Category Archives: Family Medicine

How having a good relationship with your doctor can benefit your long-term health – UChicago Medicine

Along with staying physically active and eating a healthy diet, theres something else you can do to take care of your health: establish a strong, long-term relationship with your primary care physician.

Having a doctor who knows you can make a big difference in the quality of your care, said UChicago Medicine Medical Group family medicine physician Paulo Aranas, MD*. A physician who sees the bigger picture of your overall health can ensure better communication and treatment that's more personalized to your specific needs.

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As a regular provider for that patient, you know whats been going on, Aranas said. Its easy to miss some details when you dont see the patient all the time or theyre in an urgent care setting.

Aranas recalled seeing a woman in her 40s with numerous chronic conditions, some of which caused chest pain. The patient said that when she went to a different doctor, who was not her primary care physician, she felt that staff didnt take her symptoms seriously because of her age.

They may have been dismissive because they think shes too young for a heart attack or stroke, Aranas said. But when she comes to our clinic, because I know her, I know if the chest pains are different or not.

After examining her, he was able to reassure her that her symptoms were caused by her underlying conditions, not a heart attack.

Having a long-term relationship with your primary care physician can be particularly helpful for older patients, who often have many doctors and specialists on their care team.

In these situations, the primary care physician can help provide oversight, consolidating all the information the patient is receiving and helping to explain it in plain language.

Its especially important for managing chronic conditions, because theyre not going away anytime soon, Aranas said.

A provider who knows you and your condition can lead to better communication and compliance. Youre more likely to have been part of the discussion about the best approach, and thus have more trust in your doctors advice.

I think its easier for patients to understand and manage their disease if they are a part of the treatment plan rather than the target of the treatment plan, he said.

Aranas practices weight loss medicine in addition to being a primary care physician at UChicago Medicine Orland Parkand UChicago Medicine at Ingalls - Tinley Park. He says he likes building relationships with his patients because it helps him provide more personalized advice and treatment.

Maybe I know this person likes the bike but not the treadmill, and they like keto but not low carb, he said. Its easier to adjust management if somethings not working, and theyre not as resistant to suggestions, because they know you and they know that you know the situation.

That was the case with Shannon Martin, 40, a patient of Aranas who liked him so much that when he moved from her local hospital to UChicago Medicine at Ingalls - Tinley Park, she tracked him down and followed him, even though it meant a farther drive.

Its worth it, she said. Hes pretty awesome.

Aranas had initially been caring for Martin's mother; when Martin needed a new doctor, she became his patient as well. She had been seeing him for a few years when she began having stomach problems, including pain, heartburn and digestive issues. She had also gained some weight and noticed a dip in her energy.

Aranas suggested a medication for weight loss that boosts metabolism, as well as taking regular probiotic and fiber supplements. Because of their long relationship, Martin trusted him and did her best to follow the treatment plan.

The treatment worked, and Martin began seeing results within a few weeks, noticing an improvement in her digestion and energy, and losing the excess weight.

At our first follow-up appointment, he was like, Wow! she recalled. He said, If I was a teacher, Id give you an A-plus.

Martin felt that, because Aranas knew her and her health history, he was able to zero in on the treatment that would be most helpful to her. She also appreciated his open communication, including being able to message him through his patient portal when she had questions or wanted to share her success.

Even in his messages, hed be like, Good job! and use multiple exclamation points, she said. You can just tell he cares.

In fact, medicine has long been based around relationships, Aranas noted.

Doctors forget that in the olden days we didnt have all this technology and medication, he said. The doctor would go to your house, talk to you, reassure you, and kind of hold your hand. And that actually goes a long way in my practice.

Doctors can build rapport with patients by taking time to listen, not rushing appointments, and focusing on what's bothering the patient most, even if the doctor has more concerns about other symptoms or issues.

Its about starting the conversation, he said. We can move on to the other issues when the person comes back.

For patients, its important to be open and communicate your concerns.

