Objective
Rheumatology is among the least compensated specialties in medicine today. This is a significant problem for clinical rheumatologists in academic medicine who are often expected to earn their salaries through clinical practice alone. Additionally, academic rheumatologists usually cannot generate revenue through office laboratory monitoring, radiographs, or bone densitometry to supplement their income (i.e., downstream income). The purpose of our study was to examine revenue generated from downstream income to a university by a clinical‐academic rheumatologist.
Methods
Consecutive outpatients (n = 127) seen predominately by one academic rheumatologist over one month of clinic were followed for 18 months. The total physician compensation for patient visits was calculated and compared with the revenue generated from laboratory tests, radiologic studies, consultations, and specific rheumatologic treatments and procedures performed or ordered. Medicare reimbursement rates for 2003 were used as compensation standards for all charges.
Results
Physician office visit billing generated $36,297 from 730 office visits. The total amount of downstream income from these office visits was $363,813 ($47,386 from laboratory tests, $35,582 from radiologic studies, $8,159 from rheumatologic procedures, $261,584 from rheumatologic infusions, and $11,101 from initial consultations). Therefore, $10.02 of downstream revenue was generated for every $1.00 of office visit compensation applied to the academic rheumatologist's salary.
Conclusion
Although academic rheumatologists struggle to bill their salaries through seeing more patients, they are clearly a bargain for a university hospital because they generate >$10.00 for every $1.00 they receive for an office visit.
QOL is better after conservative therapy than after cystectomy, as expected. Prospective studies with repeated measurements covering all fields of interest in QOL would offer an accurate assessment of QOL in NMBC patients.
QOL is better after conservative therapy than after cystectomy, as expected. Prospective studies with repeated measurements covering all fields of interest in QOL would offer an accurate assessment of QOL in NMBC patients.
Objective To assess the quality of life (QoL) of patients with localized prostate cancer (LPC) after treatment by radical radiotherapy (RR).
Patients and methods An ‘ad hoc’ self‐administered questionnaire was developed, which comprised a series of 41 items grouped into seven subscales reflecting the main QoL domains, and the questionnaire's psychometric properties were assessed. A consecutive series of 118 patients treated with RR for LPC from 1981 to 1994 were then selected for a retrospective study and asked to complete the questionnaire.
Results Ninety patients (76%) completed the questionnaire; because 20 of them were also treated with hormonal therapy, QoL was assessed only in the remaining 70 patients, to avoid confusion. The assessment of the psychometric properties showed that the questionnaire was valid and reliable (Cronbach's &agr; coefficient >0.8 for each subscale). The main side‐effects of RR were urinary symptoms and sexual impairment, while physical, psychological and relational well‐being were good. The degree of information available about the therapy and the disease seemed to play a major role in the patients' QoL adjustment after RR.
Conclusion The study assessed a sample of patients with LPC treated with RR and showed that QoL was acceptable after RR. Prospective studies are needed to improve knowledge of the factors involved in the restoration of the QoL after therapy for LPC.
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