Business of Medicine

Rebecca Chester, MD, an Arizona-based interventional cardiologist, recently left her position in a private practice and started employment at a hospital system.

“When I was negotiating my previous contract with the private practice, I found that navigating contracts from the standpoint of a woman still in childbearing years was a little disappointing and challenging,” Dr. Chester told this news organization.

“I wanted to have more children and hired a lawyer recommended by a male colleague to help me not only understand the contract but also negotiate time off and maternity leave, but the lawyer discouraged me from advocating for maternity leave, feeling that it might stigmatize me and prevent me from getting a job,” she says.

He also didn’t explain very much. “He just said it falls under ‘disability leave’ and left it at that.”

Fortunately, Dr. Chester had a good experience with the group. “As things turned out, I did have a child later that year, and they treated me well – I actually got time off – and they didn’t make me take extra call. But it might have turned out very differently because I didn’t know what I was getting into. If I hadn’t worked for such a conscientious group, I might have been in a much tougher situation.”

Since then, Dr. Chester has spoken to female colleagues who received “more support from their legal advisors regarding maternity leave.” She suggests turning to female physicians for recommendations to a lawyer.

Although the central components of a contract (for example, noncompete covenants, malpractice “tail” coverage, bonus structure, vacation time, disability, and call) are relevant to physicians of all genders, the needs of women and men are often different.

Dennis Hursh, managing partner of Physician Agreements Health Law, a Pennsylvania-based law firm that represents physicians, told this news organization that women physicians have “several issues that need special attention when negotiating their physician employment agreements.”
 

It starts with the interview

“Women have to be sensitive to the interviewer’s casual ‘let’s-get-to-know-each-other’ types of questions that may seem natural but really are unlawful to bring into an employment interview,” said Mr. Hursh.

He warned women to beware of questions such as “Are you married? Do you have kids? Are you planning to start a family?” These may be friendly chit-chat for male interviewees but there may be other agendas when asked to a prospective female employee.

Many of Mr. Hursh’s female clients have been asked this type of question, which “should be regarded as a ‘red flag.’ Yes, it may be an innocent, well-intentioned ice-breaker, but it’s actually unlawful to bring that up in an employment setting and, according to the Equal Opportunity Commission, can be seen as a form of discrimination.” He advises female physicians not to engage with the question and simply to refocus the discussion.
 

Know your worth and go for it

Medscape’s Physician Compensation surveys have consistently found discrepancies in earnings between male and female physicians, both in primary care and in specialties. In 2022, male primary care physicians earned 23% more than their female counterparts, whereas male specialists earned 31% more.

One reason may be that women tend to be more timid about negotiating for better compensation packages. Amanda Hill of Hill Health Law, a health care practice based in Austin, Tex., told this news organization that in her experience one of the most “overarching” features of female physicians is “that they either don’t know what they’re worth or they undersell themselves.”

In contrast to men, “many women are afraid of coming across as greedy or crass, or even demanding or bossy. But it’s a misperception that if you ask for more money, your future employer will hate you or won’t hire you,” said Ms. Hill.

Ms. Hill and Mr. Hursh encourage physicians to find out what they’re worth, which varies by region and specialty, by consulting benchmarks provided by companies such as Medical Group Management Association.

Jon Appino, MBA, principal and founder of Contract Diagnostics, a Kansas City–based consulting company that specializes in physician employment contract reviews, told this news organization that it’s important to look beyond the salary at other aspects of the position. For example, some figures “don’t take into account how much call a physician is taking. You may know what the average ob.gyn. is making, but an ob.gyn. may be working 3 days a week, while another one is working 6 days a week, one may be on call 15 times per month and another may be on call 15 times a quarter.” Other components of compensation include relative value unit (RVU) thresholds and bonuses.

Once you have that information, “don’t be intimidated, even if you’re sitting in front of several executives who are savvy about negotiations, and don’t worry about coming across as ‘high-maintenance’ or ‘all about money,’ ” Mr. Appino says. Proceed with confidence, knowing your worth and pursuing it.
 

Part-time vs. full-time

Mr. Appino has seen “more female than male physicians who want to work less than full-time. So it’s important to clarify whether that’s a possibility now or in the future and to understand the implications of working part-time.”

He explained that a full-time employee typically puts in a 40-hour work week, which translates into 1.0 Full-Time Equivalent (FTE), or one unit of work. “For example, if a person wants to work 0.8 FTEs – 4 days a week – is vacation time pro-rated? At what point is there a medical insurance fall-off or a higher monthly premium?”

In medical settings, FTEs may be tied to different metrics rather than the number of weekly hours – for example, for a hospitalist, it might be a certain number of shifts and might also vary by specialty. And it affects the call schedule too. “Call is hard to pro-rate. Many hospital bylaws mandate that call be divided equally, but if one surgeon is working 1.0 FTEs and another is working 0.8 FTEs, how does that call schedule get divided?”
 

Maternity leave: A tricky question

Many attorneys counsel against raising the question out of fear of scaring away potential employers.

“On the one hand, it is and should be absolutely reasonable to ask about the maternity leave policy or even negotiate for paid leave or additional leave, but it also highlights that you’re planning to have a baby and be out for months,” said Ms. Hill.

“And as much as we want people to be fair and reasonable, on the side of the employer, bias still very much exists, especially in a situation where revenue is based on group numbers. So suddenly, the employer thinks up some ‘nondiscriminatory’ reason why that person isn’t a great fit for the organization.”

Andrew Knoll, MD, JD, a former hospitalist who is now a partner with Cohen Compagni Beckman Appler & Knoll PLLC in Syracuse, N.Y., said that maternity leave is “rare” in an employment agreement, except sometimes in small private practice groups, because it often falls under the purview of “disability leave,” and “from a legal perspective, it’s no different than any other type of disability leave.”

The Family and Medical Leave Act (FMLA), which applies if a group is large enough, allows employees 12 weeks of unpaid leave, during which time their job is protected and their benefits maintained. And some states require employers to offer paid family leave.

“During this time, the woman can take time off – albeit without pay sometimes – to bond with the baby,” Dr. Knoll says. “Since there are statutory laws that protect the employee’s job, offering specific paid maternity leave is very unlikely.”

Ms. Hill advises carefully examining the employer’s comprehensive benefits plan to ascertain if paid maternity leave is included in the benefits. “But unless you’re currently pregnant and want to start off the relationship with true transparency – ‘I’m due in April and curious how we can handle that if you hire me now’ – I would keep the family planning questions to yourself before you get the job.”

Mr. Hursh, author of “The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement” (Charleston, S.C.: Advantage, 2012), has a different perspective. “I think all women, no matter how old they are, should ask about maternity leave, whether or not they’re planning a family,” he said.

“The employer may say, ‘We treat maternity leave like any other disability; our policy is such-and-such.’ If they cite an unacceptable policy, it’s a red flag about how they treat women, and should give a woman pause before accepting a position at that organization. Even if your rights are protected under the law and the organization’s policy is violating the law, no one wants to go to battle with HR or to have to go to court.”
 

Do you want partnership?

Not all female physicians entering a private practice want to advance to becoming partners. Many who are balancing family and work commitments “would prefer to just go into the office, perform their clinical responsibilities, go home, and be done” without the extra headaches, tasks, and time involved with business leadership, says Mr. Appino.

Some private practices have different contracts for those on partnership vs. nonpartnership tracks, so “you should ascertain this information and make sure it’s not automatically assumed that you would like to be on a partnership track,” says Mr. Appino.

On the other hand, you may want to become a partner. “I always suggest asking about the possibility of obtaining a leadership position in an organization or becoming an owner in a private practice,” says Mr. Hursh. “You may be told, ‘We’ve never had a woman in leadership before.’ This might be innocent if you’re the first woman hired, but it might be a red flag as to how women are regarded.” Either way, it’s important to have the information and know what your options are.
 

The impact of shift schedule

Mr. Hursh advises drilling down into the specifics of the schedule if you’re considering becoming a hospitalist. “Does a ‘week-on/week-off’ shift schedule assume you’ll be taking your vacation time or completing your CME requirements during the week off? This is important for all physicians, but especially for women who might want to use their weeks off to attend to children and family.”

Moreover, “there should be limits on shifts. You shouldn’t have a full day shift followed by a night shift. And there should be a limit on the number of shifts you work without time off. Twelve would be a brutal schedule. Seven is a reasonable amount. Make sure this is in writing and that the contract protects you. Don’t allow the employer to say, ‘We expect you to do the work we assign’ and leave it vague.”

Often, hospitalists will receive an annual salary under the assumption that a certain minimum number of shifts will be completed, but there is no maximum. “It’s important that the salary includes the minimum number of shifts, but that a compensation structure is created so that additional shifts receive additional compensation,” Mr. Hursh said.
 

Removing the ‘golden handcuffs’

Ms. Hill observes that there are some “really terrible contracts out there, which physicians – especially women – often feel pressured into signing.” They’re told, “This is our standard contract. You won’t find anything better.” Or, “Don’t worry about the small print and legalese.” The physician “gets scared or is artificially reassured, signs an overwhelmingly unfair contract, and then feels stuck.”

Being stuck in a bad contract “is debilitating and adds to burnout, feeling of depression, and the sense that there is no recourse and nowhere to go, especially if your family depends on you,” Ms. Hill said.

“More women than men feel hamstrung or are resigned to being harassed – which is not uncommon in the medical setting, especially in surgical specialties – or just accept poor treatment,” Ms. Hill added. Yes, you can “fight the system and go to HR, but fighting the system is very hard.”

She urges women “not to feel stuck or imprisoned by the ‘golden handcuffs’ but to consult a good lawyer, even if you have to break the contract.” Be aware of the reasons for your unhappiness and bring them to your lawyer – perhaps the system has engaged in fraud, perhaps there has been sexual or racial harassment, perhaps the organization hasn’t followed its own compliance policies.

Dr. Chester consulted Ms. Hill before signing the contract for her current position. “I wanted someone who could give me personalized advice, not only generic advice, and who understood my needs as a woman.”

Ms. Hill helped her to understand “what was and wasn’t fair and reasonable, what changes I could request based on my goals and whether they were realistic, and how to pick my battles. For example, I tried to negotiate tail coverage up front in my previous job but was unsuccessful. The new employer paid tail for me, both from my previous employment and for my current employment.”

Dr. Chester advises other female physicians “never to sign anything without having a lawyer review it and to make sure that the lawyer is sensitive to their specific needs.”

It can be hard to be a female physician. Having the right knowledge and ammunition and knowing how to negotiate well paves the way for success and thriving in an often male-dominated market.

A version of this article first appeared on Medscape.com.

Rebecca Chester, MD, an Arizona-based interventional cardiologist, recently left her position in a private practice and started employment at a hospital system.

“When I was negotiating my previous contract with the private practice, I found that navigating contracts from the standpoint of a woman still in childbearing years was a little disappointing and challenging,” Dr. Chester told this news organization.

“I wanted to have more children and hired a lawyer recommended by a male colleague to help me not only understand the contract but also negotiate time off and maternity leave, but the lawyer discouraged me from advocating for maternity leave, feeling that it might stigmatize me and prevent me from getting a job,” she says.

He also didn’t explain very much. “He just said it falls under ‘disability leave’ and left it at that.”

Fortunately, Dr. Chester had a good experience with the group. “As things turned out, I did have a child later that year, and they treated me well – I actually got time off – and they didn’t make me take extra call. But it might have turned out very differently because I didn’t know what I was getting into. If I hadn’t worked for such a conscientious group, I might have been in a much tougher situation.”

Since then, Dr. Chester has spoken to female colleagues who received “more support from their legal advisors regarding maternity leave.” She suggests turning to female physicians for recommendations to a lawyer.

Although the central components of a contract (for example, noncompete covenants, malpractice “tail” coverage, bonus structure, vacation time, disability, and call) are relevant to physicians of all genders, the needs of women and men are often different.

Dennis Hursh, managing partner of Physician Agreements Health Law, a Pennsylvania-based law firm that represents physicians, told this news organization that women physicians have “several issues that need special attention when negotiating their physician employment agreements.”
 

It starts with the interview

“Women have to be sensitive to the interviewer’s casual ‘let’s-get-to-know-each-other’ types of questions that may seem natural but really are unlawful to bring into an employment interview,” said Mr. Hursh.

He warned women to beware of questions such as “Are you married? Do you have kids? Are you planning to start a family?” These may be friendly chit-chat for male interviewees but there may be other agendas when asked to a prospective female employee.

Many of Mr. Hursh’s female clients have been asked this type of question, which “should be regarded as a ‘red flag.’ Yes, it may be an innocent, well-intentioned ice-breaker, but it’s actually unlawful to bring that up in an employment setting and, according to the Equal Opportunity Commission, can be seen as a form of discrimination.” He advises female physicians not to engage with the question and simply to refocus the discussion.
 

Know your worth and go for it

Medscape’s Physician Compensation surveys have consistently found discrepancies in earnings between male and female physicians, both in primary care and in specialties. In 2022, male primary care physicians earned 23% more than their female counterparts, whereas male specialists earned 31% more.

One reason may be that women tend to be more timid about negotiating for better compensation packages. Amanda Hill of Hill Health Law, a health care practice based in Austin, Tex., told this news organization that in her experience one of the most “overarching” features of female physicians is “that they either don’t know what they’re worth or they undersell themselves.”

In contrast to men, “many women are afraid of coming across as greedy or crass, or even demanding or bossy. But it’s a misperception that if you ask for more money, your future employer will hate you or won’t hire you,” said Ms. Hill.

Ms. Hill and Mr. Hursh encourage physicians to find out what they’re worth, which varies by region and specialty, by consulting benchmarks provided by companies such as Medical Group Management Association.

Jon Appino, MBA, principal and founder of Contract Diagnostics, a Kansas City–based consulting company that specializes in physician employment contract reviews, told this news organization that it’s important to look beyond the salary at other aspects of the position. For example, some figures “don’t take into account how much call a physician is taking. You may know what the average ob.gyn. is making, but an ob.gyn. may be working 3 days a week, while another one is working 6 days a week, one may be on call 15 times per month and another may be on call 15 times a quarter.” Other components of compensation include relative value unit (RVU) thresholds and bonuses.

Once you have that information, “don’t be intimidated, even if you’re sitting in front of several executives who are savvy about negotiations, and don’t worry about coming across as ‘high-maintenance’ or ‘all about money,’ ” Mr. Appino says. Proceed with confidence, knowing your worth and pursuing it.
 

Part-time vs. full-time

Mr. Appino has seen “more female than male physicians who want to work less than full-time. So it’s important to clarify whether that’s a possibility now or in the future and to understand the implications of working part-time.”

He explained that a full-time employee typically puts in a 40-hour work week, which translates into 1.0 Full-Time Equivalent (FTE), or one unit of work. “For example, if a person wants to work 0.8 FTEs – 4 days a week – is vacation time pro-rated? At what point is there a medical insurance fall-off or a higher monthly premium?”

In medical settings, FTEs may be tied to different metrics rather than the number of weekly hours – for example, for a hospitalist, it might be a certain number of shifts and might also vary by specialty. And it affects the call schedule too. “Call is hard to pro-rate. Many hospital bylaws mandate that call be divided equally, but if one surgeon is working 1.0 FTEs and another is working 0.8 FTEs, how does that call schedule get divided?”
 

Maternity leave: A tricky question

Many attorneys counsel against raising the question out of fear of scaring away potential employers.

“On the one hand, it is and should be absolutely reasonable to ask about the maternity leave policy or even negotiate for paid leave or additional leave, but it also highlights that you’re planning to have a baby and be out for months,” said Ms. Hill.

“And as much as we want people to be fair and reasonable, on the side of the employer, bias still very much exists, especially in a situation where revenue is based on group numbers. So suddenly, the employer thinks up some ‘nondiscriminatory’ reason why that person isn’t a great fit for the organization.”

Andrew Knoll, MD, JD, a former hospitalist who is now a partner with Cohen Compagni Beckman Appler & Knoll PLLC in Syracuse, N.Y., said that maternity leave is “rare” in an employment agreement, except sometimes in small private practice groups, because it often falls under the purview of “disability leave,” and “from a legal perspective, it’s no different than any other type of disability leave.”

The Family and Medical Leave Act (FMLA), which applies if a group is large enough, allows employees 12 weeks of unpaid leave, during which time their job is protected and their benefits maintained. And some states require employers to offer paid family leave.

“During this time, the woman can take time off – albeit without pay sometimes – to bond with the baby,” Dr. Knoll says. “Since there are statutory laws that protect the employee’s job, offering specific paid maternity leave is very unlikely.”

Ms. Hill advises carefully examining the employer’s comprehensive benefits plan to ascertain if paid maternity leave is included in the benefits. “But unless you’re currently pregnant and want to start off the relationship with true transparency – ‘I’m due in April and curious how we can handle that if you hire me now’ – I would keep the family planning questions to yourself before you get the job.”

Mr. Hursh, author of “The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement” (Charleston, S.C.: Advantage, 2012), has a different perspective. “I think all women, no matter how old they are, should ask about maternity leave, whether or not they’re planning a family,” he said.

“The employer may say, ‘We treat maternity leave like any other disability; our policy is such-and-such.’ If they cite an unacceptable policy, it’s a red flag about how they treat women, and should give a woman pause before accepting a position at that organization. Even if your rights are protected under the law and the organization’s policy is violating the law, no one wants to go to battle with HR or to have to go to court.”
 

Do you want partnership?

Not all female physicians entering a private practice want to advance to becoming partners. Many who are balancing family and work commitments “would prefer to just go into the office, perform their clinical responsibilities, go home, and be done” without the extra headaches, tasks, and time involved with business leadership, says Mr. Appino.

Some private practices have different contracts for those on partnership vs. nonpartnership tracks, so “you should ascertain this information and make sure it’s not automatically assumed that you would like to be on a partnership track,” says Mr. Appino.

