Browsing Scholarly Projects 2016 by Subjects
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The Characteristics of Physicians Elected and Serving in State Legislatures and the United States CongressPhysician participation in United States governance has a long and honorable history, dating to the nation’s inception. At a time of unprecedented change in health policy ‐ to control the growth of health care costs, to cover the uninsured through Affordable Care Act (ACA) provisions, to improve quality, to meet the demand for health services as the population grows and ages ‐ the need for physician leadership to guide policy interventions has never been greater. Yet physician‐legislator participation has declined. There is little data about physicians involved in shaping health policy in state or federal legislative branches. This study examines the characteristics of physician‐legislators at the federal and state levels, and compares them to U.S. physicians in general. Using rosters fixed on March 13, 2014, the study reviewed biographic and demographic information on physician‐legislators. The study’s four hypotheses were that physician‐legislators were more likely to be (1) men than women, (2) members of the Republican Party than the Democratic Party, (3) a non‐primary care physician than a primary care physician, and (4) elected in the states where they completed graduate medical education than where they attended college. Ninety‐five physician‐legislators were identified in 51 legislative bodies in 2014. Physician‐legislators were more likely to be male than female, to be Republican than Democrat, and to be practicing in a non‐primary care than in a primary care specialty. Physician‐legislators were less likely to be elected in the state where they completed graduate medical education training than where they attended college. No personal factor was identified that linked the majority of physician‐legislators to the state in which they were elected.
The Effects of Stigma Toward Mental Illness on Family PhysiciansMany individuals utilize primary care as their main source of mental health care, as in many areas of the US access to specialized psychiatric care does not meet the demand. Prior research has showed that many healthcare practitioners, including those working in generalist fields, carry stigmatized views about individuals with mental illness. Such stigmatized views can result in misattribution of symptoms to mental illness and a decline in proper diagnosis and treatment. Our study aims to examine if stigmatized views about mental illness relate to family medicine physicians’ comfort levels with treating mental illness, patterns of referral to psychiatrists, or amount of continuing medical education on psychiatric issues. Our hypothesis is that family medicine physicians who carry less stigmatized views will be more comfortable and up to date with psychiatric care practices and less likely to refer mental health issues to specialized mental health services. Methods: We administered an email survey to family medicine physicians via the Arizona Academy of Family Physicians monthly electronic newsletter. The survey contained demographic questions, a short (5‐question) validated stigma questionnaire (Attitudes to Mental Illness Questionnaire or AMIQ), and questions regarding self‐stated comfort level with mental illness, amount of recent mental‐health CME, and likelihood of referral for various mental illnesses. Results: AMIQ stigma ratings and referral rates for anxiety were significantly related (p=.012), as were AMIQ stigma ratings and amount of mental health CME (p=.001). Other trends were discovered, but were not significant. Impact: These results further demonstrate the need for increased emphasis on psychosocial and psychiatric issues, particularly stigma reduction, in family medicine residency training and CME. If family medicine physicians with high levels of stigma are less likely to treat mentally ill patients or seek further education regarding psychiatric issues, it could disrupt their patients’ quality, cost, and continuity of care.
“It’s About Heart”: A Qualitative Study of Rural Family Physician Training Needs.Efforts to reduce a chronic physician shortage and meet the needs of rural communities face long standing challenges such as physician recruitment and retention. While these topics have been researched at length, issues surrounding the contribution of training specifically geared toward the needs of the Southwest’s rural communities are not well understood. The goal of this investigation is to discuss with rural family physicians the realities of rural practice and to determine what, if any, skills and competencies are specific to rural family practice and that, if addressed in training, would increase the number of students and residents pursuing rural family medicine and increase the number of physicians in rural areas. Methods: Physicians throughout rural areas in the Southwest meeting the role of thought leader were interviewed. Chain sampling was used to generate diversity of ideas. Interviews were conducted in person or by phone using a semi‐structured format and a topic guide. Participants were asked to discuss what skills they feel are important to a successful practice in a rural community, the degree to which the competencies were covered in their residency training, and how having or not having these skills might affect job satisfaction and retention. Interviews were recorded and transcribed. Transcripts were analyzed by a two person committee for repeating themes. Results: Seven major repeating themes were evident in the data. Of these residency training type, individual resilience, comfort with lack of resources, community were some of the most common and important to participants. Conclusion: This study has shown that the challenges to recruitment and retention of family physicians in rural areas are many and complex. These results combined with the extensive literature studying successful recruitment and retention programs demonstrates the enormous potential that exists in a multifactorial approach to rural recruitment and retention to meet the tremendous need for more family physicians in rural areas.