Aranas noted that it can be common for patients to think of doctors as authority figures, and worry about being judged or scolded for things like not complying with the treatment plan or eating foods theyre not supposed to. In the worst case scenario, patients may even lie or hold back important information to avoid getting in trouble with their doctor.

Aranas said trust is a two-way street.

Youre not going to the principal more like the guidance counselor, he said. Were not here to judge. We want to help you figure out the issue, and then well try to solve it together.

*UChicago Medicine Medical Group is comprised of UCM Care Network Medical Group, Inc. and Primary Healthcare Associates, S.C. UChicago Medicine Medical Group providers are not employees or agents of The University of Chicago Medical Center, The University of Chicago, UChicago Medicine Ingalls Memorial, UChicago Medicine Orland Park, or UChicago Medicine at Ingalls - Tinley Park.

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How having a good relationship with your doctor can benefit your long-term health - UChicago Medicine

McArdle’s, a Rare Disease That Every Family Doctor Can Manage: A Case Report – Cureus

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Please choose I'm not a medical professional. Allergy and Immunology Anatomy Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology and Public Health Family Medicine Forensic Medicine Gastroenterology General Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based Medicine I'm not a medical professional. Infectious Disease Integrative/Complementary Medicine Internal Medicine Internal Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use and Addiction Surgery Therapeutics Trauma Urology Miscellaneous

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McArdle's, a Rare Disease That Every Family Doctor Can Manage: A Case Report - Cureus

Bringing healthcare to the community: Gracie Landeck – The Coastland Times | The Coastland Times – The Coastland Times

Published 9:12 am Thursday, December 21, 2023

Gracie Landeck knew that she wanted to be in healthcare, but it was a report about coffee in a biology class that helped her decide on family medicine. The Beaufort County Early College High School student finished an associate in arts and an associate in science and stayed to take additional courses through December at Beaufort County Community College. She plans to earn a bachelor of science in biology before attending medical school. Landeck wants to make healthcare accessible to more people and explore holistic medicine.

I wanted to explore my options before I committed to a university, and I knew Beaufort had a variety of classes, so you could explore any of your interests before committing money and time to larger school, she says. Landeck chose to stay an extra semester to take more classes toward her major in a smaller setting.

Ive always had an interest in helping people, I just didnt know what field would be best, she says. I have a knack for teaching or tutoring, which is why Im in LEC right now, but I think I would be more helpful in the medical field based on my memorization skills. She works as a professional tutor on campus through the Learning Enhancement Center (LEC).

I like clear answers. This is where your heart is. This is where your liver is. Its not going to change. I just like that consistency, she says about her perception of biology.

She will start at a university in the fall of 2024. She is searching for an internship in a doctors office until then. She wants a reality check before committing to another six years of education.

After medical school, she plans to keep working in rural eastern North Carolina. I think itd be cool to bring some help back to the Beaufort County, because a lot of people prefer Pitt County or bigger cities, but I think rural areas need more medical care, she says.

In places like Hyde County, Pantego, or Belhaven, people travel far just to get medical help, and they dont have options when it comes to emergencies unless they travel say 40 miles to get to either Washington or Greenville. Getting airlifted costs so much money, and a lot of people in those areas cant afford that. Having some type of smaller, more practical medical facility close to them where they can call on you would be beneficial for like those smaller communities.

Her mother Bonnie Landeck, a respiratory therapist at ECU Health Beaufort Hospital, has inspired her. She has worked at the hospital for over 20 years and through multiple changes in ownership.

I look up to her and her motivation helping people not necessarily for profit, she explains. Its always been about getting to know them and helping them, and I find that her most admirable character trait, and I want to reflect that in my practice.

Driven by purpose, entangling profit with healthcare is a big problem for Landeck. They will treat the symptoms, but not treat the overall cause because theyre trying to prolong it so long so they can get more money, and I honestly dont want to be a part of that practice. I want to do it because people need the help, not because I want to make money off them.

It was a presentation in Dr. Chad Smiths biology class that cemented her interest in family medicine.