On the other hand, you may want to become a partner. “I always suggest asking about the possibility of obtaining a leadership position in an organization or becoming an owner in a private practice,” says Mr. Hursh. “You may be told, ‘We’ve never had a woman in leadership before.’ This might be innocent if you’re the first woman hired, but it might be a red flag as to how women are regarded.” Either way, it’s important to have the information and know what your options are.
 

The impact of shift schedule

Mr. Hursh advises drilling down into the specifics of the schedule if you’re considering becoming a hospitalist. “Does a ‘week-on/week-off’ shift schedule assume you’ll be taking your vacation time or completing your CME requirements during the week off? This is important for all physicians, but especially for women who might want to use their weeks off to attend to children and family.”

Moreover, “there should be limits on shifts. You shouldn’t have a full day shift followed by a night shift. And there should be a limit on the number of shifts you work without time off. Twelve would be a brutal schedule. Seven is a reasonable amount. Make sure this is in writing and that the contract protects you. Don’t allow the employer to say, ‘We expect you to do the work we assign’ and leave it vague.”

Often, hospitalists will receive an annual salary under the assumption that a certain minimum number of shifts will be completed, but there is no maximum. “It’s important that the salary includes the minimum number of shifts, but that a compensation structure is created so that additional shifts receive additional compensation,” Mr. Hursh said.
 

Removing the ‘golden handcuffs’

Ms. Hill observes that there are some “really terrible contracts out there, which physicians – especially women – often feel pressured into signing.” They’re told, “This is our standard contract. You won’t find anything better.” Or, “Don’t worry about the small print and legalese.” The physician “gets scared or is artificially reassured, signs an overwhelmingly unfair contract, and then feels stuck.”

Being stuck in a bad contract “is debilitating and adds to burnout, feeling of depression, and the sense that there is no recourse and nowhere to go, especially if your family depends on you,” Ms. Hill said.

“More women than men feel hamstrung or are resigned to being harassed – which is not uncommon in the medical setting, especially in surgical specialties – or just accept poor treatment,” Ms. Hill added. Yes, you can “fight the system and go to HR, but fighting the system is very hard.”

She urges women “not to feel stuck or imprisoned by the ‘golden handcuffs’ but to consult a good lawyer, even if you have to break the contract.” Be aware of the reasons for your unhappiness and bring them to your lawyer – perhaps the system has engaged in fraud, perhaps there has been sexual or racial harassment, perhaps the organization hasn’t followed its own compliance policies.

Dr. Chester consulted Ms. Hill before signing the contract for her current position. “I wanted someone who could give me personalized advice, not only generic advice, and who understood my needs as a woman.”

Ms. Hill helped her to understand “what was and wasn’t fair and reasonable, what changes I could request based on my goals and whether they were realistic, and how to pick my battles. For example, I tried to negotiate tail coverage up front in my previous job but was unsuccessful. The new employer paid tail for me, both from my previous employment and for my current employment.”

Dr. Chester advises other female physicians “never to sign anything without having a lawyer review it and to make sure that the lawyer is sensitive to their specific needs.”

It can be hard to be a female physician. Having the right knowledge and ammunition and knowing how to negotiate well paves the way for success and thriving in an often male-dominated market.

A version of this article first appeared on Medscape.com.

Rebecca Chester, MD, an Arizona-based interventional cardiologist, recently left her position in a private practice and started employment at a hospital system.

“When I was negotiating my previous contract with the private practice, I found that navigating contracts from the standpoint of a woman still in childbearing years was a little disappointing and challenging,” Dr. Chester told this news organization.

“I wanted to have more children and hired a lawyer recommended by a male colleague to help me not only understand the contract but also negotiate time off and maternity leave, but the lawyer discouraged me from advocating for maternity leave, feeling that it might stigmatize me and prevent me from getting a job,” she says.

He also didn’t explain very much. “He just said it falls under ‘disability leave’ and left it at that.”

Fortunately, Dr. Chester had a good experience with the group. “As things turned out, I did have a child later that year, and they treated me well – I actually got time off – and they didn’t make me take extra call. But it might have turned out very differently because I didn’t know what I was getting into. If I hadn’t worked for such a conscientious group, I might have been in a much tougher situation.”

Since then, Dr. Chester has spoken to female colleagues who received “more support from their legal advisors regarding maternity leave.” She suggests turning to female physicians for recommendations to a lawyer.

Although the central components of a contract (for example, noncompete covenants, malpractice “tail” coverage, bonus structure, vacation time, disability, and call) are relevant to physicians of all genders, the needs of women and men are often different.

Dennis Hursh, managing partner of Physician Agreements Health Law, a Pennsylvania-based law firm that represents physicians, told this news organization that women physicians have “several issues that need special attention when negotiating their physician employment agreements.”
 

It starts with the interview

“Women have to be sensitive to the interviewer’s casual ‘let’s-get-to-know-each-other’ types of questions that may seem natural but really are unlawful to bring into an employment interview,” said Mr. Hursh.

He warned women to beware of questions such as “Are you married? Do you have kids? Are you planning to start a family?” These may be friendly chit-chat for male interviewees but there may be other agendas when asked to a prospective female employee.

Many of Mr. Hursh’s female clients have been asked this type of question, which “should be regarded as a ‘red flag.’ Yes, it may be an innocent, well-intentioned ice-breaker, but it’s actually unlawful to bring that up in an employment setting and, according to the Equal Opportunity Commission, can be seen as a form of discrimination.” He advises female physicians not to engage with the question and simply to refocus the discussion.
 

Know your worth and go for it

Medscape’s Physician Compensation surveys have consistently found discrepancies in earnings between male and female physicians, both in primary care and in specialties. In 2022, male primary care physicians earned 23% more than their female counterparts, whereas male specialists earned 31% more.

One reason may be that women tend to be more timid about negotiating for better compensation packages. Amanda Hill of Hill Health Law, a health care practice based in Austin, Tex., told this news organization that in her experience one of the most “overarching” features of female physicians is “that they either don’t know what they’re worth or they undersell themselves.”

In contrast to men, “many women are afraid of coming across as greedy or crass, or even demanding or bossy. But it’s a misperception that if you ask for more money, your future employer will hate you or won’t hire you,” said Ms. Hill.

Ms. Hill and Mr. Hursh encourage physicians to find out what they’re worth, which varies by region and specialty, by consulting benchmarks provided by companies such as Medical Group Management Association.

Jon Appino, MBA, principal and founder of Contract Diagnostics, a Kansas City–based consulting company that specializes in physician employment contract reviews, told this news organization that it’s important to look beyond the salary at other aspects of the position. For example, some figures “don’t take into account how much call a physician is taking. You may know what the average ob.gyn. is making, but an ob.gyn. may be working 3 days a week, while another one is working 6 days a week, one may be on call 15 times per month and another may be on call 15 times a quarter.” Other components of compensation include relative value unit (RVU) thresholds and bonuses.

Once you have that information, “don’t be intimidated, even if you’re sitting in front of several executives who are savvy about negotiations, and don’t worry about coming across as ‘high-maintenance’ or ‘all about money,’ ” Mr. Appino says. Proceed with confidence, knowing your worth and pursuing it.
 

Part-time vs. full-time

Mr. Appino has seen “more female than male physicians who want to work less than full-time. So it’s important to clarify whether that’s a possibility now or in the future and to understand the implications of working part-time.”

He explained that a full-time employee typically puts in a 40-hour work week, which translates into 1.0 Full-Time Equivalent (FTE), or one unit of work. “For example, if a person wants to work 0.8 FTEs – 4 days a week – is vacation time pro-rated? At what point is there a medical insurance fall-off or a higher monthly premium?”

In medical settings, FTEs may be tied to different metrics rather than the number of weekly hours – for example, for a hospitalist, it might be a certain number of shifts and might also vary by specialty. And it affects the call schedule too. “Call is hard to pro-rate. Many hospital bylaws mandate that call be divided equally, but if one surgeon is working 1.0 FTEs and another is working 0.8 FTEs, how does that call schedule get divided?”
 

Maternity leave: A tricky question

Many attorneys counsel against raising the question out of fear of scaring away potential employers.

“On the one hand, it is and should be absolutely reasonable to ask about the maternity leave policy or even negotiate for paid leave or additional leave, but it also highlights that you’re planning to have a baby and be out for months,” said Ms. Hill.

“And as much as we want people to be fair and reasonable, on the side of the employer, bias still very much exists, especially in a situation where revenue is based on group numbers. So suddenly, the employer thinks up some ‘nondiscriminatory’ reason why that person isn’t a great fit for the organization.”

Andrew Knoll, MD, JD, a former hospitalist who is now a partner with Cohen Compagni Beckman Appler & Knoll PLLC in Syracuse, N.Y., said that maternity leave is “rare” in an employment agreement, except sometimes in small private practice groups, because it often falls under the purview of “disability leave,” and “from a legal perspective, it’s no different than any other type of disability leave.”

The Family and Medical Leave Act (FMLA), which applies if a group is large enough, allows employees 12 weeks of unpaid leave, during which time their job is protected and their benefits maintained. And some states require employers to offer paid family leave.

“During this time, the woman can take time off – albeit without pay sometimes – to bond with the baby,” Dr. Knoll says. “Since there are statutory laws that protect the employee’s job, offering specific paid maternity leave is very unlikely.”

Ms. Hill advises carefully examining the employer’s comprehensive benefits plan to ascertain if paid maternity leave is included in the benefits. “But unless you’re currently pregnant and want to start off the relationship with true transparency – ‘I’m due in April and curious how we can handle that if you hire me now’ – I would keep the family planning questions to yourself before you get the job.”

Mr. Hursh, author of “The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement” (Charleston, S.C.: Advantage, 2012), has a different perspective. “I think all women, no matter how old they are, should ask about maternity leave, whether or not they’re planning a family,” he said.

“The employer may say, ‘We treat maternity leave like any other disability; our policy is such-and-such.’ If they cite an unacceptable policy, it’s a red flag about how they treat women, and should give a woman pause before accepting a position at that organization. Even if your rights are protected under the law and the organization’s policy is violating the law, no one wants to go to battle with HR or to have to go to court.”
 

Do you want partnership?

Not all female physicians entering a private practice want to advance to becoming partners. Many who are balancing family and work commitments “would prefer to just go into the office, perform their clinical responsibilities, go home, and be done” without the extra headaches, tasks, and time involved with business leadership, says Mr. Appino.

Some private practices have different contracts for those on partnership vs. nonpartnership tracks, so “you should ascertain this information and make sure it’s not automatically assumed that you would like to be on a partnership track,” says Mr. Appino.

On the other hand, you may want to become a partner. “I always suggest asking about the possibility of obtaining a leadership position in an organization or becoming an owner in a private practice,” says Mr. Hursh. “You may be told, ‘We’ve never had a woman in leadership before.’ This might be innocent if you’re the first woman hired, but it might be a red flag as to how women are regarded.” Either way, it’s important to have the information and know what your options are.
 

The impact of shift schedule

Mr. Hursh advises drilling down into the specifics of the schedule if you’re considering becoming a hospitalist. “Does a ‘week-on/week-off’ shift schedule assume you’ll be taking your vacation time or completing your CME requirements during the week off? This is important for all physicians, but especially for women who might want to use their weeks off to attend to children and family.”

Moreover, “there should be limits on shifts. You shouldn’t have a full day shift followed by a night shift. And there should be a limit on the number of shifts you work without time off. Twelve would be a brutal schedule. Seven is a reasonable amount. Make sure this is in writing and that the contract protects you. Don’t allow the employer to say, ‘We expect you to do the work we assign’ and leave it vague.”

Often, hospitalists will receive an annual salary under the assumption that a certain minimum number of shifts will be completed, but there is no maximum. “It’s important that the salary includes the minimum number of shifts, but that a compensation structure is created so that additional shifts receive additional compensation,” Mr. Hursh said.
 

Removing the ‘golden handcuffs’

Ms. Hill observes that there are some “really terrible contracts out there, which physicians – especially women – often feel pressured into signing.” They’re told, “This is our standard contract. You won’t find anything better.” Or, “Don’t worry about the small print and legalese.” The physician “gets scared or is artificially reassured, signs an overwhelmingly unfair contract, and then feels stuck.”

Being stuck in a bad contract “is debilitating and adds to burnout, feeling of depression, and the sense that there is no recourse and nowhere to go, especially if your family depends on you,” Ms. Hill said.

“More women than men feel hamstrung or are resigned to being harassed – which is not uncommon in the medical setting, especially in surgical specialties – or just accept poor treatment,” Ms. Hill added. Yes, you can “fight the system and go to HR, but fighting the system is very hard.”

She urges women “not to feel stuck or imprisoned by the ‘golden handcuffs’ but to consult a good lawyer, even if you have to break the contract.” Be aware of the reasons for your unhappiness and bring them to your lawyer – perhaps the system has engaged in fraud, perhaps there has been sexual or racial harassment, perhaps the organization hasn’t followed its own compliance policies.

Dr. Chester consulted Ms. Hill before signing the contract for her current position. “I wanted someone who could give me personalized advice, not only generic advice, and who understood my needs as a woman.”

Ms. Hill helped her to understand “what was and wasn’t fair and reasonable, what changes I could request based on my goals and whether they were realistic, and how to pick my battles. For example, I tried to negotiate tail coverage up front in my previous job but was unsuccessful. The new employer paid tail for me, both from my previous employment and for my current employment.”

Dr. Chester advises other female physicians “never to sign anything without having a lawyer review it and to make sure that the lawyer is sensitive to their specific needs.”

It can be hard to be a female physician. Having the right knowledge and ammunition and knowing how to negotiate well paves the way for success and thriving in an often male-dominated market.

A version of this article first appeared on Medscape.com.

Sitting across from a patient explaining a complicated treatment proposal, protocol, or medication may be one of the most complex yet crucial tasks you have as a physician. Although informed consent is at the forefront of shared decisions between you and your patient, there’s a fine line between providing enough information on the risks and benefits of a particular treatment and knowing you’ve explained it well enough to fully educate your patient about their choices.

According to the Medscape “Right and Wrong in Medicine: Life, Death, and Wrenching Choices” report, how you handle the informed consent process can be the difference between a positive outcome and a negative one.

“It is a bit of a fine line because unless your patient happens to be a health care provider, medicine is complicated for patients to understand,” said David L. Feldman, MD, chief medical officer at The Doctors Company, the nation’s largest medical malpractice insurer in New York.

In addition, documenting the interaction is critical, said James Giordano, PhD, MPhil, professor in the departments of neurology and biochemistry and chief of the neuroethics studies program at the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center, Washington.

“As with anything in medicine, the key rule is that if it’s not documented, it’s not done,” he said. “This also means diligent documentation in all aspects of the medical record, including the electronic medical record and the written one.”

That said, it’s important to know what’s enough and what’s too granular when you discuss a procedure with your patients, said Erum N. Ilyas, MD, a board-certified dermatologist at Schweiger Dermatology and a bioethicist near Philadelphia.

“One of the most challenging aspects of informed consent, especially for young physicians, is how to discuss a procedure or a medication in a manner that is both relevant and concise,” Dr. llyas said. “I’ve had residents about to perform a skin biopsy spend several minutes covering every aspect of every potential outcome of a routine skin biopsy. The patient is left traumatized and confused as to whether they should proceed with the small procedure.”

Instead, the goal of informed consent is to ensure that the patient has a general overview of the procedure and is empowered, knowing that the decision to proceed is, indeed, part of their decision-making process.

How long an informed consent discussion takes depends on the procedure.

“When I was in practice as a plastic surgeon, the conversations varied from the straightforward ‘I’m taking this mole off your cheek, and there’s a risk of scarring and bleeding’ to talking about a mastectomy and breast reconstruction, which could take an hour or more to discuss,” Dr. Feldman said.

Ultimately, it’s as essential for doctors to explain the risks associated with a procedure as it is for patients to understand precisely what’s involved, Dr. Ilyas added.

She also recommends creating a flow to the conversation that places the discussion of risks within the context of why the procedure is being performed. This way, clarity about both the risks and the need for the treatment or procedure can be achieved.

When doing so, it’s critical to make sure you’re speaking your patient’s language – literally.

“Have a translator in the room if needed,” Dr. Feldman added. “If your patient is hearing or sight impaired, you need to have every contingency ready to ensure that everyone is in complete communication.”
 

Document, document, document!

To best protect yourself, the patient must consent to each procedure and intervention via active, informed consent, said Dr. Giordano.

“It’s not enough to hand a patient a piece of paper and say sign it,” he said. “There should be some documented evidence that the patient has not only read the document but that the key parts of the document have been explained and that the patient’s level of comprehension has been assessed and verified.”

It is vital if the patient has a disability, a neurological impairment, or a neurocognitive or psychiatric condition that might impede his or her ability to understand the consent that’s being sought.

In addition, it’s best if a ‘clinical proxy’ handles the consent (for example, a nurse, office worker, or case manager).

“This can be very helpful because it means you’ve had third-party documentation of informed consent,” Dr. Giordano said. “It should then be re-documented with you as the clinician and stated that the patient has affirmatively and actively agreed to treatment.”
 

What happens when things go wrong?

If you’re sued over informed consent, with the patient claiming that you didn’t fully explain the potential risks, the first thing to consider is why this happened.

“Very often, these situations occur if there was some difficulty or competency of communication,” Dr. Giordano said. “You may have done everything right, but somehow the patient hasn’t gained an understanding of the procedure required.”

Physicians must take a hard look at how they’re explaining risks and possible side effects. For doctors who perform these procedures regularly, the risks may seem small, and they may unconsciously minimize them to the patient. But when something goes wrong, the patient may then feel that they didn’t fully understand the frequency of poor outcomes, or the potential severity.

Next, it’s important to perform a ‘gap analysis’ to assess why something went awry. That means, look at all the potential factors involved to identify which one was the weak link.

“It might be that the patient was on a signing frenzy and signed away but didn’t receive active and informed content,” Dr. Giordano said. “The goal is to learn how to close the gap for this case and for future cases.”

