As physicians increasingly assume executive leadership roles within health systems, they encounter heightened accountability and diminished job security. Termination from executive leadership is becoming an increasingly realistic occupational risk for physician leaders. Despite this trend, formal preparation for job loss remains largely absent from physician leadership training and professional development. Involuntary job loss among physician executives is an inherent hazard of leadership rather than a marker of individual failure. Organizational and management theory, particularly themes around transformational leadership and role identity, along with practical experience offer lessons to promote readiness, resilience, and professional continuity before, during, and after termination. Key domains include proactive negotiation of executive compensation, maintenance of clinical skills as a professional safety net, recognition of early organizational warning signs, and practical steps to protect professional assets and networks. Emotional and relational consequences of termination, including loss of role-based authority, shifts in professional identity, and changes in collegial relationships are also essential considerations. Ultimately, termination should be a catalyst for professional reinvention and appreciating the breadth of opportunities available to experienced physician leaders across health systems, industry, and clinical practice. Job loss is a foreseeable component of physician executive leadership. Deliberate preparation will strengthen leadership effectiveness, reduce fear-driven decision-making, and support sustainable, values-based leadership in healthcare organizations.
To determine which patient, physician, physician-group, and geographic factors influence the likelihood of health care visits to family physicians (FPs) outside of patients' enrolling physician groups. Cross-sectional analysis using administrative health data. A multilevel logistic regression model was used to determine the probability of outside use based on a set of observable factors at the patient and physician-group levels, accounting for the variation attributable to the patient, physician, physician-group, and geographic levels. Ontario. Patients enrolled in family health organizations (FHOs) during the study period from April 1, 2018, to March 31, 2019. Outside use, defined as an encounter with an FP outside of the patient's enrolling physician group who submitted an Ontario Health Insurance Plan fee code in the FHO core primary care services. Patient-level factors explained 83.7% of the variation in outside use probability. Physician- and physician-group-level variations each explained less than 2% of outside use probability, while 14.2% was explained at the physician-group geographic level. Patient-level factors associated with outside use included age (oldest versus [vs] youngest cohort, odds ratio [OR]=0.44, 95% confidence interval [CI] 0.42 to 0.45); female sex (OR=1.21, 95% CI 1.19 to 1.23); expected relative health care costs (highest vs lowest complexity score quintile, OR=3.65, 95% CI 3.53 to 3.79); distance from enrolled physician group (longest vs shortest travel time, OR=2.10, 95% CI 2.01 to 2.19); and FP to population need ratio (highest vs lowest quintile, OR=1.71, 95% CI 1.62 to 1.80). Statistically significant physician-group-level variables (P<.05) included Rurality Index for Ontario scores, group size, years of existence, proportion of female physicians, average age, and number of weekend and holiday days worked per patient. Physician- or physician-group-level policy options for effectively reducing outside use may include increasing group size to more than 5 and increasing weekend and holiday days worked per patient and after-hours care. However, because outside use is primarily explained by variations at the patient level, other innovative policy options may need to be implemented to improve care continuity. Déterminer quels patients, médecins, groupes de médecins et facteurs géographiques influent sur la probabilité de consultations médicales auprès de médecins de famille (MF) autres que ceux qui font partie du groupe avec lequel les patients