Search results

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

Appropriate access to formally-trained health workers for people living in rural and underdeveloped areas is a continuing challenge worldwide. The purpose of this paper is to investigate the willingness of formally-trained health workers to practice in underdeveloped areas and its main determinants among medical students in the western provinces of Iran.

A total of 753 medical students from four provinces in western Iran (Kermanshah, Ilam, Lorestan and Kurdistan) were surveyed cross-sectionally in 2017. A self-administrated questionnaire was used to collect data on sociodemographic characteristics, willingness to practice in underdeveloped areas, intrinsic (e.g. desire to help others and self-interest in medicine) and extrinsic (e.g. the high income of physicians and social prestige) motivations of the study population. Multivariable logistic regression was used to identify the main determinants of willingness to practice in underdeveloped areas among medical students after their graduation.

The results indicated that 58.3 percent of students were willing to practice in underdeveloped areas. While 59 percent of the study population had a strong extrinsic motivation to study medicine, the remaining 41 percent of the study population had a strong intrinsic motivation to study medicine. The logistic regression results indicated that low parental professional and educational status, an experience of living in rural areas and having strong intrinsic motivation were associated with greater willingness to practice in underdeveloped areas.

This is the first study to investigate the willingness to practice in underdeveloped areas and its main determinants among medical students in the west of Iran.

This study aims to investigate the hybridization practices that medical managers engage with to promote accounting and performance measurement in the hybrid setting of healthcare. In doing so, the authors explore how medical managers enact and become practitioners of hybridity.

The authors adopt a practice lens to conceptualize hybridization as an emergent, situated practice and capture the micro-activities that medical managers engage with when they enact hybridity. The authors conducted semi-structured interviews with medical managers, business managers and coding professionals and collected documents at an English National Health Service (NHS) hospital over the course of five years.

The findings accentuate two emergent practices through which medical managers instill hybridity to individuals who are hesitant or resistant to hybridization. Medical managers engage in equivocalizing and de-stigmatizing practices to broaden the understandings, further diversify or reconcile the teleologies of clinicians in non-managerial roles. In doing so, the authors signal the merits of accounting in improving care outcomes and remove the stigma associated to clinical engagement with costs.

The study contributes to hybridization and practice theory literature via capturing how hybridity is enacted in practice in a healthcare setting. As medical managers engage with and promote accounting information and performance measurement technologies in their practice environment, they transcend professional boundaries and hybridize the professional spaces that surround them.

The purpose of this paper is to identify the dimensions of preparedness for hospital practice among newly graduated medical officers in Malaysian hospitals who are undergoing their housemanship training; and to compare the level of preparedness among the different curricula and predict the dimensions of preparedness for hospital practice.

A national study was carried out and data collection was by means of self-administered questionnaire. Data obtained (n=1,213) were subjected to exploratory factor analysis using Statistical Package for Social Sciences version 18 in extracting the dimensions of preparedness for hospital practice.

Nine dimensions of hospital practice were identified which were access to information and IT skills, interpersonal skills, basic skills, and continuing professional development, holistic skills, coping skills, ethic and legal skills, patient management skills, scientific knowledge, and clinical skills. Overall, the respondents felt their medical schools prepared them for hospital practice. The strongest predictor for preparedness for hospital practice is coping skills. Holistic skill and preparedness for hospital practice was found to be negatively associated. Those who graduated from twining programmes between Malaysian and overseas universities were found to be better prepared for hospital practice.

An understanding on preparedness for hospital practice among newly graduated medical officers is a step forward in assuring patient safety and quality of care.

Although of significant importance, however, a study of this nature is rarely researched and the first for Malaysian houseman.

This study aims to investigate the perceived role of the Islamic medical care practice of Muslim doctors in Malaysian Muslim-friendly private hospitals.

Data were collection through self-administered questionnaires voluntarily submitted by the respondents. The survey covered selected major Muslim-friendly private hospitals in the country in the states of Kedah, Johor, Penang, Selangor, Kelantan and Kuala Lumpur. The non-probability purposive sampling was used, as the respondents and locations of the survey areas were predetermined.

Five dimensions of the Muslim-friendly medical care practice were identified, namely, medical etiquettes, physical examination, proper cleansing process of blood and body fluids, proper handling and treatment of infectious diseases and doctors’ advice to Muslim patients. The findings also indicate that the scale development analysis produced excellent results which can be used for reproducible or repetitive medical care purposes and for integration facts and figures for inclusion into wider medical care policy and practices.

The results from the study can further develop Islamic medical care practices and enable medical service providers to upgrade their performances to an enviable strategic status.

Islamic medical care is a new mode of healthcare service market, as there are very few studies on this topic from the perspective of Muslim patients or no obvious facts are known. This study has first explored Muslim doctors’ perceived role in Islamic medical care practice in Malaysian Muslim-friendly private hospitals. This empirical study can immensely contribute to the further development of Islamic medical care practice for Muslim doctors in particular and for the Muslim-friendly hospital service marketing strategy in general.

This paper aims at understanding how clinical guidelines' use in the labour process relates to clinical autonomy, that is, the self-control medical professionals exercise over medical practice.

Drawing on a qualitative case study research strategy, this paper explores how medical professionals use clinical guidelines in the labour process in one public general hospital of the Greek National Health System. Supplemented by an extensive study of documents, semi-structured interviews were conducted with 33 doctors of several specialties.