I did my presentation on the positive effects of coffee and caffeine on the body, and I thought that maybe I want to do natural medicine or holistic medication, but I knew that you cant usually do that unless its family practice or a smaller practice, she says.

The presentation cracked her curiosity about herbal medicine and home remedies. Everythings so connected, and then private industries want to get your money, and then they kind of just like cut off that connection.

As this new curiosity about herbal medicine dovetails with her connection to her region and her passion for improving its residents health, rural healthcare will have an advocate and a practitioner in Gracie Landeck, noted BCCC.

Beaufort CCC is currently accepting applications for new students and regular registration for spring 2024 is taking place through December 13. To sign up for tutoring through the Learning Enhancement Center with Landeck, visitbeaufortccc.edu/lec.

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Bringing healthcare to the community: Gracie Landeck - The Coastland Times | The Coastland Times - The Coastland Times

Dr. Stephen Petrany tapped to lead addiction science efforts at Marshall School of Medicine – Lootpress

HUNTINGTON, WV (LOOTPRESS) The Marshall University Joan C. Edwards School of Medicine has named Stephen M. Petrany, M.D., to the new role of vice dean of addiction sciences and recovery.

According to Marshall University, a board-certified family medicine physician, Petrany has served as professor and chair of the Department of Family & Community Health at the Joan C. Edwards School of Medicine since 2014.

Under his leadership, the department experienced unprecedented growth in outreach, health policy and rural medicine as well as the creation of a new Division of Addiction Sciences dedicated to leading the School of Medicine and Marshall Healths response to the addiction crisis.

In his new role, Petrany will work to integrate addiction science efforts across Marshall Health Network and facilitate collaboration throughout the university to best address the complexities of substance use disorder and recovery efforts.

Consistent with Marshall Universitys focus on addiction sciences and behavioral medicine, Dr. Petranys new role brings unique experience and dedicated leadership to an important field, said David Gozal, M.D., M.B.A., Ph.D. (Hon), vice president of health affairs and dean of the School of Medicine.

His role will be vital in establishing Marshall University as a national and international beacon of hope and innovation in the field of addiction sciences while continuing to address the pressing needs of our communities in West Virginia.

Petrany joined the Marshall University faculty in 1988 after practicing six years in Ohio and Connecticut.

He served as the family medicine residency program director for 15 years before stepping into the role of associate chair for medical education and then chair of the department.

Petrany is committed to improving access to health care across West Virginia and Appalachia.

He has served as medical director of Ebenezer Medical Outreach, a free clinic that provides health care to uninsured and underinsured patients, and is a charter member of the board of directors for PROACT, the Provider Response Organization for Addiction Care and Treatment, a collaborative effort to provide assessment, education, intervention and treatment solutions for those suffering from addiction in a single accessible service hub.

In 2023, Petrany was recognized as the schools Honorary Alumnus during its graduation and investiture ceremony and was inducted into the Greater Huntington Area Wall of Fame by the City of Huntington Foundation.

Petrany earned his medical degree from Georgetown University in Washington, D.C., and completed his family practice residency at the Medical College of Virginia in Vienna, Virginia.

Petrany will begin his new position Jan. 1, 2024. Adam M. Franks, M.D., long-time family medicine professor and vice chair, has agreed to assume the role of interim chair at that time.

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Dr. Stephen Petrany tapped to lead addiction science efforts at Marshall School of Medicine - Lootpress

App-y and healthy: Medical support just a download away – Vero News

Most of us are familiar with fitness apps that let us count our steps or see the calories weve burned from exercising, but health apps do more than that today. Dr. Jayde George, who practices Family Medicine at Health Firsts Holmes Regional Medical Center, is an enthusiastic fan of several newish apps and encourages her patients to use them. Apps will never replace going to your medical provider, but the info you gather can give them data about your health, allowing them to make a better diagnosis.

