Part-time and full-time medical specialists, are there differences in allocation of time?
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BACKGROUND: An increasing number of medical specialists prefer to work part-time. This development can be found worldwide. Problems to be faced in the realization of part-time work in medicine include the division of night and weekend shifts, as well as communication between physicians and continuity of care. People tend to think that physicians working part-time are less devoted to their work, implying that full-time physicians complete a greater number of tasks. The central question in this article is whether part-time medical specialists allocate their time differently to their tasks than full-time medical specialists. METHODS: A questionnaire was sent by mail to all internists (N = 817), surgeons (N = 693) and radiologists (N = 621) working in general hospitals in the Netherlands. Questions were asked about the actual situation, such as hours worked and night and weekend shifts. The response was 53% (n = 411) for internists, 52% (n = 359) for surgeons, and 36% (n = 213) for radiologists. Due to non-response on specific questions there were 367 internists, 316 surgeons, and 71 radiologists included in the analyses. Multilevel analyses were used to analyze the data. RESULTS: Part-time medical specialists do not spend proportionally more time on direct patient care. With respect to night and weekend shifts, part-time medical specialists account for proportionally more or an equal share of these shifts. The number of hours worked per FTE is higher for part-time than for full-time medical specialists, although this difference is only significant for surgeons. CONCLUSION: In general, part-time medical specialists do their share of the job. However, we focussed on input only. Besides input, output like the numbers of services provided deserves attention as well. The trend in medicine towards more part-time work has an important consequence: more medical specialists are needed to get the work done. Therefore, a greater number of medical specialists have to be trained. Part-time work is not only a female concern; there are also (international) trends for male medical specialists that show a decline in the number of hours worked. This indicates an overall change in attitudes towards the number of hours medical specialists should work. (+info)
Effect of reduced exposure times on the microhardness of 10 resin composites cured by high-power LED and QTH curing lights.
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PURPOSE: To compare the effect of reduced exposure times on the microhardness of resin composites cured with a "second-generation" light-emitting diode (LED) curing light and a quartz-tungsten-halogen (QTH) curing light. METHODS: Ten composites were cured with a LED curing light for 50% of the manufacturers" recommended exposure time or a QTH light at the high power setting for 50% of the recommended time or on the medium power setting for 100% of the recommended time. The composites were packed into Class I preparations in extracted human molar teeth and cured at distances of 2 or 9 mm from the light guide. The moulds were separated, and the Knoop microhardness of the composites was measured down to 3.5 mm from the surface. RESULTS: The LED light delivered the greatest irradiance at 0 and 2 mm, whereas the QTH light on the standard (high power) setting delivered the highest irradiance at 9 mm. According to distribution-free multiple comparisons of the hardness values, at 2 mm from the light guide the LED light (50% exposure time) was ranked better than or equivalent to the QTH light on the high power setting (50% exposure time) or on the medium power setting (100% exposure time). At 9 mm, the LED light was ranked better than or equivalent to the QTH light (both settings) to a depth of 1.5 mm, beyond which composites irradiated by the LED light were softer (p < 0.01). At both distances, the QTH light operated on the high power setting for 50% of the recommended exposure time produced composites that were as hard as when they were exposed on the medium power setting for 100% of the recommended exposure time. CONCLUSIONS: The ability to reduce exposure times with high-power LED or QTH lights may improve clinical time management. (+info)
"When patients have cancer, they stop seeing me"--the role of the general practitioner in early follow-up of patients with cancer--a qualitative study.
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BACKGROUND: The role of the general practitioner (GP) in cancer follow-up is poorly defined. We wanted to describe and analyse the role of the GP during initial follow-up of patients with recently treated cancer, from the perspective of patients, their relatives and their GPs. METHODS: One focus group interview with six GPs from the city of Bodo and individual interviews with 17 GPs from the city of Tromso in North Norway. Text analysis of the transcribed interviews and of free text comments in two questionnaires from 91 patients with cancer diagnosed between October 1999 and September 2000 and their relatives from Tromso. RESULTS: The role of the GP in follow-up of patients with recently treated cancer is discussed under five main headings: patient involvement, treating the cancer and treating the patient, time and accessibility, limits to competence, and the GP and the hospital should work together. CONCLUSION: The GP has a place in the follow-up of many patients with cancer, also in the initial phase after treatment. Patients trust their GP to provide competent care, especially when they have more complex health care needs on top of their cancer. GPs agree to take a more prominent role for cancer patients, provided there is good access to specialist advice. Plans for follow-up of individual patients could in many cases improve care and cooperation. Such plans could be made preferably before discharge from in-patient care by a team consisting of the patient, a carer, a hospital specialist and a general practitioner. Patients and GPs call on hospital doctors to initiate such collaboration. (+info)
The information seeking of on-duty critical care nurses: evidence from participant observation and in-context interviews.
