Physicians in small, independent primary care practices report dramatically lower levels of burnout when compared to the national average.
A new study of 235 providers practicing in 174 small independent primary care practices in New York City found those doctors reported a burnout rate of 13.5% compared to national estimates that 54.4% of doctors report they have symptoms of burnout. “The difference is stark,” lead author Donna Shelley, M.D., a professor in the departments of population health and medicine at NYU Langone Health, said in an interview with FierceHealthcare.
The findings indicate that the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout, according to the study in the Journal of the American Board of Family Medicine.
The news comes as a separate study highlights the potentially serious consequences of physician burnout. Published in Mayo Clinic Proceedings, that research linked physician burnout to medical errors.
Researchers sent surveys to physicians across the U.S., and among the 6,695 who responded, 3,574, or 54%, reported symptoms of burnout, and 10% of those reported at least one major medical error in the past three months. Burnout may be to blame for more errors than unsafe workplace conditions, the study said.
Research on physician burnout has focused primarily on hospital settings or large primary care practices.
But healthcare may be able to learn as much by looking at the group that’s not showing high burnout rates as it can by looking at what causes burnout. The researchers in the New York study say that this is the first study that examines the prevalence of burnout among physicians in small independent primary practices: practices with five or fewer physicians.
“So, the obvious question is: What is it about the work environment that results in low burnout rates in small practices?” Shelley said. Those factors can perhaps be translated into other settings where doctors report high rates of emotional exhaustion, stress and depression.
In these practices, doctors have a sense of autonomy and are the ones creating the culture of the workplace, Shelley says. They have a say in the decision-making process.
Physicians that described a culture in which individuals have opportunities for growth, and the ability to learn from mistakes by talking and listening to each, reported lower levels of burnout.
Another factor emerged from talking to these doctors. Almost 70% of the practices in the study were solo practices.
In many of the practices, doctors are working with an immigrant population and have a strong sense of commitment to their community, she says. Many doctors, particularly if they speak the language of their patients, feel if they were not taking care of those patients, they may have no access to healthcare.
As well as looking at ways of creating a workplace that supports physicians as occurs in these small practices, Shelley says another question is how can the healthcare system help these doctors in small practices remain independent.
“It’s not that these practices are not under duress,” she says, since many face financial stress as they try to adapt to new payment models and face increasing regulations. Yes, despite that stress, the doctors still experience less burnout.
Despite declines in the number of small practices in the United States, primarily due to market forces driving consolidation, close to 70% of all primary care office visits occur in small practice settings, according to the American Medical Association.
“There’s certainly value. I would hate to see them become extinct,” she says of those small, independent practices.
As of mid-2015, one in four medical practices was hospital-owned. And 2016 marked the first year in which physician practice ownership is no longer the majority arrangement, with physicians evenly distributed between owners and employees: 47.1% of doctors own their own practice, with the same percentage employed and 5.9% independent contractors.
SELF-DRIVING CAR DEVELOPERS SHOULD PUT PEDESTRIANS FIRST
Since march, when an autonomous vehicle killed a pedestrian in Arizona, forecasts for AVs have been decidedly less optimistic. But autonomous vehicle promoters are undeterred. AI entrepreneur Andrew Ng contends that self-driving cars will be safe for pedestrians when walkers and cyclists conform to their limitations. “What we tell people is, ‘Please be lawful and please be considerate,’” he told Bloomberg.
Has Mr Ng ever walked for as much as an hour in a city? If so, he should realize that consideration of pedestrians’ needs—and motorists’ compliance with the few laws that protect pedestrians—are so deficient that any pedestrian who values their time (as drivers do) must improvise. And in fact, such improvisation can even make pedestrians’ journeys safer.
To be fair, Mr. Ng’s mistake is a common one. From a driver’s point of view, pedestrians’ behavior may appear erratic, lawless, and even suicidal. The solution, then, is to train pedestrians to do better, or to restrict them. In actuality, most pedestrians are much smarter than the dumb systems that are intended to control them—far smarter than signals, and even smarter than self-driving cars. A pedestrian who is on the right side of the street and wants to turn left at the next intersection may cross early, at mid-block. What may appear to some as selfish and dangerous rule-breaking may actually be safer and less disruptive to vehicular traffic. In one study of pedestrians aged 65 or older, for example, researchers found that the risk of a pedestrian-motor vehicle collision was 2.1-fold greater at sites with marked crosswalks, particularly those with no traffic signal or stop sign.
In the 1970s, research teams led by William H. Whyte filmed pedestrians on busy sidewalks as they walked around New York City. Walkers filtered past each other with extraordinary efficiency, coming within inches of each other but almost never touching. Such performance requires human intelligence. No one would propose putting pedestrians on autonomous Segways as a way to keep them from colliding with each other. Either traffic would slow almost to a stop, or collisions would increase.
Autonomous vehicles are frequently touted as safer and more efficient alternatives to conventional cars. But if safety and efficiency are indeed primary values, then cities should not deter walking by making it harder, but invite more walking by making it easier. This would entail, among many other things, urging drivers to be more lawful and considerate about pedestrians.
Indeed, the success of self-driving cars depends upon a rise in walking as a practical means of getting around. AVs cannot deliver on their own promises of safety and efficiency if they deter walking. Safety matters because we care about human health. Sedentary living is already inducing health conditions such as heart disease, obesity, and diabetes; public health can only worsen if an autonomous future compels people to ride in cars for every mobility need. And self-driving cars will not be more efficient if we negate their per-mile efficiency benefits by increasing the total miles each person spends in the car.
