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Hospital physicians perform five types of work duties in Japan: an observational study.

ABSTRACT: BACKGROUND: Physicians are expected to perform three unique roles as a clinician, educator, and researcher in university hospitals. However, the actual practices of physicians performing different duties are relatively unknown. Therefore, the authors conducted an observational study at a university hospital to examine physicians' work activities. METHODS: Between 2011 and 2013, ten observers shadowed 20 physicians from different specialties for a day at the Tokyo Women's Medical University Hospital. Observers recorded physicians' activities every 30 seconds that were subsequently categorized into work types. The number of work types and activity changes performed by a physician in one observational period were counted. RESULTS: Authors categorized physicians' work activities into five groups: patient care (direct and indirect), education, research, professional development, and administration. All physicians performed at least one type of activity in addition to patient care. Activity change occurred 1.86 times per hour, on average. The median time-distribution of 20 physicians was 173.8 minutes, 213.8 minutes, 3.3 minutes, 5.0 minutes, 0 minutes, and 0.8 minutes for direct patient care, indirect patient care, education, research, professional development, and administration, respectively. CONCLUSION: Japanese hospital physicians performed multiple work duties including professional development and administrative activities in addition to triple duties.

SUBMITTER: Nohara M

PROVIDER: S-EPMC4262132 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Hospital physicians perform five types of work duties in Japan: an observational study.

Nohara Michiko M Yoshikawa Toru T Nakajima Norihiro N Okutsu Kosuke K

BMC health services research 20140906

<h4>Background</h4>Physicians are expected to perform three unique roles as a clinician, educator, and researcher in university hospitals. However, the actual practices of physicians performing different duties are relatively unknown. Therefore, the authors conducted an observational study at a university hospital to examine physicians' work activities.<h4>Methods</h4>Between 2011 and 2013, ten observers shadowed 20 physicians from different specialties for a day at the Tokyo Women's Medical Uni ...[more]

PMID: 25194417

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Project description:ObjectiveTo determine whether 30 day mortality, 30 day readmissions, and inpatient spending vary according to whether physicians were exposed to work hour reforms during their residency.DesignRetrospective observational study.SettingUS Medicare.Participants20% random sample (n=485 685) of Medicare beneficiaries aged 65 years or more admitted to hospital and treated by a general internist during 2000-12.Main outcome measures30 day mortality, 30 day readmissions, and inpatient Medicare Part B spending among patients treated by first year internists who were fully exposed to the 2003 Accreditation Council for Graduate Medical Education (ACGME) work hour reforms during their residency (completed residency after 2006) compared with first year internists with partial or no exposure to reforms (completed residency before 2006). Senior internists not exposed to reforms during their residency served as a control group (10th year internists) for general trends in hospital care: a difference-in-difference analysis.ResultsExposure of physicians to work hour reforms during their residency was not associated with statistically significant differences in 30 day mortality, 30 day readmissions, or inpatient spending. Among 485 685 hospital admissions, 30 day mortality rates during 2000-06 and 2007-12 for patients of first year internists were 10.6% (12 567 deaths/118 014 hospital admissions) and 9.6% (13 521/140 529), respectively, and for 10th year internists were 11.2% (11 018/98 811) and 10.6% (13 602/128 331), for an adjusted difference-in-difference effect of -0.1 percentage points (95% confidence interval -0.8% to 0.6%, P=0.68). 30 day readmission rates for first year internists during 2000-06 and 2007-12 were 20.4% (24 074/118 014) and 20.4% (28 689/140 529), respectively, and for 10th year internists were 20.1% (19 840/98 811) and 20.5% (26 277/128 331), for an adjusted difference-in-difference effect of 0.1 percentage points (-0.9% to 1.1%, P=0.87). Medicare Part B inpatient spending for first year internists during 2000-06 and 2007-12 was $1161 (£911; €1024) and $1267 per hospital admission, respectively, and for 10th year internists was $1331 and $1599, for an adjusted difference-in-difference effect of -$46 (95% confidence interval -$94 to $2, P=0.06).ConclusionsExposure of internists to work hour reforms during their residency was not associated with post-training differences in patient mortality, readmissions, or costs of care.

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Hospital physicians perform five types of work duties in Japan: an observational study.

Publications

Hospital physicians perform five types of work duties in Japan: an observational study.

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