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Introduction: Patients admitted to the hospital will receive various drugs, each carrying the risk of error. Medication errors concern our healthcare system, especially considering the relatively high number of patients admitted to hospitals. Assuming that each patient receives at least two medications twice a day, the likelihood of a medication error is considerable. Therefore, therapeutic drug monitoring (TDM) focuses on measuring blood medication levels and plays a crucial role in medication safety. Aims: This study aimed to determine the effect of TDM in ensuring the safety of medications in many Taif hospitals. Also, to enhance the safety and quality of drug use and reflect physician perception and practice regarding TDM. Methodology: A prospective cross-sectional study consisting of questionnaires was conducted to physicians at many of Taif's governmental hospitals between March and May 2021. Questionnaires evaluated three parts: physician demographics, physician perception about TDM, and physician practices regarding TDM. The collected data were processed using the Excel program. Results: More than 80% of the interviewed physicians agreed that TDM is a tool that can guide the clinician to provide effective and safe drug therapy in the individual patient. Approximately 77% agreed that TDM is a team of decision-making groups. Around 25% of physicians performed TDM weekly, 22% monthly, and 10% daily. The medications that participating physicians ordered TDM were digoxin (30%), carbamazepine (21%), and gentamycin (17%). The participants had a limited understanding of the advantages of TDM in terms of drug safety and welfare. Conclusion: The number of actual drug errors occurs in the healthcare systems. Therefore, must establishment of TDM in hospitals. Medical administration and physicians must cooperate with the clinical pharmacist. Also, establish workshops for health practitioners to educate them about the role of TDM and pharmacokinetic laboratories in controlling the therapeutic process.

The influence of historical cultural norms is evident when analyzing the physician demographics in the United States. To this day, there exists a paucity in diversity as it pertains to gender balance and ethnicity. This phenomenon is particularly concerning when studies support the notion that race and gender concordance are associated with improved outcomes. The literature presented in this article identifies potential targets for interventions on how to attract, train, and retain minority physicians.

To determine preferences of clinicians and surgeons regarding radiology reporting of liver observations in patients at risk for hepatocellular carcinoma (HCC). Members of the American College of Radiology Liver Imaging and Data Reporting System (LI-RADS) Outreach & Education Group (30 members) as well as Society of Abdominal Radiology Disease-Focused Panel on HCC diagnosis (27 members) created and distributed an 18-question survey to clinicians and surgeons, with focus on preferences regarding radiology reporting of liver observations in patients. The survey questions were directed to physician demographics, current use of LI-RADS by their local radiologists, their opinions about current LI-RADS and potential improvements. A total of 152 physicians responded, 66.4% (101/152) from North America, including 42 surgeons, 81 physicians and 29 interventional radiologists. Participants were predominantly from academic centers 83% (126/152), while 13.8% (21/152) worked in private/community centers and 3.2% (5/152) worked in a hybrid practice. Almost 90% (136/152) of participants preferred the use of LI-RADS (compared to nothing or other standardized reporting systems; OPTN and AASLD) to communicate liver-related observations. However, only 28.5% (43/152) of participants input was sought at the time of implementing LI-RADS in their institutions. Fifty-eight percent (88/152) of all participants found standardized LI-RADS management recommendations in radiology reports to be clinically helpful. However, a subgroup analysis of surgeons in academic centers showed that 61.8% (21/34) prefer not to receive standardized LI-RADS recommendations. Most participants preferred the use LI-RADS in reporting CT and MRI examination. When considering inclusion of management recommendations, radiologists should consult with their referring physicians, as preference may differ.

Press Ganey patient satisfaction scores are increasingly being used as a physician quality metric. In this retrospective review of over 25,000 patient surveys for 61 ophthalmologists, pediatric ophthalmologists and neuro-ophthalmologists received significantly lower patient satisfaction scores than their peers, suggesting that the problem for which a patient seeks care may affect whether he or she is satisfied with the care received. These findings should be taken into account when considering the validity of Press Ganey scores as an equitable, modifiable measure of physician performance, especially when considering factoring these scores into physician evaluation and reimbursement.