sont inscrits. Une analyse transversale à l’aide de données administratives sur la santé. Un modèle de régression logistique multiniveaux a été utilisé pour déterminer la probabilité d’une utilisation hors patientèle inscrite en se fondant sur un ensemble de facteurs observables sur les plans du patient et du groupe de médecins, en tenant compte de la variation attribuable au patient, au médecin, au groupe de médecins et à la situation géographique. L’Ontario. Les patients inscrits dans des organisations de santé familiale (OSF) durant la période à l’étude, soit du 1er avril 2018 au 31 mars 2019. L’utilisation hors patientèle, définie comme étant la consultation d’un MF autre que ceux du groupe de médecins avec lequel le patient est inscrit qui a présenté un code de facturation de l’Assurance-santé de l’Ontario dans les services de soins primaires de base des OSF. Les facteurs au niveau du patient expliquaient 83,7 % de la variation dans la probabilité d’une utilisation hors patientèle. Les variations au niveau du médecin et au niveau du groupe de médecins expliquaient respectivement moins de 2 % de la probabilité d’une utilisation hors patientèle, tandis que 14,2 % s’expliquaient sur le plan de la localisation géographique du groupe de médecins. Les facteurs au niveau du patient associés avec une utilisation hors patientèle incluaient l’âge (cohorte plus vieille contre [c.] plus jeune, rapport de cotes [RC]=0,44, intervalle de confiance [IC] à 95 % de 0,42 à 0,45); sexe féminin (RC=1,21, IC à 95 % de 1,19 à 1,23); les coûts relatifs prévus des soins de santé (quintile des scores de complexité le plus élevé c. le plus bas, RC=3,65, IC à 95 % de 3,53 à 3,79); distance du groupe de médecins avec lequel le patient est inscrit (durée du trajet la plus longue c. la plus courte, RC=2,10, IC à 95 % de 2,01 à 2,19); et ratio de MF par rapport aux besoins de la population (quintile le plus élevé c. le plus bas, RC=1,71, IC à 95 % de 1,62 à 1,80). Les variables statistiquement significatives au niveau du groupe de médecins (p<,05) incluaient les scores à l’Indice de ruralité de l’Ontario, la taille du groupe, les années d’existence, la proportion de femmes médecins, l’âge moyen et le nombre de jours la fin de semaine et les jours fériés travaillés par patient. Parmi les options pour réduire efficacement l’utilisation hors patientèle sur le plan des politiques s’appliquant au niveau du médecin ou du groupe de médecins, on peut mentionner l’augmentation de la taille du groupe à plus de 5 et du nombre d’heures travaillées par patient la fin de semaine et les jours de congé, de même que des soins après les heures normales. Par ailleurs, parce que l’utilisation hors patientèle s’explique principalement par des variations au niveau du patient, d’autres options novatrices de politiques pourraient devoir être mises en œuvre pour améliorer la continuité des soins.
Physician and advanced practice provider (APP) well-being is a critical focus in healthcare. Emerging technology such as generative artificial intelligence (GAI) scribes reduces physician and APP administrative burden created by electronic health records. Early adopters of this technology have demonstrated promising improvements in clinical documentation, well-being, and cognitive load. However, further exploration across professional roles is warranted. The goal of this quality improvement initiative was to explore how GAI scribes impacted well-being, cognitive load, and practice efficiency among physicians and APPs across professional roles. A cross-sectional anonymous survey was conducted prior to implementation of GAI scribe technology and 3 months after physicians and APPs were onboarded. Physicians and APPs showed a reduction in cognitive task load following scribe technology implementation. Physicians reported reduced burnout and intent to leave; however, APPs did not have a significant reduction in burnout or intent to leave. Artificial intelligence scribe technology shows potential for improving well-being among physicians and APPs by reducing cognitive load and clinical documentation time. Although some differences were found, overall, the technology appears to hold promise across professional roles.
