Life satisfaction, health status, and professional satisfaction of urologists in private practice

The medical profession still enjoys a high standing in the general population. It does, however, have considerable drawbacks. These include high levels of time expenditure and intense psychological stress, lower degree of life satisfaction, limited leisure time and private life, and immense physical stress in connection with increased health risk behavior. Between January 2004 and March 2006, a survey was conducted among urologists in private practice in the German states of Hesse, Lower Saxony, Saxony, and Thuringia concerning their life satisfaction, health status, and professional satisfaction. Of the 599 physicians contacted by mail, 194 returned the completed 14-page questionnaire. The rate of return was 30.8%. The questionnaire contained items on professional situation, wishes and plans, health, personal data, life situation, and attitude towards various aspects of life. The following questionnaires were employed: questions on professional self-efficacy according to Abele et al. (2000), on professional stress and life satisfaction according to Fahrenberg et al. (2000), and on professional gratification according to de Jonge et al. (2000). Physical complaints were assessed by the short form of the Giessen Complaint Questionnaire. When possible, the data were compared with those of a representative population sample. Analysis revealed that registered urologists considered bureaucratic administrative chores to cause the greatest strain, followed by an uncertain future and lack of a private life. Although >74.8% believed that their physical condition was good or very good, urologists suffer more frequently from cardiac and abdominal complaints than the average population and are exhausted to a considerably higher extent. With their above average willingness to overtax themselves, the imbalance between exhaustion and benefit is far greater than in the population sample. This could represent the cause of the psychosomatic complaints among the physicians.     

Current laparoscopic practice patterns in urology: results of a survey among urologists in Germany and Switzerland

OBJECTIVES: A survey was performed to assess the current practice patterns in laparoscopy among urologists in Germany and Switzerland. METHODS: Using the database directory of the German and Swiss Urological Association urological departments were identified. A detailed questionnaire was designed and sent by postal service. Responding questionnaires were analyzed. RESULTS: The overall response rate was 64%. Fifty-four percent of respondents in Germany and 33% in Switzerland already perform laparoscopy; another 50% and 56% are planning to introduce laparoscopy. Thirty-six percent think that laparoscopy is economical and 77% await shortening of hospital stay. Major concerns are: Economical aspects, lengthy learning curve, investment, and lack of scientific data. The number of laparoscopic procedures during 12 months was registered for 19 indications. More than 40 procedures for one indication are performed by only 6% of the departments. CONCLUSIONS: The survey reveals an increasing number of departments performing laparoscopy and broad acceptance of the technology but combined with some major concerns. Currently only a minority of the departments perform more than 40 procedures for one indication suggesting that at present laparoscopy is mainly a center-based technology.     

Avoiding malpractice in private practice and the hospital setting

An overview of very real considerations for the practicing plastic surgeon with regards to potential areas of risk and liability have been presented. As one can see, the hospital environment presents many potential sources of liability that can involve the attending or consulting plastic surgeon.     

Development of urologic laparoscopy in Germany,Austria, and Switzerland: a survey among urologists

Purpose

Laparoscopy introduction has dramatically changed urology. Novel techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES), might also have substantial influence. This 2012 survey evaluated present laparoscopy use, its appraisal among urologic surgeons, laparoscopy training, and use of new techniques. Results were compared to the previous surveys, demonstrating the 10-year development of laparoscopy.

Methods

A detailed questionnaire regarding demographic data, laparoscopy use, attitudes concerning laparoscopy, and novel techniques was send to 424 departments in Germany, Austria, and Switzerland. Procedures performed in 25 indications were quantitatively evaluated.

Results

The response rate was 63 % (269). Eighty-six percent of the respondents reported performing laparoscopy, compared to 54 % in 2002. Only 16 % expected economic advantages with laparoscopy, whereas 67 % expected shorter hospitalization. Seventy percent of responders anticipated comparable functional and oncological results between laparoscopic procedures and open surgery. Slow learning curves (81 %) and insufficient training facilities (32 %) were reported to impair laparoscopic surgery. On average, laparoscopic and non-laparoscopic surgical teams consisted of 2.5 and 3.5 members, respectively. LESS procedures were performed at 15 % of institutions. Twenty-two percent of respondents considered NOTES techniques valuable for future urology. Few indications (laparoscopic prostatectomies or nephrectomies) were performed frequently in specialized centers, and the rapidly increasing procedure numbers observed between 2002 and 2007 had dropped to a mild accretion. The results demonstrate broad acceptance of laparoscopy in German urologic surgery, depict the need for structured training facilities, and indicate limited impact of novel techniques (LESS and NOTES).

Conclusions

The survey demonstrates the 10-year development of urologic laparoscopy and the broad acceptance of laparoscopic techniques.     