As an example, Dr. George says, I really like Kardia, which is like a pocket-sized EKG machine that you use in conjunction with an app on your phone or tablet to monitor arrhythmias and other cardiac conditions. You can then transmit the information to your doctor. (kardia.com)

Apps are available for emotional and mental support, as well as physical health. University of California San Francisco has reported that the app Headspace, used daily for just 10 minutes, reduced stress in a meaningful way. Benefits lasted for two months after subjects stopped using the app. Headspace helps you create life-changing habits to support your mental health through evidence-based meditation and mindfulness tools, mental health coaching, therapy, and psychiatry. (headspace.com)

There are specialized apps, too. The Minnesota Department of Human Services published a list of apps that improve life for those who are deaf or hard of hearing, for instance. They include Ava, a speech-to-text app ideal for casual conversations. Installed on a deaf persons phone, the app delivers what it says is 99 percent accurate transcriptions of what is said to the deaf person to facilitate clear communication. The app currently assists more than 150,000 people worldwide (ava.me).

Dr. George welcomes it when her patients use apps. She says it is a good way for them to manage their health care and track information that will allow her to give them the best possible care during office or virtual visits. Apps help doctors in other ways, too.

One of the largest areas of growth is apps specifically designed for medical providers. Dr. George is especially impressed with Epocrates.com, a clinical decision aid that provides accurate, reliable and actionable clinical tools designed to integrate seamlessly into the daily workflow, assisting with point-of-care decisions.

You need to show your medical credentials to be able to use Epocrates and similar apps, says Dr. George. Not just anyone can download them.

Flexibility is one of the things that make medical apps such an important tool. They can be accessed at just about any point in your healthcare journey. GetWell Anywhere allows you to view your important healthcare information and connect with your care team before, during, and after a hospital stay, getting tips that will help guide you through recovery (getwellnetwork.com).

Two in five U.S. adults now use health apps, according to Healthcare Weekly, a rise of 6 percent since 2018. The share of Americans who use wearables is 35 percent, an 8-point rise over the same period.

The last five years have been very exciting, says Scott Whitaker, chief executive of the medical device industry group AdvaMed. I think the next five years is going to be potentially even more exciting and transformative as innovation continues to evolve in almost every area of healthcare.

The combination of consumers fascination with the technology and users recognition of the added value is driving up the usage tremendously.

Digital Authority Partners, a national search engine optimization company, compiled a list of the 10 most frequently used healthcare apps:

As far back as 2021, 90 percent of physicians used smartphones at work to access electronic health records, communicate with their team, reference information, or manage their schedule. New apps and services have made it increasingly possible to use phones as a valuable clinical tool that frees up time to spend with patients. The field is growing at an exciting pace, says Dr. George. The technology is there. All we have to do is figure out the best ways to utilize it.

Dr. Jayde George, D.O., has a B.S. in Biology from the University of South Florida and a D.O. from Nova Southeastern University. She completed her residency in the Osteopathic Family Medicine Residency program at Florida Hospital East, Orlando, where she was both chief resident of her class for the first and second year and program chief resident for her third year. She is board-certified by the American Osteopathic Board of Family Physicians, and is a member of the American Osteopathic Association, the Florida Osteopathic Medical Association, and the American Academy of Family Physicians. Her office is located at Health First Medical Group Crane Creek, 2222 South Harbor City Blvd., Melbourne. Call 321-312-3455.

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App-y and healthy: Medical support just a download away - Vero News

Hundreds of overseas doctors now working in B.C. family medicine, Dix says – Global News

British Columbia Health Minister Adrian Dix says almost all of the 666 international medical graduates registered in the province this year are now working as doctors, with more than half in family medicine.

Dixs comments come amid ongoing health-care woes including hospital overcrowding and many residents being left without a family doctor.

He says as many as 700 doctors who werent practicing family medicine a year ago are now working in the sector.

4:43 New SFU medical school attempts to address family doctor shortage

Dix says a new longitudinal payment model that reflects time spent with patients and complexity of their needs is proving more popular with the new doctors than the traditional fee-for-service model.

