Public Roles of US Physicians: Community Participation, Political Involvement, and Collective Advocacy
TL;DR: Public roles are definable entities that have widespread support among physicians and Civic-mindedness is associated primarily with sociodemographic factors, but civic action is associated with specialty and practice-based factors.
Abstract: ContextWhether physicians have a professional responsibility to address health-related issues beyond providing care to individual patients has been vigorously debated. Yet little is known about practicing physicians' attitudes about or the extent to which they participate in public roles, which we defined as community participation, political involvement, and collective advocacy.ObjectivesTo determine the importance physicians assign to public roles, their participation in related activities, and sociodemographic and practice factors related to physicians' rated levels of importance and activity.Design, Setting, and ParticipantsMail survey conducted between November 2003 and June 2004 of 1662 US physicians engaged in direct patient care selected from primary care specialties (family practice, internal medicine, pediatrics) and 3 non–primary care specialties (anesthesiology, general surgery, cardiology).Main Outcome MeasuresRated importance of community participation, political involvement, collective advocacy, and relevant self-reported activities encompassing the previous 3 years; rated importance of physician action on different issues.ResultsCommunity participation, political involvement, and collective advocacy were rated as important by more than 90% of respondents, and a majority rated community participation and collective advocacy as very important. Nutrition, immunization, substance abuse, and road safety issues were rated as very important by more physicians than were access-to-care issues, unemployment, or illiteracy. Two thirds of respondents had participated in at least 1 of the 3 types of activities in the previous 3 years. Factors independently related to high overall rating of importance (civic-mindedness) included age, female sex, underrepresented race/ethnicity, and graduation from a non-US or non-Canadian medical school. Civic mindedness, medical specialty, practice type, underrepresented race/ethnicity, preceptors of physicians in training, rural practice, and graduation from a non-US or non-Canadian medical school were independently related to civic activity.ConclusionsPublic roles are definable entities that have widespread support among physicians. Civic-mindedness is associated primarily with sociodemographic factors, but civic action is associated with specialty and practice-based factors.
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TL;DR: As an example of how the current "war on terrorism" could generate a durable civic renewal, Putnam points to the burst in civic practices that occurred during and after World War II, which he says "permanently marked" the generation that lived through it and had a "terrific effect on American public life over the last half-century."
Abstract: The present historical moment may seem a particularly inopportune time to review Bowling Alone, Robert Putnam's latest exploration of civic decline in America. After all, the outpouring of volunteerism, solidarity, patriotism, and self-sacrifice displayed by Americans in the wake of the September 11 terrorist attacks appears to fly in the face of Putnam's central argument: that \"social capital\" -defined as \"social networks and the norms of reciprocity and trustworthiness that arise from them\" (p. 19)'has declined to dangerously low levels in America over the last three decades. However, Putnam is not fazed in the least by the recent effusion of solidarity. Quite the contrary, he sees in it the potential to \"reverse what has been a 30to 40-year steady decline in most measures of connectedness or community.\"' As an example of how the current \"war on terrorism\" could generate a durable civic renewal, Putnam points to the burst in civic practices that occurred during and after World War II, which he says \"permanently marked\" the generation that lived through it and had a \"terrific effect on American public life over the last half-century.\" 3 If Americans can follow this example and channel their current civic
5,309 citations
Book•
01 Apr 2012
TL;DR: Because employers bear direct medical and indirect productivity costs of obesity, they can benefit from promoting and increasing physical activity, healthy eating, breastfeeding, and overall well-being in the workplace.
Abstract: One-third of adults are now obese, and children's obesity rates have climbed from 5 to 17 percent in the past 30 years. The causes of the nation's obesity epidemic are multi-factorial, having much more to do with the absence of sidewalks and the limited availability of healthy and affordable foods than a lack of personal responsibility. The broad societal changes that are needed to prevent obesity will inevitably affect activity and eating environments and settings for all ages. Many aspects of the obesity problem have been identified and discussed; however, there has not been complete agreement on what needs to be done to accelerate progress. Accelerating Progress in Obesity Prevention reviews previous studies and their recommendations and presents five key recommendations to accelerate meaningful change on a societal level during the next decade. The report suggests recommendations and strategies that, independently, can accelerate progress, but urges a systems approach of many strategies working in concert to maximize progress in accelerating obesity prevention.The recommendations in Accelerating Progress in Obesity Prevention include major reforms in access to and opportunities for physical activity; widespread reductions in the availability of unhealthy foods and beverages and increases in access to healthier options at affordable, competitive prices; an overhaul of the messages that surround Americans through marketing and education with respect to physical activity and food consumption; expansion of the obesity prevention support structure provided by health care providers, insurers, and employers; and schools as a major national focal point for obesity prevention. The report calls on all individuals, organizations, agencies, and sectors that do or can influence physical activity and nutrition environments to assess and begin to act on their potential roles as leaders in obesity prevention.
