Work satisfaction and career aspirations of internists working in teaching hospital group practices

This paper presents data on the characteristics, work activities, job-related stress, work satisfaction, and career aspirations of 150 faculty and 595 housestaff physicians who regularly provide continuous primary care in 15 teaching hospital-based group practices. The faculty were young, board-certified generalists; they had been recruited from local training programs and spent the majority of their time seeing patients and supervising housestaff. Job satisfaction among faculty and housestaff was generally high. Dissatisfaction occurred most often with aspects of work over which physicians had little control. Although work-related stress was common, it was not related to job satisfaction. Compared with housestaff in traditional residency programs, housestaff enrolled in special Primary Care Training Programs reported significantly greater job satisfaction. For all housestaff, satisfaction with work in the group practice was consistently associated with decreased interest in subspecialty training. assisted in preparing this report. Received from the Department of Medicine and the School of Public Health, UCLA Center for the Health Sciences. Los Angeles. California. Supported by Grant #59082 from the Robert Wood Johnson Foundation. The views expressed herein do not necessarily represent those of the Robert Wood Johnson Foundation.     

Correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales

Objective: To identify correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales. Design: Prospective cohort study. Setting: The emergency departments of three university and four community hospitals. Patients: Five hundred patients more than 30 years of age presenting to the emergency departments between 1984 and 1985 with a chief complaint of chest pain not explained by obvious trauma or chest x-ray abnormalities, and more than bibasilar rales on physical examination. Measurements and main results: A standard data form was used to collect the history, physical examination, vital sign, and electrocardiographic findings. Chart review was carried out to record complications and mortality. One hundred eleven (22%) of the patients had a major complication (ventricular fibrillation, Mobitz II heart block, complete heart block, atrioventricular dissociation, cardiogenic shock, cardiac arrest, endotracheal intubation, intra-aortic balloon pump) or died, 160 (32%) were diagnosed as having myocardial infarction, and 58 (12%) died. Of those patients who had major complications or who died, the first complication occurred within six hours of hospital admission for 32% of the patients and within 24 hours for 47% of the patients. Univariate correlates (p<0.10) of a major complication or death were entered into a stepwise logistic regression model. In the multivariate model, ST elevation or Q waves not known to be old [adjusted odds ratio (OR) 5.8, 95% confidence interval (CI) 3.0–11.1], ST-T changes of ischemia not known to be old (OR 2.6, 95% CI 1.5–4.6), systolic blood pressure ≤ 120 mm Hg (OR 3.2, 95% CI 1.9–5.6), and age >70 years (OR 1.8, 95% CI 1.1–3.0) were correlates of a major complication or death. Conclusion: For patients presenting to the emergency department with chest pain and more than bibasilar rales, major electrocardiographic changes, systolic blood pressure ≤ 120 mm Hg, and age >70 years were correlated with a higher risk of a major complication or death. Supported by a grant (83102-2H) from the John A. Hartford Foundation, New York. Dr. Lee is the recipient of an Established Investigator Award (900119) from the American Heart Association.