The term twice-exceptional (2e) describes individuals who combine high intellectual potential with neurodevelopmental or psychiatric conditions that may impair performance in traditional environments. While this concept has been increasingly recognized in education, its relevance to medical training and practice has received little attention. This case series presents five physicians across different stages of training who exemplify twice-exceptionality, highlighting both their cognitive strengths and the barriers they faced in clinical environments. The first case involves a surgical resident with nonverbal learning disorder (NVLD), attention deficit hyperactivity disorder (ADHD), and type 1 diabetes whose superior intellect masked significant executive dysfunction until repeated crises prompted disclosure and pursuit of accommodations. The second case describes a resident with ADHD and perfectionism who, through structured coping strategies and mentorship, thrived in a supportive environment. A third case highlights a senior resident with anxiety and obsessive-compulsive disorder whose perfectionism and rumination undermined efficiency and self-confidence despite positive evaluations. The fourth case involves an attending physician with ADHD and obsessive traits who maintained professional success through compensatory overwork but experienced disorganization, fatigue, and burnout. The fifth case describes another attending physician with ADHD, anxiety, and depression whose intellectual giftedness coexisted with executive dysfunction and impaired self-care, leading to chronic struggles despite ongoing treatment. Across these cases, recurring themes emerge: masking of disability by high achievement, misattribution of neurodivergent struggles as professionalism deficits, and delayed or absent accommodations. While some physicians succeed in supportive environments, others experience isolation, burnout, or attrition when their needs remain unrecognized. These cases underscore the paradox of twice-exceptionality in medicine, where extraordinary potential and hidden vulnerabilities coexist. Greater recognition of this duality is essential to building neurodiversity-affirming environments that move beyond deficit-based models, reduce stigma, and foster structures in which talented but vulnerable physicians can thrive.
Health care professionals may experience second victim syndrome (SVS) after adverse events or critical incidents in the workplace. This may result in untoward consequences: second victims may feel personally responsible for patient outcomes, second guess their clinical skills and knowledge, are at increased risk of future errors and have increased turnover intention. Peer support programs (PSP) are one iteration of institutional support that has the potential to systematically intervene in SVS. PSPs can reduce emotional distress, foster coping strategies, promote resilience, and reduce turnover intention. We describe the novel, broad approach to implementing an enterprise-wide physician and advanced practicing provider (APP) specific PSP at a large urban academic medical center. Since the program launch, 107 physicians and APPs across all departments have been trained as peer supporters. In the first year of program implementation (2023), there were 10 physicians and 5 APP referrals. In the second year (2024), utilization increased by 63% with 27 physicians and 3 APP referrals, with consistent utilization into 2025 with 22 physicians and 3 APP referrals. The program was utilized by physicians and APPs across 16 departments. The top 3 reasons for referral included patient death (37%, 26/70), emotional stress (39%, 27/70), and other (43%, 30/70). Most referrals (61%, 43/70) had no/unknown peer supporter departmental preference. Our experience demonstrates the feasibility of implementing an institutional PSP in a large urban academic medical center if there is executive sponsorship, dedicated program leadership, an existing institutional culture of safety, and education/training that increases awareness of SVS.
This observational study using the national US Medicare claim databases aimed to examine the association of patient and physician sex with statin discontinuation. We used data on a 20% random sample of Medicare fee-for-service beneficiaries aged 66-99 years who initiated statins for primary prevention (absence of the historical diagnosis of myocardial infarction, ischemic heart disease, stroke, transient ischemic attack, and peripheral vascular disease) from January 2017 to June 2019. The primary outcome was early discontinuation (defined as the lack of second dispense at year 1), adjusting for patient demographics, comorbidities, concomitant medications, and physicians' age and specialty. Of 423,404 patients who initiated statins, 43,053 (10.2%) experienced early discontinuations. The adjusted risk of early discontinuation was similar but slightly lower when initiated by female physicians at 9.9% [95% confidence interval (CI), 9.1 to 10.6] versus male physicians at 10.3% (95% CI, 9.6 to 11.0) with an adjusted risk difference (aRD) of -0.4 percentage-points (pp) (95% CI, -0.7 to -0.2; p < 0.001). When stratified by patient sex, the findings were similar in both female patients (aRD, -0.5 pp.; 95% CI, -0.7 to -0.2; p < 0.001) and male patients (-0.5 pp.; 95% CI, -0.8 to -0.1; p = 0.007). The findings were consistent regardless of the diabetes status or the intensity of statins. Using the nationwide administrative databases, we found that both older female and male patients were slightly less likely to experience early discontinuation of statins when prescribed by female versus male physicians, though the differences were clinically small.
Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized as a lifespan neurodevelopmental condition that persists into adulthood in a substantial proportion of individuals. Despite growing awareness, adult ADHD is frequently underrecognized, particularly in those with high intellectual ability and sustained academic or professional success. Misconceptions that high achievement without external supports excludes ADHD can delay diagnosis. This case describes a physician in his 30s with lifelong inattentive symptoms and inefficiency, who excelled in patient care yet struggled with selective task organization and completion. Years earlier, his difficulties were attributed to depression, likely influenced by the demands of medical training. When attentional symptoms persisted and began to affect personal relationships, he underwent a comprehensive neuropsychological evaluation. Testing revealed selective attentional and executive functioning vulnerabilities consistent with ADHD, Predominantly Inattentive Presentation. Depressive symptoms, including guilt and self-blame, were secondary to repeated lapses in attention and incomplete task follow-through. Receiving a formal ADHD diagnosis was profoundly clarifying, allowing the patient to pursue targeted interventions and better understand the relationship between chronic inefficiencies and self-perception. This case illustrates the value of neuropsychological assessment in clarifying diagnosis when achievement history may mask symptoms or when depressive features appear prominent. Recognition of ADHD in high-functioning adults has implications for timely intervention, self-awareness, and optimization of personal and professional functioning.
Academic medical centers face mounting challenges in providing timely access to ambulatory care. University of California (UC), Davis Health's innovative "Access Plus" program was a pilot program designed to expand ambulatory care hours into evenings and weekends while addressing physician work-life preferences. Launched in January 2023, the program offered physicians the option to provide care during extended hours for enhanced compensation. The initiative specifically targeted new patient appointments and UC Davis Health employees and families, creating a strategic approach to enhance physician and employee support for the initiative, reducing median days to be seen while supporting workforce wellness. Over 18 months, 138 physicians participated, out of 800 physicians with an ambulatory practice (17.3%), and the program served 4,312 patients, including 3,236 new patients, achieving a median 21-day reduction in wait times for new patients. While the direct program was essentially cost-neutral (negative contribution margin of <1%), the initiative generated substantial downstream revenue, resulting in a total contribution margin of $13.3 million. The UC Davis Health experience demonstrates that academic health systems can successfully expand traditional operating hours through well-designed programs that balance physician preferences with organizational goals to meet patient needs. This approach not only improves patient access but also maintains physician acceptance and has paved the way for other health system initiatives to enhance ambulatory care delivery, leveraging physician workforce engagement.
Arthritis and cognitive decline are significant health challenges in ageing populations, yet their association across diverse socioeconomic and cultural contexts remains insufficiently understood. This study examines the relationship between cognitive function and arthritis prevalence among adults aged 50 years and older, utilising data from 3 longitudinal ageing cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the English Longitudinal Study of Ageing (ELSA). The analysis included 18,562 participants from CHARLS, 23,238 from HRS, and 9848 from ELSA, all aged =50 years with physician-diagnosed arthritis and cognitive assessments. Cognitive function was evaluated across memory, orientation, and executive function domains, standardised as z-scores within each cohort. Generalised Estimating Equations (GEE) and Generalised Linear Mixed Models assessed the longitudinal association between cognition and arthritis, adjusting for sociodemographic factors, lifestyle variables, and comorbidities. Sensitivity analyses validated the findings- robustness. In fully adjusted GEE models, executive function was significantly associated with arthritis. Each 1-standard deviation (SD) lower executive score was associated with higher arthritis odds: CHARLS odds ratio (OR) 1.000 (95% confidence interval [CI] 1.000-1.001, P=0.016), HRS OR 1.13 (95% CI 1.01-1.28, P=0.037), and ELSA OR 1.07 (95% CI 1.02-1.12, P=0.009). Neither episodic memory nor orientation showed significant associations (all P>0.10), and total cognition in HRS was significant. Mixed-model estimates were concordant, and alternative correlation structures yielded consistent executive- arthritis links. Across 3 major ageing cohorts, impaired executive function is independently associated with higher odds of arthritis in adults aged =50 years. Targeting executive deficits may enhance early identification and integrated management of arthritis and cognitive health in ageing populations.