To protect yourself, consider using technology to your advantage, especially since lawsuits over informed consent usually happen several years after the procedure. This is when a patient might argue that you didn’t tell them about possible complications and that they might have opted out of the procedure if they had known about those issues ahead of time.

“Even before the statute of limitations is up for a lawsuit, it could be five years from the time the procedure occurred due to the length of time a lawsuit can take,” Dr. Feldman said. “That’s why it’s important to take a video of your conversation or make a recording of the informed consent conversation. This way if there’s a question of what you said, there’s a video of it.”

For many physicians, this would be a big change – to video record and then store all their informed consent conversations. It could most likely help you if a lawsuit occurs, but some physicians may feel that process to be cumbersome and time-consuming, and they’d rather find another way to ensure that patients understand the risks.

Ultimately, however, if there’s a legal question involved with informed consent, the general thinking is that the effect on the patient must be harmful for it to stand up.

“The question becomes whether the outcome rendered that gap in the consenting process forgivable,” Dr. Giordano said. “The hope is that there was nothing harmful to the patient and that the benefit of the procedure was demonstrable despite any gaps in the informed consent process.”

In the end, informed consent should be a matter of good communication before, during, and after any treatment or procedure.

“When you form a relationship with a patient who needs any procedure, small or large, you’re going to be guiding them through a very scary thing,” Dr. Feldman said. “You want to make patients feel like you care about them and that, while neither you nor the system is perfect, you’ll take care of them. That’s the bottom line.”

A version of this article first appeared on Medscape.com.

Sitting across from a patient explaining a complicated treatment proposal, protocol, or medication may be one of the most complex yet crucial tasks you have as a physician. Although informed consent is at the forefront of shared decisions between you and your patient, there’s a fine line between providing enough information on the risks and benefits of a particular treatment and knowing you’ve explained it well enough to fully educate your patient about their choices.

According to the Medscape “Right and Wrong in Medicine: Life, Death, and Wrenching Choices” report, how you handle the informed consent process can be the difference between a positive outcome and a negative one.

“It is a bit of a fine line because unless your patient happens to be a health care provider, medicine is complicated for patients to understand,” said David L. Feldman, MD, chief medical officer at The Doctors Company, the nation’s largest medical malpractice insurer in New York.

In addition, documenting the interaction is critical, said James Giordano, PhD, MPhil, professor in the departments of neurology and biochemistry and chief of the neuroethics studies program at the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center, Washington.

“As with anything in medicine, the key rule is that if it’s not documented, it’s not done,” he said. “This also means diligent documentation in all aspects of the medical record, including the electronic medical record and the written one.”

That said, it’s important to know what’s enough and what’s too granular when you discuss a procedure with your patients, said Erum N. Ilyas, MD, a board-certified dermatologist at Schweiger Dermatology and a bioethicist near Philadelphia.

“One of the most challenging aspects of informed consent, especially for young physicians, is how to discuss a procedure or a medication in a manner that is both relevant and concise,” Dr. llyas said. “I’ve had residents about to perform a skin biopsy spend several minutes covering every aspect of every potential outcome of a routine skin biopsy. The patient is left traumatized and confused as to whether they should proceed with the small procedure.”

Instead, the goal of informed consent is to ensure that the patient has a general overview of the procedure and is empowered, knowing that the decision to proceed is, indeed, part of their decision-making process.

How long an informed consent discussion takes depends on the procedure.

“When I was in practice as a plastic surgeon, the conversations varied from the straightforward ‘I’m taking this mole off your cheek, and there’s a risk of scarring and bleeding’ to talking about a mastectomy and breast reconstruction, which could take an hour or more to discuss,” Dr. Feldman said.

Ultimately, it’s as essential for doctors to explain the risks associated with a procedure as it is for patients to understand precisely what’s involved, Dr. Ilyas added.

She also recommends creating a flow to the conversation that places the discussion of risks within the context of why the procedure is being performed. This way, clarity about both the risks and the need for the treatment or procedure can be achieved.

When doing so, it’s critical to make sure you’re speaking your patient’s language – literally.

“Have a translator in the room if needed,” Dr. Feldman added. “If your patient is hearing or sight impaired, you need to have every contingency ready to ensure that everyone is in complete communication.”
 

Document, document, document!

To best protect yourself, the patient must consent to each procedure and intervention via active, informed consent, said Dr. Giordano.

“It’s not enough to hand a patient a piece of paper and say sign it,” he said. “There should be some documented evidence that the patient has not only read the document but that the key parts of the document have been explained and that the patient’s level of comprehension has been assessed and verified.”

It is vital if the patient has a disability, a neurological impairment, or a neurocognitive or psychiatric condition that might impede his or her ability to understand the consent that’s being sought.

In addition, it’s best if a ‘clinical proxy’ handles the consent (for example, a nurse, office worker, or case manager).

“This can be very helpful because it means you’ve had third-party documentation of informed consent,” Dr. Giordano said. “It should then be re-documented with you as the clinician and stated that the patient has affirmatively and actively agreed to treatment.”
 

What happens when things go wrong?

If you’re sued over informed consent, with the patient claiming that you didn’t fully explain the potential risks, the first thing to consider is why this happened.

“Very often, these situations occur if there was some difficulty or competency of communication,” Dr. Giordano said. “You may have done everything right, but somehow the patient hasn’t gained an understanding of the procedure required.”

Physicians must take a hard look at how they’re explaining risks and possible side effects. For doctors who perform these procedures regularly, the risks may seem small, and they may unconsciously minimize them to the patient. But when something goes wrong, the patient may then feel that they didn’t fully understand the frequency of poor outcomes, or the potential severity.

Next, it’s important to perform a ‘gap analysis’ to assess why something went awry. That means, look at all the potential factors involved to identify which one was the weak link.

“It might be that the patient was on a signing frenzy and signed away but didn’t receive active and informed content,” Dr. Giordano said. “The goal is to learn how to close the gap for this case and for future cases.”

To protect yourself, consider using technology to your advantage, especially since lawsuits over informed consent usually happen several years after the procedure. This is when a patient might argue that you didn’t tell them about possible complications and that they might have opted out of the procedure if they had known about those issues ahead of time.

“Even before the statute of limitations is up for a lawsuit, it could be five years from the time the procedure occurred due to the length of time a lawsuit can take,” Dr. Feldman said. “That’s why it’s important to take a video of your conversation or make a recording of the informed consent conversation. This way if there’s a question of what you said, there’s a video of it.”

For many physicians, this would be a big change – to video record and then store all their informed consent conversations. It could most likely help you if a lawsuit occurs, but some physicians may feel that process to be cumbersome and time-consuming, and they’d rather find another way to ensure that patients understand the risks.

Ultimately, however, if there’s a legal question involved with informed consent, the general thinking is that the effect on the patient must be harmful for it to stand up.

“The question becomes whether the outcome rendered that gap in the consenting process forgivable,” Dr. Giordano said. “The hope is that there was nothing harmful to the patient and that the benefit of the procedure was demonstrable despite any gaps in the informed consent process.”

In the end, informed consent should be a matter of good communication before, during, and after any treatment or procedure.

“When you form a relationship with a patient who needs any procedure, small or large, you’re going to be guiding them through a very scary thing,” Dr. Feldman said. “You want to make patients feel like you care about them and that, while neither you nor the system is perfect, you’ll take care of them. That’s the bottom line.”

A version of this article first appeared on Medscape.com.

Sitting across from a patient explaining a complicated treatment proposal, protocol, or medication may be one of the most complex yet crucial tasks you have as a physician. Although informed consent is at the forefront of shared decisions between you and your patient, there’s a fine line between providing enough information on the risks and benefits of a particular treatment and knowing you’ve explained it well enough to fully educate your patient about their choices.

According to the Medscape “Right and Wrong in Medicine: Life, Death, and Wrenching Choices” report, how you handle the informed consent process can be the difference between a positive outcome and a negative one.

“It is a bit of a fine line because unless your patient happens to be a health care provider, medicine is complicated for patients to understand,” said David L. Feldman, MD, chief medical officer at The Doctors Company, the nation’s largest medical malpractice insurer in New York.

In addition, documenting the interaction is critical, said James Giordano, PhD, MPhil, professor in the departments of neurology and biochemistry and chief of the neuroethics studies program at the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center, Washington.

“As with anything in medicine, the key rule is that if it’s not documented, it’s not done,” he said. “This also means diligent documentation in all aspects of the medical record, including the electronic medical record and the written one.”

That said, it’s important to know what’s enough and what’s too granular when you discuss a procedure with your patients, said Erum N. Ilyas, MD, a board-certified dermatologist at Schweiger Dermatology and a bioethicist near Philadelphia.

“One of the most challenging aspects of informed consent, especially for young physicians, is how to discuss a procedure or a medication in a manner that is both relevant and concise,” Dr. llyas said. “I’ve had residents about to perform a skin biopsy spend several minutes covering every aspect of every potential outcome of a routine skin biopsy. The patient is left traumatized and confused as to whether they should proceed with the small procedure.”

Instead, the goal of informed consent is to ensure that the patient has a general overview of the procedure and is empowered, knowing that the decision to proceed is, indeed, part of their decision-making process.

How long an informed consent discussion takes depends on the procedure.

“When I was in practice as a plastic surgeon, the conversations varied from the straightforward ‘I’m taking this mole off your cheek, and there’s a risk of scarring and bleeding’ to talking about a mastectomy and breast reconstruction, which could take an hour or more to discuss,” Dr. Feldman said.

Ultimately, it’s as essential for doctors to explain the risks associated with a procedure as it is for patients to understand precisely what’s involved, Dr. Ilyas added.

She also recommends creating a flow to the conversation that places the discussion of risks within the context of why the procedure is being performed. This way, clarity about both the risks and the need for the treatment or procedure can be achieved.

When doing so, it’s critical to make sure you’re speaking your patient’s language – literally.

“Have a translator in the room if needed,” Dr. Feldman added. “If your patient is hearing or sight impaired, you need to have every contingency ready to ensure that everyone is in complete communication.”
 

Document, document, document!

To best protect yourself, the patient must consent to each procedure and intervention via active, informed consent, said Dr. Giordano.

“It’s not enough to hand a patient a piece of paper and say sign it,” he said. “There should be some documented evidence that the patient has not only read the document but that the key parts of the document have been explained and that the patient’s level of comprehension has been assessed and verified.”

It is vital if the patient has a disability, a neurological impairment, or a neurocognitive or psychiatric condition that might impede his or her ability to understand the consent that’s being sought.

In addition, it’s best if a ‘clinical proxy’ handles the consent (for example, a nurse, office worker, or case manager).

“This can be very helpful because it means you’ve had third-party documentation of informed consent,” Dr. Giordano said. “It should then be re-documented with you as the clinician and stated that the patient has affirmatively and actively agreed to treatment.”
 

What happens when things go wrong?

If you’re sued over informed consent, with the patient claiming that you didn’t fully explain the potential risks, the first thing to consider is why this happened.

“Very often, these situations occur if there was some difficulty or competency of communication,” Dr. Giordano said. “You may have done everything right, but somehow the patient hasn’t gained an understanding of the procedure required.”

Physicians must take a hard look at how they’re explaining risks and possible side effects. For doctors who perform these procedures regularly, the risks may seem small, and they may unconsciously minimize them to the patient. But when something goes wrong, the patient may then feel that they didn’t fully understand the frequency of poor outcomes, or the potential severity.

Next, it’s important to perform a ‘gap analysis’ to assess why something went awry. That means, look at all the potential factors involved to identify which one was the weak link.

“It might be that the patient was on a signing frenzy and signed away but didn’t receive active and informed content,” Dr. Giordano said. “The goal is to learn how to close the gap for this case and for future cases.”

To protect yourself, consider using technology to your advantage, especially since lawsuits over informed consent usually happen several years after the procedure. This is when a patient might argue that you didn’t tell them about possible complications and that they might have opted out of the procedure if they had known about those issues ahead of time.

“Even before the statute of limitations is up for a lawsuit, it could be five years from the time the procedure occurred due to the length of time a lawsuit can take,” Dr. Feldman said. “That’s why it’s important to take a video of your conversation or make a recording of the informed consent conversation. This way if there’s a question of what you said, there’s a video of it.”

For many physicians, this would be a big change – to video record and then store all their informed consent conversations. It could most likely help you if a lawsuit occurs, but some physicians may feel that process to be cumbersome and time-consuming, and they’d rather find another way to ensure that patients understand the risks.

Ultimately, however, if there’s a legal question involved with informed consent, the general thinking is that the effect on the patient must be harmful for it to stand up.

“The question becomes whether the outcome rendered that gap in the consenting process forgivable,” Dr. Giordano said. “The hope is that there was nothing harmful to the patient and that the benefit of the procedure was demonstrable despite any gaps in the informed consent process.”

In the end, informed consent should be a matter of good communication before, during, and after any treatment or procedure.

“When you form a relationship with a patient who needs any procedure, small or large, you’re going to be guiding them through a very scary thing,” Dr. Feldman said. “You want to make patients feel like you care about them and that, while neither you nor the system is perfect, you’ll take care of them. That’s the bottom line.”

A version of this article first appeared on Medscape.com.

In a study published online, researchers used artificial intelligence to analyze more than 1.4 million electronic health record emails to physicians – and the results aren’t pretty.

Among the emails, 43% were from patients; the remainder were mostly from other physicians or clinicians, or automated. The content of the messages wasn’t associated with doctor burnout, as the researchers had hypothesized. And only about 5% of the messages had negative sentiment.

But the researchers were struck by the hostility of that sentiment, displayed in messages like these that surely would be distressing for physicians to read:

“I hope and expect that you will spend eternity in he**. You are an abusive, nasty, cheap person.”

“Your office is full of liars, hypocrites and I will do everything in my power to prevent anyone from going to your bullsh** office again.”

About 5% of emails had an overall negative sentiment, with high-frequency words like “cancel,” “pain,” or “problem.” Among patient messages, 3% were negative and contained words and expletives suggesting hatred, hostility, or violence.

“F***” was the most common expletive used by patients.

Researchers provided examples of profanity-laced messages, including one patient who said, “I am so upset that I was told the blood work would include the gender of the baby. I have been waiting 5 [days] to find it, and it wasn’t even fu**ing tested!!!! What a disappointment in your office and the bullsh** I was told. I will be switching plans because this is sh**!”

Researchers also noted some high-frequency words associated with violence, such as “shoot,” “fight,” and “kill.”

“This is concerning, especially given documentation of patient-inflicted violence against physicians. Health systems should be proactive in ensuring that the in-basket does not become a venue for physician abuse and cyberbullying,” the researchers wrote in JAMA Network Open.

“Posting reminders in EHR patient portals to use kind language when sending messages, applying filters for expletives or threatening words, and creating frameworks for identifying patients who frequently send negative messages are potential strategies for mitigating this risk.”

Using a form of artificial intelligence technology called natural language processing (NLP), researchers at the University of California, San Diego, analyzed the characteristics of more than 1.4 million emails received by the university’s physicians, 43% of them from patients. They specifically looked at the volume of messages, word count, and overall sentiment.

Whereas other studies have examined the growing burden of EHR messaging for doctors, this type of email sentiment analysis could help in creating solutions. Researchers say that one such solution could involve applying filters for expletives or threatening words. It also could help identify fixable health system issues that make patients so angry, the researchers say.

Among the emails from physicians to physicians, just over half reported burnout, which correlated to the following phrases: “I am beginning to burn out and have one or more symptoms of burnout” and “I feel completely burned out [and] am at the point where I may need to seek help.”

On average, physicians who reported burnout received a greater volume of patient messages. The odds of burnout were significantly higher among Hispanic/Latinx physicians and females. Physicians with more than 15 years of clinical practice had markedly lower burnout.

Despite physicians now spending more time on EHR in-basket tasks than they did before the pandemic, the study found no significant associations between message characteristics and burnout.

Data for the cross-sectional study were collected from multiple specialties from April to September 2020. Physicians then completed a survey and assessed their burnout on a 5-point scale. Of the 609 physician responses, approximately 49% of participants were women, 56% were White, and 64% worked in outpatient settings. About 70% of the doctors had been in practice for 15 years or less.

The sentiment score was based on word content as well as the use of negation, punctuation, degree modifiers, all caps, emoticons, emojis, and acronyms. Positive patient messages were more likely to convey gratitude and thanks, along with casual expressions, such as “fyi” and “lol.”

A version of this article first appeared on Medscape.com.

In a study published online, researchers used artificial intelligence to analyze more than 1.4 million electronic health record emails to physicians – and the results aren’t pretty.

Among the emails, 43% were from patients; the remainder were mostly from other physicians or clinicians, or automated. The content of the messages wasn’t associated with doctor burnout, as the researchers had hypothesized. And only about 5% of the messages had negative sentiment.

But the researchers were struck by the hostility of that sentiment, displayed in messages like these that surely would be distressing for physicians to read:

“I hope and expect that you will spend eternity in he**. You are an abusive, nasty, cheap person.”

“Your office is full of liars, hypocrites and I will do everything in my power to prevent anyone from going to your bullsh** office again.”

About 5% of emails had an overall negative sentiment, with high-frequency words like “cancel,” “pain,” or “problem.” Among patient messages, 3% were negative and contained words and expletives suggesting hatred, hostility, or violence.

“F***” was the most common expletive used by patients.

Researchers provided examples of profanity-laced messages, including one patient who said, “I am so upset that I was told the blood work would include the gender of the baby. I have been waiting 5 [days] to find it, and it wasn’t even fu**ing tested!!!! What a disappointment in your office and the bullsh** I was told. I will be switching plans because this is sh**!”

Researchers also noted some high-frequency words associated with violence, such as “shoot,” “fight,” and “kill.”

“This is concerning, especially given documentation of patient-inflicted violence against physicians. Health systems should be proactive in ensuring that the in-basket does not become a venue for physician abuse and cyberbullying,” the researchers wrote in JAMA Network Open.