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Efforts to boost the number of family doctors in B.C. also included the creation for spaces in B.C.s medical schools for both Canadian and international students, Dix says.

He says the policies have contributed to graduating doctors preferring B.C. to nearby jurisdictions such as Alberta, with as many as 80 per cent of locally trained professionals staying in the province.

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In B.C., when we train doctors here, they stay here, Dix said at a news conference on Wednesday, noting that Alberta retains about 60 per cent of the doctors it trains.

Thats because of the priority we are giving especially to family practice, but to medical practice and the support that we give to our health officials including, for example in COVID, our provincial health officer, Dix said.

The registration of 666 international medical graduates this year with the B.C. College of Physicians and Surgeons was included this month in the first update to the provinces $1-billion multi-year health human resource strategy.

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A statement by the college said not all registrants are necessarily practising in B.C., as the figure includes associate physicians, academics, and visiting physicians who could have already left.

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The provinces update said 578 internationally educated nurses were registered in 2023, almost double the number registered in 2022.

Dix had previously said that the province needed to dramatically increase the number of health-care professionals to close gaps in the system and keep up with population growth.

Beyond family medicine, a significant number of the international medical graduates registered in B.C. this year are involved in specialty medicine, Dix said.

The province is also sending international medical graduates to rural and remote communities, under return of service programs that require doctors to agree to the postings in exchange for government-funded training.

Dix said the province is meeting its targets in these programs and hopes the staffing situation will improve as investments continue.

The reason that system has been successful, why its attracting people from all over the country and the world, is because it recognizes the central role of family practice in health care in the province, he said. Thats a lot of doctors who are seeing new patients they didnt see last year, so it makes a real difference for people.

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2023 The Canadian Press

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Hundreds of overseas doctors now working in B.C. family medicine, Dix says - Global News

BCM receives multiple recognitions from the American Heart … – Baylor College of Medicine News

Baylor Medicine, the multidisciplinary practice of Baylor College of Medicine, has received Target: BP Gold+ and Silver recognition, Check. Change. Control. Cholesterol Gold recognition and Target: Type 2 Diabetes Gold recognition from the American Heart Association. These awards acknowledge the practices commitment to decreasing the number of Americans living with uncontrolled blood pressure, diabetes and cholesterol and to reducing the risk of heart disease and strokes.

We appreciate the American Heart Associations initiatives to draw attention to and drive improvements in treating hypertension, diabetes and high cholesterol, and we are honored to be recognized for our efforts in improving care for patients with these conditions, said Dr. Daniel Murphy, chief quality officer of Baylor Medicine and medical director of the Baylor Medicine General Internal Medicine Clinic. The large number of awards Baylor College of Medicine received this year helps validate our efforts to continually optimize the care we deliver to our patients.

The Baylor Medicine specialties that received the Target: BP Gold+ Achievement Award are:

Baylor Medicine Comprehensive Health Clinic Baylor Medicine Cardiology at Fannin Tower Baylor Medicine Medical Genetics

The Target: BP Gold+ award recognizes practices that demonstrate a commitment to measurement accuracy and those that achieve blood pressure control in 70% or more of adult patients with hypertension.

The Baylor Medicine specialties and clinics that received the Target: BP Silver Achievement Award are:

Baylor Medicine Allergy and Immunology Baylor Medicine Anesthesiology Baylor Medicine Atherosclerosis Baylor Medicine Bariatric Surgery Baylor Medicine Cardiology Baylor Medicine Dermatology Baylor Medicine Endocrinology Baylor Medicine Family Medicine Kirby Baylor Medicine Family Medicine River Oaks Baylor Medicine Family Medicine Fannin Tower (Texas Medical Center) Baylor Medicine Gastroenterology Baylor Medicine General Internal Medicine Baylor Medicine General Surgery Baylor Medicine Geriatrics Baylor Medicine Infectious Disease Baylor Medicine Nephrology Baylor Medicine Neurology Baylor Medicine Neurosurgery Baylor Medicine Ophthalmology Baylor Medicine Ophthalmology Springwoods Village Baylor Medicine Orthopedic Surgery Baylor Medicine Otolaryngology Baylor Medicine Physical Medicine and Rehabilitation Baylor Medicine Plastic Surgery Baylor Medicine Psychiatry and Behavioral Sciences Baylor Medicine Pulmonary Baylor Medicine Rheumatology Baylor Medicine Thoracic Surgery Baylor Medicine Transition Medicine Baylor Medicine Urology Baylor Medicine Vascular Surgery