OBJECTIVES/HYPOTHESIS Patient satisfaction is increasingly emphasized and measured in healthcare delivery. However, patient satisfaction is multifactorial and difficult to comprehensively assess. The objective of this study was to assess for correlation between patient satisfaction measured by Press Ganey surveys (PGS) and physician demographics of gender, years in practice, academic rank, and specialty in academic otolaryngology. STUDY DESIGN Review of publicly available PGS scores in academic otolaryngology practice. METHODS Public websites of academic otolaryngology departments were assessed for inclusion of PGS scores. Individual physician profiles were queried for years in practice, academic rank, and specialty. Gender was determined by picture or profile pronouns. Univariate and multivariate analyses compared PGS scores with studied variables. RESULTS Forty-seven of 113 (42.8%) academic practices publicly reported physician PGS score. Of 1,360 affiliated otolaryngologists, 742 (54.6%,592 male:150 female) revealed PGS scores. Average PGS score for male and female providers was equivalent (PGS = 4.73, P = .84). There was no significant difference in PGS scores by academic rank (P = .28). A weak statistically significant decrease in mean PGS scores was associated with longer duration of practice (r = -0.11, P = .018). Head and neck oncologic surgeons had higher mean PGS score in comparison to other specialties (PGS = 4.81, P

OBJECTIVEThe purpose of this study was to assess the impact of certain demographics, social media usage, and physician review website variables for spine surgeons across Healthgrades.com (Healthgrades), Vitals.com (Vitals), and Google.com (Google).METHODSThrough a directory of registered North American Spine Society (NASS) physicians, we identified spine surgeons practicing in Texas (107 neurosurgery trained, 192 orthopedic trained). Three physician rating websites (Healthgrades, Vitals, Google) were accessed to obtain surgeon demographics, training history, practice setting, number of ratings/reviews, and overall score (January 2, 2018–January 16, 2018). Using only the first 10 search results from Google.com, we then identified whether the surgeon had a website presence or an accessible social media account on Facebook, Twitter, and/or Instagram.RESULTSPhysicians with either a personal or institutional website had a higher overall rating on Healthgrades compared to those who did not have a website (p < 0.01). Nearly all spine surgeons had a personal or institutional website (90.3%), and at least 1 accessible social media account was recorded for 43.5% of the spine surgeons in our study cohort (39.5% Facebook, 10.4% Twitter, 2.7% Instagram). Social media presence was not significantly associated with overall ratings across all 3 sites, but it did significantly correlate with more comments on Healthgrades. In multivariable analysis, increasing surgeon age was significantly associated with a lower overall rating across all 3 review sites (p < 0.05). Neurosurgeons had higher overall ratings on Vitals (p = 0.04). Longer wait times were significantly associated with a lower overall rating on Healthgrades (p < 0.0001). Overall ratings from all 3 websites correlated significantly with each other, indicating agreement between physician ratings across different platforms.CONCLUSIONSLonger wait times, increasing physician age, and the absence of a website are indicative of lower online review scores for spine surgeons. Neurosurgery training correlated with a higher overall review score on Vitals. Having an accessible social media account does not appear to influence scores, but it is correlated with increased patient feedback on Healthgrades. Identification of ways to optimize patients’ perception of care are important in the future of performance-based medicine.

