Background: The field of medicine is constantly changing. Notable changes occur in the patterns of clinical practice, business of medicine, shift in demographics/generation of the health care workforce, emergence of sub-specialization; and advances in research and technology. These changes can affect the way young physicians establish their practice and this is an area not addressed by the medical education and training. Purpose: There is little data in the literature regarding the experience of young physicians in establishing clinical practice. This study was undertaken to answer the central question: Among physicians in the field of Internal Medicine with or without subspecialty who graduated from training in 2013 to 2018, what were the issues and challenges that they faced as they established their clinical practice in the urban or mixed setting? Methodology: Qualitative research-case study; Key informant interview was conducted among junior Internal Medicine consultants who satisfied the inclusion criteria. Data analysis used thematic analysis consisting of reading, writing notes, describing, and classifying transcripts according to categories and themes. Results: After a comprehensive analysis of narratives, five emergent themes surfaced: “Tough Days” (Period of figuring out the system; Need for Self-introduction; Few patients and Feelings of frustration and depression); “Torn and Divided” (Unpredictable work schedule and workload; Lack of time for issues outside career); “Temporary Debt” (Large start-up cost; Expensive maintenance); “Difficult but Tolerable” (Family support; Call-a-colleague; Debt of gratitude to mentors) and lastly “Dreams and To-do’s”. Conclusions Our respondents have experienced substantial challenges in starting clinical practice. Learning the ways of the healthcare business, effectively promoting oneself to the community, dealing with the emotional turmoil of having few patients, coming up with a strategic schedule and area of practice, and looking for funds and paying it back, were the challenges and experiences of these young medical specialists as they establish their careers in the urban and/or rural setting.
Private Practice

The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.
Diagnosis ; Education ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Patient Safety ; Private Practice ; Radiation, Ionizing ; Risk Assessment ; Tomography, X-Ray Computed

A 13-year-old neutered male Poodle dog was presented with a third eyelid mass in the left eye. The dog had undergone local resection of the mass about a year prior in a private practice. On cytological examination, the mass was diagnosed as adenocarcinoma. Although lung and lymph node metastases were suspected, based upon the computed tomographic results, exenteration was performed to relieve chronic pain and to improve the dog's quality of life. Exenteration carried a good prognosis with no tumor recurrence until 1 year and 10 months after surgery, when local recurrence occurred near the left zygomatic arch.
Adenocarcinoma ; Adolescent ; Animals ; Chronic Pain ; Dogs ; Humans ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Nictitating Membrane ; Orbit ; Private Practice ; Prognosis ; Quality of Life ; Recurrence ; Zygoma

BACKGROUND: Musculoskeletal disorders (MSDs) in the health industry are quite common, however, there have only been a few studies regarding physiotherapists, while in Greece, there is an apparent lack of research and data. The aim of this study is to investigate MSDs experienced by physiotherapists in Greece, their causes and specific measures, and good practices followed. Additional emerging risk factors will be examined. METHODS: A questionnaire of MSDs followed by individual and workplace characteristics was completed by 252 physiotherapists. It covered the major workplace categories such as public hospitals, private rehabilitation centers, and private practices. RESULTS: Analysis indicated that 89% of the respondents had experienced a work-related MSD; 32.2% of those injuries occurred within the first 5 years of working. The most lumbered physiotherapists were those working as private practitioners and almost half of the injured respondents chose to work while injured. The most common measure taken to tackle work related MSDs was found to be physical therapy sessions. Job satisfaction and psychosocial issues were also identified as side-effects of the economic slowdown. CONCLUSION: Physiotherapists in Greece were found to suffer from MSDs; workplace musculoskeletal injuries were quite common but under-reported. The body parts most affected were the lower back, the upper back, the shoulders, and the neck. There was a strong correlation between the workplace setting and the number of MSDs. A well-defined occupational safety and health management system and strict administration steering were found to reduce MSDs. The economic slowdown experienced in Greece during the execution of this study placed additional pressure on physiotherapists.
Greece ; Hospitals, Public ; Human Body ; Humans ; Job Satisfaction ; Neck ; Occupational Health ; Physical Therapists* ; Private Practice ; Rehabilitation Centers ; Risk Factors* ; Shoulder ; Surveys and Questionnaires

