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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. 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: Goldman AL, Barnett ML. Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021. JAMA Intern Med. Published online December 19, 2022. doi:10.1001/jamainternmed.2022.5792 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.     Read the full article

Mytien Nguyen Mytien Nguyen, MS MD-PhD Program, Yale School of Medicine, New Haven, Connecticut MedicalResearch.com:  What is the background for this study?  Response: It is well-recognized that diversity in the medical workforce is critical to improve health care access and achieve equity for neglected communities. Despite increased efforts to recruit diverse medical trainees, there remains a large chasm between the racial/ethnic and socioeconomic composition of the patient population and that of the physician workforce. MedicalResearch.com:  What are the main findings? Is the attrition rate linked to academic performance and/or admission selection factors?  Response: We examined attrition, which includes withdrawal and dismissal for any reason, among about large cohort of allopathic medical students We found that attrition rates were highest among students who belonged to a race and/or ethnicity underrepresented in medicine (URiM) group, were low income, or grew up in an underresourced neighborhood. Critically, exploration of intersectional identities showed that attrition rate increased with increasing number of marginalized identities, with low-income URiM students from underresourced neighborhoods having the highest attrition rate. MedicalResearch.com: What should readers take away from your report?  Response: There is an accumulation of disadvantage in medical education. Previous reported experiences of social isolation, racism, and discrimination have been associated with burnout and depression for marginalized students. Medical schools need to adopt a more proactive antiracism strategy, such as financial and administrative support for diversity, equity and inclusion offices, and requiring the Liaison Committee on Medical Education to monitor and attrition or early signs of it, such as leaves of absence. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: It is important to emphasize that the challenges students are encountering are not individual challenges, but challenges imposed by the medical training environment, climate, and system that are not created for students from marginalized backgrounds. Much of previous research on students’ progress have focused on individual interventions. We believe that it critical that we examine the environment and what aspect of the environment and climate that are not fostering the development of marginalized students and allowing them to thrive.  Citation: Nguyen M, Chaudhry SI, Desai MM, et al. Association of Sociodemographic Characteristics With US Medical Student Attrition. JAMA Intern Med. Published online July 11, 2022. doi:10.1001/jamainternmed.2022.2194 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. Some links may be sponsored and no links are warranted or endorsed by MedicalResearch.com or its parent company, Eminent Domains Inc. 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.   Read the full article

Dr. Peltz Alon Peltz, MD MBA MHS  Department of Population Medicine Harvard Pilgrim Health Care Institute MedicalResearch.com: What is the background for this study? Response: Thank you for taking an interest in our study. This study represented a collaboration between investigators from Harvard Medical School and Boston University School of Medicine. SNAP is an important U.S. federal aid program that serves nearly 40 million persons annually with well-established health, nutrition, and financial benefits. Families can be eligible for the SNAP program under “federal” rules or “categorical eligibility” rules that extend SNAP support to otherwise ineligible families who receive benefits under certain social assistance programs, such as Temporary Assistance for Needy Families. In July 2019, the U.S. Department of Agriculture proposed new SNAP policies that would limit qualifications via the categorical eligibility route. Although these new policies have not been finalized, it is estimated that 1 in 10 U.S. families currently participating in SNAP may lose their benefits. We wanted to investigate the potential ramifications of these changes to help inform policymakers of the vulnerabilities of the families who receive SNAP benefits and may be at risk for disenrollment if the proposed policies are implemented. MedicalResearch.com: What are the main findings? What should readers take away from your report?  Response: We found that families receiving SNAP under categorical eligibility programs, despite slightly higher incomes compared with all other SNAP participants, have substantial health, nutrition, and financial needs. These proposed changes to SNAP raise concerns for adverse effects on health, nutrition, and ability to pay for health care for those families who may be impacted. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: In the event that the proposed SNAP policies are enacted it will be important to monitor for any adverse effects on the health and financial wellbeing of those families who are impacted.  MedicalResearch.com: Is there anything else you would like to add? Response: We used national health survey data to best approximate the needs of categorically eligible SNAP participants, however the database was not specific to SNAP enrollment, and so we had to develop a model to estimate, as best we could, each family's SNAP enrollment type based on their income, household composition, and other factors. We hope follow-up studies, with access to more robust SNAP enrollment data, will help shed additional light on this important issue. Citation: Peltz A, Galbraith AA, Rogers S, Walsh R, Garg A. Socioeconomic and Health Characteristics of Families at Risk for Losing Supplemental Nutrition Assistance Program Benefits. JAMA Intern Med. Published online March 09, 2020. doi:10.1001/jamainternmed.2019.7152   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.   Read the full article