Objectives: This study compares hospital-generated online ratings to patient-generated online ratings in academic otolaryngology and evaluates physician factors influencing these results. Methods: Websites of academic otolaryngologists were assessed for inclusion of hospital-generated Press Ganey surveys. Corresponding scores on Healthgrades and Vitals.com were identified via internet search. Hospital ratings were compared with patient-generated ratings, including score, demographics, and number of ratings. All data was collected between July 15th 2019 and August 22nd 2019. Results: 742 academic otolaryngologists with hospital-generated ratings were identified. Mean hospital-generated rating was significantly higher ((4.70, 95% CI 4.69-4.72) than patient-generated rating (Vitals:4.26, 95% CI 4.18-4.34, and Healthgrades:4.02, 95% CI 3.87-4.18; P 20) was associated with male gender, professor ranking, and >30 years in practice ( P 30+ years in practice ( P = .023). Across all platforms, comprehensive otolaryngologists and neurotologists/otologists were rated lower in comparison to other specialties (PGS: P Conclusion: Hospital-generated ratings yield higher mean scores than patient-generated platforms. Between sources, Healthgrades.com scores were lower than those of Vitals.com . Professors with >30 years of practice generated more reviews in patient-generated ratings, and these physicians were generally rated lower. Access to patient-generated ratings is universal and physicians should be aware of variability between online rating platforms as scores may affect referrals and practice patterns.

This Viewpoint challenges US hospital claims that government funding to train physicians is necessary to offset costs, maintain physician supply, and keep costs

The lack of gender diversity in cardiology has long been considered a workforce problem, yet data were lacking. The past 5 years have seen the publication of a series of cardiology-specific papers on physician demographics, inequities, and barriers to recruitment ([1–5][1]), alongside a robust and

Physician recommendation is a strong predictor of vaccine uptake, however their perceived barriers may prevent vaccination. Therefore, we determined the association between physicians' perceived barriers to HPV vaccination and vaccination initiation. We surveyed pediatricians in a large network of clinics in Houston, Texas to assess their perceived barriers to vaccinating adolescents. We combined survey data with electronic medical records to determine HPV vaccination initiation over a 12-month study period (July 2014–June 2015). Patients were 11–18 year olds who had not begun the vaccination series, had a physician visit during the study period, and whose physician completed the survey. We conducted a multilevel model clustered by physician controlling for patient and physician demographics to calculate the association between physician-reported barriers and HPV vaccination initiation. Among 36,827 patients seen by 134 pediatricians, 18.6% initiated HPV vaccination. The relative risk of initiating HPV vaccination were lower for patients whose physician reported concerns about HPV vaccine safety (RR: 0.75, 95% CI: 0.58–0.97), efficacy (RR: 0.73, 95% CI: 0.54–0.99), and the financial burden of the vaccine on patients (RR: 0.72, 95% CI: 0.58–0.88). After controlling for patient and physician characteristics, physician concern about the financial burden on patients was significantly associated with lower relative risk of initiating HPV vaccination (RR: 0.76, 95% CI: 0.64–0.90). In this large study we observed that physician-reported barriers are associated with HPV vaccination initiation. Interventions should be implemented to educate physicians on vaccine safety, efficacy, and that there is no patient cost for CDC-recommended vaccines.

Objective To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge. Data Sources Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013. Study Design We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend–state indicators, and state CME change indicators. Data Collection Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports. Principal Findings More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile. Conclusions Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge.

We aim to determine what variables may influence physician decision-making about transfer of pediatric patients from a Level III Trauma Center (L3TC) to a Pediatric Trauma Center (PTC).Emergency L3TC physicians and PTC emergency physicians/TTLs were surveyed with clinical scenarios of children presenting to a L3TC with 5 injury parameters: age, hemodynamic status, GCS, intra-abdominal injury, femur/ pelvic fracture, and asked if the patient should be transferred to a PTC. Associations between parameters and physician demographics in the decision to transfer were examined.One hundred seven and 94 surveys were completed at L3TCs and PTCs, respectively. Parameters associated with decision to transfer: pelvic and GI tract injuries, GCS 12, and age 4 years. L3TCs were significantly less likely vs. PTCs to recommend transfer with femur fracture, solid organ / GI injury, or a GCS of13. Increasing town size, access to an experienced surgeon, and formal training in emergency medicine among L3TC physicians were associated with a decision not to transfer.Injuries requiring potential surgery or critical care influenced the decision to transfer. For cases with lesser severity or older ages, input of L3TCs on developing triage criteria is vital to allow families to stay in their home communities while ensuring optimal clinical outcomes.Prospective Cross Sectional Survey.Level III.