The Ministry of Health and Welfare announced a plan for community care in March 2018. Community care is a concept of social services that includes residential, welfare, and health care services, as well as direct care. It is a policy to actively prepare for an aged society. Various services must be developed for comprehensive community care. It is especially necessary to ensure that adequate resources are provided for home care and visiting care. To achieve this goal, the benefit policies of health insurance and long-term care insurance must be changed. Community service providers and infrastructure must be expanded, and a diverse professional workforce should be trained. Doctors need training and experience as team leaders, as they will be able to work with nurses, nutritionists, and social workers. It will be particularly important to operate clinics as group practices rather than as solo practices. Change is also needed in community hospitals, which must receive orientations regarding early patient discharge plans and community-centered collaboration. Hospitals should serve as health care safety nets, including short-term stays and same-day care. Regional governance is important for community care. Doctors must work with a variety of institutions, including community health centers, welfare centers, and elderly facilities. Medical professionals should prepare for and lead future social changes.
Aged ; Community Health Centers ; Community Health Services ; Cooperative Behavior ; Delivery of Health Care ; Group Practice ; Health Services for the Aged ; Home Care Services ; Hospitals, Community ; Humans ; Insurance, Health ; Insurance, Long-Term Care ; Nutritionists ; Patient Discharge ; Private Practice ; Social Change ; Social Welfare ; Social Work ; Social Workers

OBJECTIVE: The aim of this study was to evaluate retention practices commonly employed by orthodontists. The objectives were to identify the types of retainer frequently used and to investigate the variations in retention practice. METHODS: A total of 97 orthodontists were randomly selected, and a questionnaire consisting of 25 multiple-choice questions sent to them by mail. Upon receiving of the completed questionnaires, the data were statistically analyzed. RESULTS: A total of 32 responses were received; among these, 59.4% of orthodontists' practiced is in a government setting and 40.6% were in private practice. A vacuum-formed retainer was the most commonly used removable retainer for both maxillary (46.9%) and mandibular (46.9%) arches, followed by a Hawley retainer (maxilla, 43.8%; mandible, 37.5%), and a fixed retainer (maxilla, 3.1%; mandible, 9.4%). Of the responding orthodontists, 78.1% prescribed full-time wear (more than 20 h per day) for a duration of 3-9 months for a maxillary arch, compared to 71.9% for the mandibular arch. Only 18.8% of the orthodontists prescribed part-time wear of the retainer for the maxillary arch, compared to 21.9% for the mandibular arch. The majority of orthodontists did not instruct their patients to stop wearing removable retainers (71.9%) or fixed retainers (66.8%) at any specific time and they preferred their patients to continue wearing retainers. CONCLUSIONS: Vacuum-formed retainers are the most commonly used retainers among orthodontists. The majority of orthodontists prescribed full-time wear for more than 20 h per day with a duration of 3-9 months and preferred indefinite use of the retainer.
Humans ; Malaysia* ; Mandible ; Postal Service ; Private Practice

PURPOSE: The aim of this study was to investigate the use and acceptance of digital radiographic examinations by Brazilian dental practitioners in daily practice and to evaluate the advances that have occurred over the past 5 years. MATERIALS AND METHODS: Dental practitioners enrolled in extension courses at the Piracicaba Dental School, University of Campinas, Brazil, responded to a self-administered questionnaire in the years 2011 and 2015. They were asked about sociodemographic factors and their knowledge and use of digital radiographic examinations. Descriptive analysis was performed, as well as the chi-square and Fisher exact tests, with a significance level of 5% (α=0.05). RESULTS: A total of 181 participants responded to the questionnaire in the years 2011 and 2015. Most of the respondents worked in private practice, had graduated within the last 5 years, and were between 20 and 30 years old. In 2011, 55.6% of respondents reported having ever used digital radiographic examinations, while in 2015 this number increased significantly to 85.4% (p<.0001), out of which 71.4% preferred it to conventional images. Moreover, 21.4% of respondents reported having used digital radiographic examinations for more than 3 years. A significant increase in use of intraoral digital radiography (p=0.0316) was observed in 2015. In both years, image quality and high cost were indicated, respectively, as the main advantage and disadvantage of digital radiographic examinations. CONCLUSION: This study showed that digital radiology has become more common in Brazil over the past 5 years. Most of the Brazilian dental practitioners evaluated in 2015 used digital radiographic examinations.
Brazil ; Dentists ; General Practice, Dental ; Humans ; Private Practice ; Radiographic Image Enhancement ; Schools, Dental ; Surveys and Questionnaires

