RESUMO
STUDY DESIGN: Cohort study. OBJECTIVE: The aim of this study was to determine the rate of accurate conflict of interest (COI) disclosure within three prominent subspecialty Spine journals during a 4-year period. SUMMARY OF BACKGROUND DATA: Industry-physician relationships are crucial for technological advancement in spine surgery but serve as a source of bias in biomedical research. The Open Payments Database (OPD) was established after 2010 to increase financial transparency. METHODS: All research articles published from 2014 to 2017 in Spine, The Spine Journal (TSJ), and the Journal of Neurosurgery: Spine (JNS) were reviewed in this study. In these articles, all author's COI statements were recorded. The OPD was queried for all author entries within the disclose period of the journal. Discrepancies between the author's self-reported COIs and the documented COIs from OPD were recorded. RESULTS: A total of 6816 articles meeting inclusion criteria between 2014 and 2017 in Spine, TSJ, and JNS with 39,869 contributing authors. Overall, 15.8% of all authors were found to have an OPD financial relationship. Of 2633 authors in Spine with financial disclosures, 77.1% had accurate financial disclosures; 42.5% and 41.0% of authors with financial relationships in the OPD had accurate financial disclosures in TSJ and JNS, respectively. The total value of undisclosed conflicts of interest between 2014 and 2017 was $421 million with $1.48 billion in accurate disclosures. Of undisclosed payments, 68.7% were <$1000 and only 7.2% were >$10,000. Undisclosed payments included $180 million in research funding and $188 million in royalties. CONCLUSION: This study demonstrates that undisclosed COI is highly prevalent for authors in major Spine journals. This study indicates that there remains a need to standardize definitions and financial thresholds for significant COI as well as to shift the reporting burden for COI to journals who actively review potential COIs instead of relying on self-reporting. LEVEL OF EVIDENCE: 3.
Assuntos
Conflito de Interesses , Revelação/normas , Publicações Periódicas como Assunto/normas , Médicos/normas , Doenças da Coluna Vertebral , Pesquisa Biomédica/economia , Pesquisa Biomédica/normas , Estudos de Coortes , Conflito de Interesses/economia , Bases de Dados Factuais/normas , Humanos , Publicações Periódicas como Assunto/economia , Médicos/economia , Autorrelato/economia , Autorrelato/normas , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/cirurgiaRESUMO
INTRODUCTION: There are few studies on the impact of social service programs on health in the professional development of doctors in the Andean States (Argentina, Bolivia, Chile, Colombia, Ecuador, Peru, and Venezuela). The purpose of these programs is to increase the availability of human resources in health in rural and remote areas. OBJECTIVE: To describe the regulations of social service programs for medical professionals in the Andean countries. METHODS: We carried out a bibliographic review of normative documents concerning the social service for medical professionals using websites of governments of the Andean States as data sources. We sought to obtain information regarding service conditions, funding of these programsincluding remunerations, and means of program allocation. Additionally, we used PubMed/MEDLINE to find complementary information on mandatory social services in these countries. RESULTS: Social service for medical professionals is established under a regulatory framework in all the Andean countries, except for Argentina, where this program does not exist. Participants receive remuneration (except in Bolivia, where students perform the service). The allocation systems used for these programs are heterogeneous, and in some Andean countries, the allocation is merit-based. Participation in social programs influences later professional opportunities (Ecuador, Colombia, and Venezuela) and the ability to specialize (Chile and Peru). CONCLUSIONS: It is necessary to study the impact of these programs on the professional development of the participants to design and implement quality improvement strategies tailored to each context.
