Changing Landscape of Academic Women's Health Care in the United States (eBook)

Foreword 6
Preface 8
Contents 9
Contributors 10
1 The Flexner Report and Evidence-Based Medicine Over the Past 100 Years 12
1.1 Introduction 12
1.2 Background: The Development of the Human Propensity for Problem Solving 13
1.3 Gaps in American Medical Education in the 19th Century: Looking to Europe and Setting the Stage for Medical Education Reform 15
1.4 Reforming Medical Education to Highlight the Importance of Evidence and Problem-Solving: Abraham Flexner, the Flexner Report, and Medical Education Over the Past 100 Years 17
1.5 Medical Decision Making and Evidence-Based Medicine (EBM): Flexners Ideals in Practice 20
1.6 Decision Science and Medical Decision Making 22
1.7 Shared Decision Making: Patient Rights and Safety 23
1.8 Lifelong Learning and Continuing Medical Education: Flexners Ideals Applied to Physicians Throughout Their Careers 24
1.9 CME and Avoidance of Physician Burnout 26
1.10 Changing Landscapes: Part-Time Options, Lifestyles, and Physician Satisfaction 27
1.11 Conclusion: Flexner for Any Century 30
Notes 31
References 31
2 Generational and Gender Shifts in Academic Medicine 35
2.1 Introduction 35
2.2 Generational Issues 36
2.3 The Silent Generation (1925--1942) 37
2.4 Baby Boomer Generation (1943--1961) 37
2.5 Generation X (1962--1981) 38
2.6 Generation Y (1982--2000) 40
2.7 Gender Issues 42
2.8 Work Life Balance 45
2.9 Impact of the Changing Workforce on Academic Manpower 46
2.10 Summary 47
References 47
3 Clinician Educators: How Can We Meet the Expanding Need 49
3.1 Introduction 49
3.2 What Motivates Clinician Educators 52
3.3 How Do We Create Excellence and Scholarship in Clinical Educators 54
3.4 Recognizing the Value of Clinician Educators and Community Faculty 57
3.5 Steps to a New Future: Confronting the Ivory Tower Does the Future Lie in Increasing or Decreasing Medical School Faculties in Favor of Clinical Site and/or Community Faculty 58
References 59
4 Interdisciplinary Womens Health Research and Career Development 62
4.1 Historical Introduction 62
4.2 Evolution and Expansion of the Field of Womens Health Research 64
4.2.1 Expanding the Vision for Women's Health Research 65
4.2.2 Designing New Programs to Promote Interdisciplinary Women's Health Career Development and Research 66
4.3 Interdisciplinary Research Defined 67
4.4 Building Interdisciplinary Research Careers in Womens Health (BIRCWH) Program 68
4.5 Specialized Centers of Research on Sex and Gender Factors Affecting Womens Health (SCOR) 70
4.6 Advancing Novel Science in Womens Health Research (ANSWHR) Program 72
4.7 Interdisciplinary Research and Career Development: Benefits and Challenges 72
4.8 Conclusions and New Models of Womens Health Care 74
4.8.1 New Dimensions and Strategies for Women's Health Research at the National Institutes of Health 75
4.8.2 Women in Biomedical Careers -- The Changing Landscape in Medical and Research Careers in the United States 77
References 81
5 Part-Time Faculty and Their Hidden Value 85
5.1 History of Part-Time Faculty Positions 86
5.2 Incidence of Part-Time Faculty 87
5.3 Productivity and Quality of Patient Care for Part-Time Faculty 88
5.4 Career Development for Part-Time Faculty 90
5.5 2008 WPC Survey Barriers to Part Time Work (Data from E Tracy) 92
5.6 The Future 92
5.7 Conclusions 93
References 93
6 Trends in Faculty Salaries 95
6.1 Introduction 95
6.2 Fundamental Themes 96
6.2.1 Transparency and Fairness 96
6.2.2 Culture and Leadership 96
6.2.3 Faculty Activity Database 96
6.2.4 Work RVUs 97
6.2.5 Annual Bonuses 97
6.2.6 Discretionary Funds 97
6.2.7 Tenure 97
6.3 Trends in Faculty Compensation 98
6.3.1 The 1990s 98
6.3.2 The 2000s 99
6.4 Aligning Compensation with Education 100
6.5 Performance-Based Compensation for Research 101
6.6 Salary Contract Negotiation 102
6.7 Costs of Faculty Turnover 103
6.8 Special Considerations 104
6.8.1 Gender Equity 104
6.8.2 Public Versus Private Medical Schools 105
6.8.3 Comparison with Private Practice 105
6.9 Conclusions 105
References 106
7 Healthcare Reform and its Potential Impact on Academic Womens Healthcare Practice and Training 108
7.1 Introduction 108
7.2 The Excessive Cost of U.S. Health Care 109
7.3 Prior to Health Care Reform Many Americans Particularly Women Were Uninsured, Underinsured, or at Risk of Losing Benefits 109
7.4 Access Does Not Guarantee Quality, Equitable or Safe Care 111
7.5 The US Healthcare System Provides Erratic and Uncoordinated Care 111
7.6 Our Health Care Delivery System is Fundamentally Flawed 112
7.7 Future Reform of the Delivery System: Two Contrasting Models 112
7.8 Porter and Teisberg and Value-Based Care 113
7.9 Enthoven and Competition Based on Integrated Delivery Systems 114
7.10 Both Care Delivery Models Require Improved Information Technology (IT) Platforms 116
7.11 The Short-Term Repercussions of Health Care Reform 116
7.12 Long Term Consequences of Reform: A Two-Tiered System 117
7.13 Renewing Interest in Primary Care Specialties 117
7.14 Patient Centered Medical Home 118
7.15 Accountable Care Organizations (ACO) 119
7.16 Retail Clinics 120
7.17 The First Steps to Reform are Already Underway 120
7.18 Medical Workforce Reform: Encouraging Medical Students to Pursue Needed Specialties 121
7.19 Changes in Graduate Medical Education (GME) and Continuing Medical Education (CME) are Necessary to Prepare Doctors for a Reformed Health Care System 121
7.20 Reform in the Funding of GME 122
7.21 Long-Term Health Care Reform and the Practice of OB/GYN 122
7.22 Health Care Reform and OB/GYN GME 123
7.23 Health Care Reform and Womens Reproductive Health 124
7.24 Conclusions 124
References 125
8 Faculty Satisfaction and Retention in Obstetrics and Gynecology 128
8.1 Background 128
8.2 Physician Satisfaction in General 129
8.3 Satisfaction for the Obstetrician Gynecologist 131
8.4 Faculty Satisfaction 132
8.5 Shifting Gender Balance 134
8.6 A New Generation of Physicians 137
8.7 Future Directions 139
8.7.1 Career Flexibility 140
8.7.2 Patient Safety 143
8.7.3 Physician Wellness 146
References 148
9 Ethics in Academic Medicine 153
9.1 Introduction 153
9.2 Ethics in Medicine 154
9.3 Challenges for Academic Physicians: Ethics of Teaching and Research 155
9.4 Challenges for Institutions: An Ethical Workplace 159
9.5 Ethical Challenges for the Profession 161
9.6 Conclusion 164
References 165
10 Preparing for Tomorrow in Academic Womens Health Care 168
10.1 Introduction 168
10.2 Trends in Medical School Enrollment and Residency Matching 169
10.3 Need for Additional Graduates in Obstetrics and Gynecology 172
10.4 Trends in Academic Departments 174
10.5 Preparing for Tomorrows Educational Needs 175
References 176
Index 178