The NHS has introduced a range of new and extended roles in recent decades. Physician associates / assistants (PAs) have become one of the most politically scrutinised of these roles. In 2024, the UK government-commissioned Leng Review highlighted national concerns around the clarity, governance, supervision, and career development of PAs, but offered limited guidance for NHS organisations to operationalise them. This study, initiated prior to and independent of the Leng Review, examined how NHS hospitals and clinical teams in England and Scotland develop, integrate, retain, and support PAs in practice. We conducted a multiple-case qualitative study across five NHS organisations in England and Scotland. Semi-structured interviews (n = 126) and one focus group (n = 8) were undertaken with PAs, consultants, resident doctors, other team members, senior organisational leaders, and stakeholders involved in workforce planning, supervision, and governance. Data were analysed thematically using a framework informed by prior scoping review and organised across macro (system), meso (organisational), and micro (individual/team) levels, with within- and cross-case comparisons. We identified 12 themes across macro, meso, and micro levels of the health system. At the macro-system level, labour market dynamics, fluctuating policy and regulatory signals, and wider public and professional debates, influenced organisational confidence in the PA role. At the meso-organisational level, PA role implementation was sometimes driven by well-intentioned local leaders responding to service needs but with short-term business case logics and pragmatic pressures, rather than long-term workforce planning. Governance arrangements were often developed retrospectively and inconsistently communicated. At the micro-team level, PAs' interpersonal skills and contribution to continuity of care were widely valued, though progression remained highly variable and reliant on local supervision and individual negotiation. The development, integration, retention, and career progression of PAs in hospitals are shaped by interacting system, organisational, team and individual influences. Many of these challenges reflected wider NHS workforce implementation dynamics, rather than features unique to PAs. To continue to support safe, effective, and sustainable use of PAs, and other new and extended roles, organisations and clinical teams need strong workforce planning, local change management processes, and fair career pathways.
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Workforce data analyses of contemporary US podiatric physicians might be relatively lacking in comparison to other specialties. This information is important given concerns for the aging US population and predicted long-term physician shortages. The objective of this investigation was to provide a comprehensive contemporary demographic and geographic descriptive analysis of the podiatric specialty in the US. Epidemiologic descriptive analysis. The National Downloadable File produced by the Centers for Medicare & Medicaid Services (CMS) was accessed in July 2025. Demographic and geographic data related to those physicians with a credential of "DPM" was extracted and analyzed. The number of podiatric physicians with an active NPI was 15658. Of these, 70.9% were male. 22.8% graduated from podiatric medical school prior to 1991, while 31.6% graduated after 2011. Podiatric physicians with an active NPI billed within 6678 different zip codes and at 26386 different billing addresses. Although it was most frequent for DPMs with an active NPI to bill from one address (37.8%), the mean±standard deviation (range) of billing addresses per NPI was 1.7 ± 1.5 (1-50). The results of this investigation provide unique information on the demographic and geographic characteristics of podiatric physicians with an active NPI. It is our hope that this primarily descriptive raw data is utilized by state and national organizations for improved work force analyses for the podiatric specialty.