INTRODUCCIÓN: Se ha estudiado poco sobre el impacto de los programas de servicio social en salud en el desarrollo profesional de médicos de los Estados Andinos (Argentina, Bolivia, Chile, Colombia, Ecuador, Perú y Venezuela), programas cuya finalidad es incrementar los recursos humanos en salud en zonas rurales y remotas. OBJETIVO: Describir la normativa de los programas de servicio social para profesionales médicos de los Estados Andinos. MÉTODOS: Se realizó una revisión bibliográfica de documentos normativos concernientes al servicio social para profesionales médicos en sitios web de gobiernos de los Estados Andinos, con la finalidad de obtener información la condición de servicio, financiamiento del programa/remuneraciones y modos de adjudicación. Adicionalmente, se empleó el motor de búsqueda PubMed para complementar la información sobre servicios sociales obligatorios en estos países. RESULTADOS: El servicio social para profesionales médicos está establecido bajo un marco normativo en todos los Estados Andinos, a excepción de Argentina, donde no existe este programa. Los participantes perciben una remuneración, salvo en Bolivia, donde el servicio es realizado por estudiantes. Los sistemas de adjudicación para estos programas son heterogéneos, siendo que en algunos Estados Andinos existe asignación de plazas según criterios meritocráticos. La participación en programas sociales en salud condiciona el ejercicio profesional (Ecuador, Colombia y Venezuela) y el poder realizar una especialización (Chile y Perú). CONCLUSIONES: Se requiere estudiar del impacto de estos programas en el desarrollo profesional del participante, con el objetivo de implementar estrategias de mejora adecuadas a sus contextos particulares.
Assuntos
Mão de Obra em Saúde/legislação & jurisprudência , Programas Obrigatórios/legislação & jurisprudência , Área Carente de Assistência Médica , Médicos/provisão & distribuição , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/legislação & jurisprudência , Argentina , Bolívia , Chile , Colômbia , Equador , Mão de Obra em Saúde/economia , Humanos , Programas Obrigatórios/economia , Peru , Médicos/economia , Serviços de Saúde Rural/economia , Salários e Benefícios/economia , Salários e Benefícios/legislação & jurisprudência , VenezuelaRESUMO
INTRODUCCIÓN: Se ha estudiado poco sobre el impacto de los programas de servicio social en salud en el desarrollo profesional de médicos de los Estados Andinos (Argentina, Bolivia, Chile, Colombia, Ecuador, Perú y Venezuela), programas cuya finalidad es incrementar los recursos humanos en salud en zonas rurales y remotas. OBJETIVO: Describir la normativa de los programas de servicio social para profesionales médicos de los Estados Andinos. MÉTODOS: Se realizó una revisión bibliográfica de documentos normativos concernientes al servicio social para profesionales médicos en sitios web de gobiernos de los Estados Andinos, con la finalidad de obtener información la condición de servicio, financiamiento del programa/remuneraciones y modos de adjudicación. Adicionalmente, se empleó el motor de búsqueda PubMed para complementar la información sobre servicios sociales obligatorios en estos países. RESULTADOS: El servicio social para profesionales médicos está establecido bajo un marco normativo en todos los Estados Andinos, a excepción de Argentina, donde no existe este programa. Los participantes perciben una remuneración, salvo en Bolivia, donde el servicio es realizado por estudiantes. Los sistemas de adjudicación para estos programas son heterogéneos, siendo que en algunos Estados Andinos existe asignación de plazas según criterios meritocráticos. La participación en programas sociales en salud condiciona el ejercicio profesional (Ecuador, Colombia y Venezuela) y el poder realizar una especialización (Chile y Perú). CONCLUSIONES: Se requiere estudiar del impacto de estos programas en el desarrollo profesional del participante, con el objetivo de implementar estrategias de mejora adecuadas a sus contextos particulares.
INTRODUCTION: There are few studies on the impact of social service programs on health in the professional development of doctors in the Andean States (Argentina, Bolivia, Chile, Colombia, Ecuador, Peru, and Venezuela). The purpose of these programs is to increase the availability of human resources in health in rural and remote areas. OBJECTIVE: To describe the regulations of social service programs for medical professionals in the Andean countries. METHODS: We carried out a bibliographic review of normative documents concerning the social service for medical professionals using websites of governments of the Andean States as data sources. We sought to obtain information regarding service conditions, funding of these programsincluding remunerations, and means of program allocation. Additionally, we used PubMed/MEDLINE to find complementary information on mandatory social services in these countries. RESULTS: Social service for medical professionals is established under a regulatory framework in all the Andean countries, except for Argentina, where this program does not exist. Participants receive remuneration (except in Bolivia, where students perform the service). The allocation systems used for these programs are heterogeneous, and in some Andean countries, the allocation is merit-based. Participation in social programs influences later professional opportunities (Ecuador, Colombia, and Venezuela) and the ability to specialize (Chile and Peru). CONCLUSIONS: It is necessary to study the impact of these programs on the professional development of the participants to design and implement quality improvement strategies tailored to each context.