This cross-sectional study uses data from the American Medical Association Physician Masterfile to examine physician density by specialty type across metropolitan and rural US counties from 2010 to 2017.

PURPOSE We examined the perspectives of family physicians (FPs) on opioid prescribing and management of chronic pain to better understand the barriers to safer prescribing in primary care and differences in perspectives that may be potential drivers of practice variation. METHODS We used an exploratory qualitative study design. Semistructured interviews were conducted in June and July 2017 with 22 FPs in Ontario and coded inductively. Thematic analysis was used to identify themes, and a framework analysis explored the influence of physician demographics on prescribing experience. RESULTS Three key themes emerged: the discrepancy between FPs’ training and current practice, the tension between the FP’s role and patient and system expectations, and the influence of length of time in practice and strength of therapeutic relationships on perspectives on opioid prescribing. There was an overarching sentiment among participants that FPs are unsupported in their efforts to manage chronic pain. More years in practice (≥15 years) seems to influence practice patterns by increasing trust in therapeutic relationships and decreasing reliance on emergent guidelines (vs clinical experience). CONCLUSION Number of years in practice influences FPs’ response to emergent evidence, requiring initiatives to include strategies tailored to individual beliefs. Initiatives must move beyond dissemination and education to equip FPs with the skills they need to navigate emotionally charged conversations. External pressures and misaligned system and patient expectations place FPs at the center of a challenging situation, which may result in a higher risk of burnout compared with that of their specialist colleagues.

Background Systemic sclerosis (SSc) is an uncommon, complex and heterogeneous condition, making it challenging to manage. Individual rheumatologists see relatively few cases and patient surveys identify numerous gaps in clinical care. There are no published data on the educational needs of rheumatologists caring for patients with SSc. We aimed to determine rheumatologists’ self-rated knowledge and learning needs. Methods Survey questions were adapted from the EULAR Recommendations for the Treatment of SSc with reference to patient-identified care gaps. The survey was conducted on paper and on SurveyMonkey (a cloud-based online survey development software program). The target audience was Ontario rheumatologists, serving a population of 13.6 million. We sought to explore self-reported knowledge, experience, attitudes and perceived barriers in caring for SSc patients. Physician demographics and preferred educational methods were also collected. Gaps between perceived and desired knowledge were calculated to identify the greatest unmet learning needs. Results One hundred and eighteen responses were received with a response rate of 54%. The greatest unmet learning needs were seen in the management of sexual dysfunction (average gap of 1.4 on a 5-point scale), pulmonary hypertension (1.1), interstitial lung disease (1.0) and gastrointestinal manifestations of the disease (1.0). The smallest learning gap concerned screening recommendations (0.7). 19% of rheumatologists agreed with the statement “Scleroderma is an untreatable disease.” Agreement with this statement was highest (33%) among rheumatologists who treat relatively small numbers1–10 of scleroderma patients. Conclusions We have identified several unmet learning needs regarding the management of SSc among rheumatologists. These can be used to inform future educational resources and programs for rheumatologists regarding SSc and to direct further research into their needs. Disclosure of Interest None declared

BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) has established the requirement for residency programs to assess trainees' competencies in 6 core domains (patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice). As attending rounds serve as a primary means for educating trainees at academic medical centers, our study aimed to identify current rounding practices and attending physician perceived capacity of different rounding models to promote teaching within the ACGME core competencies. METHODS We disseminated a 24-question survey electronically using educational and hospital medicine leadership mailing lists. We assessed attending physician demographics and the frequency with which they used various rounding models, as defined by the location of the discussion of the patient and care plan: bedside rounds (BR), hallway rounds (HR), and card-flipping rounds (CFR). Using the ACGME framework, we assessed the perceived educational value of each model. RESULTS We received 153 completed surveys from attending physicians representing 34 institutions. HR was used most frequently for both new and established patients (61% and 43%), followed by CFR for established patients (36%) and BR for new patients (22%). Most attending physicians indicated that BR and HR were superior to CFR in promoting the following ACGME competencies: patient care, systems-based practice, professionalism, and interpersonal skills. CONCLUSIONS HR is the most commonly employed rounding model. BR and HR are perceived to be valuable for teaching patient care, systems-based practice, professionalism, and interpersonal skills. CFR remains prevalent despite its perceived inferiority in promoting teaching across most of the ACGME core competencies. Journal of Hospital Medicine 2014;9:239–243. © 2014 Society of Hospital Medicine

