Search Results

You are looking at 1 - 10 of 14 items for :

  • "medical economics" x
Clear All
Full access

Daniel L. Friedlich, Paul J. Feustel and A. John Popp

Object

The workforce demand for neurosurgeons was quantified by a review and an analysis of journal recruitment advertisements published over the past 13 years.

Methods

A retrospective analysis of recruitment advertisements from July 1985 through June 1998 was performed by examining issues of the Journal of Neurosurgery and Neurosurgery. Advertisement information that appeared in each journal during the last 3 years was collected from alternating months (July to May); information that appeared prior to that time was collected from alternating recruitment years back to 1985. The authors examined the following workforce parameters: practice venue, subspecialization, and practice size.

They found no significant decrease in neurosurgical recruitment advertisements. There was an average of 102.7 ± 22.4 (standard deviation) advertised positions per year during the most recent 3 years compared with 92.6 ± 17.9 advertised positions per year during the preceding decade. Similarly, there has been no decline in advertised positions either in academic (33 ± 6.1/year for the most recent 3 years compared with 32.8 ± 5.9/year for 1985–1995) or private practice (69.7 ± 21.6/year for the most recent 3 years compared with 59.8 ± 13.4/year for 1985–1995). A shift in demand toward subspecialty neurosurgery was observed. During the past 3 years, 31.2 ± 5.9% of advertised positions called for subspecialty expertise, compared with 18.5 ± 2.8% for the preceding decade (p < 0.05). The largest number of subspecialty advertisements designated positions for spine and pediatric neurosurgeons. Private practice advertisements increasingly sought to add neurosurgeons to group practices.

Conclusions

Contrary to previous reports and a prevailing myth, our data show no decrease in workforce demand for neurosurgeons in the United States over the past 3 years compared with the prior decade. A shift toward subspecialist recruitment, particularly for spine neurosurgeons, has been demonstrated in both academic and private practice venues.

Restricted access

Joseph T. King Jr., Henry A. Glick, Thomas J. Mason and Eugene S. Flamm

✓ Cost-effectiveness analysis uses both economic and clinical outcomes data to evaluate treatment options. In this era of economic constraints on health care, treatments that are not cost-effective will increasingly be denied public and private insurance reimbursement. The authors used mathematical modeling techniques to assess the cost-effectiveness of elective surgery for the treatment of asymptomatic, unruptured, intracranial aneurysms. Input values for the Markov model used in this study were determined from both the literature and clinical judgment. Direct medical costs for hospitalization and physician fees were derived from Medicare cost reports and resource-based relative-value units, expressed in 1992 U.S. dollars. Costs and benefits were discounted at an annual rate of 5%.

Using baseline model assumptions for a 50-year-old patient, elective aneurysm surgery provides an average of 0.88 additional quality-adjusted life years (QALYs) compared with nonsurgical treatment. However, prompt elective surgery ($23,300) costs more than expectant management ($2100), in which only patients whose aneurysms rupture incur treatment costs. Combining the outcomes and cost data, the incremental cost-effectiveness of elective aneurysm surgery is $24,200 per QALY, which is comparable to other accepted medical or surgical interventions, such as total knee arthroplasty ($15,200/QALY) or antihypertensive therapy in a 50-year-old patient ($29,800/QALY).

Prompt elective surgery for asymptomatic, unruptured, intracranial aneurysms is recommended as a cost-effective use of medical resources provided: 1) surgical morbidity and mortality remain at reported levels; 2) the patient has a life expectancy of at least 13 additional years; and 3) the patient experiences a decrease in quality of life from knowingly living with an unruptured aneurysm.

Restricted access

Daniel L. Friedlich, Paul J. Feustel and A. John Popp

Object. The workforce demand for neurosurgeons was quantified by a review and an analysis of journal recruitment advertisements published over the past 13 years.

Methods. A retrospective analysis of recruitment advertisements from July 1985 through June 1998 was performed by examining issues of the Journal of Neurosurgery and Neurosurgery. Advertisement information that appeared in each journal during the last 3 years was collected from alternating months (July to May); information that appeared prior to that time was collected from alternating recruitment years back to 1985. The authors examined the following workforce parameters: practice venue, subspecialization, and practice size.

They found no significant decrease in neurosurgical recruitment advertisements. There was an average of 102.7 ± 22.4 (standard deviation) advertised positions per year during the most recent 3 years compared with 92.6 ± 17.9 advertised positions per year during the preceding decade. Similarly, there has been no decline in advertised positions either in academic (33 ± 6.1/year for the most recent 3 years compared with 32.8 ± 5.9/year for 1985–1995) or private practice (69.7 ± 21.6/year for the most recent 3 years compared with 59.8 ± 13.4/year for 1985–1995). A shift in demand toward subspecialty neurosurgery was observed. During the past 3 years, 31.2 ± 5.9% of advertised positions called for subspecialty expertise, compared with 18.5 ± 2.8% for the preceding decade (p < 0.05). The largest number of subspecialty advertisements designated positions for spine and pediatric neurosurgeons. Private practice advertisements increasingly sought to add neurosurgeons to group practices.