Solo surgery is a practice in which a surgeon operates alone, without other surgical member's assistance or cooperation, except for a scrub nurse and an anesthetist. Solo surgery at our institution is facilitated by several equipment, including Lone Star Retractor systems and a passive camera holder. The introduction of single-port laparoscopic surgery (SPLS) has dramatically increased the applicability of solo surgery, because SPLS reduces the number of surgical members participating in the surgery. A shortcoming of laparoscopic surgery is the indirect way of observing and manipulating. Solo surgery effectively eliminates this limitation by enabling operator-driven manipulation of the camera. Solo surgery is particularly advantageous in surgeries that are limited to a single quadrant, such as appendectomy, cholecystectomy, and herniorrhaphy, because they require less adjustment of the camera. However, its indications can be extended to include operations that involve multiple quadrants, such as various types of colectomies including total colectomy. In addition, solo open surgery can be performed with the aid of a larger retractor (i.e., the Bookwalter Retractor system). It appears that solo surgery can be performed by any surgeon who can perform SPLS competently and its indications can be extended, possibly after the development of supporting equipment.
Appendectomy ; Cholecystectomy ; Colectomy ; Herniorrhaphy ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Private Practice

This study was conducted to understand the current state of medical malpractice through analyzing recorded incidents by characteristics of medical intervention, and treatment results classified by treatment type and so on. The data for this study were extracted from the recorded incidents of medical malpractices committed by private practice physicians, which were provided by the Korean Medical Association Medical Indemnity Mutuals (KMAMA). The analysis was based on the treatment codes registered as primary medical practice of the respective private practice physicians at the time of joining KMAMA Medical malpractice occurrence rate by region was highest in Daegu with 7.1%. Analysis of causes of malpractice by codes showed dermatology/urology/plastic surgery department's C5 (standard medical care [outpatient] including standard injection, drug administration, simple topical anesthesia, simple treatment+regional anesthesia [spinal/epidural anesthesia]+general anesthesia [intravenous/inhaled anesthesia]) had the highest number of incidents with 223 cases. For the cases of death as prognosis, code B2, consisting of "basic treatment+regional anesthesia, intra-articular injection, epidural nerve block," had the highest incidents. This study concluded with the suggestion for the need to establish a system that will allow reporting and sharing incidents of private practice medical malpractice, and the necessity of acknowledging the importance of sharing such knowledge among medical practitioners.
Anesthesia ; Daegu ; Humans ; Injections, Intra-Articular ; Malpractice* ; Medical Errors ; Private Practice* ; Prognosis

PURPOSE: This retrospective study aims at the evaluation of implant-supported overdentures (IODs) supported by ceramo-galvanic double crowns (CGDCs: zirconia primary crowns + galvano-formed secondary crown). MATERIALS AND METHODS: In a private practice, 14 patients were restored with 18 IODs (mandible: 11, maxilla: 7) retained by CGDCs on 4 - 8 implants and annually evaluated for technical and/or biological failures/complications. RESULTS: One of the 86 inserted implants failed during the healing period (cumulative survival rate (CSR) implants: 98.8%). During the prosthetic functional period (mean: 5.9 +/- 2.2 years), 1 implant demonstrated an abutment fracture (CSR-abutments: 98.2%), and one case of peri-implantitis was detected. All IODs remained in function (CSR-denture: 100%). A total of 15 technical complications required interventions to maintain function (technical complication rate: 0.178 treatments/patients/year). CONCLUSION: Considering the small sample size, the use of CGDCs for the attachment of IODs is possible without an increased risk of technical complications. However, for a final evaluation, results from a larger cohort are required.
Cohort Studies ; Crowns* ; Denture, Overlay* ; Humans ; Maxilla ; Peri-Implantitis ; Private Practice ; Retrospective Studies ; Sample Size ; Survival Rate