Dr. Hripcsak George Hripcsak, MD, MS Vivian Beaumont Allen Professor of Biomedical Informatics Chair, Department of Biomedical Informatics Columbia University Director, Medical Informatics Services NewYork-Presbyterian Hospital/Columbia MedicalResearch.com: What is the background for this study? Response: Diuretics are considered among the best drugs to treat hypertension, but there are no randomized studies to tell us which diuretic is best. Hydrochlorothiazide is the most frequently used diuretic for hypertension, but another drug, chlorthalidone, is gaining favor, with the most recent US hypertension guideline expressing a preference for it. Chlorthalidone is known to be longer acting and therefore perhaps more effective. Other (non-randomized) studies have been inconsistent, and some of them imply that chlorthalidone may be more effective. But other studies have shown that chlorthalidone may have more side effects. MedicalResearch.com: What are the main findings?  Response: We carried out the largest and--we believe--most sophisticated non-randomized study comparing the two drugs, and we found little difference in effectiveness (preventing heart attacks, strokes, and heart failure) but we found that chlorthalidone produces more side effects, especially low potassium (almost three times as much) and other electrolyte disorders and kidney problems.  MedicalResearch.com: What should readers take away from your report?  Response: We believe that if you are already taking hydrochlorothazide, our study shows no reason to switch to chlorthalidone at this time. And if you are taking chlorthalidone, your physician should be monitoring your electrolytes and kidney function carefully.  MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: A large randomized study to compare the two drugs is currently in progress and may reveal more information in a few years. Even so, our study is reflective of what happens in real world practice. Disclosures: This study was funded in part by the US National Institutes of Health and the National Science Foundation. George Hripcsak has received grant funding from Janssen Research through his university to support methods research not directly related to this study. Janssen did not have input in the design, execution, interpretation of results, or decision to publish. Citation: Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension. JAMA Intern Med. Published online February 17, 2020. doi:10.1001/jamainternmed.2019.7454 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2760777 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.   Read the full article