The enactment of the Korean Nursing Act emerged through a prolonged and conflict-laden policy process shaped by workforce instability, interprofessional conflict, and changing political conditions within the Korean healthcare system. Recent healthcare crises, including the COVID-19 pandemic and the 2024 healthcare service vacuum, further intensified policy attention toward nursing workforce governance and healthcare system sustainability. This study examines the legislative trajectory and postenactment policy developments of the Korean Nursing Act between 2005 and 2025 through the analytical lens of Kingdon's Multiple Streams Framework (MSF). Using qualitative document analysis, this study analyzed legislative bills, National Assembly records, government documents, organizational statements, media reports, and academic literature related to the Nursing Act. The analysis focused on interactions among the problem, policy, and politics streams, as well as the role of policy windows and policy entrepreneurs throughout the legislative process. The findings indicate that longstanding issues-including poor working conditions, ambiguity in nursing roles, workforce instability, and concerns regarding healthcare sustainability-gradually evolved from profession-specific grievances into broader public policy concerns. Focusing events such as the COVID-19 pandemic and the 2024 healthcare service vacuum substantially strengthened the problem stream and altered the political environment surrounding the legislation. The policy stream evolved through repeated revision, negotiation, and conflict over issues including professional boundaries, the "community" clause, and physician assistant (PA) nurses. Within the politics stream, partisan realignment, organized interest-group conflict, and executive intervention significantly influenced the trajectory of policy change. Although convergence among the problem, policy, and legislative political streams enabled passage of the Nursing Act during the 21st National Assembly, presidential veto power ultimately disrupted policy adoption. Enactment during the 22nd National Assembly became possible only after crisis-driven political realignment weakened institutional resistance and enabled renewed stream coupling. This study demonstrates that stream convergence within healthcare policymaking processes may remain unstable under presidential systems characterized by strong executive authority. The findings extend existing applications of the MSF by illustrating how executive veto power may destabilize policy convergence even after substantial legislative agreement has emerged. The study provides important implications for healthcare workforce governance, nursing leadership, and policy advocacy in aging societies facing healthcare workforce shortages. The findings suggest that effective nursing policy reform requires sustained interprofessional coordination, strategic policy entrepreneurship, and governance systems capable of responding flexibly to healthcare crises and workforce instability.
Driving engages cognitive, sensory, motor, and visual functions, all of which may become compromised in patients with brain tumours or brain metastases. Many of these diagnoses are incurable and clinically dynamic, which poses added risk to safety on the road. While driving restrictions are essential for public safety, they may reduce patient independence and quality of life, particularly in palliative contexts. In Canada, no tumour-specific national guidelines exist, highlighting the need for a multidisciplinary framework that balances patient well-being and public safety. A scoping review was conducted using Medline, American Psychological Association (APA) PsycInfo, and Google Scholar to identify studies examining driving safety, licensing outcomes, fitness-to-drive assessments, or the impact of driving restrictions among patients with primary brain tumours or brain metastases. Canadian national and provincial driving policies were further reviewed and compared with international guidelines. Findings were synthesized to identify determinants of driving safety and gaps in current regulatory frameworks. One hundred and seventy-five studies were initially screened and 13 met the inclusion criteria. Simulation-based and standardized driving assessments demonstrated that deficits in attention, executive function, visuomotor coordination, and visual processing were associated with impaired driving performance, even among patients with preserved functional status. Canadian guidance remains largely seizure-focused and defers to physician discretion, with limited incorporation of structured cognitive or functional assessment pathways. Canadian surveys revealed low physician confidence, limited awareness of existing resources, and variability in reporting practice. In contrast, international frameworks such as the United Kingdom Driver & Vehicle Licensing Agency provide tumour- and treatment-specific timelines, while Austroads emphasizes function-based assessment similar to Canada. Driving fitness assessment in patients with brain tumour is inconsistent in Canada, shaped by reliance on seizure history, heterogeneous provincial legislation, and lack of tumour-specific standards. Evidence supports a multidisciplinary, function-focused approach to driving fitness assessment that incorporates structured evaluation with ongoing reassessment. Development of national, brain-tumour specific guidelines is needed to ensure clear and safe decision-making for this patient population.