Assuntos
Humanos , Médicos/provisão & distribuição , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/legislação & jurisprudência , Programas Obrigatórios/legislação & jurisprudência , Mão de Obra em Saúde/legislação & jurisprudência , Área Carente de Assistência Médica , Peru , Argentina , Médicos/economia , Salários e Benefícios/economia , Salários e Benefícios/legislação & jurisprudência , Venezuela , Bolívia , Chile , Colômbia , Serviços de Saúde Rural/economia , Programas Obrigatórios/economia , Equador , Mão de Obra em Saúde/economiaRESUMO
In recent decades, the number of women pursuing careers in health has significantly increased. However, the physician labor market is still characterized by gender differences regarding payment. Using a nationally representative Peruvian sample of health providers (3,219 male and 1,063 female physicians), we estimated the gender gap in the likelihood of earning high wages for physicians and decomposed this gap in a proportion related to differences in individual characteristics (e.g. specialty, labor experience), and a residual proportion related to differences in returns to these characteristics. Our main results reveal that male physicians have on average an 81% higher likelihood of earning high salaries (monthly earning level > 5,000 PEN) relative to their female counterparts. Further, the main proportion of this gap is associated to the unexplained component (among 57% and 77%, according to the model specification), which may be associated to unobservable characteristics and discrimination in the Peruvian labor market.
Assuntos
Seleção de Pessoal/economia , Médicos/economia , Salários e Benefícios/economia , Sexismo/economia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pessoal/estatística & dados numéricos , Peru , Médicos/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Salários e Benefícios/tendências , Fatores Sexuais , Sexismo/estatística & dados numéricos , Fatores Socioeconômicos , Mulheres Trabalhadoras/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: In 2010, the Affordable Care Act introduced new restrictions on the expansion of physician-owned hospitals (POHs) due to concerns over financial incentives and increased costs. The purpose of this study is to determine whether joint ventures between tertiary care and specialty hospitals (SHs) allowing physician ownership (POHs) have improved outcomes and lower cost following THA and TKA. METHODS: After institutional review board approval, a retrospective review of consecutive series of primary THA and TKA patients from 2015 to 2016 across a single institution comprised of 14 full-service hospitals and 2 SHs owned as a joint venture between physicians and their health system partners. Ninety-day episode-of-care claims cost data from Medicare and a single private insurer were reviewed with the collection of the same demographic data, medical comorbidities, and readmission rates for both the SHs and non-SHs. A multivariate regression analysis was performed to determine the independent effect of the SHs on episode-of-care costs. RESULTS: Of the 6537 patients in the study, 1936 patients underwent a total joint arthroplasty at an SH (29.6%). Patients undergoing a procedure at an SH had shorter lengths of stay (1.29 days vs 2.23 days for Medicare, 1.15 vs 1.86 for private payer, both P < .001), were less likely to be readmitted (4% vs 7% for Medicare, P = .001), and had lower mean 90-day episode-of-care costs ($16,661 vs $20,579 for Medicare, $26,166 vs $35,222 for private payers, both P < .001). When controlling for the medical comorbidities and demographic variables, undergoing THA or TKA at an SH was associated with a decrease in overall episode costs ($3266 for Medicare, $13,132 for private payer, both P < .001). CONCLUSION: Even after adjusting for a healthier patient population, the joint venture partnership with health systems and physician-owned SHs demonstrated lower 90-day episode-of-care costs than non-SHs following THA and TKA. Policymakers and practices should consider these data when considering the current care pathways.
Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Hospitais Especializados/economia , Modelos Econômicos , Ortopedia/economia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Comorbidade , Atenção à Saúde/economia , Feminino , Convênios Hospital-Médico/economia , Hospitais , Humanos , Masculino , Medicare/economia , Pessoa de Meia-Idade , Propriedade , Patient Protection and Affordable Care Act , Médicos/economia , Estudos Retrospectivos , Estados UnidosRESUMO
OBJECTIVE: In many countries an increase in the number of women in medicine is accompanied by gender inequality in various aspects of professional practice. Women in medical workforce usually earn less than their male counterparts. The aim of this study was to describe the gender wage difference and analyse the associated factors in relation to Brazil's physicians. PARTICIPANTS: 2400 physicians. SETTING: Nationwide, cross-sectional study conducted in 2014. METHODS: Data were collected via a telephone enquiry. Sociodemographic and work characteristics were considered factors, and monthly wages (only the monthly earnings based on a medical profession) were considered as the primary outcome. A hierarchical multiple regression model was used to study the factors related to wage differences between male and female physicians. The adjustment of different models was verified by indicators of residual deviance and the Akaike information criterion. Analysis of variance was used to verify the equality hypothesis subsequently among the different models. RESULTS: The probability of men receiving the highest monthly wage range is higher than women for all factors. Almost 80% of women are concentrated in the three lowest wage categories, while 51% of men are in the three highest categories. Among physicians working between 20 and 40 hours a week, only 2.7% of women reported receiving >US$10 762 per month, compared with 13% of men. After adjustment for work characteristics in the hierarchical multiple regression model, the gender variable estimations (ß) remained, with no significant modifications. The final effect of this full model suggests that the probability of men receiving the highest salary level (≥US$10 762) is 17.1%, and for women it is 4.1%. Results indicate that a significant gender wage difference exists in Brazil. CONCLUSION: The inequality between sexes persisted even after adjusting for working factors such as weekly workload, number of weekly on-call shifts, physician office work, length of practice and specialisation.
Assuntos
Médicos/economia , Salários e Benefícios/estatística & dados numéricos , Sexismo/economia , Fatores Socioeconômicos , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicas/estatística & dados numéricos , Análise de Regressão , Salários e Benefícios/tendências , Fatores SexuaisRESUMO
AIM: To assess the adherence of physicians to the Medical-Care Guidelines for Malignant Breast Tumors in Mexico, before and after the allocation of federal subsidies from the Catastrophic Health Expenditure Fund (FPGC by its Spanish initials) to accredited hospitals, a strategy implemented with the view of offering free treatment to women with breast cancer (BC). MATERIAL AND METHODS: Based on a cross-sectional design, we gathered information on 479 BC patients who had been attended to at in four FPGC-accredited hospitals. Analysis centered on those treated within either three years before or three years after the accreditation of their attending hospitals. The four hospitals analyzed were located in the North, South, West and Center of the country. Information on all medical procedures performed during treatment was drawn from hospital medical records. Information on the socio-demographic characteristics of the patients was obtained by means of face-to-face interviews conducted in their homes. RESULTS: Adherence of physicians to the Guidelines grew by 12.8 percent (from 43.4 to 56.2 percent) after FPGC accreditation (p<0.001) and varied according to the clinical stage of the disease, with much lower levels of adherence observed in the advanced stages (p<0.05). CONCLUSIONS: The FPGC strategy increased the adherence of physicians to the Medical-Care Guidelines for Malignant Breast Tumors in Mexico.
Assuntos
Neoplasias da Mama/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Oncologia/normas , Programas Nacionais de Saúde/economia , Médicos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/economia , Neoplasias da Mama/patologia , Estudos Transversais , Feminino , Hospitais Públicos/economia , Hospitais Públicos/normas , Humanos , Oncologia/economia , Oncologia/estatística & dados numéricos , México , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Médicos/economia , Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de SaúdeRESUMO
Abstract: In recent decades, the number of women pursuing careers in health has significantly increased. However, the physician labor market is still characterized by gender differences regarding payment. Using a nationally representative Peruvian sample of health providers (3,219 male and 1,063 female physicians), we estimated the gender gap in the likelihood of earning high wages for physicians and decomposed this gap in a proportion related to differences in individual characteristics (e.g. specialty, labor experience), and a residual proportion related to differences in returns to these characteristics. Our main results reveal that male physicians have on average an 81% higher likelihood of earning high salaries (monthly earning level > 5,000 PEN) relative to their female counterparts. Further, the main proportion of this gap is associated to the unexplained component (among 57% and 77%, according to the model specification), which may be associated to unobservable characteristics and discrimination in the Peruvian labor market.