A county hospital surgical practice: a model for acute care surgery

BACKGROUND: Trauma surgery has changed significantly over the past decade. Nonoperative evidence-based algorithms have become common and surgical trauma volume has become increasingly difficult to maintain. The acute care surgery (ACS) model, which integrates trauma, critical care, and emergency surgery, has been proposed as a future model of trauma practice. METHODS: Database information from an academic, county-based, trauma center was reviewed. A performance improvement surgical procedure database and level I trauma registry from 2005 were used to evaluate one center's ACS practice. RESULTS: There were 2,276 cases performed by 7 full-time and 5 part-time surgeons. Elective cases accounted for 64% (1,480) of caseload, emergency/urgent general surgery accounted for 32% (719) of cases, and emergency trauma surgeries accounted for 4% (96 procedures in 77 patients). In all, 23% were performed after hours. The ACS model supported controllable hours, adequate surgical volume, excellent patient care, and an appealing clinical practice. CONCLUSION: Surgical practice in a county-run trauma hospital can be similar to the ACS model, with positive results in terms of clinical volume and physician satisfaction. As clinical practices shift to the ACS model, there are lessons to be learned from currently existing, thriving, long-standing similar prototypes.     

The surgeon's assistant in private surgical practice and in the university hospital

The increased demand for medical care and the uneven geographic distribution of doctors in this country have stimulated physicians and nonphysicians to seek additional methods of improving health care through the use of paramedical personnel. Surgeon's assistants now in practice have been of considerable help in the operating room, within the hospital, and in an outpatient area. These individuals perform patient care services thereby allowing the house staff to participate primarily in those activities of medical care relating to education. Surgeon's assistants may be especially valuable in community hospitals where patient care is the major consideration.However, the use of paramedical personnel alone will not provide sufficient treatment to the medically underserved areas in the State of Alabama. The state law requires all paramedical assistants to work directly under the supervision of the physician and the surgeon. Therefore, the absence of a surgeon precludes the presence of a surgical assistant in remote rural areas.The medical-legal implications are considerable and must be examined with care to protect both the surgeon and the assistant. The act passed by the state legislature of Alabama and the rules and regulations promulgated by the Alabama State Board of Medical Examiners have been reviewed with attention given to the surgeon's assistant, the physician, and the Board.     

Quality management in private practice. A nationwide survey in Germany

Quality management (QM) will soon become mandatory for private practice physicians in Germany. We aimed to assess the knowledge about and state of implementation of QM in German private practices. In cooperation with the Stiftung Gesundheit (Foundation for Health), Hamburg, a stratified sample of 15,383 physicians was requested via e-mail in 2006 to participate in the online survey. The survey covered sources of information and experiences with QM, cost of implementing QM, and general attitudes towards QM in private health care. A total of 787 doctors (5.1% response rate) rendered useful data sets; 16% of doctors had not yet familiarized themselves with QM. The DIN-ISO QM System is by far the best-known system, with 86% of doctors having heard about it. All other systems are known by only 30% or less of the physicians. Only about 20% of private practices have already implemented QM or are about to have it implemented. The cost of QM depends heavily on the system used with DIN-ISO (5600 euros) and EFQM (2800 euros) being the more expensive, while EPA (1800 euros) and QEP (850 euros) are much less costly. All QM systems require roughly the same amount of time from staff to be implemented and maintained. Two thirds of all doctors have not yet decided which QM system to use and contacts during seminars and recommendations from colleagues are most important when selecting a system. The level of satisfaction with QM service providers is generally high. In general, the study revealed a very heterogeneous picture. As with other new technologies or organizational changes there is a group of enthusiastic "early adopters," but we also found a substantial number of physicians (about 25%) who are highly skeptical about implementing QM. They posed a challenge for health policy and service providers alike and careful market segmentation will be needed to cater for the different needs of the different groups of doctors. Moreover, the still rather technical approach towards QM might not be helpful in convincing the clinical and patient-oriented doctors of the need to install systematic and organization-based quality systems.     

Vasectomy reversal in central Europe: results of questionnaire of urologists in Austria, Germany and Switzerland

A detailed questionnaire was sent to urologists in Austria, Switzerland and West Germany on the frequency of contraceptive vasectomies, vasectomy reversal, technique and success rates. The response rate was 859 of 2,137 (40.2%). The rate of annual contraceptive vasectomies averaged 28,519 or 378 vasectomies per million inhabitants. The rate of vasovasostomies and vasoepididymostomies was 8.3 and 3.8 procedures per million inhabitants, respectively. A macroscopic technique was used by 9.5% of the responding urologists, loupes were used by 58.5% and an operating microscope by 32%. The majority (74.1%) preferred a 1-layer technique and an unstented anastomosis (84.4%). The average patency and pregnancy rates were 73 and 47%, respectively, for vasovasostomy and 45 and 18%, respectively, for vasoepididymostomy. A total of 78 alloplastic spermatoceles was reported, with detection of motile spermatozoa in 19 and pregnancy in 1.     