Thyroid eye disease (TED) can be visually debilitating and cosmetically disfiguring. Symptoms vary in severity and can lead to drastically impaired quality of life (QoL), ability to work, and mental health. The ElevaTED survey was developed to characterize impacts of TED on QoL, mental health, activities of daily living, sleep, work, and treatment experience. ElevaTED was conducted in July and August 2024. Participants included adult, US residents, with self-reported physician diagnosis of TED and symptoms that negatively impact daily life. Among 204 participants who completed the survey, mean age was 50 years (30 to 82) and 74% female. Most (93%) reported experiencing symptoms of TED within the prior month of survey participation, 23% categorized their symptoms as "mild" in severity, 58% "moderate", and 18% "severe." Mean number of symptoms experienced was 6 at any time and 3 in the past month, with the most common symptoms reported being "red, swollen, or burning eyes" and "pressure or pain around or behind the eyes." The majority (72%) of participants indicated their TED symptoms had a "moderate" or "major" impact on their daily life over the prior month. Negative impacts were reported in QoL, sleep, depression, anxiety, and work, across symptom severity groups. Over 80% are worried about their symptoms returning/worsening regardless of treatments and most want to discuss QoL/impacts with their physicians. The results of ElevaTED highlight the impact that TED has on daily activities and mental health and underscore the need for more in-depth physician-patient dialogue beyond the visible signs and symptoms.
Evaluating resident physicians is essential for resident development and patient safety. Fear of retaliation from residents may be a barrier to faculty completing resident physician evaluations. This study examined family medicine program directors' perceptions on fear of retaliation from resident physicians as a barrier to faculty completing honest, high-quality evaluations. The study was conducted as part of the 2024 Council of Academic Family Medicine Educational Research Alliance study of family medicine residency program directors. The 10-item survey assessed program directors' perceptions of faculty fear of retaliation, the impact of this fear, and rates of retaliation occurring in their programs in the last 3 years. The response rate was 45.39% (320/705). More than half (56.4%, 172/305) perceived that faculty in their programs are reluctant to give critical feedback on evaluations; nearly half (48.9%, 150/305) believed that fear of retaliation is a barrier. Fear of a reciprocal negative evaluation (34.5%, 106/305) and fear of formal complaints (38.9%, 119/305) were prevalent. Lack of adequate documentation was attributed to a failure to remediate and dismiss a resident in 19.8% (61/307) and 11.7% (36/306) of programs, respectively. Formal complaints against an evaluator or program occurred in 18.6% (57/307) of programs, and civil lawsuits were filed in 5.2% (16/306) in the preceding 3 years. Family medicine program directors perceive fear of retaliation from residents as a barrier to faculty completing honest, high-quality evaluations. Formal complaints and even civil lawsuits against evaluators or programs are not uncommon.
MD/MBA programs have expanded rapidly in the United States, providing formal training in management and organizational principles relevant to clinical and institutional practice. However, it remains unclear how this dual-degree training is reflected in senior academic medical leadership positions. This study evaluates how MD/MBA graduates are deployed as senior leaders and compares them with MBA-only administrators and MD-only physician leaders. The authors hypothesize that MD/MBA holders would be more frequently represented in finance, operations, and other system-facing roles relative to MD-only leaders. This study provided a cross-sectional analysis of senior leaders at the 50 U.S. medical schools receiving the most NIH funding in 2024. Public organizational charts and biographies identified educational backgrounds, leadership roles, and demographic information for deans, vice deans, associate deans, and assistant deans. Leadership titles were coded into 16 categories and then collapsed into six domains. Three groups were selected for comparative analysis: MD/MBA, MBA-only, and MD-only individuals. Descriptive statistics and a 3 × 6 Pearson chi-square test assessed differences in leadership placement; pairwise Fisher’s exact tests compared likelihoods of holding system-facing roles; and demographic comparisons used chi-square tests. p < 0.05 defined significance. Of 1,300 individuals screened, 634 met inclusion criteria (22 MD/MBA, 38 MBA-only, 574 MD-only). Leadership placement differed significantly across groups (χ²(10) = 119.5, p < 0.0001). MBA-only leaders were concentrated in system-facing roles (25/38), whereas MD/MBA graduates rarely held such positions (3/22) and resembled MD-only leaders (48/574) who were primarily assigned to educational and clinically-centered domains. MBA-only leaders were significantly more likely than MD/MBA (OR 12.18, 95% CI 3.03–48.9; p = 0.0004) or MD-only leaders (OR 21.07, 95% CI 10.12–43.85; p < 0.0001) to hold system-facing roles (i.e., school-level executive leadership roles involving finance, operations, or institutional administration). No demographic differences were found. MD/MBA graduates were not more frequently represented in systems-facing roles than MD-only peers, suggesting that other factors, including professional identity and organizational norms, may outweigh degree attainment in leadership role placement decisions. These findings highlight a possible need for clearer integration of management preparation into physician leadership pathways.