The authors examined the responses of 63 primary care physicians to diabetes clinical protocols (DCPs) for the management of type II diabetes (T2DM). We measured physician demographics, current diabetes patient loads, and responses to DCPs (physician attitudes, physician familiarity, and physician recommendation of DCPs) using a 20-question electronic survey. Results of the survey indicate that primary care physicians may be unfamiliar with the benefits of diabetes clinical protocols for the self-management of T2DM. Given the importance of diabetes self-management education in controlling T2DM, those interested in implementing DCPs should address the beliefs and attitudes of primary care physicians.

Literature suggests early post-percutaneous endoscopic gastrostomy (PEG) feeding is as safe as delayed feeding. No consensus exists regarding feeding initiation after PEG placement. We performed a national survey to assess current practice regarding feeding initiation after PEG placement as well as clinical and practitioner based factors associated with early or delayed feeding.A survey assessing feeding initiation in general ward and intensive care unit patients, current literature knowledge, motility agent use, number of PEG placed per year, along with physician demographics was emailed to 5256 gastroenterologists. Statistical analysis was done using SAS software (V.9).28% of gastroenterologists responded. Amongst respondents, 59% were private consultants, 25% academic physicians and 16% trainees. Private gastroenterologists initiated feeding earlier (≤12 h) compared to academic gastroenterologists in general ward and intensive care unit patients (p0.0001). Amongst respondents, 41% of physicians were aware of current literature on post-PEG feeding times. Physicians aware of current literature started feeding earlier (12h) compared to those not aware in general ward and intensive care unit patients (p=0.0002). Male physicians instituted feeding earlier than females (p0.0001).Feeding initiation after PEG placement varies amongst gastroenterologists. Further studies are required to explore obstacles in standardizing post-PEG feeding practices.

Background and Purpose— Past studies consistently show an inverse relationship between physicians’ surgical procedures/diagnoses volume and cost. There is little information available on this aspect of stroke care. We used nationwide population-based data to explore the association between physician case volume and costs per discharge for patients with stroke. Methods— Data on all 83 748 hospitalizations for stroke in 2004, treated by 3757 physicians in Taiwan, from Taiwan’s National Health Insurance Research Database, was analyzed using hierarchical linear regression modeling to explore associations between costs per discharge and physician case volume (one to 44 cases=low volume, 44 to 135=medium volume, ≥136 cases=high volume) adjusting for patient’s age, gender, comorbidities, and stroke type; hospital ownership, teaching status, and geographic region; and physician demographics. Results— Unadjusted mean cost per discharge was highest for patients treated by low-volume physicians, at NT $79 993 compared with NT $78 588 for medium-volume physicians and NT $43 942 for high-volume physicians ( P P =0.001) and NT $7761 higher than medium-volume physicians ( P =0.027). Conclusions— Our data confirm an inverse volume–cost relationship for stroke care in Taiwan. After adjusting for patient, hospital, and physician characteristics, the potential cost savings if all patients were treated or supervised by high-volume physicians could be 41.0% of the mean treatment cost incurred by low-volume physicians.