“Posting reminders in EHR patient portals to use kind language when sending messages, applying filters for expletives or threatening words, and creating frameworks for identifying patients who frequently send negative messages are potential strategies for mitigating this risk.”

Using a form of artificial intelligence technology called natural language processing (NLP), researchers at the University of California, San Diego, analyzed the characteristics of more than 1.4 million emails received by the university’s physicians, 43% of them from patients. They specifically looked at the volume of messages, word count, and overall sentiment.

Whereas other studies have examined the growing burden of EHR messaging for doctors, this type of email sentiment analysis could help in creating solutions. Researchers say that one such solution could involve applying filters for expletives or threatening words. It also could help identify fixable health system issues that make patients so angry, the researchers say.

Among the emails from physicians to physicians, just over half reported burnout, which correlated to the following phrases: “I am beginning to burn out and have one or more symptoms of burnout” and “I feel completely burned out [and] am at the point where I may need to seek help.”

On average, physicians who reported burnout received a greater volume of patient messages. The odds of burnout were significantly higher among Hispanic/Latinx physicians and females. Physicians with more than 15 years of clinical practice had markedly lower burnout.

Despite physicians now spending more time on EHR in-basket tasks than they did before the pandemic, the study found no significant associations between message characteristics and burnout.

Data for the cross-sectional study were collected from multiple specialties from April to September 2020. Physicians then completed a survey and assessed their burnout on a 5-point scale. Of the 609 physician responses, approximately 49% of participants were women, 56% were White, and 64% worked in outpatient settings. About 70% of the doctors had been in practice for 15 years or less.

The sentiment score was based on word content as well as the use of negation, punctuation, degree modifiers, all caps, emoticons, emojis, and acronyms. Positive patient messages were more likely to convey gratitude and thanks, along with casual expressions, such as “fyi” and “lol.”

A version of this article first appeared on Medscape.com.

In a study published online, researchers used artificial intelligence to analyze more than 1.4 million electronic health record emails to physicians – and the results aren’t pretty.

Among the emails, 43% were from patients; the remainder were mostly from other physicians or clinicians, or automated. The content of the messages wasn’t associated with doctor burnout, as the researchers had hypothesized. And only about 5% of the messages had negative sentiment.

But the researchers were struck by the hostility of that sentiment, displayed in messages like these that surely would be distressing for physicians to read:

“I hope and expect that you will spend eternity in he**. You are an abusive, nasty, cheap person.”

“Your office is full of liars, hypocrites and I will do everything in my power to prevent anyone from going to your bullsh** office again.”

About 5% of emails had an overall negative sentiment, with high-frequency words like “cancel,” “pain,” or “problem.” Among patient messages, 3% were negative and contained words and expletives suggesting hatred, hostility, or violence.

“F***” was the most common expletive used by patients.

Researchers provided examples of profanity-laced messages, including one patient who said, “I am so upset that I was told the blood work would include the gender of the baby. I have been waiting 5 [days] to find it, and it wasn’t even fu**ing tested!!!! What a disappointment in your office and the bullsh** I was told. I will be switching plans because this is sh**!”

Researchers also noted some high-frequency words associated with violence, such as “shoot,” “fight,” and “kill.”

“This is concerning, especially given documentation of patient-inflicted violence against physicians. Health systems should be proactive in ensuring that the in-basket does not become a venue for physician abuse and cyberbullying,” the researchers wrote in JAMA Network Open.

“Posting reminders in EHR patient portals to use kind language when sending messages, applying filters for expletives or threatening words, and creating frameworks for identifying patients who frequently send negative messages are potential strategies for mitigating this risk.”

Using a form of artificial intelligence technology called natural language processing (NLP), researchers at the University of California, San Diego, analyzed the characteristics of more than 1.4 million emails received by the university’s physicians, 43% of them from patients. They specifically looked at the volume of messages, word count, and overall sentiment.

Whereas other studies have examined the growing burden of EHR messaging for doctors, this type of email sentiment analysis could help in creating solutions. Researchers say that one such solution could involve applying filters for expletives or threatening words. It also could help identify fixable health system issues that make patients so angry, the researchers say.

Among the emails from physicians to physicians, just over half reported burnout, which correlated to the following phrases: “I am beginning to burn out and have one or more symptoms of burnout” and “I feel completely burned out [and] am at the point where I may need to seek help.”

On average, physicians who reported burnout received a greater volume of patient messages. The odds of burnout were significantly higher among Hispanic/Latinx physicians and females. Physicians with more than 15 years of clinical practice had markedly lower burnout.

Despite physicians now spending more time on EHR in-basket tasks than they did before the pandemic, the study found no significant associations between message characteristics and burnout.

Data for the cross-sectional study were collected from multiple specialties from April to September 2020. Physicians then completed a survey and assessed their burnout on a 5-point scale. Of the 609 physician responses, approximately 49% of participants were women, 56% were White, and 64% worked in outpatient settings. About 70% of the doctors had been in practice for 15 years or less.

The sentiment score was based on word content as well as the use of negation, punctuation, degree modifiers, all caps, emoticons, emojis, and acronyms. Positive patient messages were more likely to convey gratitude and thanks, along with casual expressions, such as “fyi” and “lol.”

A version of this article first appeared on Medscape.com.

The uptake and treatment costs of biosimilar drugs in the United States from 2011 to 2020 were significantly higher than in both Germany and Switzerland, based on data from a cohort study of publicly available commercial databases.

Biologics remain the fastest growing segment of drug research and development, but their costs remain high, David L. Carl, MSc, of the University of Zurich, and colleagues wrote in their study, published online in JAMA Network Open.

As patents and regulatory exclusivity periods expire, biologics face competition from biosimilars, which may drive competition and lower prices, they said.

“However, studies have shown that there are varying policies and biosimilar uptake in European countries and that the observed levels of competition and uptake have not reached the expected levels in the U.S.,” the researchers said.

To assist the discussions of policy makers in the United States and Europe as they consider legislative and regulatory reforms that are intended to promote the competition of biosimilars, the researchers reviewed data from 15 biosimilars and 6 biologics in the United States, 52 biosimilars and 15 biologics in Germany, and 28 biosimilars and 13 biologics in Switzerland.

They analyzed temporal trends in the uptake of biosimilars and their relative prices, compared with the prices of biologics in each country, by obtaining wholesale acquisition costs from online drug pricing databases. They extracted quarterly sales volume data for 2011-2020 from the IQVIA database. In the case of confidential rebates in Switzerland, the researchers obtained list prices.

Overall, the uptake of biosimilars increased in all three countries during the study period. However, the prices of biosimilars and the reference products were significantly higher in the United States, compared with Germany and Switzerland, both of which have national mechanisms for drug price negotiation. The monthly treatment cost of biosimilars was a median of 1.94 and 2.74 times higher in the United States than in Germany and Switzerland, respectively.

On average, the biosimilar market share at launch was highest in Germany; however, it increased at the fastest rate in the United States.

The findings were limited by several factors, including the sample size and the inclusion only of sales data provided by IQVIA, and by the use of list prices only without accounting for drug rebates, the researchers noted. Other limitations were the inability to compare conclusions from the United States and European Union directly because the drugs entered markets at different times, and not all the same drugs have been approved or designated as biosimilars, they said.

However, the results illustrate a difference in uptake of biosimilars in the United States with a reduced impact on drug costs, they said.

Looking ahead, “Policies for drug pricing negotiations in the U.S. against anticompetitive practices of exclusionary contracts could allow biosimilars to enter the market sooner and at lower costs, which could result in lower health care costs and improved patient access,” they concluded.

The study was partially funded by the Swiss National Science Foundation. Lead author Mr. Carl had no financial conflicts to disclose; several coauthors disclosed funding from organizations including The Health Foundation, the U.K. National Institute for Health Research, and the Pharmaceutical Group of the European Union; all were unrelated to the current study.

The uptake and treatment costs of biosimilar drugs in the United States from 2011 to 2020 were significantly higher than in both Germany and Switzerland, based on data from a cohort study of publicly available commercial databases.

Biologics remain the fastest growing segment of drug research and development, but their costs remain high, David L. Carl, MSc, of the University of Zurich, and colleagues wrote in their study, published online in JAMA Network Open.

As patents and regulatory exclusivity periods expire, biologics face competition from biosimilars, which may drive competition and lower prices, they said.

“However, studies have shown that there are varying policies and biosimilar uptake in European countries and that the observed levels of competition and uptake have not reached the expected levels in the U.S.,” the researchers said.

To assist the discussions of policy makers in the United States and Europe as they consider legislative and regulatory reforms that are intended to promote the competition of biosimilars, the researchers reviewed data from 15 biosimilars and 6 biologics in the United States, 52 biosimilars and 15 biologics in Germany, and 28 biosimilars and 13 biologics in Switzerland.

They analyzed temporal trends in the uptake of biosimilars and their relative prices, compared with the prices of biologics in each country, by obtaining wholesale acquisition costs from online drug pricing databases. They extracted quarterly sales volume data for 2011-2020 from the IQVIA database. In the case of confidential rebates in Switzerland, the researchers obtained list prices.

Overall, the uptake of biosimilars increased in all three countries during the study period. However, the prices of biosimilars and the reference products were significantly higher in the United States, compared with Germany and Switzerland, both of which have national mechanisms for drug price negotiation. The monthly treatment cost of biosimilars was a median of 1.94 and 2.74 times higher in the United States than in Germany and Switzerland, respectively.

On average, the biosimilar market share at launch was highest in Germany; however, it increased at the fastest rate in the United States.

The findings were limited by several factors, including the sample size and the inclusion only of sales data provided by IQVIA, and by the use of list prices only without accounting for drug rebates, the researchers noted. Other limitations were the inability to compare conclusions from the United States and European Union directly because the drugs entered markets at different times, and not all the same drugs have been approved or designated as biosimilars, they said.

However, the results illustrate a difference in uptake of biosimilars in the United States with a reduced impact on drug costs, they said.

Looking ahead, “Policies for drug pricing negotiations in the U.S. against anticompetitive practices of exclusionary contracts could allow biosimilars to enter the market sooner and at lower costs, which could result in lower health care costs and improved patient access,” they concluded.

The study was partially funded by the Swiss National Science Foundation. Lead author Mr. Carl had no financial conflicts to disclose; several coauthors disclosed funding from organizations including The Health Foundation, the U.K. National Institute for Health Research, and the Pharmaceutical Group of the European Union; all were unrelated to the current study.

The uptake and treatment costs of biosimilar drugs in the United States from 2011 to 2020 were significantly higher than in both Germany and Switzerland, based on data from a cohort study of publicly available commercial databases.

Biologics remain the fastest growing segment of drug research and development, but their costs remain high, David L. Carl, MSc, of the University of Zurich, and colleagues wrote in their study, published online in JAMA Network Open.

As patents and regulatory exclusivity periods expire, biologics face competition from biosimilars, which may drive competition and lower prices, they said.

“However, studies have shown that there are varying policies and biosimilar uptake in European countries and that the observed levels of competition and uptake have not reached the expected levels in the U.S.,” the researchers said.

To assist the discussions of policy makers in the United States and Europe as they consider legislative and regulatory reforms that are intended to promote the competition of biosimilars, the researchers reviewed data from 15 biosimilars and 6 biologics in the United States, 52 biosimilars and 15 biologics in Germany, and 28 biosimilars and 13 biologics in Switzerland.

They analyzed temporal trends in the uptake of biosimilars and their relative prices, compared with the prices of biologics in each country, by obtaining wholesale acquisition costs from online drug pricing databases. They extracted quarterly sales volume data for 2011-2020 from the IQVIA database. In the case of confidential rebates in Switzerland, the researchers obtained list prices.

Overall, the uptake of biosimilars increased in all three countries during the study period. However, the prices of biosimilars and the reference products were significantly higher in the United States, compared with Germany and Switzerland, both of which have national mechanisms for drug price negotiation. The monthly treatment cost of biosimilars was a median of 1.94 and 2.74 times higher in the United States than in Germany and Switzerland, respectively.

On average, the biosimilar market share at launch was highest in Germany; however, it increased at the fastest rate in the United States.

The findings were limited by several factors, including the sample size and the inclusion only of sales data provided by IQVIA, and by the use of list prices only without accounting for drug rebates, the researchers noted. Other limitations were the inability to compare conclusions from the United States and European Union directly because the drugs entered markets at different times, and not all the same drugs have been approved or designated as biosimilars, they said.

However, the results illustrate a difference in uptake of biosimilars in the United States with a reduced impact on drug costs, they said.

Looking ahead, “Policies for drug pricing negotiations in the U.S. against anticompetitive practices of exclusionary contracts could allow biosimilars to enter the market sooner and at lower costs, which could result in lower health care costs and improved patient access,” they concluded.

The study was partially funded by the Swiss National Science Foundation. Lead author Mr. Carl had no financial conflicts to disclose; several coauthors disclosed funding from organizations including The Health Foundation, the U.K. National Institute for Health Research, and the Pharmaceutical Group of the European Union; all were unrelated to the current study.

Heather Meador and Anna Herber-Downey use dating apps on the job – and their boss knows it.

Both are public health nurses employed by Linn County Public Health in eastern Iowa. They’ve learned that dating apps are the most efficient way to inform users that people they previously met on the sites may have exposed them to sexually transmitted infections.

A nationwide surge in STIs, also known as STDs – with reported cases of gonorrhea and syphilis increasing 10% and 7%, respectively, from 2019 to 2020, according to the Centers for Disease Control and Prevention – isn’t sparing Iowa. The duo has found that the telephone call, a traditional method of contact tracing, no longer works well.

“When I started 12 years ago, we called everyone,” said Ms. Meador, the county health department’s clinical branch supervisor. “It’s getting harder and harder to just call someone on the phone.”

Even texting is ineffective, they said. And people aren’t necessarily answering messages on Facebook. The dating apps are where they’re at.

Because many people are meeting sex partners online – via sites like Grindr or Snapchat, which are headquartered in West Hollywood and Santa Monica, Calif., respectively – contact tracers often don’t have much information to go on, just a screen name or a picture.

So, about a year ago, Ms. Meador and her colleagues got approval from their bosses at the local level to build profiles on the app, through which they can contact the sex partners of infected people.

Traditionally, contact tracers interview people infected with an STI about their recent encounters and then reach out to those partners to tell them about the potential exposure.

Linn County contact tracers use the apps throughout their workday. Grindr, in particular, relies on geolocation, showing users matches who are close by. So the tracers use the apps when they’re out and about, hoping to wander into the same neighborhoods as the person diagnosed with an STI. Sometimes users “tap” the contract tracers to see whether they’re interested – in dating, that is.

When the public health officials spot someone they’re looking for, they send a message asking for a call. It’s a successful method: Ms. Herber-Downey estimated they make an initial contact 75% of the time.

Linn County’s decision to move online comes as STI rates rise nationally, funding to fight them falls, and people adopt new technologies to meet people and seek fun. “STIs are increasing way faster than the funding we have,” said Leo Parker, director of prevention programs for the National Coalition of STD Directors, all while public health departments – many underfunded – are grappling with new behaviors.

“Social media companies have billions; we have tens of thousands,” said Jeffrey Klausner, MD, MPH, a University of Southern California, Los Angeles, public health professor, who previously served as San Francisco’s director of STD prevention and control services. That funding disparity means few public health departments have staff members who can go online. “It’s only really in major cities that they have anyone who’s tasked for that,” Dr. Klausner said.

Even when departments have enough employees to take on the challenge, institutional support can be lacking. Some public health officials question employees who log into the apps. Dr. Klausner once testified on behalf of a Ventura County, Calif., contact tracer who was fired for using sex sites for work.

But with people migrating online to meet partners, following them there makes sense. “We’re now in a digital age,” Mr. Parker said. Individuals might not be out, or might be questioning their identity, making online venues comfortable, anonymous spaces for romance – which, in turn, means people are harder to reach face-to-face, at least at first.

What’s more, online spaces like Grindr are effective public health tools beyond contact tracing. They can be useful ways to get the word out about public health concerns.

Mr. Parker and the Linn County officials said public service announcements on dating apps – advocating for condom use or sharing the business hours for sexual health clinics – do seem to lead people to services. “We do have individuals coming in, saying, ‘I saw you had free testing. I saw it on Grindr,’ ” Mr. Parker said.

Grindr, which touts itself as the biggest dating app focused on LGBTQ+ people, pushes out messages and information to its members, said Jack Harrison-Quintana, director of Grindr for Equality. That engagement intensified during a 2015 meningitis outbreak among LGBTQ+ communities in Chicago, for example.

During that outbreak, the app sent citywide messages about vaccination. Then Mr. Harrison-Quintana took advantage of the service’s design: Using the site’s geolocating capabilities, Grindr workers targeted messages to specific neighborhoods. “We could go in and really go block to block and say, ‘Is this where the cases are showing up?’ ” he said. If so, they sent more messages to that area.

That campaign encouraged further efforts from the app, which regularly sends public health messages about everything from COVID-19 to monkeypox to the platform’s base of roughly 11 million monthly users. Grindr also allows users to display their HIV status and indicate whether they’re vaccinated against COVID, monkeypox, and meningitis.

There are a couple of things Grindr won’t do, however. The company won’t allow public health departments to create institutional accounts. And it won’t allow automated notifications about STI exposures to be sent to users.

That’s due to privacy concerns, the company said, despite calls from public health advocates to deploy better messaging features. Grindr believes that a government presence on the app would be too intrusive and that even anonymous notifications would allow users to trace infections back to their source. (When asked about public health officials who join the site on their own, company spokesperson Patrick Lenihan said: “Individuals are free to say something like ‘I’m a public health professional – ask me about my work!’ in their profile and are free to discuss sexual and public health matters however they see fit.”)

Grindr’s position – however disappointing to some in the public health world – reflects a longtime balancing act attempted by the private sector, which aims to square government concerns with users’ privacy interests.