The analysis shows (1) how clinical autonomy, as a self-control structure, mediates the use of clinical guidelines as a knowledge tool in the labour process, and (2) how employing clinical guidelines as a means towards coordinating medical work, but also towards regulating and standardising medical practice, is exercising pressure on the individualistic character of clinical autonomy.

Advancing the analytic value of workplace control structures, this paper contributes novel theoretical understanding of emerging tendencies characterising medical work organisation and clinical autonomy, and explains how medical professionals' non-adherence to clinical practice guidelines (CPGs) relates to CPGs' role as a resource to medical practice. Finally, this research proposes a more critical approach to health policy towards addressing the challenges associated with centrally introducing clinical guidelines in healthcare organisations.

The focus of this paper is on the mediating role of medical records in patient care. Their informative, communicative and constitutive facets are analysed on the basis of a case study in an African University teaching hospital.

A practice-oriented approach and the concept of boundary objects were adopted to examine medical records as information artefacts. Data from nonparticipant observations and interviews with physicians were triangulated in a qualitative analysis.

Three distinctive practices for information sharing – absorbing by reading, augmenting by documenting and recounting by presenting – were identified as central to the mediating role of medical records in the care of patients. Additionally, three information-sharing functions outside the immediate care of patients were identified: facilitating interactions, controlling hegemonic order and supporting learning. The records were both a useful information resource and a blueprint for sustaining shared practices over time. The medical records appeared as an essential part of patient care and amendments to them resulted in changes in several other work practices.

The analysis contributes to research on documents as enacting and sustaining work practices in a workplace.

This paper is specifically developed on the basis of a pragmatic model for the Muslim-friendly medical tourism supply chain industry. The purpose of this study is to investigate the effectiveness and viability of the Muslim-friendly medical tourism supply chain practices in Malaysia.

A framework for the service supply chain management of the Muslim-friendly medical tourism with the effective outcomes was theoretically developed and explored in this study, using a structural equation modelling with the partial least squares technique. A structured questionnaire was developed, distributed and collected from 38 Islamic-friendly hospitals, 9 Muslim-friendly medical agencies and 44 Muslim-friendly hotels that will form the potential relevant associations of the medical tourism supply chain practices in Malaysia.

The findings provide reliable evidence that the effectiveness of the Muslim-friendly medical tourism supply-chain practice has a positive impact on the Muslim-friendly medical tourism supply chain. In addition, the Muslim-friendly medical tourism supply chain practice has also a significant and positive impact on the organizational performance as a whole. The result also demonstrates that collaboration is dependent on the demand management, whilst the productivity is not associated with it.

Practicing and implementing a Muslim-friendly medical tourism service supply chain is important, in the sense that the Muslim patients’ demand on the choice of halal practice of medical treatment and halal food consumption criteria. This investigation is the first to embark on the research on the Muslim medical tourism supply chain production network in Malaysia. This study provides practitioners with the important related data to improve their policies and their performances in the organization. The statistical results provide indispensable valuable information in comprehending the critical medical tourism supply chain practices and most specially to assist the Muslim-friendly medical tourism sector to offer quality medical tourism service that suits and attracts the Muslim medical tourists’ broad needs regionally and abroad.

Fundholding (the opportunity to hold a budget at practice level) has given general practitioners (GPs) purchasing power for medical services within the reformed UK National Health Service (NHS). This new purchasing power equates to financial leverage with the NHS consultants in hospitals. Argues that fundholding is presented as an opportunity for GPs to engage in a “turf battle” with the hospital consultants without this battle becoming publicly visible. Fundholding as an accounting‐based intervention masked the nature of the professional challenge which GPs launched against the consultants and, hence, allowed territorial claims to be renegotiated through the medium of contracting. This circumvented the damage to medical professional ideologies which would have ensued if intra‐professional conflicts had become overt. The empirical study which is referred to indicates that GPs are using contracts to improve processes of case management at the hospital interface (an area where consultants have failed to communicate with GPs) and to have an input into the setting of quality standards within the hospitals. The increased financial flexibility conferred through holding budgets is also enabling GPs to expand in‐house services for primary care. Theorizes the changing power relations between GPs and consultants through exploring four dimensions of intra‐professional differentiation: task specialization; client differentiation; organization of work; and career pattern. Concludes that budgets have constituted a catalyst for professional development through reconnecting the monetary bonds between the polarized professionals in British medicine. This study indicates that, as fundholding progresses, the boundary between primary and secondary care is becoming blurred; that lead fundholding GPs are being managerialized; and that the purchasing dialogue between the GPs and the Trusts is marginalizing the role of the Health Boards (bodies which had previously held sole responsibility for the co‐ordination and delivery of health care but which now have a more limited purchasing/commissioning role).

The resurgence of interest in professionalism necessarily focuses us on the moral core of medicine and the character of the good doctor. While medical education reform projects aimed at educating for professionalism are replete with lists of laudable virtues necessary for the doctor, we have made little progress in mapping those character traits, values and behaviors to admission procedures, curricular reform and faculty development. If educating for professionalism is to be effective, medicine must re-claim the moral core of professionalism and identify clearly the fundamental traits, values and virtues necessary for good medical practice in the twenty-first century.