We analyze the claims database of a large malpractice insurer covering more than 8,000 physicians and 9,300 claims. Applying empirical Bayes methods in a regression setting, we construct a predictor of each physician's underlying propensity to incur malpractice claims. Our explanatory factors are physician demographics (age, sex, specialty, training) and physician practice pattern characteristics (practice setting, procedures performed, practice intensity, special risk factors, and characteristics of hospital(s) on staff of). We divide physicians into medical and surgical/ancillary specialty categories and fit separate models to each. In the surgical/ancillary specialty group, physician characteristics can effectively distinguish between more and less claims-prone physicians. Physician characteristics have somewhat less predictive power in the medical specialty group. As measured by predictive information, physician characteristics are superior to 10 years of claims history. Insofar as medical malpractice claims can be thought of as extreme indicators of poor-quality care, this finding suggests that easily gathered physician characteristics can be helpful in designing targeted quality of care improvement policies.

Little is known about how physicians' knowledge of and attitudes to practice guidelines for stable angina may influence their implementation.To explore the association between physicians' demographics, their knowledge, and opinions about stable angina and their self-reported adherence to guideline recommendations.Questionnaire-based survey.We surveyed 1228 Quebec physicians using a questionnaire based on the 'awareness-to-adherence' conceptual framework to measure their adherence with recommendations for the pharmacological treatment of stable angina. Independent predictors of adherence with the targeted recommendations were determined by stepwise linear regression analysis.We received 877 (71.4%) responses from the 1228 eligible physicians. More than 90% of respondents were aware of and agreed with the targeted recommendations. However, the adoption rate varied, even among physicians who generally agreed with the guidelines. Factor analysis indicated that most physicians agreed with recommendations concerning ASA. More negative attitudes were expressed toward beta-blockers and hypolipaemic drugs. Respondents trusted the recommendations of a variety of scientific and professional organizations. Awareness, agreement, and adoption were the strongest predictors of adherence for the three recommendations. Physician demographics and practice characteristics did not predict adherence.Physicians were aware of and agreed with the recommendations, so additional large-scale dissemination of the guidelines would be unlikely to improve prescription patterns. However, negative attitudes about beta-blockers and hypolipaemic therapy affected adherence to recommendations for these drugs. Continuing medical education interventions involving local opinion leaders might address some of the obstacles identified.

In focusing on individual and physician demographics and system characteristics that lead to hysterectomy rate variations, researchers overlook the impact of culturally mediated meanings women assign to their bodies, hysterectomy, and other treatments. In this study I sought to provide a fuller description of this decision-making process by examining the role of meaning making in women’s decision not to have a hysterectomy. Using a descriptive qualitative approach, nine women diagnosed with menstrual disorders in Halifax, Nova Scotia, Canada each took part in a semi-structured interview. Factors deemed “irrational” in biomedical understandings of informed choice played a significant role in participants’ decisions not to have a hysterectomy. When these factors are hidden, they cannot be properly addressed during the treatment selection process. By shifting the approach to informed choice to incorporate a holistic view of the body and knowledge, requirements for informed choice may be more likely to be met. Keywords: Menstrual Disorders, Treatment Decision-Making, Women’s Health, Descriptive Qualitative Research

In this study we sought to better understand how EMR systems are actually being used by family physicians and what they perceive to be the performance outcomes for themselves and their medical practices. To achieve our objectives, we conducted a survey of family physicians in Quebec, Canada and obtained responses from 331 user physicians. Key findings reveal that EMR systems "as-used" vary from one physician to another in terms of the EMR capabilities that are actually mobilized by them. Two user profiles were identified, that is, Meaningful and Basic users. Significant differences between the two groups were found in terms of physician demographics and system characteristics. In terms of perceived outcomes, physicians were clustered under three profiles that could be clearly distinguished from one another, namely Highly Impacted, Slightly Impacted and Non Impacted users. Findings show that Highly Impacted physicians are those who are the most experienced with EMRs and those who make the most wide-ranging use of their system capabilities. Practical and research implications of this study are discussed.

The American Society of Pediatric Hematology/Oncology (ASPHO) recognized recent changes in medical practice and the potential impact on pediatric hematology-oncology (PHO) workforce. ASPHO surveyed society members and PHO Division Directors between 2010 and 2016 and studied PHO workforce data collected by the American Board of Pediatrics and the American Medical Association to characterize the current state of the PHO workforce. The analysis of this information has led to a comprehensive description of PHO physicians, professional activities, and workplace. It is important to continue to collect data to identify changes in composition and needs of the PHO workforce.

