November 8, 2017| Today’s News

Study: Physicians who seek to reduce work hours or leave practice cite burnout and dissatisfaction as leading factors

Findings from a survey published in the November issue of the journal Mayo Clinic Proceedings suggest that many U.S. physicians intend to reduce their clinical work hours, and about one in 50 intend to leave medicine to pursue a different career. The research team surveyed 6,880 physicians during 2014 regarding the likelihood of reducing clinical hours in the next 12 months and the likelihood of leaving current practice within the next 24 months. Of the 6,695 physicians in clinical practice at the time of the survey, 19.8 percent of respondents reported it was “likely” or “definite” that they would reduce clinical work hours in the next 12 months. In addition, 26.6 percent indicated it was “likely” or “definite” that they would leave their current practice during the next 2 years. Of the latter group, 1.9 percent said that they planned to leave practice altogether and pursue a different career. Predictors of intent to reduce work hours or leave practice included burnout (odds ratio [OR] 1.81), dissatisfaction with work-life integration (OR 1.65), and dissatisfaction with electronic health records (OR 1.44).

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Study: What factors contribute to increases in healthcare spending?

A study published in the Nov. 7 issue of The Journal of the American Medical Association ( JAMA) examines factors that may affect growth in U.S. healthcare spending. The researchers reviewed data from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation’s U.S. Disease Expenditure 2013 project regarding five factors linked to healthcare spending: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity. After adjustment for price inflation, they found that annual healthcare spending increased from $1.2 trillion to $2.1 trillion from 1996 through 2013. The researchers estimate that changes in service price and intensity accounted for 50 percent of the increase in spending, followed by increases in the U.S. population (23.1 percent), and population aging (11.6 percent). They state that changes in disease prevalence or incidence were associated with spending reductions of 2.4 percent, and changes in service utilization were not associated with a statistically significant change in spending.

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A study conducted in China and published online in the journal Seminars in Arthritis & Rheumatism attempts to identify risk factors and clinical characteristics of injection-induced deep knee infection (DKI). The authors conducted a case-control study of 50 patients with intra-articular (IA) injection-induced DKI (21 sepsis arthritis [SA] and 29 chronic low-grade infection [CLGI]) and 250 non-infected control patients. They found that body mass index ≥25 kg/m ², corticosteroid injection, rheumatoid arthritis, and injections performed by general practitioners were associated with an increased risk of DKI following IA injection. The authors note that, compared to patients with CLGI, patients with SA had significantly higher metrics in the categories of fever, local warmth, swelling, rest pain, night pain, limited motion, serum white blood cell count, and C-reactive protein level.

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According to a study published in the Nov. 7 issue of JAMA, single-dose treatment with ibuprofen and acetaminophen may be as effective as three different opioid and acetaminophen combination analgesics for reducing acute extremity pain in patients who present to the emergency department (ED). The researchers conducted a randomized, controlled trial of 416 patients aged 21 to 64 years who presented with moderate to severe acute extremity pain. Patients received either 400 mg of ibuprofen and 1,000 mg of acetaminophen (n = 104), 5 mg of oxycodone and 325 mg of acetaminophen (n = 104), 5 mg of hydrocodone and 300 mg of acetaminophen (n = 104), or 30 mg of codeine and 300 mg of acetaminophen (n = 104). Among 411 patients analyzed, the researchers found that, at 2 hours, mean numerical rating scale (NRS) pain score decreased by 4.3 in the ibuprofen/acetaminophen group, 4.4 in the oxycodone/acetaminophen group, 3.5 in the hydrocodone/acetaminophen group, and 3.9 in the codeine/acetaminophen group. The researchers write that the largest difference in decline in NRS pain score from baseline to 2 hours was between the oxycodone/acetaminophen group and the hydrocodone/acetaminophen group, which was less than the minimum clinically important difference in NRS pain score of 1.3. They suggest that further research to assess adverse events and other dosing may be warranted.

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Findings from a study published online in the journal JAMA Surgery suggest that overlapping surgery may be safely performed if appropriate precautions and patient selection are taken into consideration. Members of the research team conducted a retrospective, cohort study of 2,275 patients who underwent neurosurgical procedures, of which 972 (42.7 percent) were nonoverlapping and 1,303 (57.3 percent) were overlapping. They found that median surgical times were significantly longer for patients in the overlapping cohort compared to the nonoverlapping cohort. However, regression analysis at 90-day follow-up failed to demonstrate an association between overlapping surgery and complications such as mortality, morbidity, or worsened functional status.

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AAOS Nominating Committee recommends 2018 slate

The AAOS Nominating Committee has released its recommended slate of nominees 120 days in advance of the business meeting at the Annual Meeting as required by AAOS Bylaws. Chaired by Frederick M. Azar, MD, the 2018 Nominating Committee included: James H. Beaty, MD (Tenn.); Andrew R. Burgess, MD (Texas); Serena S. Hu, MD (Calif.); Alexandra E. Page, MD (Calif.); Alexander Vaccaro, MD, PhD, MBA (Pa.); and Joseph D. Zuckerman, MD (N.Y.).

After an expansive search process, the development of Plans for Active Management of conflicts of interest and extensive discussion, the 2018 Nominating Committee recommended the following individuals to serve in the specified AAOS leadership positions:

• Second Vice-President: Joseph A. Bosco, III, MD (N.Y.)
• Treasurer-Elect: Alan S. Hilibrand, MD, MBA (Pa.)
• Member-at-Large (age 45 or older): Elizabeth G. Matzkin, MD (Mass.)
• Member-at-Large (under age 45): Thomas W. Throckmorton, MD (Tenn.)

The AAOS Nominating Committee also recommended four nominees and two alternate nominees to the American Board of Orthopaedic Surgery (ABOS) Board of Directors:

• ABOS Nominee: Matthew B. Dobbs, MD (Mo.)
• ABOS Nominee: Michael F. Fry, MD (Nev.)
• ABOS Nominee: Kevin L. Garvin, MD (Neb.)
• ABOS Nominee: William R. Martin III, MD (Alaska)
• ABOS Nominee (Alternate): Donald H. Lee, MD (Tenn.)
• ABOS Nominee (Alternate): Afshin Razi, MD (N.Y.)

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AAOS is sponsoring 15 young investigators to attend and present their research at the upcoming AAOS/Orthopaedic Research Society (ORS) symposium. The Physis: Fundamental Knowledge to a Fantastic Future through Research Symposium will be held Feb. 7 to 9, 2018, in Rosemont, Ill. AAOS is seeking abstracts on research addressing growth plate function, regulation, or novel treatments for physeal disorders. Selected young investigators will present a poster during a dedicated poster session and have the opportunity to learn from experienced mentors in the field. In addition, authors of five selected abstracts will be invited to give a podium presentation. Selected young investigators will receive airfare, lodging, and meals at the event. The submission deadline is Dec. 1, 2017.

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