600 citations
TL;DR: The authors propose a definition and, using the biographies of actual physician advocates, describe the spectrum of physician advocacy, as first steps toward building a model for competency-based physician advocacy training and delineating physician advocacy in common practice.
Abstract: Many medical authors and organizations have called for physician advocacy as a core component of medical professionalism. Despite widespread acceptance of advocacy as a professional obligation, the concept remains problematic within the profession of medicine because it remains undefined in concept, scope, and practice. If advocacy is to be a professional imperative, then medical schools and graduate education programs must deliberately train physicians as advocates. Accrediting bodies must clearly define advocacy competencies, and all physicians must meet them at some basic level. Sustaining and fostering physician advocacy will require modest changes to both undergraduate and graduate medical education. Developing advocacy training and practice opportunities for practicing physicians will also be necessary. In this article, as first steps toward building a model for competency-based physician advocacy training and delineating physician advocacy in common practice, the authors propose a definition and, using the biographies of actual physician advocates, describe the spectrum of physician advocacy.
223 citations
TL;DR: In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.
Abstract: Importance Physicians’ views about health care costs are germane to pending policy reforms. Objective To assess physicians’ attitudes toward and perceived role in addressing health care costs. Design, Setting, and Participants A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Main Outcomes and Measures Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. Results A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for “eliminating fee for service” (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the “uncertainty involved in patient care disconcerting” was negatively associated with cost-consciousness (β = −1.95; 95% CI, −2.71 to −1.18; P Conclusion and Relevance In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.
221 citations
TL;DR: An expanded income-based subsidy, analogous to the earned income tax credit, combined with a requirement that each person have evidence of ability to pay for minor and preventive care, would increase efficiency and equity and achieve both universal coverage and improved efficiency.
Abstract: ventionandearlyinterventionthatcouldsavethepoolmoney in future expenses. An expanded income-based subsidy, analogous to the earned income tax credit, combined with a requirement that each person have evidence of ability to pay for minor and preventive care, would increase efficiency and equity. Some funds for such coverage are already included in Medicaid program expenditures. This fundamental restructuring of the payment system would achieve both universal coverage and improved efficiency. Focusing attention on patient outcomes would free clinicians and hospitals to creatively explore ways to deliver care and eliminate payers’ focus on fee constraints and micromanagement of clinical decisions. The government’s role in the operation of the system would shift to ensuring informationavailabilityandtransparencyinpayment.Government would maintain current employment-based subsidies (if a payroll tax is not substituted) and implement income-basedredistributionforindividualswithlowincomes. A collective risk pool would reallocate funds so all can access appropriate care regardless of their individual health status. The simplified system would eliminate unnecessary administration. Market-disciplined carriers would facilitate payment, provide information, and respond to patient preferences. Appropriate incentives would help ensure that healthcareexpendituresaredrivenbyinformedpatientand clinician decisions about the care needed to achieve highquality outcomes. Financial Disclosures: None reported.
149 citations
Cites background from "Public Roles of US Physicians: Comm..."
...A substantial proportion of US physicians view issues related to access to care, public health influences on health, and nonmedical determinants of health as important areas for their public responsibilities.(23) However, far fewer physicians reported being engaged in community participation, political action, or collective advocacy regarding these topics in the past 3 years....
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References
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Book•
01 Jan 2000TL;DR: Putnam as mentioned in this paper showed that changes in work, family structure, age, suburban life, television, computers, women's roles and other factors are isolating Americans from each other in a trend whose reflection can clearly be seen in British society.
