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Hospitalists behaving badly?
Plus, more evidence of the MD gender gap

Keywords: Hospitalists focus on unprofessional physician behavior





Published in the July 2012 issue of Today's Hospitalist

Hospitalists behaving badly?

A NEW SURVEY THAT ASKED HOSPITALISTS when and if they acted unprofessionally found that working nights, being younger and having fewer clinical hours correlated to higher rates of unprofessional behavior.

Hospitalists who were surveyed at three academic centers reported very few instances of egregious behaviors, such as falsifying patient records. But for behaviors that hospitalists considered "somewhat unprofessional," 67% reported having personal conversations on the job, while 62% reported ordering stat tests to expedite care and 40% admitted making fun of other physicians.

The Journal of Hospital Medicine posted the study results online in May. Researchers found that younger physicians and those with more administrative time reported more unprofessional workload management behaviors such as blocking admissions, while hospitalists with less clinical time reported more instances of making fun of their colleagues.

Doctors working nights, by comparison, reported more unprofessional time pressure behaviors such as ignoring family requests for a meeting or signing out via phone instead of face to face.

Gender gap persists for women MD researchers

A STUDY THAT LOOKS AT PAY for both women and men MD researchers finds that women consistently earn less.

University of Michigan researchers surveyed 800 MD researchers who'd received NIH grants within the last six to 10 years. (Among that group, 31% were women.) The average salary reported by women MD researchers was just under $168,000, while the average for their male colleagues was slightly more than $200,000.

Even after adjusting for a host of variables including specialty, rank, number of work hours and parental status, women MD researchers were receiving $13,399 less a year than the men. The research also revealed that a higher proportion of women researchers work in lower-paying specialties than men (34% vs. 22%), are less likely to serve as administrative leaders in their academic centers (10% vs. 16%), and publish less often than men (a mean of 27 publications vs. 33).

The study was published in the June 13 issue of the Journal of the American Medical Association.

Don't stop statins in stroke patients

ISCHEMIC STROKE PATIENTS WHO ARE TAKING STATINS at the time of admission have a better chance of surviving and being discharged home (instead of to a nursing home) than those not taking statins.

That's according to a study in the May 22 issue of Neurology. Researchers found that patients' odds of being discharged home are even greater if they were taking statins on admission and continue to take statins during their hospitalization. Results indicate that 55% of ischemic stroke patients taking statins on admission are discharged home, compared to 50% of those not taking the drugs. Patients taking statins were also less likely to die in the hospital (8% vs. 9%).

The authors noted that statin use was "strongly associated" with better discharge disposition for patients with ischemic stroke. The results were based on an analysis of discharge data for nearly 13,000 patients in 17 hospitals in the Kaiser Permanente system.

Time to talk about sex?

A STUDY LOOKING AT SEXUAL ACTIVITY OF PATIENTS with acute myocardial infarction before and after their AMI finds that one factor associated with loss of post-AMI sexual activity is the fact that doctors don't discuss resuming sex when patients are being discharged.

The observational study based on registry data found that only one-third of female AMI patients and 47% of men had been counseled about sexual activity by physicians in the hospital. Those who didn't receive counseling were found to be at higher risk for a loss of sexual activity (either reduced or no activity) in the year after their AMI.

The study also found no association between resuming sexual activity and one-year mortality. The study indicated that the reported rates of before-and-after sexual activity for AMI patients differed by gender: Among women, 44% reported being sexually active the year before their AMI, while 40% were active in the year after; for men, those figures were 74% and 68%.

Results appeared in the May 15 issue of The American Journal of Cardiology.

Location, specialty determine size of on-call stipends

ACCORDING TO NEW MGMA SURVEY DATA, daily stipends for physicians taking call are still the most common form of on-call compensation. However, the percentage of physicians receiving daily stipends fell from 33% in 2009 to 29% in 2011.

Over the same period, physicians who received annual call stipends fell from 14% to 10%, while the use of per-shift pay rose from 0% to 7.5%. Median on-call stipends reported included $1,000 for internists, only $100 for a family physician without OB and a whopping $1,740 a day for neurosurgeons. But the survey found that many factors went into determining the size of daily stipends including region, specialty and business model. For general surgeons, for instance, daily on-call stipends ranged from $500 in the Midwest to $920 in the East and $1,000 in the West.

Data also indicated that larger systems and those with more employed physicians were less likely to pay doctors stipends for taking call.

Hospital-at-home success story

SINCE 2008, PRESBYTERIAN HEALTHCARE in New Mexico has been treating elderly patients in an ambitious hospital-at-home program—and saving 19% of what it would have cost to treat those patients in the hospital. According to results in the June issue of Health Affairs, those cost savings resulted from a shorter length of stay (3.3 days vs. 4.5 for inpatients) and fewer labs and diagnostic tests.

In the program, elderly patients with a range of conditions—including heart failure, community-acquired pneumonia, and DVT and PE—are offered the hospital-at-home option. Physicians visit once a day, while nurses and aides visit more frequently. Homes are outfitted with equipment like video technology so patients can reach nurses quickly.

Neither Medicare Part A or B reimburse for in-home care, nor do private insurers, the authors point out. However, Presbyterian formed its own health plan to bundle payments for hospital-at-home episodes. The authors write that Medicare's new push into bundled payments and value-based purchasing should make hospital-at-home arrangements financially feasible for more hospitals.

Dabigatran: No. 1 for serious event reports

IN 2011, THE FDA RECEIVED MORE ADVERSE DRUG EVENT REPORTS related to dabigatran than to any other medication, according to a new analysis.

Researchers with QuarterWatch, a publication sponsored by the Institute for Safe Medication Practices, reported in May that the FDA last year received reports of 3,800 serious adverse events related to dabigatran, including 542 deaths. While warfarin was the No. 2 drug on the event list, warfarin garnered many fewer serious event reports: 1,106, including 72 deaths.

Among the events related to dabigatran, the FDA recorded 2,367 reports of hemorrhage, 291 for acute renal failure and 644 for stroke. Rounding out the top five list of drugs in direct adverse event reports to the FDA were levofloxacin, carboplatin and lisinopril.

According to QuarterWatch, the FDA received nearly 180,000 reports in 2011 of serious, disabling or fatal adverse drug events. That represented a 9.4% increase over the number of reports filed in 2010.

Medmal scorecard

AN ANALYSIS OF 2002-05 MEDICAL MALPRACTICE CLAIMS that involved some defense costs finds that just over half of those claims (55.2%) go on to litigation.

Analysts writing in the June 11 issue of Archives of Internal Medicine also reported that just over half of cases that proceed to litigation (54.1%) are dismissed, a finding that applies to all specialties. Internists and medicine-based subspecialists have an even higher percentage of dismissed claims: 61.5%.

Among claims against internists and medicine-based subspecialists that go to litigation, 33% are resolved before trial verdict. Across specialties, however, a big majority of cases that go to verdict (79.6%) are decided in favor of physicians.

The analysis also found that litigation rates are highest for claims against obstetricians (62.6%). The mean time to close a claim was 19 months, although that time frame was 25.1 months for cases that went to litigation. That's twice as long as for claims not litigated (11.6 months).

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