This study describes the number of H-1B visa physician applications and active care H-1B visa applications physicians by state and employer in 2016.

Introduction Maintenance of Certification (MOC) for Family Physicians (MC-FP) includes clinical Self-Assessment Modules (SAMs). Whether family physicians choose SAMs that reflect their aptitudes or knowledge gaps has not been studied. Method Secondary analysis of demographic data, 2009 certification examination scores, and 2009–2012 SAM participation data. We computed disease-specific scores for asthma, diabetes, and hypertension from the examination. We ran unadjusted logistic and adjusted conditional logistic regression models of score quintiles, matched on the number of SAMs completed and controlling for physician demographics and area-level social deprivation. Results In 2009, 9 610 physicians passed the exam. Mean scores were 591.4 (SD ± 308.5) for asthma, 558.6 (SD ± 216.1) for diabetes, and 533.3 (± 226.7) for hypertension. Average scores on hypertension and diabetes were higher for physicians who subsequently completed related SAMs but not for those who completed the asthma SAM. The percentage of physicians in each quintile of scaled score who completed each SAM increased for diabetes (32.3%–40.9%) and hypertension (33.0%–36.9%). For asthma, logistic regression analyses found no statistically significant associations. For diabetes, there was a consistent association in both models between higher score quintile and likelihood of taking the SAM. For hypertension, an association of higher score and higher likelihood of taking the SAM was significant only in the third quintile (OR = 1.20 (1.03, 1.39)). Discussion We found inconsistent relationships between physician knowledge and SAM selection. For MOC to better impact quality, boards should consider directing physicians toward MOC activities that fill knowledge gaps rather than areas of strength.

Purpose To understand perceptions of primary care physicians (PCPs) about the value of advanced medical imaging. Methods A national quantitative survey of 500 PCPs was conducted using an online self-administered questionnaire. Questions focused on advanced medical imaging (CT, MRI, and PET) and its perceived impact on the delivery of patient care. Responses were stratified by physician demographics. Results Large majorities of the PCPs indicated that advanced imaging increases their diagnostic confidence (441; 88%); provides data not otherwise available (451; 90%); permits better clinical decision making (440; 88%); increases confidence in treatment choices (438; 88%), and shortens time to definitive diagnosis (430; 86%]). Most (424; 85%) believe that patient care would be negatively affected without access to advanced imaging. PCPs whose clinical careers predated the proliferation of advanced imaging modalities (>20 years of practice) assigned higher value to advanced imaging on several dimensions compared with younger physicians whose training overlapped widespread technology availability. Conclusions By a variety of metrics, large majorities of PCPs believe that advanced medical imaging provides considerable value to patient care. Those whose careers predated the widespread availability of advanced imaging tended to associate it with even higher value.

Beta blockers have repeatedly demonstrated their therapeutic value in the treatment of a variety of diseases; as a result, multiple treatment guidelines advocate the use of beta blockers. Despite these guidelines, the use of beta blockers is remarkably low. Numerous factors that influence the trends of drug use include pharmaceutical advertisements, physician legal concerns, marketing influences, outdated therapeutic contraindications, and patient and physician demographics. Recent primary evidence from randomized clinical trials has demonstrated a significant benefit to patients with heart failure when beta-blocker therapy is added to standard therapy. To ensure proper treatment, continuing efforts must be made to provide patients with appropriate therapy that is proven to reduce the risks of mortality and morbidity.