The Target: BP Silver award recognizes practices that have demonstrated a commitment to improving blood pressure control through measurement accuracy.

The Baylor Medicine specialties and clinics that received the Check. Change. Control. Cholesterol Gold Achievement Award are: Baylor Medicine Allergy and Immunology Baylor Medicine Anesthesiology Baylor Medicine Atherosclerosis Baylor Medicine Bariatric Surgery Baylor Medicine Cardiology Baylor Medicine Dermatology Baylor Medicine Endocrinology Baylor Medicine Family Medicine Kirby Baylor Medicine Family Medicine River Oaks Baylor Medicine Family Medicine Fannin Tower (Texas Medical Center) Baylor Medicine Cardiology at Fannin Tower Baylor Medicine Gastroenterology Baylor Medicine General Internal Medicine

Baylor Medicine General Surgery

Baylor Medicine Geriatrics Baylor Medicine Infectious Disease Baylor Medicine Nephrology Baylor Medicine Neurology Baylor Medicine Neurosurgery Baylor Medicine Ophthalmology Baylor Medicine Ophthalmology Springwoods Village Baylor Medicine Orthopedic Surgery Baylor Medicine Otolaryngology Baylor Medicine Physical Medicine and Rehabilitation Baylor Medicine Psychiatry and Behavioral Sciences Baylor Medicine Pulmonary Baylor Medicine Rheumatology Baylor Medicine Thoracic Surgery Baylor Medicine Urology Baylor Medicine Vascular Surgery

The Check. Change. Control. Cholesterol Gold award recognizes practices that appropriately manage with statin therapy at least 70% of their adult patients at high risk of atherosclerotic cardiovascular disease.

The Baylor Medicine specialties and clinics that received the Target: Type 2 Diabetes Gold recognition are:

Baylor Medicine Allergy and Immunology Baylor Medicine Comprehensive Health Clinic Baylor Medicine Endocrinology Baylor Medicine Family Medicine Kirby Baylor Medicine Family Medicine River Oaks Baylor Medicine Family Medicine Fannin Tower (Texas Medical Center) Baylor Medicine General Internal Medicine Baylor Medicine Geriatrics Baylor Medicine Nephrology

The Target: Type 2 Diabetes Honor Roll recognizes healthcare organizations for providing the most up-to-date, evidence-based care for patients with type 2 diabetes who are hospitalized with heart failure, heart attack or stroke.

Target: BP is a national initiative formed by the American Heart Association and the American Medical Association in response to the high prevalence of uncontrolled blood pressure (BP). Target: BP helps healthcare organizations and care teams, at no cost, improve BP control rates through an evidence-based quality improvement program and recognizes organizations committed to improving BP control.

The American Heart Association created the Check. Change. Control. Cholesterol initiative with national support from Amgen to improve awareness, detection and management of high cholesterol for consumers, patients and healthcare professionals.

The American Heart Association and the American Diabetes Association launched the collaborative initiative called Know Diabetes by Heart to comprehensively combat the national public health impact of type 2 diabetes and cardiovascular disease. To bring attention to this critical high-risk population, the AHA established the Target: Type 2 Diabetes Honor Roll recognition opportunity.

Cardiovascular disease is currently the leading cause of death in the United States, and uncontrolled hypertension, diabetes and cholesterol increase the likelihood of cardiovascular complications, Murphy said. The use of evidence-based methods to optimize blood pressure, cholesterol and diabetes care allows us to make meaningful impacts in reducing the risk of heart attacks, strokes and other cardiovascular events, leading to longer and healthier lives for our patients.

