Background: Health care reform is not dead but merely on hiatus. The vehicle for the reform is managed care, in particular health maintenance organizations (HMOs). HMOs employ primary care physicians as gatekeepers to act as regulators and points of entry into the health care system. It is through these gatekeepers that most dermatologic care is rendered. Objective: Our purpose was to assess (1) the level of dermatology training of family practice physicians compared with dermatologists and (2) the impact on the delivery of quality dermatology services. Methods: A national study of university residency programs was undertaken. Twenty color Kodachromes of typical cutaneous diseases were analyzed by the two physician groups. A questionnaire was used to evaluate the average formal dermatology training received, the number of primary dermatology patients examined by family practitioners, the correct response rates to the questions, and the dermatologic procedures performed by family practitioners. A total of 723 family practice physicians and 443 dermatologists responded. Results: Our results indicate that, in comparison to dermatologists, primary care physicians significantly are deficient in their ability to recognize common and serious dermatoses. Conclusion: This study provides data emphasizing the need for reevaluation of the dermatology curriculum in medical schools and family practice residencies. Most important, it suggests that direct access to dermatologists provides better quality of care to members of HMOs and hence indirectly is most cost effective for the provision of dermatology services.

Quality of care: Issue or oversight in health care reform?

This paper reports the results of a national survey of perceptions of practice and career satisfaction among the first cohorts of residency-trained family physicians The findings indicate that a large majority of the respondents (n = 876), most of whom had been in practice for only three years or less at the time of the survey in 1979, were well satisfied with their careers and work in general as well as with their residency training, practice arrangements and facilities, colleague relationships, and hospital privileges Several sources of relative dissatisfaction and difficulty were reported by the physicians, however, including practice time pressures, the necessity of treating emotional problems beyond their training, financial costs associated with operating their practice, paperwork, and perceived interference of external regulations and/or agencies in the physician-patient relationship

Practice and career satisfaction among residency trained family physicians: a national survey.

Introduction In 2005, competency based training was introduced into the curriculum of the postgraduate training of Dutch medical residents. The role as manager is one of the seven competencies and, compared to the other roles, it is presently thought to receive little attention during training. The goal of this study was to investigate medical residents’ understanding of this competency and how they perceive their role as manager. Methods In October 2009, 506 residents from different specialties in four teaching hospitals were invited via email to participate in the study. A 29-item Likert scale questionnaire was designed to investigate residents perceived healthcare management skills and knowledge in four management areas. Results 177 of 506 residents (35%) responded to the survey. More than half of the residents (106/177, 60%) did not feel confident in their (contract) negotiating skills and 56% (98/175) stated that they lacked sufficient knowledge of how the Dutch healthcare system is financed and organised. The residents were most confident in their ability to handle feedback (151/177, 85%), medical information data registration (168/173, 97%), and how to allocate healthcare resources based on evidence based principles (143/173, 83%). Conclusion These results demonstrate that residents in the Netherlands perceive their knowledge and skills in certain essential medical management concepts to be inadequate. The results suggest that a course in medical management should be considered as a mandatory part of the curricula of residency training programmes.

https://pmj.bmj.com/content/postgradmedj/early/2011/06/20/pgmj.2010.110254.full.pdf

How Dutch medical residents perceive their competency as manager in the revised postgraduate medical curriculum

Using the definitions of "medically underserved areas" developed by the California Health Manpower Policy Commission and data on physician location derived from a survey of California physicians applying for licensure or relicensure between 1984 and 1986, we examined the extent to which different kinds of primary care physicians located in underserved areas. Among physicians completing postgraduate medical education after 1974, board-certified family physicians were 3 times more likely to locate in medically underserved rural communities than were other primary care physicians. Non-board-certified family and general physicians were 1.6 times more likely than other non-board-certified primary care physicians to locate in rural underserved areas. Family and general practice physicians also showed a slightly greater likelihood than other primary care physicians of being located in urban underserved areas.

Primary care physicians in underserved areas. Family physicians dominate

BACKGROUND: Skin lesions are often noted by the individuals bearing them, as well as by their relatives. There is a significant number of patients with skin complaints who search for medical care. OBJECTIVES: To determine the frequency of dermatological complaints and/or findings in users of the primary health care system of the city of Campinas, Brazil. METHODS: Five units were chosen by the Municipal Health Department to participate in this research. All the patients assisted by health professionals of these units were evaluated regarding the presence or absence of dermatological symptoms/ signals in a time period of twenty working days. RESULTS: The acquired data demonstrated that 358 (24.01%) out of 1,491 assisted patients displayed dermatological complaints and/or findings, with a greater prevalence among the younger patients. Of all the users assisted by health professionals who participated in the study and had their records adequately filled out, 9.98% sought the primary care unit primarily because of a dermatological complaint. CONCLUSIONS: These results, in accordance to those of similar surveys carried out in other countries, show the importance of the specialty for the performance of non-dermatologist physicians, pediatricians in particular, and provide elements for the discussion surrounding the curricular reform, concerning the amount of time dedicated to the teaching of dermatology.

http://www.scielo.br/pdf/abd/v82n5/a04v82n05.pdf

Prevalência de dermatoses na rede básica de saúde de Campinas, São Paulo - Brasil

Graduate follow-up in the University of Minnesota affiliated hospitals residency training program in family practice and community health.

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Graduate follow-up in the University of Minnesota affiliated hospitals residency training program in family practice and community health.