Dr. Simpkin Arabella L. Simpkin,  MD, MMSc Associate Director, Center for Educational Innovation and Scholarship, MGH Associate Program Director, Education and Curriculum, Internal Medicine Residency, MGH Instructor in Medicine, Harvard Medical School Boston, MA 02114 MedicalResearch.com: What is the background for this study? Response: The academic health care environment has changed in unprecedented ways over several decades, with mounting evidence that faculty are becoming increasingly more unhappy, dissatisfied, and burnt out in their work. Concern for faculty wellbeing is high, with much speculation about causes of burnout. Comprehending what affects satisfaction at work in academic health care centers is critically important to stem this epidemic of discontent. For physicians, satisfaction has been reported to be associated with quality of care delivered, particularly as measured by patient satisfaction; faculty retention and job satisfaction are intricately linked, with dissatisfied physicians more likely to leave the profession and to discourage others from entering. Other industries that have suffered similar rises in employee discontent have found that demonstration of respect is the most important leadership behavior in improving employees satisfaction. To our knowledge this factor has not been looked at in healthcare professionals. To address this gap, we sought to determine key variables influencing satisfaction at work for faculty in a large academic medical center in the United States. MedicalResearch.com: What are the main findings? Response: In this observational study that included 988 faculty at a large academic medical center, job satisfaction was significantly associated with feeling valued, feeling treated with respect, and working in a social and supportive environment. It was not associated with gender, race, rank, or feeling fairly compensated. MedicalResearch.com: What should readers take away from your report? Response: Our results clearly demonstrate significant associations between satisfaction, feeling valued and being treated with respect. Investment in social capital and sense of value and respect for employees is critical. A challenge of the fast-paced, technology-driven environment that is rapidly growing around us, is the imperative to stay connected personally (and not electronically) and reduce isolation. Intentional efforts to establish and nurture social and supportive environments will be ever-more critical in the years ahead. Compensation has previously been reported to be an important factor in faculty satisfaction, yet our results suggest wiser investments would be in social, not financial, capital. Feelings of gender discrimination were associated with not feeling valued, and there is no doubt that it is imperative that leaders take measures to align and embed the values of diversity, inclusion, and respect into institutional policies—recognizing that discrimination, often considered an individual problem, is also an organizational one.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: This study suggests that we need to ensure efforts are focused on building and nurturing social and supportive environments where employees feel valued and treated with respect. The good news is that there is much that is amenable to change—medical practices and hospital systems need to make investments in social capital, paying more attention to relational connection and sense of community. Understanding what constitutes respect for all faculty are early steps to ensure it is woven into the workplace culture. We need more research as to how best to implement strategies that enhance social capital, and to evaluate their effect on faculty wellbeing in healthcare settings.  MedicalResearch.com: Is there anything else you would like to add? Response: The authors report no declarations of interest. The study was supported by the Steve and Deborah Gorlin MGH Research Scholar award to Rochelle P. Walensky, MD, MPH.  Citation: Simpkin AL, Chang Y, Yu L, Campbell EG, Armstrong K, Walensky RP. Assessment of Job Satisfaction and Feeling Valued in Academic Medicine. JAMA Intern Med. Published online May 06, 2019. doi:10.1001/jamainternmed.2019.0377   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.   Read the full article

Dr. Chaiyachati Krisda Chaiyachati, MD, MPH, MSHP Assistant Professor Medicine, Perelman School of Medicine Clinical Innovation Manager Penn's Center for Health Care Innovation Perelman School of Medicine Medical Director, Penn Medicine's FirstCall Virtual Care   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The United States spends more than $12 billion annually on training young doctors who have rates of burnout and depression at an alarmingly high rate. Yet, we have limited evidence as to what they are doing while training in the hospital. We sought to glimpse into how their day is spent. In the largest study to date, we observed 80 first-year internal medicine physicians (“interns”) for nearly 2200 hours across 194 work shifts at 6 different sites. Our research sought to understand what medical residents did by categorizing training activities into themes such as time spent in education or patient care.  MedicalResearch.com: What should readers take away from your report? Response: We believe our findings reveal a previously hidden picture of how young physicians are trained, and the reality of medical practice today. Interns spend 87 percent of their work time away from patients, half of that time being spent interacting with electronic health records. Of the 13 percent of time spent with patients face-to-face, much of it is spent multitasking in other activities such as interacting with the electronic health record and coordinating care with other health care workers. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Although interns are spending a significant amount of time not interacting directly with patients, our study is not designed to tell us whether or not this allocation of time is a “good” or “bad” signal. That could come with further research into how time spent on these shifts affects patient care or physician well-being. Indirect patient care has tradeoffs. If it takes time away to the point that patients feel like we aren’t listening to their needs or we lose out on human interactions that provide physicians with a sense of purpose, that is a bad thing. But if it helps us diagnose diseases more efficiently, then maybe that’s not that bad in the end. At minimum, we believe our study can help residency program leaders take stock of what their interns are doing and consider whether the time and processes are right for developing the physicians we need tomorrow. Citation: Chaiyachati KH, Shea JA, Asch DA, et al. Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations. JAMA Intern Med. Published online April 15, 2019. doi:10.1001/jamainternmed.2019.0095   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.   Read the full article