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BCM receives multiple recognitions from the American Heart ... - Baylor College of Medicine News

The physician specialists most likely to be sued – Becker’s ASC Review

General surgeons are the most likely to face malpractice lawsuits during their careers, with 90% reporting being either a sole or co-defendant in a lawsuit, according to Medscape's 2023 "Physicians and Malpractice Report," published Oct. 26.

Here are 22 physician specialties and the frequencies at which they face malpractice lawsuits:

General surgery: 90%

OB-GYN: 85%

Orthopedics: 82%

Plastic surgery: 73%

Otolaryngology: 72%

Radiology: 72%

Urology: 72%

Emergency medicine: 71%

Critical care: 66%

Cardiology: 64%

Gastroenterology: 64%

Neurology: 59%

Anesthesiology: 57%

Infectious diseases: 50%

Ophthalmology: 49%

Oncology: 47%

Internal medicine: 46%

Family medicine: 45%

Physical medicine and rehabilitation: 45%

Pathology: 44%

Pediatrics: 43%

Psychiatry: 30%

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The physician specialists most likely to be sued - Becker's ASC Review

Factors associated with regional retention of physicians: a cross … – Human Resources for Health

Physician shortage and maldistribution is one of the urgent health policy issues requiring resolution [1]. Determination of factors associated with regional retention of physicians and development of effective policy interventions will assist in solving this issue.

Many studies have been conducted to identify factors that contribute to the recruitment and retention of physicians in medically underserved regions and communities. Original attributes (nature) and educational perspectives (nurture) are used as frameworks for these studies [2]. Regarding the nature of physicians, originating from a rural area was strongly associated with a desire to work in a rural area, and actual work location as well as being interested in a comprehensive specialty were related to primary care [3]. For the nurture of education, medical students who have experienced a long period of rural training and physicians who have had both middle and high school education and training in the same rural area were likely to remain in the same rural area after training [4]. The salmon homecoming theory, which states that people educated in rural areas often work in rural areas, is also well known [5].

Various policies to secure physicians are in place in different countries. For example, Thomas Jefferson University initiated the Physician Shortage Area Program in 1974. The program selectively admits medical school students who both grew up in and plan to practice in a rural area. The program contributed 12% of all rural family physicians in Pennsylvania and helped to achieve>70% long-term physician retention in rural family medicine after 2025 years [6]. In Thailand, the government has implemented a multi-pronged intervention strategy over several decades to attract and retain doctors in underserved areas, including a special track for recruitment and training that enrolls students with rural backgrounds, trains the students at medical schools and hospitals close to their home towns, and obliges the students to return to their home provinces upon graduation. This track currently accounts for 47% of the total number of new graduates for general practice [7].

The World Health Organization published policy guidelines and recommendations in 2010 [1]. Among the suggested measures, one of the most frequently used approaches is a compulsory placement program, which is implemented in 70 countries [8]. However, there is a limited reliable evidence for the effects of interventions to address the inequitable distribution of health professionals [9], and the evidence is mixed for financial incentives and return of service programs [10, 11].

The issue of uneven distribution and availability of physicians is also a major health policy issue in Japan. Past empirical research has shown that simply increasing the number of physicians is not sufficient to mitigate the maldistribution of physicians [12, 13]. Consequently, there are two major approaches to increase the number of physicians working in the community. One is to establish a medical school that produces physicians for rural medicine (Jichi Medical University [JMU]), and the other is to allocate certain entrance quotas for medical schools to select students engaged in community medicine (regional quotas).

JMU was founded in 1972. Its budget is derived from the national government, as well as all 47 prefectural governments. Several entrance quotas are set for each prefecture. The JMU undergraduate education program is designed to focus on community and rural medicine, as well as other areas of medicine. After students have passed their national medical license and completed a 9-year obligation period including several years of rural service, the tuition fees are waived [3]. A previous study confirmed that JMU graduates who completed their obligation period were four times more likely to work in rural areas than non-JMU graduates [14].

