Showing posts with label practice administration. Show all posts
Showing posts with label practice administration. Show all posts

Monday, September 14, 2015

Early Career Opinions of Practicing General Pediatricians vs Fellowship-Trained Specialists: Who Finds More Satisfaction and Balance with Their Careers?

By: Lewis First, MD, MS; Editor-in-Chief   

          In national medical surveys of physician satisfaction and overall career happiness, pediatricians tend to be one of the happiest and most satisfied of all medical specialties.  But what happens inside the pediatrics bubble where there are general practicing pediatricians and specialists over time?  Are there differences in career satisfaction as well as work-life balance as pediatricians complete their residency and/or fellowship training and go into their chosen aspects of our specialty?   
        Byrne et al. (doi: 10.1542/peds.2014-3973) offer us some insight into the early careers of pediatricians by sharing the results of a national survey of more than 800 pediatricians 8-10 years out from residency who were asked about their work environment, balance, and overall satisfaction with that which they were doing professionally and personally with their lives.  Just this description of what this article contains should drive anyone in training or post-training (even years out of training) to read the extensive collection of data shared in this article and then think whether you agree or disagree with the findings relative to your own professional life. 
      If you are thinking about Pediatrics as a career choice, you will be reassured that life and career satisfaction is good, no matter which career trajectory you choose—but there are also differences between those who do and do not fellowship train.  Link to this study being released this week and learn more!

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Wednesday, August 26, 2015

Are We “Choosing Wisely” to Reduce the Frequency of CT Scans in Children? New Study Tells All!

By: Lewis First, MD, MS; Editor-in-Chief 

          Our journal along with many other peer-reviewed pediatric journals have certainly published our share of studies suggesting the potential radiation risks of computed tomography (CT)  scans—especially multiple CT scan exposures in the same child.  This has led to lower dosages of radiation when children need to use this imaging modality as well as a national campaign to “Image Gently” or to avoid overuse of this readily accessible technology unless it’s medically or surgically indicated relative to other radiologic options.  
       So are trends in CT scanning improving?  Parker et al. (doi: 10.1542/peds.2015-0995) opted to assess these trends in a study being released this week in Pediatrics.  The authors performed a cross-sectional study of 33 tertiary care children’s hospitals using data from the Pediatric Health Information System between 2004 and 2012 looking at trends in not just CT but also ultrasound (US) and magnetic resonance imaging (MRI) for ten leading pediatric diagnoses recorded in this extensive dataset.   
      The results show that CT utilization is decreasing for most of the leading diagnoses and US and MRI trends and that alternative radiologic modalities are increasing.  Just what do the trends show more specifically for what disease?  The answers can be found by carefully scanning through the extensive data shared in this interesting study and then reassuring families that just because a CT scanner is available, doesn’t mean that the benefit of using it outweighs some radiation risks when less risky modalities may exist.

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Friday, August 14, 2015

A Study of Rudeness and Its Effect on Medical Team Performance: How Rude Is That?


By: Lewis First, MD, MS; Editor-in-Chief       

COD Newsroom
          Ever wonder if clinical performance in the ability to diagnose or perform a procedure can be hampered when someone on the team or watching your team is rude to you?  Riskin et al. (doi: 10.1542/peds.2015-1385) decided to answer that question using an innovative methodology involving a training simulation in which one group of neonatal intensive care unit (NICU) teams were observed by someone offering rude comments and the other control teams received neutral comments.   
      While it would be rude for me to give away the results, it would not be rude for me to say that rudeness had adverse consequences on NICU team performance in terms of diagnostic and procedural performance. So have you found the rudeness of others affecting your ability to do what you need to do clinically?   
     If so, what have you done to overcome the problem?  Share with us your anti-rudeness strategies via a response to this blog, an e-letter or by posting your thoughts on our Facebook site or Twitter.