Dr. Klausner pointed to a 1999 syphilis outbreak in San Francisco as one of the first times he saw how those interests could be at odds. The outbreak was traced to an AOL chatroom. Based on his research, Dr. Klausner said it seemed as though people could go online and “get a sex partner faster than you can get a pizza delivered.”

But persuading New York–based Time Warner, eventually AOL’s corporate parent, to cooperate was time-intensive and tricky – gaining entrée into the chatroom required help from the New York attorney general’s office.

The online industry has advanced since then, Dr. Klausner said. He helped one service develop a system to send digital postcards to potentially exposed people. “Congratulations, you got syphilis,” the postcards read. “They were edgy postcards,” he said, although some options were less “snarky.”

Overall, however, the dating app world is still “bifurcated,” he said. For public health efforts, apps that appeal to LGBTQ+ users are generally more helpful than those that predominantly cater to heterosexual clients.

That’s due to the community’s history with sexual health, explained Jen Hecht, a leader of Building Healthy Online Communities, a public health group partnering with dating apps. “Folks in the queer community have – what – 30, 40 years of thinking about HIV?” she said.

Even though STIs affect everyone, “the norm and the expectation is not there” for straight-focused dating apps, she said. Indeed, neither Match Group nor Bumble – the corporations with the biggest apps focused on heterosexual dating, both based in Texas – responded to multiple requests for comment from KHN.

But users, at least so far, seem to appreciate the app-based interventions. Mr. Harrison-Quintana said Grindr has landed on a just-the-facts approach to conveying health information. He has never received any backlash, “which has been very nice.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Heather Meador and Anna Herber-Downey use dating apps on the job – and their boss knows it.

Both are public health nurses employed by Linn County Public Health in eastern Iowa. They’ve learned that dating apps are the most efficient way to inform users that people they previously met on the sites may have exposed them to sexually transmitted infections.

A nationwide surge in STIs, also known as STDs – with reported cases of gonorrhea and syphilis increasing 10% and 7%, respectively, from 2019 to 2020, according to the Centers for Disease Control and Prevention – isn’t sparing Iowa. The duo has found that the telephone call, a traditional method of contact tracing, no longer works well.

“When I started 12 years ago, we called everyone,” said Ms. Meador, the county health department’s clinical branch supervisor. “It’s getting harder and harder to just call someone on the phone.”

Even texting is ineffective, they said. And people aren’t necessarily answering messages on Facebook. The dating apps are where they’re at.

Because many people are meeting sex partners online – via sites like Grindr or Snapchat, which are headquartered in West Hollywood and Santa Monica, Calif., respectively – contact tracers often don’t have much information to go on, just a screen name or a picture.

So, about a year ago, Ms. Meador and her colleagues got approval from their bosses at the local level to build profiles on the app, through which they can contact the sex partners of infected people.

Traditionally, contact tracers interview people infected with an STI about their recent encounters and then reach out to those partners to tell them about the potential exposure.

Linn County contact tracers use the apps throughout their workday. Grindr, in particular, relies on geolocation, showing users matches who are close by. So the tracers use the apps when they’re out and about, hoping to wander into the same neighborhoods as the person diagnosed with an STI. Sometimes users “tap” the contract tracers to see whether they’re interested – in dating, that is.

When the public health officials spot someone they’re looking for, they send a message asking for a call. It’s a successful method: Ms. Herber-Downey estimated they make an initial contact 75% of the time.

Linn County’s decision to move online comes as STI rates rise nationally, funding to fight them falls, and people adopt new technologies to meet people and seek fun. “STIs are increasing way faster than the funding we have,” said Leo Parker, director of prevention programs for the National Coalition of STD Directors, all while public health departments – many underfunded – are grappling with new behaviors.

“Social media companies have billions; we have tens of thousands,” said Jeffrey Klausner, MD, MPH, a University of Southern California, Los Angeles, public health professor, who previously served as San Francisco’s director of STD prevention and control services. That funding disparity means few public health departments have staff members who can go online. “It’s only really in major cities that they have anyone who’s tasked for that,” Dr. Klausner said.

Even when departments have enough employees to take on the challenge, institutional support can be lacking. Some public health officials question employees who log into the apps. Dr. Klausner once testified on behalf of a Ventura County, Calif., contact tracer who was fired for using sex sites for work.

But with people migrating online to meet partners, following them there makes sense. “We’re now in a digital age,” Mr. Parker said. Individuals might not be out, or might be questioning their identity, making online venues comfortable, anonymous spaces for romance – which, in turn, means people are harder to reach face-to-face, at least at first.

What’s more, online spaces like Grindr are effective public health tools beyond contact tracing. They can be useful ways to get the word out about public health concerns.

Mr. Parker and the Linn County officials said public service announcements on dating apps – advocating for condom use or sharing the business hours for sexual health clinics – do seem to lead people to services. “We do have individuals coming in, saying, ‘I saw you had free testing. I saw it on Grindr,’ ” Mr. Parker said.

Grindr, which touts itself as the biggest dating app focused on LGBTQ+ people, pushes out messages and information to its members, said Jack Harrison-Quintana, director of Grindr for Equality. That engagement intensified during a 2015 meningitis outbreak among LGBTQ+ communities in Chicago, for example.

During that outbreak, the app sent citywide messages about vaccination. Then Mr. Harrison-Quintana took advantage of the service’s design: Using the site’s geolocating capabilities, Grindr workers targeted messages to specific neighborhoods. “We could go in and really go block to block and say, ‘Is this where the cases are showing up?’ ” he said. If so, they sent more messages to that area.

That campaign encouraged further efforts from the app, which regularly sends public health messages about everything from COVID-19 to monkeypox to the platform’s base of roughly 11 million monthly users. Grindr also allows users to display their HIV status and indicate whether they’re vaccinated against COVID, monkeypox, and meningitis.

There are a couple of things Grindr won’t do, however. The company won’t allow public health departments to create institutional accounts. And it won’t allow automated notifications about STI exposures to be sent to users.

That’s due to privacy concerns, the company said, despite calls from public health advocates to deploy better messaging features. Grindr believes that a government presence on the app would be too intrusive and that even anonymous notifications would allow users to trace infections back to their source. (When asked about public health officials who join the site on their own, company spokesperson Patrick Lenihan said: “Individuals are free to say something like ‘I’m a public health professional – ask me about my work!’ in their profile and are free to discuss sexual and public health matters however they see fit.”)

Grindr’s position – however disappointing to some in the public health world – reflects a longtime balancing act attempted by the private sector, which aims to square government concerns with users’ privacy interests.

Dr. Klausner pointed to a 1999 syphilis outbreak in San Francisco as one of the first times he saw how those interests could be at odds. The outbreak was traced to an AOL chatroom. Based on his research, Dr. Klausner said it seemed as though people could go online and “get a sex partner faster than you can get a pizza delivered.”

But persuading New York–based Time Warner, eventually AOL’s corporate parent, to cooperate was time-intensive and tricky – gaining entrée into the chatroom required help from the New York attorney general’s office.

The online industry has advanced since then, Dr. Klausner said. He helped one service develop a system to send digital postcards to potentially exposed people. “Congratulations, you got syphilis,” the postcards read. “They were edgy postcards,” he said, although some options were less “snarky.”

Overall, however, the dating app world is still “bifurcated,” he said. For public health efforts, apps that appeal to LGBTQ+ users are generally more helpful than those that predominantly cater to heterosexual clients.

That’s due to the community’s history with sexual health, explained Jen Hecht, a leader of Building Healthy Online Communities, a public health group partnering with dating apps. “Folks in the queer community have – what – 30, 40 years of thinking about HIV?” she said.

Even though STIs affect everyone, “the norm and the expectation is not there” for straight-focused dating apps, she said. Indeed, neither Match Group nor Bumble – the corporations with the biggest apps focused on heterosexual dating, both based in Texas – responded to multiple requests for comment from KHN.

But users, at least so far, seem to appreciate the app-based interventions. Mr. Harrison-Quintana said Grindr has landed on a just-the-facts approach to conveying health information. He has never received any backlash, “which has been very nice.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Heather Meador and Anna Herber-Downey use dating apps on the job – and their boss knows it.

Both are public health nurses employed by Linn County Public Health in eastern Iowa. They’ve learned that dating apps are the most efficient way to inform users that people they previously met on the sites may have exposed them to sexually transmitted infections.

A nationwide surge in STIs, also known as STDs – with reported cases of gonorrhea and syphilis increasing 10% and 7%, respectively, from 2019 to 2020, according to the Centers for Disease Control and Prevention – isn’t sparing Iowa. The duo has found that the telephone call, a traditional method of contact tracing, no longer works well.

“When I started 12 years ago, we called everyone,” said Ms. Meador, the county health department’s clinical branch supervisor. “It’s getting harder and harder to just call someone on the phone.”

Even texting is ineffective, they said. And people aren’t necessarily answering messages on Facebook. The dating apps are where they’re at.

Because many people are meeting sex partners online – via sites like Grindr or Snapchat, which are headquartered in West Hollywood and Santa Monica, Calif., respectively – contact tracers often don’t have much information to go on, just a screen name or a picture.

So, about a year ago, Ms. Meador and her colleagues got approval from their bosses at the local level to build profiles on the app, through which they can contact the sex partners of infected people.

Traditionally, contact tracers interview people infected with an STI about their recent encounters and then reach out to those partners to tell them about the potential exposure.

Linn County contact tracers use the apps throughout their workday. Grindr, in particular, relies on geolocation, showing users matches who are close by. So the tracers use the apps when they’re out and about, hoping to wander into the same neighborhoods as the person diagnosed with an STI. Sometimes users “tap” the contract tracers to see whether they’re interested – in dating, that is.

When the public health officials spot someone they’re looking for, they send a message asking for a call. It’s a successful method: Ms. Herber-Downey estimated they make an initial contact 75% of the time.

Linn County’s decision to move online comes as STI rates rise nationally, funding to fight them falls, and people adopt new technologies to meet people and seek fun. “STIs are increasing way faster than the funding we have,” said Leo Parker, director of prevention programs for the National Coalition of STD Directors, all while public health departments – many underfunded – are grappling with new behaviors.

“Social media companies have billions; we have tens of thousands,” said Jeffrey Klausner, MD, MPH, a University of Southern California, Los Angeles, public health professor, who previously served as San Francisco’s director of STD prevention and control services. That funding disparity means few public health departments have staff members who can go online. “It’s only really in major cities that they have anyone who’s tasked for that,” Dr. Klausner said.

Even when departments have enough employees to take on the challenge, institutional support can be lacking. Some public health officials question employees who log into the apps. Dr. Klausner once testified on behalf of a Ventura County, Calif., contact tracer who was fired for using sex sites for work.

But with people migrating online to meet partners, following them there makes sense. “We’re now in a digital age,” Mr. Parker said. Individuals might not be out, or might be questioning their identity, making online venues comfortable, anonymous spaces for romance – which, in turn, means people are harder to reach face-to-face, at least at first.

What’s more, online spaces like Grindr are effective public health tools beyond contact tracing. They can be useful ways to get the word out about public health concerns.

Mr. Parker and the Linn County officials said public service announcements on dating apps – advocating for condom use or sharing the business hours for sexual health clinics – do seem to lead people to services. “We do have individuals coming in, saying, ‘I saw you had free testing. I saw it on Grindr,’ ” Mr. Parker said.

Grindr, which touts itself as the biggest dating app focused on LGBTQ+ people, pushes out messages and information to its members, said Jack Harrison-Quintana, director of Grindr for Equality. That engagement intensified during a 2015 meningitis outbreak among LGBTQ+ communities in Chicago, for example.

During that outbreak, the app sent citywide messages about vaccination. Then Mr. Harrison-Quintana took advantage of the service’s design: Using the site’s geolocating capabilities, Grindr workers targeted messages to specific neighborhoods. “We could go in and really go block to block and say, ‘Is this where the cases are showing up?’ ” he said. If so, they sent more messages to that area.

That campaign encouraged further efforts from the app, which regularly sends public health messages about everything from COVID-19 to monkeypox to the platform’s base of roughly 11 million monthly users. Grindr also allows users to display their HIV status and indicate whether they’re vaccinated against COVID, monkeypox, and meningitis.

There are a couple of things Grindr won’t do, however. The company won’t allow public health departments to create institutional accounts. And it won’t allow automated notifications about STI exposures to be sent to users.

That’s due to privacy concerns, the company said, despite calls from public health advocates to deploy better messaging features. Grindr believes that a government presence on the app would be too intrusive and that even anonymous notifications would allow users to trace infections back to their source. (When asked about public health officials who join the site on their own, company spokesperson Patrick Lenihan said: “Individuals are free to say something like ‘I’m a public health professional – ask me about my work!’ in their profile and are free to discuss sexual and public health matters however they see fit.”)

Grindr’s position – however disappointing to some in the public health world – reflects a longtime balancing act attempted by the private sector, which aims to square government concerns with users’ privacy interests.

Dr. Klausner pointed to a 1999 syphilis outbreak in San Francisco as one of the first times he saw how those interests could be at odds. The outbreak was traced to an AOL chatroom. Based on his research, Dr. Klausner said it seemed as though people could go online and “get a sex partner faster than you can get a pizza delivered.”

But persuading New York–based Time Warner, eventually AOL’s corporate parent, to cooperate was time-intensive and tricky – gaining entrée into the chatroom required help from the New York attorney general’s office.

The online industry has advanced since then, Dr. Klausner said. He helped one service develop a system to send digital postcards to potentially exposed people. “Congratulations, you got syphilis,” the postcards read. “They were edgy postcards,” he said, although some options were less “snarky.”

Overall, however, the dating app world is still “bifurcated,” he said. For public health efforts, apps that appeal to LGBTQ+ users are generally more helpful than those that predominantly cater to heterosexual clients.

That’s due to the community’s history with sexual health, explained Jen Hecht, a leader of Building Healthy Online Communities, a public health group partnering with dating apps. “Folks in the queer community have – what – 30, 40 years of thinking about HIV?” she said.

Even though STIs affect everyone, “the norm and the expectation is not there” for straight-focused dating apps, she said. Indeed, neither Match Group nor Bumble – the corporations with the biggest apps focused on heterosexual dating, both based in Texas – responded to multiple requests for comment from KHN.

But users, at least so far, seem to appreciate the app-based interventions. Mr. Harrison-Quintana said Grindr has landed on a just-the-facts approach to conveying health information. He has never received any backlash, “which has been very nice.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

A new collaborative position paper on radiation exposure during pregnancy states that pregnant women can safely work in an ionizing radiation environment if exposure to the fetus does not exceed certain dose thresholds.

The position paper aims to “avoid discouraging” women from pursuing careers in interventional cardiology/electrophysiology (IC/EP) and to “dismantle” a barrier that says, “activity under x-rays, without any weighting, is incompatible with continuation of pregnancy,” lead author Stéphane Manzo-Silberman, MD, of AP-HP, Sorbonne Université, Paris, told this news organization.

“The main point of the statement is to show that it is possible and safe to maintain activity under radiation during pregnancy, [given] the data we have on the risk for the fetus at exposed doses, the regulations, and feedback from practice,” she said. “The data we currently have allowed us to be largely reassuring.”

The research showed that adverse effects on a fetus generally occur when radiation exposure is greater than 100 mGy. Most countries that permit pregnant women to work in IC/EP require that the cumulative dose during the pregnancy be less than 1 mSv. An exception is the United States, which permits a cumulative dose of less than 5 mSv.

The position paper, a collaboration among the European Association of Percutaneous Cardiovascular Interventions, the European Heart Rhythm Association, the European Association of Cardiovascular Imaging, the European Society of Cardiology Regulatory Affairs Committee, and Women as One, was published online in EuroIntervention.

The position paper covers regulations in various countries; fetal radiation doses that have been associated with ill effects, including abortion, malformations, and intelligence quotient reductions; the spontaneous probability of having a newborn with a congenital malformation or childhood cancer; and proposals to improve practice.

Highlights include the following:
 

• European, North American, Japanese, and Australian regulations permit pregnant women to work if closely monitored with an abdominal dosimeter; some countries, such as Austria, Hungary, Portugal, and Romania, do not allow women to work in IC/EP during pregnancy or breastfeeding.
• The maximum fetal dose exposure during pregnancy is 1 mSv in Europe, Australia, and Israel; 2 mSv in Japan; and 5 mSv in the United States.
• Doses associated with fetal harm are 100 times higher than those allowed during an interventional cardiologist’s entire pregnancy.
• There is a negligible risk increase in the spontaneous probability of a newborn having a congenital malformation or childhood cancer when the occupational exposure range of the mother respects a country’s limits.
• No studies have shown an increased risk of noncancerous adverse effects from prenatal radiation exposure less than 50 mSv.

To improve practice, the position paper suggests the following:

• Fluoroscopy operators must be guided by the “as low as reasonably achievable” principle: Obtaining optimal images must be balanced with procedure safety.
• Scatter radiation emitted from the patient is the main source of radiation exposure to the operator and personnel; reducing radiation to the patient will reduce exposure for staff.
• The three fundamentals of radiation safety for an operator are (1) time, (2) distance, and (3) shielding and dosimeter monitoring. Time refers to the amount of time the operator spends using the x-ray system; distance means maximizing distance from the x-ray source; and shielding includes personal, tableside, or external protection, with each form having a degree of lead equivalence defining its radiation protective effect.
• Changes in medical school curricula and creating a friendlier workplace environment for families and pregnant interventionists are among the strategies that will promote gender equity in the profession.

“Institutional radiation protection programs should be established to increase knowledge about radiation exposure and improve specific safety requirements for everyone. This would ensure safe exposure for all physicians, [including] during pregnancy,” Dr. Manzo-Silberman concluded.

Furthermore, she said, “As has already been demonstrated in the business world, improving representation and gender equity and diversity is key to improving results and efficiency. In the field of health, this translates into better care for our patients and better working conditions for health care professionals.”