BackgroundExercise is beneficial for persons with Huntington's disease (HD). Inpatient rehabilitation settings are well-suited for implementing exercise programs. Exercise parameters, such as duration and intensity, need to be further investigated. The objective of our study was to evaluate the effects of an exercise program at moderate intensity performed five times a week for persons with mid-stage HD during a four-week inpatient rehabilitation program.MethodsIn a single-blind randomized monocentric controlled trial, two groups followed a four-week inpatient rehabilitation program including: occupational therapy, psychomotor therapy, psychosocial workshop, mobility sessions, dietary management, nursing, socio-educational activities, physician consultations and personalized consultations. In addition, the intervention group specifically participated in five one-hour exercise sessions per week at moderate intensity (flat ground walking, sand walking, resistance training, adaptive cycling and water activities), whereas the control group engaged in specific activities without physical activity. The primary outcome was the UHDRS-modified Motor Score (mMS). Functional, cognitive and psychological assessments were also completed.ResultsThirty-two patients were recruited. The UHDRS-mMS did not significantly differ at post-intervention. In the intervention group (n = 16), within-group improvements were observed for HAD-Anxiety, PBA-apathy, PBA-depression, PBA-psychosis; both within and between-group for 6-min walk test, Stroop Word Reading, and PBA-executive function; and between-group only for Borg. The control group (n = 16) improved within-group on PBA components: depression, apathy and irritability.ConclusionsInpatient rehabilitation program had positive effects on psychological symptoms, while exercise produced additional positive effects beyond exercise tolerance, anxiety, STROOP Word Reading and executive function. Inpatient rehabilitation programs may require longer-term post-rehabilitation support.Trial registrationNCT04917133.
Down syndrome regression disorder (DSRD) is a rare phenomenon of regression impacting individuals with Down syndrome (DS), occurring in adolescence to early adulthood and characterized by acute-to-subacute deterioration of functioning. Cognitive and behavioural phenotypes associated with DSRD have been examined using physician checklists but not yet through direct assessments or caregiver questionnaires. The goal of this initial study was to explore the cognitive and behavioural features of those with DS and regression (DS+regression) through direct assessment and informant questionnaires. A total of 25 individuals (DS+regression n = 13 and DS n = 12) participated in the study. Participants were administered a standardized measure of intellectual functioning, and caregivers completed questionnaires assessing executive functioning, mood, and adaptive functioning. The two groups did not significantly differ on a standardized measure of intellectual functioning, although these results were based upon a reduced sample size (DS+regression n = 8), which limited interpretability. Results tentatively suggest that caregivers of those with DS+regression endorsed concern for executive functioning, mood and adaptive functioning in comparison to those without regression. This study provides emerging evidence of cognitive and behavioural features reported by caregivers that may be associated with DSRD, with the goal of informing future studies with larger sample sizes. Our findings also emphasize the importance of evaluations for patients with DSRD, and the utility of caregiver-report measures to identify symptoms of regression for treatment planning.