Recruiting and retaining physicians to work in rural emergency departments (EDs) have reached a crisis level, threatening the availability of services to rural residents. In this study, a case study design was used to explore strategies that rural ED administrators use to recruit and retain physicians to work in their facilities. The study population consisted of 5 rural hospital administrators operating EDs in central Mississippi. These administrators were charged with the responsibility to recruit and retain ED physicians. The on-going staffing of ED physicians, with no lapses in coverage, was evidence that these administrators successfully recruited and retained ED physicians at their facilities. The conceptual framework that grounded this study was strategic human resource management. Semistructured interviews were used to collect data from participants, and the modified van Kaam method of data analysis was used to create and cluster themes, validate data, and to construct and describe textural meaning. One of the dominate themes that emerged from the study was the challenge of maintaining rural ED physician coverage. Deterrents to maintaining ED coverage included insufficient pools of available physicians, changing technological demands, and financial constraints. A second dominate theme permeating the study was the insufficient focus on retention of rural ED physicians. Study findings may contribute to social change by providing a replicable recruitment and retention model for recruiting and retaining rural ED physicians. The most successful strategies to recruit and retain ED physicians, as identified in this study, were provision of financial incentives and development of a sense of family and community.

Since 2008, physician-led primary care practices have decreased as physician's encounter sustainability challenges because of government regulations and the requirements of the Affordable Care Act. The problem is that some physician-led primary care practice leaders lack strategies to sustain a medical practice longer than 5 years. The purpose of this study was to explore strategies primary-care practice leaders use to sustain a practice longer than 5 years. This study followed a case study design, including a purposeful sampling of 3 physician-led primary care practice leaders in southern Indiana. Open-ended semistructured interviews were conducted and triangulated with company policies and procedures as well as government statistics. Coded data and themes were identified using the complex adaptive systems theory. Three sustainability themes emerged: (1) patient engagement, (2) relationship development and retention, and (3) adaptation and innovation. The recommended action is for physician leaders to apply the strategies to develop their primary care medical practices. Results from the study may contribute a positive social change by presenting strategies to develop and sustain physician-led primary care practices, which could lead to an increase of primary care medical practices, resulting in more patients having access to primary care physicians.

Indiana University-Purdue University Indianapolis (IUPUI) / In relationship-centered care, the relationship formed between physician and patient is critical to the creation of positive patient outcomes and patient satisfaction (Inui, 1996; Laine & Davidoff, 1996; Tresolini, 1994). Medical educators have increasingly utilized Objective Structured Clinical Examinations (OSCEs) to assess medical students’ abilities to utilize a relationship-centered approach in clinical interviewing. OSCEs, however, have recently come under scrutiny as critics contend that the overly scripted and standardized nature of the OSCE may not accurately reflect how medical students build and maintain relationships with patients. Although some studies have looked at how standardized patients help teach medical students interviewing skills, few studies have looked specifically at how the structured nature of the OSCE may influence relationship-building between standardized patients and medical students. Therefore, this study asks the question “How is relationship-centered care negotiated between standardized patients and medical students during a summative diagnostic OSCE?” Using an ethnographic methodology (Bochner & Ellis, 1996), data consists of an ethnographic field journal, transcripts of semi-structured interviews with SPs and medical students, and transcripts of headache and chronic cough videotaped scenarios. Using grounded theory (Strauss & Corbin, 1990, 1998), a back-and-forth thematic analysis was conducted in discovering the saturation of conceptual categories, linking relationships, and in critically comparing interpretive categorical concepts with relevant literature (Josselson & Leeblich, 1999). Findings suggest that standardized patients and medical students hold differing expectations for 1) diagnostic information gathering and 2) making personal connections upon entering a diagnostic summative OSCE. SPs “open up” both verbally and nonverbally when medical students “go beyond the checklist” by asking discrete diagnostic questions and when overtly trying to connect emotionally. Fourth year medical students, however, expect SPs to “open-up” during what they experience as a rushed, time-constrained, and overly structured “gaming” exercise which contradicts their own clinical experiences in being more improvisational during empathetic rapport building. Differences between SPs and medical students’ expectations and communication practices influence how they perform during summative diagnostic OSCEs. Findings may suggest the re-introduction of more relationship-focused OSCEs which positions SPs as proactive patients who reflexively co-teach students about the importance of making personal connections.