Smart traffic signals can increase streets’ vehicle capacity by shepherding cars safely through intersections without compelling them to stop. But we don’t yet know how they’d work for cyclists and pedestrians, those who make the most efficient use of street space, use the least energy, and cause the least danger to others. Either they will have to be equipped with devices that incorporate them into signal systems, or smart signal systems will have to get much better at detecting and tracking them. The social and technical complications of either alternative are substantial.
In the meantime, we have access to innumerable low-tech possibilities. Traffic calming—design features that slow vehicles down—can make select streets much safer for everyone. Planners in the Netherlands, for example, apply humans’ smartness, instead of trying to suppress it, by designating certain streets “bicycle streets”; though drivers can still use them as “guests,” they must defer to cyclists. By conventional U.S. standards, this method is considered dangerous because it depends too much on human judgment. But the traffic safety record in the Netherlands should compel us to reconsider. In 2013, there were 3.4 road traffic deaths per 100,000 people in the Netherlands; the figure for the U.S. was 10.6. Extravagant promises about the driverless future too often distract us from implementing effective, inexpensive, low-tech improvements today.
To succeed on their own terms, AV developers will have to do much better by pedestrians. Bloomberg reports that AV developers are looking into “distinctive sounds—much like the beeping noise large vehicles make when reversing—to help ensure safe interactions between humans and autonomous vehicles.” This technique, in the form of the klaxon or car horn, is well over a century old. Honking was then attacked as a public health menace. Today, such noises can only make the walking environment less inviting, relative to the quiet, climate-controlled interior of a vehicle. For pedestrians who can’t afford this alternative, walking will be less pleasant than ever.
Too often we hear extravagant promises for self-driving cars, or warnings that “the AV future is coming; we have to get ready.” But the saw does not use the carpenter; the carpenter uses the saw. AVs are a tool. We humans have to decide if and how we want to use them. Despite the public relations, AVs will not, on their own, deliver safety or efficiency. We have to put them to work for the purposes of our choosing.
Chinese electric vehicle maker Nio closes 10 per cent up in New York IPO debut
In one of the year’s largest Chinese public offerings in the US, Nio, an electric-vehicle maker backed by the Chinese technology giant Tencent, debuted on the New York Stock Exchange Wednesday and closed up nearly 10 per cent.
Nio stock opened below range at US$6 a share, and had a mixed reception on a day when the Dow Jones Industrial Average was flat. After dropping to a low of US$5.35, however, shares recovered to close up at US$6.58.
Nio raised US$1 billion and has a goal to turn profitable within three to four years.
Founded by Chinese entrepreneur William Li in 2014 and based in Shanghai, Nio is regarded as China’s answer to Tesla, with its ES8 pure-electric, seven-seat sport-utility vehicle being compared to Tesla’s Model X.
Like Tesla, Nio continues to report a loss, posting a net loss of US$502.6 million in the first six months of 2018 on revenue of US$6.95 million, according to the company. Nio which is still at the outset of production, has sold 2,100 vehicles so far.
“We are aiming to turn a profit within three to four years by focusing on the Chinese market before going global,” Nio Chief Financial Officer Louis Hsieh told the South China Morning Post on Wednesday. “China accounts for about 60 per cent of the electric vehicle market in the world.”
The IPO comes as China continues to push into the electric-vehicle market. About 375,000 vehicles were manufactured by China in 2016, counting for about 43 per cent of total production globally, according to McKinsey & Company.
Nio, formerly known as NextEV, is backed by Tencent Holdings, along with other high-profile corporate investors including the tech giant Baidu, private equity firm Hillhouse Capital and Temasek, a holding company owned by the government of Singapore.
All the early investors have kept their stakes in the company at the time of the IPO, said Hsieh, indicating their faith in Nio’s prospects.
In the immediate future, however, uncertainty is building as trade disputes between the US and China continue to escalate.
“Tariffs currently help us for now because they make US cars more expensive,” Hsieh said. “But this is something we are monitoring closely as situations evolve.”
While acknowledging the comparison between Nio and Tesla, he said that Nio regards other high-end brands such as Mercedes and Audi as competitors as well.
“We are catering to the premium car buyers in China who want bigger cars like SUVs and that is how we design the cars,” said Hsieh said.
USS New York sailors pause to honor 9/11 victims, first responders
The sailors of Mayport-based Naval ship USS New York remember the Sept. 11 terrorist attacks every day.
Seven and a half tons of steel remains from the World Trade Center towers literally helped build their ship, reminding those on board daily of the sacrifices of the first responders.
The hat of a fallen police officer and the helmet of a fallen firefighter are displayed inside the ship, and a surviving fireman’s jacket hangs in the ship’s bridge, always standing guard as the crew’s “12th man.”
On the 17th anniversary of the worst act of terrorism on U.S. soil, hundreds of sailors gathered Tuesday for a brief but emotional ceremony at Naval Station Mayport.
Capt. Brent Devore spoke about the 9/11 memorial items throughout the ship, which is one of only three Navy ships with items from the World Trade Center.
“We constantly say that every day is 9/11 and that we have to constantly remind ourselves we’re surrounded by the heroes,” Devore said. “We know that Trade Center steel is baked into the ship. We have memoirs throughout the entire ship that remind us of the first responders and all of the families who gave the sacrifice.”
News clips showing the planes hitting the Twin Towers had sailors holding back tears during the remembrance ceremony as they listened to the screams and cries of people on the ground that day.
As the video played, smoke was released from one of several areas of the ship that includes steel from the World Trade Center, serving as a reminder of what New York City residents and first responders saw for weeks, even months after the attacks — a plume of smoke that made losing thousands even more difficult.
Shivanane Harry, a sailor from New York City, said the attacks affected his career path.
“It will be in the history books. It’s one of those things that’s going to be there — remember the people that passed,” Harry said. “I’m here, and that’s one of the reasons why I joined the military.”
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