Dr. Cain Cindy L. Cain, PhD Assistant Professor Department of Sociology University of Alabama at Birmingham Birmingham, AL 35233   MedicalResearch.com: What is the background for this study? What are the main findings? Response: The End of Life Option Act permits terminally ill Californians to request a prescription for medications that would hasten death, providing they meet all requirements of the law and follow the steps outlined by their health care provider. However, the law also allows health care providers and organizations to opt out of participating. Until now, we did not know how common it was for entire health care organizations to opt out. In this study, we found that 61% of the surveyed hospitals prohibited physician participation in the End of Life Option Act. Thirty-nine percent of hospitals did allow participation in the law; these participating hospitals were less likely to be religiously affiliated and more likely to be nonprofit. MedicalResearch.com: What should readers take away from your report?  Response: Policies set by health care organizations affect patient access to the End of Life Option Act.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Much of the care for people at end of life happens outside hospital settings, so more research is needed on the policies of these other settings. We also need more research on physicians’ willingness to participate in the End of Life Option Act. MedicalResearch.com: Is there anything else you would like to add?  Response: This research was funded by the California Health Care Foundation and the Stupski Foundation.  Citation: Cain CL, Koenig BA, Starks H, et al. Hospital Responses to the End of Life Option Act: Implementation of Aid in Dying in California. JAMA Intern Med. Published online April 08, 2019. doi:10.1001/jamainternmed.2018.8690      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.   Read the full article

Sean Dickson, JD MPH Sean Dickson, JD MPH Officer, Drug Spending Research Initiative The Pew Charitable Trusts Washington, DC 20004 MedicalResearch.com: What is the background for this study? Response: Price increases on existing drugs are an ongoing challenge for patients and insurers, including government programs like Medicaid and Medicare. The Medicaid program requires drug manufacturers to provide a rebate that offsets price increases greater than inflation, but that rebate is capped once price increases exceed 433 percent above inflation. When these rebates are capped, manufacturers may find it more profitable to take very large price increases, raising costs for all payers. The Medicaid program has proposed removing the cap, and this study considers the effects of that proposal.  MedicalResearch.com: What are the main findings?  Response: 271 drugs had capped rebates in 2017, reducing Medicaid rebates by $104M, or 0.4 percent of 2016 net drug expenditures (the most recent year for net expenditure data at the time of the study). 85 percent of the reduced rebates were attributable to 25 drugs, with 46 percent attributable to diabetes treatments. One form of insulin (insulin lispro) accounted for 38 percent of reduced rebates, or $40M. However, these increased rebate payments would only have reduced 2017 insulin lispro total U.S. revenues by 2.3 percent, which may not be sufficient to encourage the manufacturer to reduce the price. The second-highest reduced rebate ($6M) was for pyrimethamine and would have reduced revenues by 9 percent. MedicalResearch.com: What should readers take away from your report? Response: Removing the Medicaid rebate cap would only modestly increase Medicaid rebates, and the additional penalty may not be enough to discourage price increases. However, uncapping Medicaid rebates may discourage some of the largest price hikes, such as those seen on older drugs used by a small population.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Another policy proposal – doubling the Medicaid inflation rebate for price increases more than 10 percent above inflation and tripling it for price increases more than 25 percent above inflation – may be more effective in discouraging large price increases. Using the Medicaid rebate program to discourage price increases would not only reduce Medicaid spending, but it could reduce price growth for other payers.  No disclosures. Citation: Dickson S. Estimates of the Number of Brand-Name Drugs Affected by the Medicaid Rebate Cap in 2017. JAMA Intern Med. Published online January 22, 2019. doi:10.1001/jamainternmed.2018.6559 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.   Read the full article