more…)

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