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Friday, August 7, 2015

Oh the Places We Will Go…

By: Lewis First, MD, MS; Editor-in-Chief       

          One of the most fascinating trends to watch nowadays is who is choosing to go into pediatrics and what do pediatricians do once they make that choice and complete their residency?  Is pediatrics viewed more and more as a part-time or full-time specialty?  Are more of our trainees heading for specialty training and away from primary care or vice-versa?   
     It is becoming more and more timely to get a handle on the decisions being made professionally by the next generation of pediatricians by tracking their trajectory post-residency to determine present and future workforce needs. To help with that, the American Academy of Pediatrics has launched its PLACES study where PLACES stands for Pediatrician Life and Career Experience Study which kicked off in 2012.  This week Frinter et al. (doi: 10.1542/peds.2014-3972) who are overseeing this study share with us the design of this study involving 2 cohorts of US pediatricians , one who graduated residency in 2002-2004 and the other who recently graduated (2009-2022) with a total of over 1800 pediatricians enrolled.   
     This study sets the table for what will be twice yearly surveys of both cohorts with the hope of learning more about career, life choices, and the transitions experienced early in post-graduate training.  If you want a window into the recent world of our work force, then find a place for this special article and in turn the subsequent findings that will determine what will influence the career trajectory of the next generation of pediatricians.

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Tuesday, July 28, 2015

Home Is Where The Heart Is: New Ways of Thinking About Discharge Planning


By: Lydia Furman, MD,  Assistant Editor 
 
      Discharging preterm infants is an arduous duty.  Both residents and supervising neonatologists are familiar with the many pitfalls that hold up the show. Coordination of care, services and appointments, and needed equipment, are massive tasks. And there is often enough angst about readiness- i.e. “will this baby ‘fly’ and “will the parents be able to meet the baby’s needs” – to put off the discharge date several days for non-medical reasons.  All that is in addition to the strong desire of parents to finally “escape” home with their baby.  Any prolongation of the hospital stay is very expensive.
Dr. Temple et al. (doi: 10.1542/peds.2015-0456) have written a highly pragmatic article that gives providers a new “crystal ball” algorithm with which to plan discharges.  Using daily progress note information, their work teaches us how to predict discharge within a 2-10 day period, giving providers and staff the information and a level of certitude with which to plan.  They emphasize that their study is not about predicting length of stay at admission, but it’s about using “real time” data to predict future discharge during the hospital stay.
      What parameters are most useful? It’s an interesting exercise to try to predict or guess ahead what information will be most useful. Will it be lab values, growth parameters, feeding information, cessation of “A’s and B’s” (apneas and bradycardias), vital signs, original birthweight or gestational age, number of medications, or some golden combination of these?
      The authors evaluated a total of 4,693 patients and 103,206 patient-days, and examined four subpopulations, including premature infants, babies with cardiac disease, babies with gastrointestinal surgery, and those with neurosurgical conditions. They used progress notes to identify qualitative and quantitative parameters, and two types of “derived” or calculated data. The retrospective data they used is clinical and intuitive, and highly available, and will likely appeal to neonatologists and trainees. Ultimately with the use of just two features (no spoiler here- please read to find out!), days to discharge of 4 days can be predicted with surprising accuracy for three of the four subpopulations (neurosurgical patients were a challenge for the algorithm). This excellent work needs prospective confirmation, but the results are highly encouraging.
       Clearly the most important thing is getting babies and parents home in a way that is comfortable and safe, but there is a huge carrot at the end for making this transition as timely as possible. A brief peek at some crude financial data suggests that the work of Temple and colleagues has the potential to create enormous societal savings. The average cost of a preterm birth in the US is $32,325, and for infants born at less than 28 weeks, the average cost of the hospital stay was $280,811 (March of Dimes Peristats, https://www.marchofdimes.org/peristats). Single day charges for the NICU range around $3,000, not including costs related to specific surgical procedures or imaging (http://www.managedcaremag.com/archives/1001/1001.preterm.html).   
      Thus any comprehensive incremental decreases in length of NICU hospital stay could have a profound impact on total health care dollars.  Kudos to the authors for their forward thinking work, since ultimately safe healthcare change must be driven and led by knowledgeable physicians, rather than by administrators or insurance companies alone.

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