Incisional hernia repair in Germany at the crossroads: a comparison of two hospital surveys in 1995 and 2001

INTRODUCTION: Incisional hernia repair has become a controversial issue in surgery. METHODS: To survey the current practice patterns of incisional hernia repair, a questionnaire was mailed to 2 380 surgical departments in Germany. Responses were received from 732 hospitals. The results of the current survey were compared with that of a similar survey performed in 1995. RESULTS: Overall, the incidence of incisional hernia surgery seems to have markedly increased. An increasing number of operations is performed in specialized large centres. Depending on hernia type (primary hernia < 5 cm, primary hernia > 5 cm, recurrent hernia) mesh materials have gained popularity (15 %, 67 %, and 79 %, respectively) as compared to 1995. Prolene(R) (34 %) and Vypro(R) (25 %) are the currently preferred meshes. The number of hospitals that use non-resorbable suturing material has doubled between 1995 (22 %) and 2001 (45 %). Interrupted suture are no longer the standard technique for fascia closure (80 % in 1995, 50 % in 2001). Autodermal skin graft and laparoscopic hernia repair are of little importance. Although literature data suggest high recurrence rates, most surgeons still expect that only 5-10 % of their primary or recurrent hernia repairs will fail. CONCLUSIONS: Incisional hernia repair is undergoing radical changes. However, it is unclear whether these changes in surgical techniques and materials were caused by the individual surgeon's clinical expertise, the recent publication of important trials, or the financial circumstances.     

Blunt trauma of the diaphragm: a 15-county, private hospital experience.

During a 6-year period, 52 patients with nonpenetrating trauma to the diaphragm were treated in eight acute care hospitals, serving a 15-county area of Michigan. Charts were reviewed to identify patterns of injury, treatment, and outcome. Preoperative diagnosis was made in 50 per cent of cases based on chest x-ray findings; the remainder were diagnosed intraoperatively. Clinical examination revealed respiratory distress, decreased breath sounds, or elevated hemidiaphragm in 81 per cent of patients. Forty-two per cent of patients sustained significant head injuries. Fractures were present in 75 per cent of patients. Major chest injury was found in 92 per cent. Intra-abdominal organs were herniated in 67 per cent of cases with the stomach being most common (54%). The spleen was the most commonly injured abdominal organ (60%). The left diaphragm was injured in 75 per cent of cases; 2 per cent were bilateral. The most common postoperative complication was pneumonia. Mortality in this series was 13 per cent, with no case being related to the diaphragmatic injury. The authors conclude that blunt injuries to the diaphragm in the multiply-injured patient present a clinical diagnostic challenge requiring a high index of suspicion. Optimal care requires a multi-disciplinary critical care team to manage the high incidence of associated central nervous system, orthopedic, and chest injuries and associated high mortality rates.     

Breast conservation therapy in affiliated county, university, and private hospitals

BACKGROUND: Breast conservation therapy (BCT) offers equivalent survival to modified radical mastectomy in patients with early-stage (I and IIa) breast cancer, but is utilized in less than 50% of eligible patients. While patient demographics have been linked to BCT rates, we suspected that physician influence was a major factor. The purpose of this study was to compare BCT at three affiliated centers staffed by similarly trained surgeons yet serving widely disparate populations, in order to assess the importance of physician influence on the utilization of BCT. METHODS: Tumor registry data were reviewed from 1993 through 1997 at affiliated city/county (CH), university (UH), and private hospitals (PH). Data were analyzed for clinical stage, treatment, and age of patient. RESULTS: The utilization of BCT for stage I and IIa breast cancer is similar at the three hospitals: 45% of patients at CH, 55% of patient at UH, and 57% of patients at PH (P>0.05). Rates of BCT were similar across all patient age groups at all sites. CONCLUSIONS: Similar BCT utilization rates can be achieved despite widely disparate patient populations. The three affiliated hospitals are staffed by surgeons with similar training, and all offer a multidisciplinary approach to breast cancer care. This suggests that physician influence may override patients' socioeconomic issues in providing optimal breast cancer therapy.     

Breast-feeding practices in a private maternity hospital

An interview questionnaire study of 51 breast-feeding mothers was conducted to assess the stated policy of breast-feeding promotion in a private maternity hospital. A mean period of 20.6 hours elapsed after delivery before initiation of breast-feeding, and 39.9 hours elapsed before rooming-in took place. At least 47.1% of babies received prelacteal feeds, 94.1% were routinely test-weighed, and 56.9% received complementary feeds. A patient-administered questionnaire is proposed to provide hospital management and attendant medical practitioners with essential feedback that could assist them to close the gap between policy and practice.