Physicians

The supply, distribution, specialty mix, and other characteristics of the nearly 900,000 professionally-active U.S. physicians

Expanding Scope of Practice After COVID-19

Feb. 15, 2021

To expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.

Post-Acute Stays in Skilled Nursing Facilities: Patient Experiences

Feb. 10, 2021

What kind of care do patients expect after they are discharged from a hospital to a skilled nursing facility (SNF)? And how do those expectations align with care they actually receive from physicians and advanced practitioners? We know surprisingly little about the patient care experience in these post-acute settings, even though 1.5 million people in the U.S. are discharged to them each year. One fourth of those people die or are readmitted to the hospital within 30 days.

Bringing Gynecologic Cancer Care Closer to Patients

Jan. 13, 2021

For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist.

Clarifying the Role of the Modern General Surgeon: The Effect of Specialization on Inpatient Practice Patterns in General Surgery

Jan. 13, 2021

Catherine L. Mavroudis, Christopher Wirtalla, Jason Tong, Ezra S. Brooks, Cary B. Aarons, Rachel R. Kelz

Abstract [from journal]

Objective: The growing concentration of fellowship-trained and integrated residency-trained subspecialty surgeons has encroached on the breadth and volume of a so-called "true" general surgery practice, leaving the role of new general surgeons in flux. We aimed to describe the surgical practice of new general surgeons with and without subspecialty fellowship training.

Design: In this retrospective cohort study, state discharge data was linked to American Medical Association Masterfile and

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Choice Architecture in Physician-Patient Communication: A Mixed-Methods Assessments of Physicians’ Competency

Joanna Hart, MD, MSHP
Jan. 5, 2021

Joanna HartKuldeep Yadav, Stephanie Szymanski, Amy Summer, Aaron Tannenbaum, Julian Zlatev, David Daniels, Scott D. Halpern

Abstract [from journal]

Background: Clinicians' use of choice architecture, or how they present options, systematically influences the choices made by patients and their surrogate decision makers. However, clinicians may incompletely understand this influence.

Objective: To assess physicians' abilities to predict how common choice frames influence people's choices.

Methods: We conducted a prospective mixed-methods study using a scenario-based competency questionnaire and semistructured

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Interprofessional Training and Communication Practices Among Clinicians in the Postoperative ICU Handoff

Meghan Lane-Fall, MD, MSHP, Penn Medicine
Dec. 30, 2020

Scott Massa, Jasmine Wu, Cecilia Wang, Hannah Peifer, Meghan B. Lane-Fall

Abstract [from journal]

Background: Operating room (OR)-to-ICU handoffs require coordinated communication between clinicians with different professional backgrounds. However, individual studies have not simultaneously evaluated handoff training and OR-to-ICU handoff practices among interprofessional clinicians that participate in these team-based handoffs.

Methods: The objective of this study was to characterize communication training, practices, and preferences of interprofessional clinicians who engage in OR-to-ICU

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Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons

Research Brief
Dec. 10, 2020

Despite concerns that duty hour reform might adversely affect the performance of new surgeons, this national study found no impact on patient outcomes, including 30-day mortality rates, failure-to-rescue, length of stay, and use of intensive care units. These findings should allay fears that reduced work hours during residency would produce surgeons less prepared for practice than their more experienced colleagues.

Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained To Prescribe Buprenorphine

Dec. 1, 2020

Max Jordan Nguemeni Tiako, Jennifer Culhane, Eugenia SouthSindhu K. SrinivasZachary F. Meisel 

Abstract [from journal]

Importance: The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone.

Objective: To describe the prevalence and geographic distribution

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Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?

Research Brief
Kira Rysinka, MD
Nov. 16, 2020

In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.

Hospital and ICU Patient Volume per Physician at Peak of COVID Pandemic: State-Level Estimates

Kira Rysinka, MD
Oct. 22, 2020

Anjali Bhatla, Kira L. Ryskina

Abstract [from journal]

Background: In anticipation of patient surge due to COVID-19, many states are working to increase the available healthcare workforce. To help inform state policies and initiatives aimed at physician deployment during COVID-19, we used predictions of peak patient volume for hospitals and intensive care units (ICU) and regional physician workforce estimates to measure patient to physician ratios at the peak of the pandemic for each state.

Methods: We

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Promotion Of Clinical Educators: A Critical Need In Academic Family Medicine

Peter Cronholm, MD, MSCE
Oct. 1, 2020

Christine K. Jacobs, Kelly M. Everard, Peter F. Cronholm

Abstract [from journal]

Background and objectives: Academic family medicine departments have traditionally promoted faculty using research and scholarship criteria augmented by teaching, clinical care, and service. Clinic-focused faculty who spend significant time in direct patient care may not have enough time to meet promotion criteria, although they are critical for training future family physicians and for rebalancing the system of academic promotion.

Methods: We surveyed family medicine department chairs on the

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