No commercial funding was disclosed. Dr. Manzo-Silberman has received consulting fees from Bayer, Organon, and Exeltis; lecture fees from Bayer, BMS, Exeltis, and Organon; and has served on the adjudication board for a study for Biotronik.

A version of this article first appeared on Medscape.com.

A new collaborative position paper on radiation exposure during pregnancy states that pregnant women can safely work in an ionizing radiation environment if exposure to the fetus does not exceed certain dose thresholds.

The position paper aims to “avoid discouraging” women from pursuing careers in interventional cardiology/electrophysiology (IC/EP) and to “dismantle” a barrier that says, “activity under x-rays, without any weighting, is incompatible with continuation of pregnancy,” lead author Stéphane Manzo-Silberman, MD, of AP-HP, Sorbonne Université, Paris, told this news organization.

“The main point of the statement is to show that it is possible and safe to maintain activity under radiation during pregnancy, [given] the data we have on the risk for the fetus at exposed doses, the regulations, and feedback from practice,” she said. “The data we currently have allowed us to be largely reassuring.”

The research showed that adverse effects on a fetus generally occur when radiation exposure is greater than 100 mGy. Most countries that permit pregnant women to work in IC/EP require that the cumulative dose during the pregnancy be less than 1 mSv. An exception is the United States, which permits a cumulative dose of less than 5 mSv.

The position paper, a collaboration among the European Association of Percutaneous Cardiovascular Interventions, the European Heart Rhythm Association, the European Association of Cardiovascular Imaging, the European Society of Cardiology Regulatory Affairs Committee, and Women as One, was published online in EuroIntervention.

The position paper covers regulations in various countries; fetal radiation doses that have been associated with ill effects, including abortion, malformations, and intelligence quotient reductions; the spontaneous probability of having a newborn with a congenital malformation or childhood cancer; and proposals to improve practice.

Highlights include the following:
 

• European, North American, Japanese, and Australian regulations permit pregnant women to work if closely monitored with an abdominal dosimeter; some countries, such as Austria, Hungary, Portugal, and Romania, do not allow women to work in IC/EP during pregnancy or breastfeeding.
• The maximum fetal dose exposure during pregnancy is 1 mSv in Europe, Australia, and Israel; 2 mSv in Japan; and 5 mSv in the United States.
• Doses associated with fetal harm are 100 times higher than those allowed during an interventional cardiologist’s entire pregnancy.
• There is a negligible risk increase in the spontaneous probability of a newborn having a congenital malformation or childhood cancer when the occupational exposure range of the mother respects a country’s limits.
• No studies have shown an increased risk of noncancerous adverse effects from prenatal radiation exposure less than 50 mSv.

To improve practice, the position paper suggests the following:

• Fluoroscopy operators must be guided by the “as low as reasonably achievable” principle: Obtaining optimal images must be balanced with procedure safety.
• Scatter radiation emitted from the patient is the main source of radiation exposure to the operator and personnel; reducing radiation to the patient will reduce exposure for staff.
• The three fundamentals of radiation safety for an operator are (1) time, (2) distance, and (3) shielding and dosimeter monitoring. Time refers to the amount of time the operator spends using the x-ray system; distance means maximizing distance from the x-ray source; and shielding includes personal, tableside, or external protection, with each form having a degree of lead equivalence defining its radiation protective effect.
• Changes in medical school curricula and creating a friendlier workplace environment for families and pregnant interventionists are among the strategies that will promote gender equity in the profession.

“Institutional radiation protection programs should be established to increase knowledge about radiation exposure and improve specific safety requirements for everyone. This would ensure safe exposure for all physicians, [including] during pregnancy,” Dr. Manzo-Silberman concluded.

Furthermore, she said, “As has already been demonstrated in the business world, improving representation and gender equity and diversity is key to improving results and efficiency. In the field of health, this translates into better care for our patients and better working conditions for health care professionals.”

No commercial funding was disclosed. Dr. Manzo-Silberman has received consulting fees from Bayer, Organon, and Exeltis; lecture fees from Bayer, BMS, Exeltis, and Organon; and has served on the adjudication board for a study for Biotronik.

A version of this article first appeared on Medscape.com.

A new collaborative position paper on radiation exposure during pregnancy states that pregnant women can safely work in an ionizing radiation environment if exposure to the fetus does not exceed certain dose thresholds.

The position paper aims to “avoid discouraging” women from pursuing careers in interventional cardiology/electrophysiology (IC/EP) and to “dismantle” a barrier that says, “activity under x-rays, without any weighting, is incompatible with continuation of pregnancy,” lead author Stéphane Manzo-Silberman, MD, of AP-HP, Sorbonne Université, Paris, told this news organization.

“The main point of the statement is to show that it is possible and safe to maintain activity under radiation during pregnancy, [given] the data we have on the risk for the fetus at exposed doses, the regulations, and feedback from practice,” she said. “The data we currently have allowed us to be largely reassuring.”

The research showed that adverse effects on a fetus generally occur when radiation exposure is greater than 100 mGy. Most countries that permit pregnant women to work in IC/EP require that the cumulative dose during the pregnancy be less than 1 mSv. An exception is the United States, which permits a cumulative dose of less than 5 mSv.

The position paper, a collaboration among the European Association of Percutaneous Cardiovascular Interventions, the European Heart Rhythm Association, the European Association of Cardiovascular Imaging, the European Society of Cardiology Regulatory Affairs Committee, and Women as One, was published online in EuroIntervention.

The position paper covers regulations in various countries; fetal radiation doses that have been associated with ill effects, including abortion, malformations, and intelligence quotient reductions; the spontaneous probability of having a newborn with a congenital malformation or childhood cancer; and proposals to improve practice.

Highlights include the following:
 

• European, North American, Japanese, and Australian regulations permit pregnant women to work if closely monitored with an abdominal dosimeter; some countries, such as Austria, Hungary, Portugal, and Romania, do not allow women to work in IC/EP during pregnancy or breastfeeding.
• The maximum fetal dose exposure during pregnancy is 1 mSv in Europe, Australia, and Israel; 2 mSv in Japan; and 5 mSv in the United States.
• Doses associated with fetal harm are 100 times higher than those allowed during an interventional cardiologist’s entire pregnancy.
• There is a negligible risk increase in the spontaneous probability of a newborn having a congenital malformation or childhood cancer when the occupational exposure range of the mother respects a country’s limits.
• No studies have shown an increased risk of noncancerous adverse effects from prenatal radiation exposure less than 50 mSv.

To improve practice, the position paper suggests the following:

• Fluoroscopy operators must be guided by the “as low as reasonably achievable” principle: Obtaining optimal images must be balanced with procedure safety.
• Scatter radiation emitted from the patient is the main source of radiation exposure to the operator and personnel; reducing radiation to the patient will reduce exposure for staff.
• The three fundamentals of radiation safety for an operator are (1) time, (2) distance, and (3) shielding and dosimeter monitoring. Time refers to the amount of time the operator spends using the x-ray system; distance means maximizing distance from the x-ray source; and shielding includes personal, tableside, or external protection, with each form having a degree of lead equivalence defining its radiation protective effect.
• Changes in medical school curricula and creating a friendlier workplace environment for families and pregnant interventionists are among the strategies that will promote gender equity in the profession.

“Institutional radiation protection programs should be established to increase knowledge about radiation exposure and improve specific safety requirements for everyone. This would ensure safe exposure for all physicians, [including] during pregnancy,” Dr. Manzo-Silberman concluded.

Furthermore, she said, “As has already been demonstrated in the business world, improving representation and gender equity and diversity is key to improving results and efficiency. In the field of health, this translates into better care for our patients and better working conditions for health care professionals.”

No commercial funding was disclosed. Dr. Manzo-Silberman has received consulting fees from Bayer, Organon, and Exeltis; lecture fees from Bayer, BMS, Exeltis, and Organon; and has served on the adjudication board for a study for Biotronik.

A version of this article first appeared on Medscape.com.

Despite recent efforts to improve the landscape of diversity, equity, and inclusion in medicine, advances in the field of dermatology have been unremarkable to date, results from two cross-sectional studies recently published in JAMA Dermatology suggest.

To evaluate diversity and career goals of graduating allopathic medical students pursuing careers in dermatology, corresponding author Matthew Mansh, MD, of the department of dermatology at the University of Minnesota, Minneapolis, and colleagues drew from the 2016-2019 Association of American Medical Colleges Graduation Questionnaire for their study. The main outcome measures were the proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology versus those pursuing other specialties, as well as the proportions and multivariable adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties, and by sex, race, and ethnicity, and sexual orientation among students pursuing dermatology.

Of the 58,077 graduating students, 49% were women, 15% were URM, and 6% were SM. The researchers found that women pursuing dermatology were significantly less likely than women pursuing other specialties to identify as URM (11.6% vs. 17.2%; P < .001) or SM (1.9% vs. 5.7%; P < .001).

In multivariable-adjusted analyses of all students, those pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (18.3% vs. 34%; adjusted odd ratio, 0.40; P < .001), practice in underserved areas (12.7% vs. 25.9%; aOR, 0.40; P < .001), and practice public health (17% vs. 30.2%; aOR, 0.44; P < .001). The odds for pursuing research in their careers was greater among those pursuing dermatology (64.7% vs. 51.7%; aOR, 1.76; P < .001).

“Addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline,” the authors concluded. They acknowledged certain limitations of the analysis, including lack of data delineating sex, sex assigned at birth, and gender identity, and lack of intersectional analyses between multiple minority identities and multiple career goals. “Importantly, diversity factors and their relationship to underserved care is likely multidimensional, and many students pursuing dermatology identified with multiple minority identities, highlighting the need for future studies focused on intersectionality,” they wrote.
 

Trends over 15 years

In a separate study, Jazzmin C. Williams, a medical student at the University of California, San Francisco, and coauthors drew from an Association of American Medical Colleges report of trainees’ and applicants’ self-reported race and ethnicity by specialty from 2005 to 2020 to evaluate diversity trends over the 15-year period. They found that Black and Latinx trainees were underrepresented in all specialties, but even more so in dermatology (mean annual rate ratios of 0.32 and 0.14, respectively), compared with those in primary care (mean annual RRs of 0.54 and 0.23) and those in specialty care (mean annual RRs of 0.39 and 0.18).

In other findings, the annual representation of Black trainees remained unchanged in dermatology between 2005 and 2020, but down-trended for primary (P < .001) and specialty care (P = .001). At the same time, representation of Latinx trainees remained unchanged in dermatology and specialty care but increased in primary care (P < .001). Finally, Black and Latinx race and ethnicity comprised a lower mean proportion of matriculating dermatology trainees (postgraduate year-2s) compared with annual dermatology applicants (4.01% vs. 5.97%, respectively, and 2.06% vs. 6.37% among Latinx; P < .001 for all associations).

“Much of these disparities can be attributed to the leaky pipeline – the disproportionate, stepwise reduction in racial and ethnic minority representation along the path to medicine,” the authors wrote. “This leaky pipeline is the direct result of structural racism, which includes, but is not limited to, historical and contemporary economic disinvestment from majority-minority schools, kindergarten through grade 12.” They concluded by stating that “dermatologists must intervene throughout the educational pipeline, including residency selection and mentorship, to effectively increase diversity.”

Solutions to address diversity

In an editorial accompanying the two studies published in the same issue of JAMA Dermatology, Ellen N. Pritchett, MD, MPH, of the department of dermatology at Howard University, Washington, and Andrew J. Park, MD, MBA, and Rebecca Vasquez, MD, of the department of dermatology at the University of Texas Southwestern Medical Center, Dallas, offered several solutions to address diversity in the dermatology work force. They include:

Go beyond individual bias in recruitment. “A residency selection framework that meaningfully incorporates diversity, equity, and inclusion (DEI) will require more than strategies that address individual bias,” they wrote. “Departmental recruitment committees must become familiar with systems that serve to perpetuate individual bias, like institutional racism or practices that disproportionately favor non-URM versus URM individuals.”

Challenge the myth of meritocracy. “The inaccurate notion of meritocracy – that success purely derives from individual effort has become the foundation of residency selection,” the authors wrote. “Unfortunately, this view ignores the inequitably distributed sociostructural resources that limit the rewards of individual effort.”

Avoid tokenism in retention strategies. Tokenism, which they defined as “a symbolic addition of members from a marginalized group to give the impression of social inclusiveness and diversity without meaningful incorporation of DEI in the policies, processes, and culture,” can lead to depression, burnout, and attrition, they wrote. They advise leaders of dermatology departments to “review their residency selection framework to ensure that it allows for meaningful representation, inclusion, and equity among trainees and faculty to better support URM individuals at all levels.”

Omar N. Qutub, MD, a Portland, Ore.–based dermatologist who was asked to comment on the studies, characterized the findings by Dr. Mansh and colleagues as sobering. “It appears that there is work to do as far as improving diversity in the dermatology workforce that will likely benefit greatly from an honest and steadfast approach to equitable application standards as well as mentorship during all stages of the application process,” such as medical school and residency, said Dr. Qutub, who is the director of equity, diversity, and inclusion of the ODAC Dermatology, Aesthetic & Surgical Conference. “With a focused attempt, we are likely to matriculate more racial minorities into our residency programs, maximizing patient outcomes.”

As for the study by Ms. Williams and colleagues, he told this news organization that efforts toward recruiting URM students as well as sexual minority students “is likely to not only improve health inequities in underserved areas, but will also enrich the specialty as a whole, allowing for better understanding of our diverse patient population and [for us to] to deliver quality care more readily for people and in areas where the focus has often been limited.”

In an interview, Chesahna Kindred, MD, a Columbia, Md.–based dermatologist and immediate past chair of the National Medical Association dermatology section, pointed out that the number of Black physicians in the United States has increased by only 4% in the last 120 years. The study by Dr. Mansh and colleagues, she commented, “underscores what I’ve recognized in the last couple of years: Where are the Black male dermatologists? NMA Derm started recruiting this demographic aggressively about a year ago and started the Black Men in Derm events. Black male members of NMA Derm travel to the Student National Medical Association and NMA conference and hold a panel to expose Black male students into dermatology. This article provides the numbers needed to measure how successful this and other programs are to closing the equity gap.”

Ms. Williams reported having no financial disclosures. Dr. Mansh reported receiving grants from National Institute of Environmental Health Sciences outside the submitted work. Dr. Pritchett and colleagues reported having no relevant financial disclosures, as did Dr. Qutub and Dr. Kindred.

Despite recent efforts to improve the landscape of diversity, equity, and inclusion in medicine, advances in the field of dermatology have been unremarkable to date, results from two cross-sectional studies recently published in JAMA Dermatology suggest.

To evaluate diversity and career goals of graduating allopathic medical students pursuing careers in dermatology, corresponding author Matthew Mansh, MD, of the department of dermatology at the University of Minnesota, Minneapolis, and colleagues drew from the 2016-2019 Association of American Medical Colleges Graduation Questionnaire for their study. The main outcome measures were the proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology versus those pursuing other specialties, as well as the proportions and multivariable adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties, and by sex, race, and ethnicity, and sexual orientation among students pursuing dermatology.

Of the 58,077 graduating students, 49% were women, 15% were URM, and 6% were SM. The researchers found that women pursuing dermatology were significantly less likely than women pursuing other specialties to identify as URM (11.6% vs. 17.2%; P < .001) or SM (1.9% vs. 5.7%; P < .001).

In multivariable-adjusted analyses of all students, those pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (18.3% vs. 34%; adjusted odd ratio, 0.40; P < .001), practice in underserved areas (12.7% vs. 25.9%; aOR, 0.40; P < .001), and practice public health (17% vs. 30.2%; aOR, 0.44; P < .001). The odds for pursuing research in their careers was greater among those pursuing dermatology (64.7% vs. 51.7%; aOR, 1.76; P < .001).

“Addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline,” the authors concluded. They acknowledged certain limitations of the analysis, including lack of data delineating sex, sex assigned at birth, and gender identity, and lack of intersectional analyses between multiple minority identities and multiple career goals. “Importantly, diversity factors and their relationship to underserved care is likely multidimensional, and many students pursuing dermatology identified with multiple minority identities, highlighting the need for future studies focused on intersectionality,” they wrote.
 

Trends over 15 years

In a separate study, Jazzmin C. Williams, a medical student at the University of California, San Francisco, and coauthors drew from an Association of American Medical Colleges report of trainees’ and applicants’ self-reported race and ethnicity by specialty from 2005 to 2020 to evaluate diversity trends over the 15-year period. They found that Black and Latinx trainees were underrepresented in all specialties, but even more so in dermatology (mean annual rate ratios of 0.32 and 0.14, respectively), compared with those in primary care (mean annual RRs of 0.54 and 0.23) and those in specialty care (mean annual RRs of 0.39 and 0.18).

In other findings, the annual representation of Black trainees remained unchanged in dermatology between 2005 and 2020, but down-trended for primary (P < .001) and specialty care (P = .001). At the same time, representation of Latinx trainees remained unchanged in dermatology and specialty care but increased in primary care (P < .001). Finally, Black and Latinx race and ethnicity comprised a lower mean proportion of matriculating dermatology trainees (postgraduate year-2s) compared with annual dermatology applicants (4.01% vs. 5.97%, respectively, and 2.06% vs. 6.37% among Latinx; P < .001 for all associations).

“Much of these disparities can be attributed to the leaky pipeline – the disproportionate, stepwise reduction in racial and ethnic minority representation along the path to medicine,” the authors wrote. “This leaky pipeline is the direct result of structural racism, which includes, but is not limited to, historical and contemporary economic disinvestment from majority-minority schools, kindergarten through grade 12.” They concluded by stating that “dermatologists must intervene throughout the educational pipeline, including residency selection and mentorship, to effectively increase diversity.”