The patient-physician relationship is established when a doctor provides care for their patient. This interpersonal interaction consists of perspectives on health issues, treatment plans, confidentiality, and support. Trust is also a component of the patient-physician relationship. Existing findings show that patient-physician trust is critical for achieving compliance and higher satisfaction rates with medical care (Cohen, 2002). Previous studies have investigated the physician's emotional intelligence as a factor in patient-physician trust, as well as the health locus of control on outlook, religious viewpoints on patient outcomes, and vulnerable attachment styles on the patient trust of the patients in determining the patient-physician trust. However, this study addresses the collective role of these variables from the patient's perspective in the patient-physician relationship. Past literature focuses on the physician's perspective and health outcomes. This study aims to understand how college students as patients view their relationship with their physicians. Consistent with existing literature, it was concluded that higher scores on emotional intelligence, internal health locus of control, and ease of vulnerability were associated with higher levels of patient-physician trust. However, a significant association between religious locus of control and patient-physician trust was not found. These findings regarding patients from the population of college students can inform college administrators to develop and implement plans to enhance the quality of care that physicians provide for college students. Further research can then be conducted to optimize these factors and ultimately improve the patient-physician relationship.

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<p><strong>OBJECTIVE: </strong>The aim of this study was to explore an alternative method of secure data exchange of patient information among physicians using their existing email.<strong></strong></p> <p><strong>METHODS: </strong>A four-step framework was designed to effectively conduct the research. It involved designing a prototype of a web-based system called ST-SecRx to simulate secure communication between physicians while exchanging sensitive patient data through email. The simulation achieved through the system was meant to determine and measure response of physicians to the use of secure email or similar communication tools for exchanging patient data. Physicians were invited to use ST-SecRx and subsequently participate in a survey to determine its acceptability and their perceptions about the usefulness of the software. Finally, the data collected from the survey were analyzed.</p> <p><strong>RESULTS:</strong> Data were collected from 22 physicians from various healthcare facilities in the province of Ontario, Canada. Eliminating questionnaires with no response resulted in 19 valid responses. Results revealed that 57.9% used email support provided by their organization for exchanging patient data. Over 70% acknowledged that factors such as: ease of use, not having to use an email different from the one provided by their employer, not having to create and remember new password every three to six months, and data transfer complying with privacy regulations would facilitate their use of ST-SecRx. More than 50% of the physicians felt that the simulated system as demonstrated to them was more secure and easier to use when compared to previously used methods of patient data exchange through email. The majority of the physicians (from 57.9% to 73.7%) agreed with all the six questions on behavioral intention to use ST-SecRx. Overall 42% were willing to pay between $5 and $20 per month for ST-SecRx. Additional analysis of data by age, sex and discipline did not reveal any substantial differences in their enthusiasm to use the system.</p> <p><strong>CONCLUSION: </strong>The current research was successful providing data on what is important to clinicians who want to exchange data on patients with other clinicians. Use of systems similar to the prototype ST-SecRx could be an improvement over conventional email, provided that they would ensure security using encrypted technology under public key infrastructure methods and systems. Overall the physicians were satisfied with ST-SexRx and found it simple, fast, easy to use, and secure, and they indicated that they intended to use it if it were made available and it conformed to privacy and security standards. Also, such a secure system would have the potential to reduce the overall cost of healthcare by reducing duplication of diagnostic tests and making patient- specific information exchange faster. More research needs to be conducted with a larger sample size to validate the findings of this study. The limitations, dissatisfaction, and concerns expressed by the physicians who used ST-SecRx could direct future research. Future studies could include other healthcare professionals in the exchange of sensitive clinical data.</p> / Master of Science (MSc)

