Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care
Bibliographic record
Abstract
Ideas and Opinions4 October 2016Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient CareAllan S. Detsky, MD, PhD and Michael A. Gropper, MD, PhDAllan S. Detsky, MD, PhDFrom the Institute of Health Policy, Management, and Evaluation, University of Toronto, and Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada, and University of California, San Francisco, San Francisco, California.Search for more papers by this author and Michael A. Gropper, MD, PhDFrom the Institute of Health Policy, Management, and Evaluation, University of Toronto, and Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada, and University of California, San Francisco, San Francisco, California.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0820 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicians assume a variety of leadership positions in health care. The most common ones are heads of clinical divisions, chiefs and chairs of clinical departments, and deans of medical schools. Some ultimately become chief executive officers of hospitals or health systems. Others lead national medical organizations like the American Board of Internal Medicine or the Royal College of Physicians and Surgeons of Canada. Physician leaders profoundly affect the way health care is delivered. They influence and sometimes determine working conditions; professional standards; training programs; research environments; payment schemes; certification requirements; and the quality, safety, and type of care that patients ...References1. Cain DM, Detsky AS. Everyone's a little bit biased (even physicians). JAMA. 2008;299:2893-5. [PMID: 18577735] doi:10.1001/jama.299.24.2893 CrossrefMedlineGoogle Scholar2. Detsky AS. How to be a good academic leader. J Gen Intern Med. 2011;26:88-90. [PMID: 20809156] doi:10.1007/s11606-010-1486-7 CrossrefMedlineGoogle Scholar3. Schwendimann R, Milne J, Frush K, Ausserhofer D, Frankel A, Sexton JB. A closer look at associations between hospital leadership walkrounds and patient safety climate and risk reduction: a cross-sectional study. Am J Med Qual. 2013;28:414-21. [PMID: 23354869] doi:10.1177/1062860612473635 CrossrefMedlineGoogle Scholar4. Teirstein PS. Boarded to death—why maintenance of certification is bad for doctors and patients. N Engl J Med. 2015;372:106-8. [PMID: 25564895] doi:10.1056/NEJMp1407422 CrossrefMedlineGoogle Scholar5. Annals of Internal Medicine. Information for readers: comments. 2016. Accessed at http://annals.org/public/readersinfo.aspx on 1 June 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the Institute of Health Policy, Management, and Evaluation, University of Toronto, and Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada, and University of California, San Francisco, San Francisco, California.Acknowledgment: The authors thank Donald Berwick, MD, MPP (Boston), and Catherine Zahn, MD, MHSc, and Michael Baker, MD (both in Toronto), for comments on an earlier draft.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0820.Corresponding Author: Allan S. Detsky, MD, PhD, Room 429, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; e-mail, [email protected]on.ca.Current Author Addresses: Dr. Detsky: Room 429, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.Dr. Gropper: University of California, San Francisco, 500 Parnassus Avenue, MUE 410, San Francisco, CA 94143-0648.Author Contributions: Conception and design: A.S. Detsky, M.A. Gropper.Drafting of the article: A.S. Detsky, M.A. Gropper.Critical revision of the article for important intellectual content: A.S. Detsky, M.A. Gropper.Final approval of the article: A.S. Detsky, M.A. Gropper.Administrative, technical, or logistic support: A.S. Detsky.This article was published at www.annals.org on 12 July 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoWhy Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care David S. Channin Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care Richard Rohr Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care Allan S. Detsky and Michael A. Gropper Metrics Cited byEthical and Professionalism Implications of Physician Employment and Health Care Business Practices: A Policy Paper From the American College of PhysiciansMatthew DeCamp, MD, PhD and Lois Snyder Sulmasy, JD, for the American College of Physicians Ethics, Professionalism and Human Rights Committee*Health Care Providers and Managers: Seeking Concordance in the DiscordWhy Physician Leaders of Health Care Organizations Should Participate in Direct Patient CareDavid S. Channin, MDWhy Physician Leaders of Health Care Organizations Should Participate in Direct Patient CareRichard Rohr, MD 4 October 2016Volume 165, Issue 7Page: 519-520KeywordsEmergency departmentHealth careIntensive care unitsInternetMemoryOutpatientsPatientsResearch quality assessmentSafetySurgeons ePublished: 12 July 2016 Issue Published: 4 October 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.055 | 0.212 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.004 |
| Scholarly communication | 0.012 | 0.009 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.011 | 0.009 |
| Insufficient payload (model declined to judge) | 0.024 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".