Solutions to address diversity

In an editorial accompanying the two studies published in the same issue of JAMA Dermatology, Ellen N. Pritchett, MD, MPH, of the department of dermatology at Howard University, Washington, and Andrew J. Park, MD, MBA, and Rebecca Vasquez, MD, of the department of dermatology at the University of Texas Southwestern Medical Center, Dallas, offered several solutions to address diversity in the dermatology work force. They include:

Go beyond individual bias in recruitment. “A residency selection framework that meaningfully incorporates diversity, equity, and inclusion (DEI) will require more than strategies that address individual bias,” they wrote. “Departmental recruitment committees must become familiar with systems that serve to perpetuate individual bias, like institutional racism or practices that disproportionately favor non-URM versus URM individuals.”

Challenge the myth of meritocracy. “The inaccurate notion of meritocracy – that success purely derives from individual effort has become the foundation of residency selection,” the authors wrote. “Unfortunately, this view ignores the inequitably distributed sociostructural resources that limit the rewards of individual effort.”

Avoid tokenism in retention strategies. Tokenism, which they defined as “a symbolic addition of members from a marginalized group to give the impression of social inclusiveness and diversity without meaningful incorporation of DEI in the policies, processes, and culture,” can lead to depression, burnout, and attrition, they wrote. They advise leaders of dermatology departments to “review their residency selection framework to ensure that it allows for meaningful representation, inclusion, and equity among trainees and faculty to better support URM individuals at all levels.”

Omar N. Qutub, MD, a Portland, Ore.–based dermatologist who was asked to comment on the studies, characterized the findings by Dr. Mansh and colleagues as sobering. “It appears that there is work to do as far as improving diversity in the dermatology workforce that will likely benefit greatly from an honest and steadfast approach to equitable application standards as well as mentorship during all stages of the application process,” such as medical school and residency, said Dr. Qutub, who is the director of equity, diversity, and inclusion of the ODAC Dermatology, Aesthetic & Surgical Conference. “With a focused attempt, we are likely to matriculate more racial minorities into our residency programs, maximizing patient outcomes.”

As for the study by Ms. Williams and colleagues, he told this news organization that efforts toward recruiting URM students as well as sexual minority students “is likely to not only improve health inequities in underserved areas, but will also enrich the specialty as a whole, allowing for better understanding of our diverse patient population and [for us to] to deliver quality care more readily for people and in areas where the focus has often been limited.”

In an interview, Chesahna Kindred, MD, a Columbia, Md.–based dermatologist and immediate past chair of the National Medical Association dermatology section, pointed out that the number of Black physicians in the United States has increased by only 4% in the last 120 years. The study by Dr. Mansh and colleagues, she commented, “underscores what I’ve recognized in the last couple of years: Where are the Black male dermatologists? NMA Derm started recruiting this demographic aggressively about a year ago and started the Black Men in Derm events. Black male members of NMA Derm travel to the Student National Medical Association and NMA conference and hold a panel to expose Black male students into dermatology. This article provides the numbers needed to measure how successful this and other programs are to closing the equity gap.”

Ms. Williams reported having no financial disclosures. Dr. Mansh reported receiving grants from National Institute of Environmental Health Sciences outside the submitted work. Dr. Pritchett and colleagues reported having no relevant financial disclosures, as did Dr. Qutub and Dr. Kindred.

Despite recent efforts to improve the landscape of diversity, equity, and inclusion in medicine, advances in the field of dermatology have been unremarkable to date, results from two cross-sectional studies recently published in JAMA Dermatology suggest.

To evaluate diversity and career goals of graduating allopathic medical students pursuing careers in dermatology, corresponding author Matthew Mansh, MD, of the department of dermatology at the University of Minnesota, Minneapolis, and colleagues drew from the 2016-2019 Association of American Medical Colleges Graduation Questionnaire for their study. The main outcome measures were the proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology versus those pursuing other specialties, as well as the proportions and multivariable adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties, and by sex, race, and ethnicity, and sexual orientation among students pursuing dermatology.

Of the 58,077 graduating students, 49% were women, 15% were URM, and 6% were SM. The researchers found that women pursuing dermatology were significantly less likely than women pursuing other specialties to identify as URM (11.6% vs. 17.2%; P < .001) or SM (1.9% vs. 5.7%; P < .001).

In multivariable-adjusted analyses of all students, those pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (18.3% vs. 34%; adjusted odd ratio, 0.40; P < .001), practice in underserved areas (12.7% vs. 25.9%; aOR, 0.40; P < .001), and practice public health (17% vs. 30.2%; aOR, 0.44; P < .001). The odds for pursuing research in their careers was greater among those pursuing dermatology (64.7% vs. 51.7%; aOR, 1.76; P < .001).

“Addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline,” the authors concluded. They acknowledged certain limitations of the analysis, including lack of data delineating sex, sex assigned at birth, and gender identity, and lack of intersectional analyses between multiple minority identities and multiple career goals. “Importantly, diversity factors and their relationship to underserved care is likely multidimensional, and many students pursuing dermatology identified with multiple minority identities, highlighting the need for future studies focused on intersectionality,” they wrote.
 

Trends over 15 years

In a separate study, Jazzmin C. Williams, a medical student at the University of California, San Francisco, and coauthors drew from an Association of American Medical Colleges report of trainees’ and applicants’ self-reported race and ethnicity by specialty from 2005 to 2020 to evaluate diversity trends over the 15-year period. They found that Black and Latinx trainees were underrepresented in all specialties, but even more so in dermatology (mean annual rate ratios of 0.32 and 0.14, respectively), compared with those in primary care (mean annual RRs of 0.54 and 0.23) and those in specialty care (mean annual RRs of 0.39 and 0.18).

In other findings, the annual representation of Black trainees remained unchanged in dermatology between 2005 and 2020, but down-trended for primary (P < .001) and specialty care (P = .001). At the same time, representation of Latinx trainees remained unchanged in dermatology and specialty care but increased in primary care (P < .001). Finally, Black and Latinx race and ethnicity comprised a lower mean proportion of matriculating dermatology trainees (postgraduate year-2s) compared with annual dermatology applicants (4.01% vs. 5.97%, respectively, and 2.06% vs. 6.37% among Latinx; P < .001 for all associations).

“Much of these disparities can be attributed to the leaky pipeline – the disproportionate, stepwise reduction in racial and ethnic minority representation along the path to medicine,” the authors wrote. “This leaky pipeline is the direct result of structural racism, which includes, but is not limited to, historical and contemporary economic disinvestment from majority-minority schools, kindergarten through grade 12.” They concluded by stating that “dermatologists must intervene throughout the educational pipeline, including residency selection and mentorship, to effectively increase diversity.”

Solutions to address diversity

In an editorial accompanying the two studies published in the same issue of JAMA Dermatology, Ellen N. Pritchett, MD, MPH, of the department of dermatology at Howard University, Washington, and Andrew J. Park, MD, MBA, and Rebecca Vasquez, MD, of the department of dermatology at the University of Texas Southwestern Medical Center, Dallas, offered several solutions to address diversity in the dermatology work force. They include:

Go beyond individual bias in recruitment. “A residency selection framework that meaningfully incorporates diversity, equity, and inclusion (DEI) will require more than strategies that address individual bias,” they wrote. “Departmental recruitment committees must become familiar with systems that serve to perpetuate individual bias, like institutional racism or practices that disproportionately favor non-URM versus URM individuals.”

Challenge the myth of meritocracy. “The inaccurate notion of meritocracy – that success purely derives from individual effort has become the foundation of residency selection,” the authors wrote. “Unfortunately, this view ignores the inequitably distributed sociostructural resources that limit the rewards of individual effort.”

Avoid tokenism in retention strategies. Tokenism, which they defined as “a symbolic addition of members from a marginalized group to give the impression of social inclusiveness and diversity without meaningful incorporation of DEI in the policies, processes, and culture,” can lead to depression, burnout, and attrition, they wrote. They advise leaders of dermatology departments to “review their residency selection framework to ensure that it allows for meaningful representation, inclusion, and equity among trainees and faculty to better support URM individuals at all levels.”

Omar N. Qutub, MD, a Portland, Ore.–based dermatologist who was asked to comment on the studies, characterized the findings by Dr. Mansh and colleagues as sobering. “It appears that there is work to do as far as improving diversity in the dermatology workforce that will likely benefit greatly from an honest and steadfast approach to equitable application standards as well as mentorship during all stages of the application process,” such as medical school and residency, said Dr. Qutub, who is the director of equity, diversity, and inclusion of the ODAC Dermatology, Aesthetic & Surgical Conference. “With a focused attempt, we are likely to matriculate more racial minorities into our residency programs, maximizing patient outcomes.”

As for the study by Ms. Williams and colleagues, he told this news organization that efforts toward recruiting URM students as well as sexual minority students “is likely to not only improve health inequities in underserved areas, but will also enrich the specialty as a whole, allowing for better understanding of our diverse patient population and [for us to] to deliver quality care more readily for people and in areas where the focus has often been limited.”

In an interview, Chesahna Kindred, MD, a Columbia, Md.–based dermatologist and immediate past chair of the National Medical Association dermatology section, pointed out that the number of Black physicians in the United States has increased by only 4% in the last 120 years. The study by Dr. Mansh and colleagues, she commented, “underscores what I’ve recognized in the last couple of years: Where are the Black male dermatologists? NMA Derm started recruiting this demographic aggressively about a year ago and started the Black Men in Derm events. Black male members of NMA Derm travel to the Student National Medical Association and NMA conference and hold a panel to expose Black male students into dermatology. This article provides the numbers needed to measure how successful this and other programs are to closing the equity gap.”

Ms. Williams reported having no financial disclosures. Dr. Mansh reported receiving grants from National Institute of Environmental Health Sciences outside the submitted work. Dr. Pritchett and colleagues reported having no relevant financial disclosures, as did Dr. Qutub and Dr. Kindred.

TAMPA – Boosting screening for sexually transmitted infections in primary care settings could help alleviate some of the barriers to optimal testing and treatment, a new quality improvement initiative suggests.

Many primary care doctors are challenged for time and send people to other health care settings, such as a local health department or a clinic that specializes in STI diagnosis and treatment, said Wendy Kays, DNP, APRN, AGNP-BC, AAHIVS, a nurse practitioner and researcher at Care Resource, Miami.

However, for multiple reasons, many patients do not follow up and are not screened or treated, Dr. Kays said at the Association of Nurses in AIDS Care annual meeting. Some people can afford the copay to see a primary care provider, for example, but do not have the resources to pay for a second clinical visit or laboratory testing.

In other instances, transportation can be a problem. “People, especially in the neighborhood where we are located, depend a lot on buses to go to their primary care,” Dr. Kays told this news organization. But “follow-up is very important. It can promote early treatment and prevent the spread of disease.”

Primary care is critical as a gateway into health care that could help address low rates of STI screening, she said. There is also evidence that STIs are on the rise because of the COVID-19 pandemic.

If more primary care doctors tested and treated STIs using standardized Centers for Disease Control and Prevention guidelines, patients would not have to make a trip to another location, Dr. Kays said.

“The primary health setting … is actually the perfect place to get your screening,” said Jimmie Leckliter, MSN-Ed, RN, PHN, in an interview. He was not affiliated with the presentation. “I’m a former ER nurse, and a lot of people are using the ER as primary care, and it’s not really set up to do that screening.”

Mr. Leckliter suggested that primary care doctors incorporate some questions about sexual health during a regular head-to-toe checkup and ask questions in a very clinical, nonjudgmental way.

He also acknowledged that for some physicians it can be uncomfortable to raise the issues. “Unfortunately, I think in our society, talking to people about sex is taboo, and people become uncomfortable. We need to be able to learn to put our biases aside and treat our patients. That’s what our job is, added Mr. Leckliter, an adjunct faculty member at the College of the Desert’s School of Nursing and Allied Health Programs, Palm Springs, Calif.

Clinicians should be aware of the stigma associated with sending a person to an STD clinic for further workup, Mr. Leckliter advised. “You have to look at the stigma in the community in which you’re located. It makes a big difference,” he said. “Is it mainly a Latino or African American community?”
 

Compliance was a challenge

Dr. Kays and colleague performed a quality improvement project focused on implementing the CDC’s STI treatment guidelines at Care Resource. One goal was to educate a multidisciplinary team on the importance of screening in the primary care setting. The clientele at Care Resource consists primarily of underprivileged minorities, including the Latino, Black, gay, and transgender communities.

Six health care providers participated – two medical doctors and four advanced-practice providers. They evaluated patient charts from the electronic health record system 4 weeks before the intervention and 4 weeks after.

The education had a positive impact, the researchers reported, even though three providers were compliant with the CDC-recommended screening protocol and three others were not.

The quality improvement initiative had some limitations, Dr. Kays noted. “The hope is that the [quality improvement] process will continue moving forward, and early diagnosis and treatment of STIs will be standardized in this primary care practice.”

An evidence-based tool to screen for STIs in primary care is “crucial,” she added. Using a standardized, evidence-based protocol in primary care “can create positive change in patients’ outcomes.”

The study was independently supported. Dr. Kays and Mr. Leckliter report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TAMPA – Boosting screening for sexually transmitted infections in primary care settings could help alleviate some of the barriers to optimal testing and treatment, a new quality improvement initiative suggests.

Many primary care doctors are challenged for time and send people to other health care settings, such as a local health department or a clinic that specializes in STI diagnosis and treatment, said Wendy Kays, DNP, APRN, AGNP-BC, AAHIVS, a nurse practitioner and researcher at Care Resource, Miami.

However, for multiple reasons, many patients do not follow up and are not screened or treated, Dr. Kays said at the Association of Nurses in AIDS Care annual meeting. Some people can afford the copay to see a primary care provider, for example, but do not have the resources to pay for a second clinical visit or laboratory testing.

In other instances, transportation can be a problem. “People, especially in the neighborhood where we are located, depend a lot on buses to go to their primary care,” Dr. Kays told this news organization. But “follow-up is very important. It can promote early treatment and prevent the spread of disease.”

Primary care is critical as a gateway into health care that could help address low rates of STI screening, she said. There is also evidence that STIs are on the rise because of the COVID-19 pandemic.

If more primary care doctors tested and treated STIs using standardized Centers for Disease Control and Prevention guidelines, patients would not have to make a trip to another location, Dr. Kays said.

“The primary health setting … is actually the perfect place to get your screening,” said Jimmie Leckliter, MSN-Ed, RN, PHN, in an interview. He was not affiliated with the presentation. “I’m a former ER nurse, and a lot of people are using the ER as primary care, and it’s not really set up to do that screening.”

Mr. Leckliter suggested that primary care doctors incorporate some questions about sexual health during a regular head-to-toe checkup and ask questions in a very clinical, nonjudgmental way.

He also acknowledged that for some physicians it can be uncomfortable to raise the issues. “Unfortunately, I think in our society, talking to people about sex is taboo, and people become uncomfortable. We need to be able to learn to put our biases aside and treat our patients. That’s what our job is, added Mr. Leckliter, an adjunct faculty member at the College of the Desert’s School of Nursing and Allied Health Programs, Palm Springs, Calif.

Clinicians should be aware of the stigma associated with sending a person to an STD clinic for further workup, Mr. Leckliter advised. “You have to look at the stigma in the community in which you’re located. It makes a big difference,” he said. “Is it mainly a Latino or African American community?”
 

Compliance was a challenge

Dr. Kays and colleague performed a quality improvement project focused on implementing the CDC’s STI treatment guidelines at Care Resource. One goal was to educate a multidisciplinary team on the importance of screening in the primary care setting. The clientele at Care Resource consists primarily of underprivileged minorities, including the Latino, Black, gay, and transgender communities.

Six health care providers participated – two medical doctors and four advanced-practice providers. They evaluated patient charts from the electronic health record system 4 weeks before the intervention and 4 weeks after.

The education had a positive impact, the researchers reported, even though three providers were compliant with the CDC-recommended screening protocol and three others were not.

The quality improvement initiative had some limitations, Dr. Kays noted. “The hope is that the [quality improvement] process will continue moving forward, and early diagnosis and treatment of STIs will be standardized in this primary care practice.”

An evidence-based tool to screen for STIs in primary care is “crucial,” she added. Using a standardized, evidence-based protocol in primary care “can create positive change in patients’ outcomes.”

The study was independently supported. Dr. Kays and Mr. Leckliter report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TAMPA – Boosting screening for sexually transmitted infections in primary care settings could help alleviate some of the barriers to optimal testing and treatment, a new quality improvement initiative suggests.

Many primary care doctors are challenged for time and send people to other health care settings, such as a local health department or a clinic that specializes in STI diagnosis and treatment, said Wendy Kays, DNP, APRN, AGNP-BC, AAHIVS, a nurse practitioner and researcher at Care Resource, Miami.

However, for multiple reasons, many patients do not follow up and are not screened or treated, Dr. Kays said at the Association of Nurses in AIDS Care annual meeting. Some people can afford the copay to see a primary care provider, for example, but do not have the resources to pay for a second clinical visit or laboratory testing.

In other instances, transportation can be a problem. “People, especially in the neighborhood where we are located, depend a lot on buses to go to their primary care,” Dr. Kays told this news organization. But “follow-up is very important. It can promote early treatment and prevent the spread of disease.”

Primary care is critical as a gateway into health care that could help address low rates of STI screening, she said. There is also evidence that STIs are on the rise because of the COVID-19 pandemic.

If more primary care doctors tested and treated STIs using standardized Centers for Disease Control and Prevention guidelines, patients would not have to make a trip to another location, Dr. Kays said.

“The primary health setting … is actually the perfect place to get your screening,” said Jimmie Leckliter, MSN-Ed, RN, PHN, in an interview. He was not affiliated with the presentation. “I’m a former ER nurse, and a lot of people are using the ER as primary care, and it’s not really set up to do that screening.”

Mr. Leckliter suggested that primary care doctors incorporate some questions about sexual health during a regular head-to-toe checkup and ask questions in a very clinical, nonjudgmental way.