Abstract: BOWLING ALONE warns Americans that their stock of "social capital", the very fabric of their connections with each other, has been accelerating down. Putnam describes the resulting impoverishment of their lives and communities. Drawing on evidence that includes nearly half a million interviews conducted over a quarter of a century in America, Putnam shows how changes in work, family structure, age, suburban life, television, computers, women's roles and other factors are isolating Americans from each other in a trend whose reflection can clearly be seen in British society. We sign 30 percent fewer petitions than we did ten years ago. Membership in organisations- from the Boy Scouts to political parties and the Church is falling. Ties with friends and relatives are fraying: we're 35 percent less likely to visit our neighbours or have dinner with our families than we were thirty years ago. We watch sport alone instead of with our friends. A century ago, American citizens' means of connecting were at a low point after decades of urbanisation, industrialisation and immigration uprooted them from families and friends. That generation demonstrated a capacity for renewal by creating the organisations that pulled Americans together. Putnam shows how we can learn from them and reinvent common enterprises that will make us secure, productive, happy and hopeful.
24,532 citations
TL;DR: As an example of how the current "war on terrorism" could generate a durable civic renewal, Putnam points to the burst in civic practices that occurred during and after World War II, which he says "permanently marked" the generation that lived through it and had a "terrific effect on American public life over the last half-century."
Abstract: The present historical moment may seem a particularly inopportune time to review Bowling Alone, Robert Putnam's latest exploration of civic decline in America. After all, the outpouring of volunteerism, solidarity, patriotism, and self-sacrifice displayed by Americans in the wake of the September 11 terrorist attacks appears to fly in the face of Putnam's central argument: that \"social capital\" -defined as \"social networks and the norms of reciprocity and trustworthiness that arise from them\" (p. 19)'has declined to dangerously low levels in America over the last three decades. However, Putnam is not fazed in the least by the recent effusion of solidarity. Quite the contrary, he sees in it the potential to \"reverse what has been a 30to 40-year steady decline in most measures of connectedness or community.\"' As an example of how the current \"war on terrorism\" could generate a durable civic renewal, Putnam points to the burst in civic practices that occurred during and after World War II, which he says \"permanently marked\" the generation that lived through it and had a \"terrific effect on American public life over the last half-century.\" 3 If Americans can follow this example and channel their current civic
5,309 citations
TL;DR: Deficits in cancer screening, cardiovascular risk reduction, and diabetes care were most pronounced among long-term-un uninsured adults, and providing insurance to improve access to care for long- term-uninsured adults, particularly those with major health risks, could have substantial clinical benefits.
Abstract: ContextIn 1998, 33 million US adults aged 18 to 64 years lacked health insurance.
Determining the unmet health needs of this population may aid efforts to improve
access to care.ObjectiveTo compare nationally representative estimates of the unmet health needs
of uninsured and insured adults, particularly among persons with major health
risks.Design and SettingRandom household telephone survey conducted in all 50 states and the
District of Columbia through the Behavioral Risk Factor Surveillance System.ParticipantsA total of 105,764 adults aged 18 to 64 years in 1997 and 117,364 in
1998, classified as long-term (≥1 year) uninsured (9.7%), short-term (<1
year) uninsured (4.3%), or insured (86.0%).Main Outcome MeasuresAdjusted proportions of participants who could not see a physician when
needed due to cost in the past year, had not had a routine checkup within
2 years, and had not received clinically indicated preventive services, compared
by insurance status.ResultsLong-term– and short-term–uninsured adults were more likely
than insured adults to report that they could not see a physician when needed
due to cost (26.8%, 21.7%, and 8.2%, respectively), especially among those
in poor health (69.1%, 51.9%, and 21.8%) or fair health (48.8%, 42.4%, and
15.7%) (P<.001). Long-term–uninsured adults
in general were much more likely than short-term–uninsured and insured
adults not to have had a routine checkup in the last 2 years (42.8%, 22.3%,
and 17.8%, respectively) and among smokers, obese individuals, binge drinkers,
and people with hypertension, elevated cholesterol, diabetes, or human immunodeficiency
virus risk factors (P<.001). Deficits in cancer
screening, cardiovascular risk reduction, and diabetes care were most pronounced
among long-term–uninsured adults.ConclusionsIn our study, long-term–uninsured adults reported much greater
unmet health needs than insured adults. Providing insurance to improve access
to care for long-term–uninsured adults, particularly those with major
health risks, could have substantial clinical benefits.
