On a day-to-day basis, doctors must decide which treatments are most beneficial for their patients, and which make the most sense in terms of costs. In medical decision making, factors such as efficiency and cost-effectiveness can be particularly challenging to navigate because many of the most expensive procedures encountered in medical practice are also high-stake treatments for patients. One-hundred-six obstetricians-gynecologists (Obs/Gyns) completed a survey asking them to allocate the following resources in scenarios in which they are scarce: human papilloma virus (HPV) vaccinations, mammograms, and in vitro fertilization (IVF) treatments. Additional questions focused on how fairness and cost-effectiveness factored into the allocation decisions of each group. Results indicated that Obs/Gyns were more efficient in their distribution of HPV vaccinations and mammograms than in their distribution of IVF treatments. More efficient responding was associated with placing less emphasis on fairness in decision making. This study demonstrates the differences that exist in the emphasis that physicians place on medical evidence, cost, outcomes, and perceptions of fair (equal) allocation when faced with different costs and health impacts.

BACKGROUND: Hypothetical choice studies suggest that physicians often take more risk for themselves than on their patient's behalf. OBJECTIVE: To examine if physicians recommend more screening tests than they personally undergo in the real-world context of breast cancer screening. DESIGN: Within-subjects survey. PARTICIPANTS: A national sample of female obstetricians and gynecologists (N = 135, response rate 54%) from the United States. In total, they provided breast care to approximately 2,800 patients per week. MEASURES: Personal usage history and patient recommendations regarding mammography screening and breast self-examination, a measure of defensive medicine practices. RESULTS: Across age groups, female physicians were more likely to recommend mammography screening than to have performed the procedure in the past 5 years (86% vs. 81%, p = .10). In respondents aged 40-49 this difference was significant (91% vs. 82%, p < .05), whereas no differences were detected for younger or older physicians. Among respondents in their 40s, 18% had undergone annual screenings in the past 5 years, compared to 48% of their colleagues above 50. Respondents were as likely to practice breast self-examination (98%) as to recommend it (93%), a pattern that was consistent across age groups. A logistic regression model of personal use of mammography significantly predicted recommending the procedure to patients (OR = 15.29, p = .001). Similarly, number of breast self-examinations performed over the past 2 years positively predicted patient recommendations of the procedure (OR = 1.31, p < .001). CONCLUSIONS: Obstetricians and gynecologists tended to recommend early mammography screening to their patients, though their personal practices indicated later start than their own recommendations and lower frequency of screening than peers in recent studies have recommended.

OBJECTIVE: The objective was to report results from the seventh survey that monitored trends in numbers of full-time department faculty and from a first survey on the current and anticipated numbers of part-time faculty. METHODS: A faculty workforce survey, drafted in the same format as the prior published questionnaire, was sent electronically to chairs of obstetrics and gynecology at all 125 U.S. medical schools. Each chair was asked to provide the number of current full-time and part-time (0.5-0.9 full-time equivalent) faculty in each specialty and the projected department size in 5 years. When accuracy of data were questioned, we reviewed the department's Web site and directly communicated with the chair. RESULTS: The mean number of full-time faculty per department increased from 25 in 1994 to 29 in 2008 (95% confidence interval 25-33). Most departments (84.0%) had part-time faculty, which constituted 21.2% of the total faculty. Growth was only substantial in the number of medical faculty. In 2008, half (50.1%) of all faculty were women. Private schools and research-oriented departments had the largest faculty sizes. Two-thirds of all chairs anticipated that the number of faculty will increase, especially for part-time faculty and entry-level assistant professors as generalists or maternal-fetal medicine specialists. CONCLUSION: Continued growth in department sizes was accompanied by considerably more women and more part-time faculty. The numbers of full-time and part-time faculty are anticipated to increase. LEVEL OF EVIDENCE: III.