Regarding regional quotas, although the programs vary, most contain at least one of the following components: applicants should have a geographical background in the prefecture where the medical school is located; applicants should undertake a special admission process with an emphasis on their motivation to commit to community medicine in their prefecture; applicants should have more exposure to community-based practice in their undergraduate medical education; and upon graduation, applicants are obliged or expected to work in the prefecture for several years [15]. Most of the regional quota programs are bundled with a scholarship, and in exchange, the graduates must work in the prefecture for a certain period of time. In most programs, one-third to one-half of the required period is dedicated to working in a rural area within the prefecture. Many programs offer special undergraduate curricula and programs. The percentage of medical school enrollment for regional quotas has increased rapidly, reaching 1,723 places, or 18.7% of the enrollment capacity of all medical schools in fiscal year 2021 [16].

In addition to being community medicine-oriented, one of the common features of JMU and regional quotas is the introduction and application of a career development program developed by each prefecture. From the physicians point of view, the obligation to work in a rural area for several years after graduation coincides with a critical period in their career development pathway, and thus it is an important issue how to balance their scholarship-bonded rural service obligation, career development, and other major life events, such as marriage and child-raising, that are often experienced in the same life stage. The introduction of a career development program is designed to solve this dilemma by providing multiple courses for each area of practice and type of medical institution where the physicians work and by visualizing the career paths that can be undertaken in each course including the board certification that can be obtained.

As such, the regional quotas and JMU have much in common and play major roles in securing physicians in community medicine and rural regions. However, there are also differences between the two approaches. The retention rate for contractual rural service was higher among JMU graduates than among regional quota graduates with a scholarship [17]. It was also shown that a higher percentage of physicians from regional quotas work in non-urban areas compared with physicians in general [15]. It was documented that students within regional quotas become less willing to work in the region as the academic year progresses [18]. Meanwhile, the cost forprefecturefor JMU was higher than that for regional quotas [17]. Thus, how to combine these two approaches and determine ways to retain medical school graduates in community medicine and rural regions remains an important issue.

Historically, the Japanese medical specialist system has been operated independently by individual academic societies, and there have been concerns about accreditation standards and quality assurance. In 2013, a national panel recommended the establishment of a third-party organization to unify the evaluation and accreditation of medical specialists and training programs. A new board certification system established general practice as one of the 19 basic specialties. In Japan, general practice and family medicine remain unpopular, and specialists also provide primary care [19]. In this regard, the change in policy has the potential to alter the mode of medical provision. A new training system for board certification was launched in 2018. Nevertheless, the number of students who commenced training to become a board-certified general practitioner in 2023 was only 285, or 3.1% of the 9,325 students who began training in any one of the basic specialties [20].

To mitigate physician maldistribution, it is also important to consider the placement mechanism of physicians. In this regard, ikyoku, a historical and traditional system for physician allocation, should be taken into account. During the modernization process in Japan, the training and personnel system for doctors based on ikyoku (literal translation: the clinical department of a medical school characterized by a professor at the top of the hierarchy) was imported from Germany. Combined with the traditional Japanese apprentice system and the spirit of craftsmanship, the system in Japan has developed in its own way. Its unique feature is the power of professors in university hospitals to rotate physicians among affiliated hospitals [19, 21]. The Japanese postgraduate medical education system is regarded as an apprenticeship-based system [22], with most new graduates trained in a medical school and belonging to that school. Even after their residency is completed, the relationship continues [23]. The physicians in most larger hospitals remain under the influence of this system.

Meanwhile, little is known about the actual conditions and contributing factors that influence the intention to work in rural regions and community medicine, especially with a focus on career development. Therefore, the purpose of the present study was to identify factors associated with regional retention and to discuss their policy implications.

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Factors associated with regional retention of physicians: a cross ... - Human Resources for Health