Clinical Journal Of Oncology Nursin

U-M Study: More Subspecialty Pediatricians Heading for Private Practice

The process unfolding will have ripple effects across pediatrics.  The numbers need to be watched to ensure that the pipeline of doctors entering jobs at academic centers does not diminish significantly, says , M.D., M.P.H., chief of the division of general pediatrics and director of the Child Health Evaluation and Research (CHEAR) Unit at U-M C.S. Mott Children's Hospital.

"In contrast to adult medicine, in pediatrics, there is an overall shortage of subspecialists, both to provide clinical care and to conduct research," Freed says. "If more leave academics without commensurate increase in the total overall, it could severely impact new discoveries for the care of children."

The results of this study are available today in the journal Pediatrics .

researchers surveyed a random national sample of 1,696 pediatricians from five subspecialties and assessed the ownership of their current clinical practice setting.

The study found that there are significant proportions of pediatric subspecialists in private practice across most of the five subspecialties studied. Differences also exist among these specialties in the proportion of physicians in private practice.

Neonatology is the largest pediatric subspecialty and had the highest proportion of its providers in non-academic settings (51 percent). Hematology-oncology is the subspecialty with the highest proportion practicing in academic settings (77 percent). This is likely, at least in part, due to the relative rarity of childhood cancers and the need for highly sophisticated treatment environments usually only available in academic centers. A larger proportion of cardiologists (27 percent) and gastroenterologists (24 percent), reported that they work in private outpatient practice.

Respondents from procedure-based subspecialties, such as gastroenterology, had the highest proportion of providers in private outpatient practice. Such procedures provide significant opportunities for income generation in private practice.

Cognitive-Behavioral Therapy for Insomnia | ONS Connect

Key Def­i­n­i­tions Insom­nia: dif­fi­culty ini­ti­at­ing or main­tain­ing sleep, wak­ing up too early, non­restora­tive sleep, or sleep dif­fi­culty despite appro­pri­ate oppor­tu­ni­ties for sleep. Sec­ondary insom­nia: also called comor­bid insom­nia, this type of insom­nia is attrib­uted to a med­ical condition Short-​​term insom­nia: insom­nia last­ing one to six months Sleep effi­ciency: the amount of time spent in bed actu­ally asleep Sleep latency: the amount of time spent in bed but awake Tran­sient insom­nia: insom­nia last­ing less than one month

Insom­nia is the most com­mon sleep-​​wake dis­or­der expe­ri­enced by patients with can­cer and healthy indi­vid­u­als alike. Inabil­ity to achieve suf­fi­cient sleep can decrease patients’ qual­ity of life and impair their immune, cog­ni­tive, and func­tional sta­tus. Stud­ies have shown that insom­nia in patients with can­cer can result in reduced occurrence-​​free peri­ods, shorter over­all sur­vival, and increased risk of death.

Cognitive-​​behavioral ther­apy has been the stan­dard of care for insom­nia in the gen­eral pop­u­la­tion and is con­sid­ered “likely to be effec­tive” accord­ing to the ONS Putting Evi­dence Into Prac­tice (PEP) guide­lines. In her arti­cle in the August 2011 issue of the Clin­i­cal Jour­nal of Oncol­ogy Nurs­ing, Wood­ward described how cognitive-​​behavioral ther­apy can be used to treat insom­nia in patients with can­cer and the oncol­ogy nurse’s role in iden­ti­fy­ing patients for treatment.