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OBJECTIVES: An observational study describes on-duty nurses' informative behaviors from the perspective of library and information science, rather than patient care,. It reveals their information sources, the kinds of information they seek, and their barriers to information acquisition. METHODS: Participant observation and in-context interviews were used to record in detail fifty hours of the information behavior of a purposive sample of on-duty critical care nurses on twenty-bed critical care unit in a community hospital. The investigator used rigorous ethnographic methods-including open, in vivo, and axial coding--to analyze the resulting rich textual data. RESULTS: The nurses' information behavior centered on the patient, seeking information from people, the patient record, and other systems. The nurses mostly used patient-specific information, but they also used some social and logistic information. They occasionally sought knowledge-based information. Barriers to information acquisition included illegible handwriting, difficult navigation of online systems, equipment failure, unavailable people, social protocols, and mistakes caused by people multitasking while working with multiple complex systems. Although the participating nurses understood and respected evidence-based practice, many believed that taking time to read published information on duty was not only difficult, but perhaps also ethically wrong. They said that a personal information service available to them at all hours of the day or night would be very useful. CONCLUSIONS: On-duty critical care nursing is a patient-centric information activity. A major implication of this study for librarians is that immediate professional reference service--including quality and quantity filtering-may be more useful to on-duty nurses than do-it-yourself searching and traditional document delivery are. (+info)
Techniques for terminating patient-physician encounters in primary care settings.
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BACKGROUND: Physicians in the community work on a tight and often pressured schedule; verbal and non-verbal techniques to terminate the patient-physician encounter are therefore necessary. OBJECTIVES: To characterize ways of terminating the encounter. METHODS: Using a structured questionnaire we observed seven family physicians and nine consultants and recorded patient-physician encounters to assess techniques for terminating the encounter. RESULTS: In all, 320 encounters were recorded, 179 (55.9%) by consultants and 141 (44.1%) by family physicians. The mean duration of the encounters was 9.02 +/- 5.34 minutes. The mean duration of encounters with family physicians was longer than with consultants (10.39 vs. 7.93 minutes, P< 0.001). In most cases the encounter ended with the patient receiving printed documentation from the physician (no difference between family physicians and with consultants). Consultants were more likely to end the encounter with a positive concluding remark such as "feel good" or "be well" (P < 0.01). There was no single occasion where termination of the encounter was initiated by the patient. CONCLUSIONS: Giving a printed document to the patient appears to be perceived by both patients and physicians as an accepted way to end an encounter. Another good way to end the encounter is a positive comment such as "feel good" or "be well." (+info)
Research participation, protected time, and research output by family physicians in family medicine residencies.
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BACKGROUND AND OBJECTIVES: The Future of Family Medicine project concluded that research must become a greater part of the culture of the specialty. We examined the participation of family physician residency faculty in research, their protected time, and their research output and how these varied by program type. METHODS: This was a cross-sectional survey of all family medicine residency programs in the United States. The response rate was 66% (298/453). RESULTS: The majority of programs reported at least one family physician who participates in research, though the medical school-based (MSB) programs reported a higher total number of faculty than the community-based, medical school affiliated (MSA) programs (9.53 versus 2.72) and percentage of faculty (56% versus 37%). Substantially more MSB programs reported that they had at least one family physician with significant protected time for research (48% versus 7% for > 25% protected time) or any protected time (69% for MSB versus 45% for MSA). MSB programs and MSA programs reported similar success at producing at least one poster or paper for national meetings within the last 3 years (63% versus 41%) but not for published papers (86% versus 43%). CONCLUSIONS: We found that only about half of the family medicine residencies produced any nationally recognized research over a 3-year period and that this represents only a small improvement over the last 10 years. Our findings suggest that more support is needed if research is to become an integral part of the culture of family medicine. (+info)
Learning to lead.
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A successful research career requires not only an aptitude for science but also the mastering of other skills including communication, management, and grant writing. A growing number of programs at universities and research institutes aim to teach these crucial skills to graduate students, postdoctoral fellows, and junior faculty. (+info)
A survey of time management and particular tasks undertaken by consultant microbiologists in the UK.
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BACKGROUND: Medical microbiology practice encompasses a diverse range of activities. Consultant medical microbiologists (CMMs) attribute widely differing priorities to, and spend differing proportions of time on various components of the job. AIM: To obtain a professional consensus on what are high-priority and low-priority activities, and to identify the time spent on low-priority activities. METHOD: National survey. RESULTS: Many respondents felt that time spent on report authorisation and telephoning of results was excessive, whereas time spent on ward-based work was inadequate. Timesaving could also be achieved through better prioritisation of infection-control activities. CONCLUSION: CMMs should apportion their time at work focusing on high-priority activities identified through professional consensus. (+info)