Objective : To survey obstetrician-gynecologists regarding current approaches to partner notification of women with sexually transmitted diseases (STDs) and to relate reported practices to state requirements. Methods : An anonymous questionnaire was sent to community, hospital-employed, and university-based physicians within a single health care system. The survey was designed to assess physician demographics, knowledge, and attitudes about partner notification of women with STDs. Results : One hundred eight (49%) of 222 surveys were returned. Respondents were 36% private practitioners, 38% hospital-employed, and 23% university faculty physicians. Although most correctly identified the importance of partner notification for several STDs, they (63 of 108, 58%, confidence interval [CI] 50%, 67%) could not identify all of those conditions. Most respondents (84 of 108, 78%, CI 69%, 85%) were unaware of all required reportable STDs and the state's preferred method of partner notification. The vast majority of respondents (96 of 108, 89%, CI 82%, 94%) relied on women to notify their partners of the STD. Conclusion : Educational efforts are needed to increase physician awareness of required reportable STDs and the role of partner notification and treatment in disease control. Physicians need to be aware of state regulations for partner notification when they are in practice. Development of standard algorithms for partner notification and treatment might be needed.

Background Methicillin-resistant staphylococcus aureus (MRSA), central line associated with blood stream infections (CLABSIs), catheter associated urinary tract infections (CAUTIs) and surgical site infections (SSIs) are health care associated infections (HAIs) which are a massive burden on the health care system. These issues are closely linked with reimbursement and outcomes. It is postulated that the spread of these health care associated infections is linked closely with mortality from sepsis. Methods De identified data about the number of board certified Infectious Disease (ID) physicians by zip code was obtained from the Doximity physician database. We then conducted a descriptive analysis using mortality data from the National Center for Health Statistics’(NCHS), Compressed Mortality File (CMF), which contains descriptive data on the age, race, sex, year and causes of all deaths in the US. We defined sepsis death as death attributed to an infection. In addition, the location of current ID fellowships was obtained from the National Residency Matching Program (NRMP) public data. These were mapped using Google fusion tables and the results compared with CDC databases: prevalence of MRSA, CLABSIs, CAUTIs and SSIs. Results A total 147 fellowship programs and 7129 board certified physicians were identified in ID. Mortality from sepsis was highest in states: Arkansas, Louisiana, Mississippi, Tennessee, Kentucky, West Virginia and Florida, which correlated with the highest prevalence of MRSA, CLABSIs, CAUTIs and SSIs. ID fellowships and board certified physicians on the other hand tend to be concentrated on the East coast and the metropolitan cities of the West. Studies have also shown in the past that physicians tend to practice in geographical locations where they completed their training. Conclusion The use of this novel social network mapping approach to assess the Infectious Diseases physician workforce has the potential of providing real-time data regarding their geographical spread. HAIs and mortality from sepsis tend to be higher in locations with fewer ID fellowships and board certified physicians. This problem could be addressed by rebalancing interventions and focussing on efforts to match the work force with the prevalence of HAIs and locations with higher sepsis mortality. Disclosures All authors: No reported disclosures.

Objectives This study was conducted to determine if there is practice variation for emergency physicians’ (EPs) management of recent-onset atrial fibrillation (RAF) in various world regions (Canada, United States, United Kingdom, and Australasia). Methods The authors completed a mail and e-mail survey of members from four national emergency medicine (EM) associations. One prenotification letter and three survey letters were sent to members of the Canadian Association of Emergency Physicians (CAEP; Canada—1,177 members surveyed), American College of Emergency Physicians (ACEP; United States—500), College of Emergency Medicine UK (CEM; United Kingdom—1,864), and Australasian College for Emergency Medicine (ACEM; Australasia—1,188) as per the modified Dillman technique. The survey contained 23 questions related to the management of adult patients with symptomatic RAF (either a first episode or paroxysmal-recurrent) where onset is less than 48 hours and cardioversion is considered a treatment option. Data were analyzed using descriptive and chi-square statistics. Results Response rates were as follows: overall, 40.5%; Canada, 43.0%; United States, 50.1%; United Kingdom, 38.1%; and Australasia, 38.0%. Physician demographics were as follows: 72% male and mean (±SD) age 41.7 (±8.39) years. The proportions of physicians attempting rate control as their initial strategy are United States, 94.0%; Canada, 70.7%; Australasia, 61.1%; and United Kingdom, 43.1% (p