He also acknowledged that for some physicians it can be uncomfortable to raise the issues. “Unfortunately, I think in our society, talking to people about sex is taboo, and people become uncomfortable. We need to be able to learn to put our biases aside and treat our patients. That’s what our job is, added Mr. Leckliter, an adjunct faculty member at the College of the Desert’s School of Nursing and Allied Health Programs, Palm Springs, Calif.

Clinicians should be aware of the stigma associated with sending a person to an STD clinic for further workup, Mr. Leckliter advised. “You have to look at the stigma in the community in which you’re located. It makes a big difference,” he said. “Is it mainly a Latino or African American community?”
 

Compliance was a challenge

Dr. Kays and colleague performed a quality improvement project focused on implementing the CDC’s STI treatment guidelines at Care Resource. One goal was to educate a multidisciplinary team on the importance of screening in the primary care setting. The clientele at Care Resource consists primarily of underprivileged minorities, including the Latino, Black, gay, and transgender communities.

Six health care providers participated – two medical doctors and four advanced-practice providers. They evaluated patient charts from the electronic health record system 4 weeks before the intervention and 4 weeks after.

The education had a positive impact, the researchers reported, even though three providers were compliant with the CDC-recommended screening protocol and three others were not.

The quality improvement initiative had some limitations, Dr. Kays noted. “The hope is that the [quality improvement] process will continue moving forward, and early diagnosis and treatment of STIs will be standardized in this primary care practice.”

An evidence-based tool to screen for STIs in primary care is “crucial,” she added. Using a standardized, evidence-based protocol in primary care “can create positive change in patients’ outcomes.”

The study was independently supported. Dr. Kays and Mr. Leckliter report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

One night, at the beginning of Thanksgiving week, my son called from his place across town. His car was having trouble starting, so I went to see what was up.

I got to his place to find his car wouldn’t start, even though the battery was only a few months old. I used my car to jump his, left him mine, and headed back. My plan was to leave it at our usual repair place and walk home.

Easier said than done.

I’d just gotten on the 101, the main loop freeway for the Phoenix metro area, when his car completely died. The lights flickered, the gauges stopped working, and then the engine cut out. Mercifully I was able to pull over into the right emergency lane as it did so. I was nowhere near an exit.

Not even the emergency flashers worked. It was dark. I was on a major freeway. I couldn’t make myself visible. Cars and trucks were whizzing by 2-3 feet to my left, and I was hoping they’d see me.

I called AAA and explained the situation. They were sending a tow truck, but it could take up to another 3 hours. I sent some quick texts to family to let them know what was up. I called the AZ highway patrol to let them know my predicament, in case they wanted to come put a flare or two behind me (they didn’t).

And then I settled in. Seatbelt on, staring at the road in front of me ... and had nothing to do.

When was the last time you had absolutely nothing to do?

It’s pretty rare these days. I mean, we all have breaks in the action, so we watch a cute animal video, or play a round of Wordle, or whatever.

But I had none of that. No books, iPad, or computer. Sure, I had my phone, but it was less than 50% charged with no way to charge it, and so I wanted to conserve that in case I needed it.

I don’t think I’ve ever had a moment like this since I began carrying a phone in 1998. There was, literally, nothing to do but wait. I couldn’t even try to nod off with the seat unadjustable and cars whizzing by.

So my mind wandered, and I thought. I turned over office cases. I went through year-end finances. I thought about my current predicament. I stared endlessly at the road ahead and cars passing me.

At some point I began to realize that I’m actually pretty lucky, and that nothing was nearly as bad as it had seemed earlier in the day. As the initial adrenaline rush drained out of me I calmed down and the things I’d been worrying about that afternoon seemed workable.

The tow truck pulled in front of me, ending my reverie. Mercifully, it had only taken them an hour. I was home 45 minutes later.

I was thankful to be home and I was thankful that nothing more serious had happened in a potentially bad situation.

And, somewhere in there, I was glad to be reminded that having nothing to do but think for a while can be a good thing.

In today’s world of endless screens and texts and calls and notifications, it’s easy to lose track of that.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

One night, at the beginning of Thanksgiving week, my son called from his place across town. His car was having trouble starting, so I went to see what was up.

I got to his place to find his car wouldn’t start, even though the battery was only a few months old. I used my car to jump his, left him mine, and headed back. My plan was to leave it at our usual repair place and walk home.

Easier said than done.

I’d just gotten on the 101, the main loop freeway for the Phoenix metro area, when his car completely died. The lights flickered, the gauges stopped working, and then the engine cut out. Mercifully I was able to pull over into the right emergency lane as it did so. I was nowhere near an exit.

Not even the emergency flashers worked. It was dark. I was on a major freeway. I couldn’t make myself visible. Cars and trucks were whizzing by 2-3 feet to my left, and I was hoping they’d see me.

I called AAA and explained the situation. They were sending a tow truck, but it could take up to another 3 hours. I sent some quick texts to family to let them know what was up. I called the AZ highway patrol to let them know my predicament, in case they wanted to come put a flare or two behind me (they didn’t).

And then I settled in. Seatbelt on, staring at the road in front of me ... and had nothing to do.

When was the last time you had absolutely nothing to do?

It’s pretty rare these days. I mean, we all have breaks in the action, so we watch a cute animal video, or play a round of Wordle, or whatever.

But I had none of that. No books, iPad, or computer. Sure, I had my phone, but it was less than 50% charged with no way to charge it, and so I wanted to conserve that in case I needed it.

I don’t think I’ve ever had a moment like this since I began carrying a phone in 1998. There was, literally, nothing to do but wait. I couldn’t even try to nod off with the seat unadjustable and cars whizzing by.

So my mind wandered, and I thought. I turned over office cases. I went through year-end finances. I thought about my current predicament. I stared endlessly at the road ahead and cars passing me.

At some point I began to realize that I’m actually pretty lucky, and that nothing was nearly as bad as it had seemed earlier in the day. As the initial adrenaline rush drained out of me I calmed down and the things I’d been worrying about that afternoon seemed workable.

The tow truck pulled in front of me, ending my reverie. Mercifully, it had only taken them an hour. I was home 45 minutes later.

I was thankful to be home and I was thankful that nothing more serious had happened in a potentially bad situation.

And, somewhere in there, I was glad to be reminded that having nothing to do but think for a while can be a good thing.

In today’s world of endless screens and texts and calls and notifications, it’s easy to lose track of that.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

One night, at the beginning of Thanksgiving week, my son called from his place across town. His car was having trouble starting, so I went to see what was up.

I got to his place to find his car wouldn’t start, even though the battery was only a few months old. I used my car to jump his, left him mine, and headed back. My plan was to leave it at our usual repair place and walk home.

Easier said than done.

I’d just gotten on the 101, the main loop freeway for the Phoenix metro area, when his car completely died. The lights flickered, the gauges stopped working, and then the engine cut out. Mercifully I was able to pull over into the right emergency lane as it did so. I was nowhere near an exit.

Not even the emergency flashers worked. It was dark. I was on a major freeway. I couldn’t make myself visible. Cars and trucks were whizzing by 2-3 feet to my left, and I was hoping they’d see me.

I called AAA and explained the situation. They were sending a tow truck, but it could take up to another 3 hours. I sent some quick texts to family to let them know what was up. I called the AZ highway patrol to let them know my predicament, in case they wanted to come put a flare or two behind me (they didn’t).

And then I settled in. Seatbelt on, staring at the road in front of me ... and had nothing to do.

When was the last time you had absolutely nothing to do?

It’s pretty rare these days. I mean, we all have breaks in the action, so we watch a cute animal video, or play a round of Wordle, or whatever.

But I had none of that. No books, iPad, or computer. Sure, I had my phone, but it was less than 50% charged with no way to charge it, and so I wanted to conserve that in case I needed it.

I don’t think I’ve ever had a moment like this since I began carrying a phone in 1998. There was, literally, nothing to do but wait. I couldn’t even try to nod off with the seat unadjustable and cars whizzing by.

So my mind wandered, and I thought. I turned over office cases. I went through year-end finances. I thought about my current predicament. I stared endlessly at the road ahead and cars passing me.

At some point I began to realize that I’m actually pretty lucky, and that nothing was nearly as bad as it had seemed earlier in the day. As the initial adrenaline rush drained out of me I calmed down and the things I’d been worrying about that afternoon seemed workable.

The tow truck pulled in front of me, ending my reverie. Mercifully, it had only taken them an hour. I was home 45 minutes later.

I was thankful to be home and I was thankful that nothing more serious had happened in a potentially bad situation.

And, somewhere in there, I was glad to be reminded that having nothing to do but think for a while can be a good thing.

In today’s world of endless screens and texts and calls and notifications, it’s easy to lose track of that.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Major cardiovascular societies are more apt to give out awards to men and White individuals than to women and minorities, according to a look at 2 decades’ worth of data.

“Women received significantly fewer awards than men in all societies, countries, and award categories,” author Martha Gulati, MD, director of preventive cardiology at Smidt Heart Institute at Cedars-Sinai, Los Angeles, said in a news release. “This bias may be responsible for preventing underrepresented groups from ascending the academic ladder and receiving senior awards like lifetime achievement awards.”

The study was published online in the Journal of the American College of Cardiology.
 

A slow climb

The findings are based on a review of honors given from 2000 to 2021 by the ACC, the American Heart Association, the American Society of Echocardiography, the Society for Cardiovascular Angiography and Interventions, the Heart Rhythm Society, the European Society of Cardiology, and the Canadian Cardiovascular Society.

Among the 173 unique awards, 94 were given by the AHA, 27 by the HRS, 17 by the ACC, 16 by the CCS, 8 by the ASE, 7 by the ESC, and 4 by the SCAI. There were 3,044 recipients of these awards, including 2,830 unique awardees.

The vast majority of the awardees were White (75.2%), with Asian, Hispanic/Latino, and Black awardees representing just 18.9%, 4.5%, and 1.4% of the total awardees, respectively.

In a gender analysis, the researchers looked at 169 awards after excluding female-specific awards. These 169 awards were distributed to 2,995 recipients. More than three-quarters of these awardees (76.2%) were men, with women making up less than one-quarter (23.8%).

Encouragingly, there was an increasing trend in recognition of women over time, with 7.7% of female awardees in 2000 and climbing to 31.2% in 2021 (average annual percentage change, 6.6%; P < .05).

The distribution of awards also became more racially/ethnically diverse over time; in 2000, 92.3% of awardees were White versus 62.8% in 2021 (AAPC, –1.4%; P < .001).

There was also a significant increase in Asian (AAPC, 5.7%; P < .001), Hispanic/Latino (AAPC, 4.8%; P = .040), and Black (AAPC, 7.8%; P < .05) honorees.
 

Core influencers

By award type, women received fewer leadership awards than men, “which can be attributed to fewer leadership opportunities for women and a lack of acknowledgment of leadership responsibilities fulfilled by women,” the researchers said.

Award recipients with a PhD degree were nearly gender balanced (48.2% women), whereas men formed an overwhelming majority of awardees with an MD (84.7%).

Awards with male eponyms had fewer women recipients than did noneponymous awards (20.9% vs. 23.2%; P < .01).

“Male-eponymous awards can deter women applicants and give a subtle hint to selection committees to favor men as winners, creating an implicit bias,” the researchers said.

“Given the increased emphasis on redesigning cardiovascular health care delivery by incorporating the tenets of diversity, equity, and inclusion (DEI), cardiovascular societies have a significant role as core influencers,” Dr. Gulati and colleagues wrote.

They said that equitable award distribution can be a “key strategy to celebrate women and diverse members of the cardiovascular workforce and promulgate DEI.”

“Recognition of their contributions is pivotal to enhancing their self-perception. In addition to boosting confidence, receiving an award can also catalyze their career trajectory,” the authors added.

The study had no specific funding. The authors have declared no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

Major cardiovascular societies are more apt to give out awards to men and White individuals than to women and minorities, according to a look at 2 decades’ worth of data.

“Women received significantly fewer awards than men in all societies, countries, and award categories,” author Martha Gulati, MD, director of preventive cardiology at Smidt Heart Institute at Cedars-Sinai, Los Angeles, said in a news release. “This bias may be responsible for preventing underrepresented groups from ascending the academic ladder and receiving senior awards like lifetime achievement awards.”

The study was published online in the Journal of the American College of Cardiology.
 

A slow climb

The findings are based on a review of honors given from 2000 to 2021 by the ACC, the American Heart Association, the American Society of Echocardiography, the Society for Cardiovascular Angiography and Interventions, the Heart Rhythm Society, the European Society of Cardiology, and the Canadian Cardiovascular Society.

Among the 173 unique awards, 94 were given by the AHA, 27 by the HRS, 17 by the ACC, 16 by the CCS, 8 by the ASE, 7 by the ESC, and 4 by the SCAI. There were 3,044 recipients of these awards, including 2,830 unique awardees.

The vast majority of the awardees were White (75.2%), with Asian, Hispanic/Latino, and Black awardees representing just 18.9%, 4.5%, and 1.4% of the total awardees, respectively.

In a gender analysis, the researchers looked at 169 awards after excluding female-specific awards. These 169 awards were distributed to 2,995 recipients. More than three-quarters of these awardees (76.2%) were men, with women making up less than one-quarter (23.8%).

Encouragingly, there was an increasing trend in recognition of women over time, with 7.7% of female awardees in 2000 and climbing to 31.2% in 2021 (average annual percentage change, 6.6%; P < .05).

The distribution of awards also became more racially/ethnically diverse over time; in 2000, 92.3% of awardees were White versus 62.8% in 2021 (AAPC, –1.4%; P < .001).

There was also a significant increase in Asian (AAPC, 5.7%; P < .001), Hispanic/Latino (AAPC, 4.8%; P = .040), and Black (AAPC, 7.8%; P < .05) honorees.
 

Core influencers

By award type, women received fewer leadership awards than men, “which can be attributed to fewer leadership opportunities for women and a lack of acknowledgment of leadership responsibilities fulfilled by women,” the researchers said.

Award recipients with a PhD degree were nearly gender balanced (48.2% women), whereas men formed an overwhelming majority of awardees with an MD (84.7%).

Awards with male eponyms had fewer women recipients than did noneponymous awards (20.9% vs. 23.2%; P < .01).

“Male-eponymous awards can deter women applicants and give a subtle hint to selection committees to favor men as winners, creating an implicit bias,” the researchers said.

“Given the increased emphasis on redesigning cardiovascular health care delivery by incorporating the tenets of diversity, equity, and inclusion (DEI), cardiovascular societies have a significant role as core influencers,” Dr. Gulati and colleagues wrote.

They said that equitable award distribution can be a “key strategy to celebrate women and diverse members of the cardiovascular workforce and promulgate DEI.”

“Recognition of their contributions is pivotal to enhancing their self-perception. In addition to boosting confidence, receiving an award can also catalyze their career trajectory,” the authors added.

The study had no specific funding. The authors have declared no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

Major cardiovascular societies are more apt to give out awards to men and White individuals than to women and minorities, according to a look at 2 decades’ worth of data.

“Women received significantly fewer awards than men in all societies, countries, and award categories,” author Martha Gulati, MD, director of preventive cardiology at Smidt Heart Institute at Cedars-Sinai, Los Angeles, said in a news release. “This bias may be responsible for preventing underrepresented groups from ascending the academic ladder and receiving senior awards like lifetime achievement awards.”

The study was published online in the Journal of the American College of Cardiology.
 

A slow climb

The findings are based on a review of honors given from 2000 to 2021 by the ACC, the American Heart Association, the American Society of Echocardiography, the Society for Cardiovascular Angiography and Interventions, the Heart Rhythm Society, the European Society of Cardiology, and the Canadian Cardiovascular Society.

Among the 173 unique awards, 94 were given by the AHA, 27 by the HRS, 17 by the ACC, 16 by the CCS, 8 by the ASE, 7 by the ESC, and 4 by the SCAI. There were 3,044 recipients of these awards, including 2,830 unique awardees.

The vast majority of the awardees were White (75.2%), with Asian, Hispanic/Latino, and Black awardees representing just 18.9%, 4.5%, and 1.4% of the total awardees, respectively.

In a gender analysis, the researchers looked at 169 awards after excluding female-specific awards. These 169 awards were distributed to 2,995 recipients. More than three-quarters of these awardees (76.2%) were men, with women making up less than one-quarter (23.8%).

Encouragingly, there was an increasing trend in recognition of women over time, with 7.7% of female awardees in 2000 and climbing to 31.2% in 2021 (average annual percentage change, 6.6%; P < .05).

The distribution of awards also became more racially/ethnically diverse over time; in 2000, 92.3% of awardees were White versus 62.8% in 2021 (AAPC, –1.4%; P < .001).

There was also a significant increase in Asian (AAPC, 5.7%; P < .001), Hispanic/Latino (AAPC, 4.8%; P = .040), and Black (AAPC, 7.8%; P < .05) honorees.
 

Core influencers

By award type, women received fewer leadership awards than men, “which can be attributed to fewer leadership opportunities for women and a lack of acknowledgment of leadership responsibilities fulfilled by women,” the researchers said.

Award recipients with a PhD degree were nearly gender balanced (48.2% women), whereas men formed an overwhelming majority of awardees with an MD (84.7%).

Awards with male eponyms had fewer women recipients than did noneponymous awards (20.9% vs. 23.2%; P < .01).

“Male-eponymous awards can deter women applicants and give a subtle hint to selection committees to favor men as winners, creating an implicit bias,” the researchers said.

“Given the increased emphasis on redesigning cardiovascular health care delivery by incorporating the tenets of diversity, equity, and inclusion (DEI), cardiovascular societies have a significant role as core influencers,” Dr. Gulati and colleagues wrote.

They said that equitable award distribution can be a “key strategy to celebrate women and diverse members of the cardiovascular workforce and promulgate DEI.”

“Recognition of their contributions is pivotal to enhancing their self-perception. In addition to boosting confidence, receiving an award can also catalyze their career trajectory,” the authors added.

The study had no specific funding. The authors have declared no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.