Resumen: En décadas recientes, el número de mujeres realizando su carrera en el ámbito de salud se ha incrementado significativamente. No obstante, el mercado laboral de los médicos está todavía caracterizado por diferencias de género respecto a los salarios. Utilizando una muestra peruana nacionalmente representativa de proveedores de salud (3.219 hombres y 1.063 mujeres médicos), estimamos la brecha de género en la probabilidad para los médicos de ganar sueldos altos y la desglosamos según los porcentajes vinculados a las diferencias relacionadas con las características individuales (p.ej. especialidad, experiencia laboral) y un porcentaje residual vinculado a las diferencias relacionadas con estas características. Nuestros resultados principales revelaron que los médicos hombres contaban en promedio con un 81% mayor probabilidad de ganar sueldos más altos (nivel mensual de renta > 5.000 PEN) frente a sus compañeras mujeres. Asimismo, gran parte del porcentaje de esta brecha está asociado a un componente inexplicable (entre un 57% y un 77%, según la especificación del modelo), lo que tal vez esté relacionado con las características no observables y la discriminación en el mercado laboral peruano.
Resumo: Nas últimas décadas, o número de mulheres atuando em carreiras da saúde aumentou significativamente. Contudo, o mercado de trabalho médico continua caracterizado por diferenças de gênero nos salários. Usando uma amostra nacional representativa de profissionais da saúde peruanos (3.219 médicos e 1.063 médicas), nós estimamos a diferença de gênero na probabilidade de receber altos salários para médicos e decompomos essa diferença em uma proporção relacionada a diferenças em características individuais (p.ex.: especialidade, experiência profissional) e uma proporção residual relacionada a diferenças de retornos dessas características. Nossos resultados principais revelam que os médicos têm, em média, uma probabilidade 81% maior de receber salários altos (nível de rendimentos mensais > 5.000 PEN) em relação às médicas. Adicionalmente, a principal proporção dessa diferença está associada ao componente não-explicado (entre 57% e 77%, de acordo com a especificação do modelo), o que pode estar associado a características não-observadas e discriminação no mercado de trabalho peruano.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Seleção de Pessoal/economia , Médicos/economia , Salários e Benefícios/economia , Sexismo/economia , Seleção de Pessoal/estatística & dados numéricos , Peru , Médicos/estatística & dados numéricos , Salários e Benefícios/tendências , Salários e Benefícios/estatística & dados numéricos , Fatores Socioeconômicos , Mulheres Trabalhadoras/estatística & dados numéricos , Fatores Sexuais , Estudos Transversais , Sexismo/estatística & dados numéricosRESUMO
OBJECTIVES: To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru. MATERIALS AND METHODS: : We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. RESULTS: Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earn > S/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. CONCLUSIONS: Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.
OBJETIVOS: Evaluar la asociación entre tener una especialidad médica y el ingreso económico mensual en médicos peruanos, y comparar los ingresos económicos entre áreas con mayor y menor densidad de médicos en Perú. MATERIALES Y MÉTODOS: Se analizaron los datos de la Encuesta Nacional de Satisfacción de Usuarios de Salud realizada en Perú el año 2015. Esta encuesta con nivel de inferencia nacional fue realizada a médicos que laboran en establecimientos de salud de Perú. Se evaluó el ingreso económico considerando todas las actividades remuneradas del médico. Se calcularon las razones de prevalencia crudas y ajustadas (RP y RPa) y sus intervalos de confianza al 95% (IC95%) mediante regresiones de Poisson con varianza robusta, tomando en cuenta el muestreo complejo de la encuesta. RESULTADOS: De 2219 médicos encuestados, se analizaron 2154 (97,0%) observaciones. La frecuencia de ganar >S/ 5000 (1572,3 USD) mensuales fue de 29,1% en médicos generales; 65,6% en especialistas; 63,0% en especialidades clínicas; 70,5% en especialidades quirúrgicas, y 55,7% en otras especialidades. En comparación a los médicos generales, los médicos con especialidades clínicas, quirúrgicas, y otras especialidades, tuvieron más probabilidades de ganar >S/ 5000 mensuales (RPa = 1,44, 1,49, y 1,26, respectivamente). La probabilidad de ganar >S/ 5000 fue mayor en quienes laboraban en departamentos con baja densidad de médicos. CONCLUSIONES: Los ingresos económicos fueron mayores en médicos especialistas que en no especialistas. Los ingresos económicos fueron mayores en departamentos con menor densidad de médicos, lo cual puede animar a que los médicos laboren en dichos departamentos.