751 citations
Book•
01 Jan 1995
TL;DR: In this paper, the crisis and promise of professionalism are discussed and the evolution of professional knowledge from the professional profession of office to the professional education of organizational professionals are discussed. But the focus is on the professional knowledge itself.
Abstract: Foreword About the Author Introduction: The Crisis and Promise of Professionalism 1 Professionalism 2 The Evolution of the Professions: From Professions of Office to the Organizational Professions 3 A Metropolitan Maturity: The Progressives' Struggle for a Civic Professionalism 4 No Center to Hold: The Era of Expertise 5 Reinventing Professionalism 6 Renewing Professional Education 7 What Is Professional Knowledge? Expertise and the University 8 Confronting Moral Ambiguity: The Struggle for Professional Ethics Conclusion: Experts and Citizens Notes Index
448 citations
"Public Roles of US Physicians: Comm..." refers result in this paper
...These findings are consistent with a view of professionalism in which physicians are responsible in their areas of expertise to contribute to helping the society that grants them professional status.(3,8,16) If physicians subscribe to this view, then they likely perceive a point where their responsibilities as experts end, and their civic responsibilities are no greater than those of other members of society....
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TL;DR: This work proposes a definition and a conceptual model of public roles that require evidence of disease causation and are guided by the feasibility and efficacy of physician involvement, and frames a public agenda for individual physicians and physician organizations that focuses on advocacy and community participation.
Abstract: Although leaders and other commentators have called for the medical profession's greater engagement in improving systems of care and population health, neither medical education nor the practice environment has fostered such engagement. Missing have been a clear definition of physicians' public roles, reasonable limits to what can be expected, and familiarity with tasks that are compatible with busy medical practices. We address these issues by proposing a definition and a conceptual model of public roles that require evidence of disease causation and are guided by the feasibility and efficacy of physician involvement. We then frame a public agenda for individual physicians and physician organizations that focuses on advocacy and community participation. By doing so, we aim to stimulate dialogue about the appropriateness of such roles and promote physician engagement with pressing health issues in the public arena.
290 citations
"Public Roles of US Physicians: Comm..." refers background or methods or result in this paper
...sicians either individually or as part of physician organizations.(10) If calls for social responsibility are to be promoted, it is important to understand the degree to which practicing physicians are supportive of assuming public roles and the sociodemographic and practice factors that influence their attitudes and activity in this regard....
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...The finding that 72% to 82% of physicians regarded involvement in issues closely connected to individual patients’ health to be very important but only 22% to 43% regarded involvement in issues less clearly linked to individual patient health to be very important, was consistent with our previous hypothesis.(10) Given estimates of over 60 million uninsured and underinsured Americans,(17) and the impact that access to care has on receipt of quality health care,(18) it is worth considering why only 58% and 46% of our respondents regarded universal health insurance Table 3....
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...Other influences and behaviors that have less obvious or less direct apparent influence on individual health care, labeled “broad socioeconomic issues in the model,” would be rated less important as topics for public involvement by physicians.(10)...
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...We operationalized the concept of social responsibility by explicating 3 types of public roles in which physicians may engage: community participation, political involvement as an individual, and collective advocacy through professional organizations.(10) Survey questions were developed that assessed physicians’ ratings of importance of each of these dimensions on a 4-point scale (1, not at all important; 2, not very important; 3, somewhat important; and 4, very important) and assessed whether or not each physician had acted in each of the 3 dimensions in past 3 years (for which responses were yes or no)....
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...We had previously suggested that this distinction lies between advocacy on issues that are perceived to be closely connected to individual patients’ health (such as tobacco control, nutrition, immunization, substance abuse, and seat belt use), and broader population health concerns that physicians may perceive to be less clearly linked to the health of individual patients (such as unemployment, illiteracy, and air pollution).(10) The finding that 72% to 82% of physicians regarded involvement in issues closely connected to individual patients’ health to be very important but only 22% to 43% regarded involvement in issues less clearly linked to individual patient health to be very important, was consistent with our previous hypothesis....
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