Conclusions. Contrary to previous reports and a prevailing myth, our data show no decrease in workforce demand for neurosurgeons in the United States over the past 3 years compared with the prior decade. A shift toward subspecialist recruitment, particularly for spine neurosurgeons, has been demonstrated in both academic and private practice venues.

Restricted access

William E. Gordon, William M. Mangham, L. Madison Michael II and Paul Klimo Jr.

OBJECTIVE

The cost of training neurosurgical residents is especially high considering the duration of training and the technical nature of the specialty. Despite these costs, on-call residents are a source of significant economic value, through both indirectly and directly supervised activities. The authors sought to identify the economic value of on-call services provided by neurosurgical residents.

METHODS

A personal call log kept by a single junior neurosurgical resident over a 2-year period was used to obtain the total number of consultations, admissions, and procedures. Current Procedural Terminology (CPT) codes were used to estimate the resident’s on-call economic value.

RESULTS

A single on-call neurosurgical resident at the authors’ institution produced 8172 work relative value units (wRVUs) over the study period from indirectly and directly supervised activities. Indirectly supervised procedures produced 7052 wRVUs, and directly supervised activities using the CPT modifier 80 yielded an additional 1120 wRVUs. Using the assistant surgeon billing rate for directly supervised activities and the Medical Group Management Association nationwide median neurosurgery reimbursement rate, the on-call activities of a single resident generated a theoretical billing value of $689,514 over the 2-year period, or $344,757 annually. As a program, the on-call residents collectively produced 39,550 wRVUs over the study period, or 19,775 wRVUs annually, which equates to potential reimbursements of $1,668,386 annually.

CONCLUSIONS

Neurosurgery residents at the authors’ institution theoretically produce enough economic value exclusively from on-call activities to far exceed the cost of their education. This information could be used to more precisely estimate the true overall cost of neurosurgical training and determine future graduate medical education funding.

Restricted access

Venkat K. Rao, Paul D. Feldman and David G. Dibbell

J Med 311 : 1186 – 1187 , 1984 (Letter) Kilarski DJ, Buchanan C, Von Behren L: Soft-tissue damage associated with intravenous phenytoin. N Engl J Med 311: 1186–1187, 1984 (Letter) 6. Paul WL : Phenytoin injection precautions. Clin Pharm 5 : 370 – 371 , 1986 (Letter) Paul WL: Phenytoin injection precautions. Clin Pharm 5: 370–371, 1986 (Letter) 7. Physicians' Desk Reference , ed 41 . Oradell, NJ : Medical Economics , 1987 , pp 1480 – 1481 Physicians' Desk Reference, ed 41

Restricted access

Franklin D. Westhout, Michael G. Muhonen and Chiedozie I. Nwagwu

administration: discussion of propofol and review of the literature . Pharmacotherapy 17 : 1331 – 1337 , 1997 11 McKillop D , Wild MJ , Butters CJ , Simcock C : Effects of propofol on human hepatic microsomal cytochrome P450 activities . Xenobiotica 28 : 845 – 853 , 1998 12 Medical Economics Company : Diprivan (propofol) Injectable Emulsion, 10mg/ml, (AstraZeneca Pharmaceuticals, LP, Wilmington, DE) . in Physicians’ Desk Reference ed 60 Montvale, NJ , Thompson PDR , 2006 . p 676 13 Osaka Y , Inomata S , Tanaka E , Nakamura T , Honda

Restricted access

Frank Turnbull

medical profession as a whole, having in mind the problems of medical economics. This Society was formed during a period that some dismal realists now refer to as the “Hungry Thirties.” It was a time when agencies outside of medicine were beginning, in this country, to scrutinize critically the costs of medical care. Dr. Cushing was keenly aware of the far-reaching implications of the problems and became earnestly involved in the activities of a committee of national importance. The story is well told by John Fulton. 2 During 1934–35, Dr. Cushing was a member of the

Restricted access

Melissa LoPresti, Sandi Lam, Katie Orrico, Samuel R. Browd, Richard G. Ellenbogen and Jonathan Martin

of Membership Support Public health  Transitional care 55.71%  Abusive head trauma 52.86%  Sports safety and health 42.86%  Trauma systems 31.43%  Firearm safety 31.43%  International health 11.43% Clinical  Hydrocephalus 42.86%  Traumatic brain injury 38.57%  Spina bifida 25.71%  CNS tumors 10.00% Medical economics  Patient access to care 37.14%  Funding/reimbursement 27.14%  Medical liability reform 20.00%  Board certification and maintenance 15.71%  Graduate medical education 14.29%  Work–life balance 4.29% Dissenting Opinions Regarding Advocacy Role for the

Restricted access

Richard L. Rovit

Printing Office. 4. Cushing H : The Life of Sir William Osler. Oxford : Clarendon Press , 1925 , Vol 1 and 2 Cushing H: The Life of Sir William Osler. Oxford: Clarendon Press, 1925, Vol 1 and 2 5. Deckert GH : How to retire happy. Medical Economics 69 (11) : 73 – 80 , 1992 Deckert GH: How to retire happy. Medical Economics 69(11): 73–80, 1992 6. Garg A , Funke S , Janlsch D : One-handed dynamic pulling strength with special applications to lawn mowers