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Thesis advisor: Marc Landy / The “Death with Dignity Act,” if passed in November 2012 in Massachusetts by means of a ballot initiative, would have allowed doctors to prescribe lethal drugs to patients with fewer than six months to live. Introduced by two pro-assisted suicide organizations from the Pacific Northwest, the initiative was expected to take advantage of a political “perfect storm” brewing in the Bay State. A blue state in a presidential election year, with President Obama at the top of the Democratic ticket, Massachusetts was expected to produce an electoral outcome favorable to assisted suicide. Oregon and Washington State had legalized physician-assisted suicide in 1998 and 2008, respectively. Polling in 2011 showed a 2-1 majority among Massachusetts voters in favor of assisted suicide. Nonetheless, the Archbishop of Boston and the Bishops of Worcester, Fall River and Springfield, organized as the Massachusetts Catholic Conference, took up the challenge to oppose the initiative. Relying on the expertise of paid political consultants, they mounted a two-tiered campaign. An internal component, directed at Catholics, included the dissemination of over 2 million pieces of in-print and electronic materials urging a “no” vote on the measure. An external component, directed at the wider public, relied on a coalition of organizations representing the three major religions, health and hospice organizations, disabilities rights activists, and pharmacists. Using “flaws” in the bill identified through strategic polling, they appealed to voters even sympathetic to assisted suicide to reject the bill. When the votes were counted 2.7 million Massachusetts citizens voted on the physician-assisted suicide initiative and it was defeated by 67,891 votes, 51.1% to 48.9%. One key to the defeat was the split in the vote in the city of Boston, where Question 2 was defeated 50.9% to 49.1% . Twelve of Boston’s 22 wards voted against the measure. Leading the way among the twelve were Dorchester, Roxbury, and Hyde Park, traditionally black, liberal Democratic strongholds. This study shows that even the most effective, well-funded, Church-initiated campaign in Massachusetts in 2012 might well have foundered on the 2-1 majority in favor of assisted suicide at the polls, not for the strategic identification of “flaws in the bill,” the broad-based coalition campaign based on them, and the “split in the vote in the black community in Boston.” . / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Political Science.

Formål:Hensikten med studien er å undersøke hvilken effekt det lovbaserte legefordelingssystemet, som var aktivt i Norge fra 1.1.1999 til 30.6.2013, har hatt, og hvordan ordningen har påvirket utviklingen i legestillinger i primærhelsetjenesten og spesialisthelsetjenesten i Norge. Studien kan gi myndighetene et bedre kunnskapsgrunnlag om statlig regulering av legestillinger. Metode: Forskningsspørsmålene er i hovedsak belyst gjennom kvantitative deskriptive analyser av registerdata og tilgjengelig statistikk. Saksdokumenter og vedtak om tildeling av legestillinger er gjennomgått, og det er gjennomført en kvalitativ analyse av bakgrunnsdokumentene ved innføringen av ordningen. Den teoretiske rammen for studien er folkehelsearbeid, organisasjonsteori og resultatkjeden som et styringsverktøy ved gjennomføring av evalueringer. Resultat: Studienviser at nye legestillinger i primærhelsetjenesten har vært prioritert i hele perioden. Dette kan ha bidratt til å redusere sosiale ulikheter i helse. Antall ubesatte legestillinger er i perioden 1.1.1999 til 30.6.2013 redusert til under 1% av alle legestillinger, både i primærhelsetjenesten og spesialisthelsetjenesten. I samme periode økte antall utdanningsstillinger for leger i spesialisering med 36%. I alt 54% av alle nye legestillinger i spesialisthelsetjenesten er gitt innen nasjonale satsningsområder og prioriterte spesialiteter. Av de nordiske landene har Norge hatt høyest økningen i legedekning pr 1000 innbyggere i allmennlegetjenesten. Konklusjon: Studien viser at den statligereguleringenav nye legestillinger har hatt en effekt, og at et målrettet reguleringssystem kan være et godt administrativt virkemiddel for nasjonal legefordeling og geografisk fordeling av leger. God forankring og bred deltaking er suksesskriterier. / Purpose: This study aimedto investigate the effect of the legally based system for allocating new positions for physiciansunder a policy that wasin effectin Norway between 1 January 1999 and 30 June 2013.The study also aimed to increase understanding of a government-regulated physician distribution system. Method: The primary methodology involved using quantitative descriptive analysis to review registry data and available statistics. Case documents and decisions related to theallocation of physician positions, and case and policy documents related to the original justification for the government-regulated physician distribution systemw ere also reviewed. The theoretical thesis and framework for this study is public health, organization theory, and the "result chain" as a management tool for executing evaluations and deliberations. Result: Theresults of the study show that vacant positions for physicians, both primary and specialists, decreased to less than 1% during the study period. During this same time period, 54% of all new hospital positions were assigned a priority specialty. Positions for specialist education increased 36%. Among the Nordic countries, Norway had the highest increase in coverage by primary care physiciansper 1,000 capita during the past 15 years. Conclusion:The government-regulated physician distribution systemin Norway has been effective. Robustness, consensus building, and broad participation are key conditions and ingredients in the recipe for success. / <p>ISBN 978-91-982282-2-9</p>