Perry Pugno | University of Kansas Medical Center (original) (raw)
Papers by Perry Pugno
Annals of family medicine
Family Medicine, Sep 1, 2012
This study determined the demographic and practice characteristics of current Pennsylvania family... more This study determined the demographic and practice characteristics of current Pennsylvania family medicine residency faculty. Surveys were sent electronically to program directors to distribute to their faculty members. Participants were surveyed for age, race, gender, current and completed residency training program, fellowship completion, practice track, and current practice characteristics. Survey response rate represented 35.3% of residency faculty in Pennsylvania. The majority represented full-time faculty (83.7%), were male (53.8%), were Caucasian (84.8%), did not enter their faculty position following residency (65.9%), had completed their residency training in Pennsylvania (57.9%), and did not complete a fellowship. While most faculty have continued inpatient and outpatient care, less than half participate in other surveyed elements of comprehensive family medicine care. The environment within academic family medicine and changing cultures have created a shift that the future of academic practice may need to depend on new graduates. Current demographics suggest a poorly diverse faculty with private practice experience and limited full-spectrum mentors that may have contributed to family medicine's difficulties within the academic marketplace. Creating a strong primary care workforce demands ensuring a sustainable faculty.
The Journal of the American Board of Family Practice, Sep 1, 1991
The Journal of the American Board of Family Practice, Jul 1, 1991
The Journal of family practice
This review discusses the factors responsible for problems incurred by family physicians in the p... more This review discusses the factors responsible for problems incurred by family physicians in the process of applying for hospital privileges. They include issues such as local unfamiliarity with family practice as a specialty, regional needs for primary care providers, reluctance to "make waves," and the breadth of privileges sought. Major areas of contention center on the utilization of obstetrical, surgical, and critical care facilities. If a request for privileges is denied, the applicant does, however, possess the right of due process. This right is substantiated in law and includes appeal procedures consisting of an enumeration of specific justifications for denial, adequate notice of a hearing, and the opportunity to be present, rebut the evidence, and present a defense. When dealing with such conflicts, the family physician will recognize the importance of training-content documentation, a willingness to demonstrate competence, and resources for professional assistance through both local and regional offices of the American Academy of Family Physicians.
JAMA The Journal of the American Medical Association
The Journal of clinical ethics
Family medicine
First brought to the attention of the medical education community in 1977, the "one-and-... more First brought to the attention of the medical education community in 1977, the "one-and-two" program was designed to improve the relevance of residency training by using both a university teaching hospital and a smaller community hospital as training centers. This paper reviews the progress of implementing this format over the past ten years, and cites some of the advantages and disadvantages encountered from doing so.
Family medicine
The turbulent health care environment, combined with recent reductions in federal support for gra... more The turbulent health care environment, combined with recent reductions in federal support for graduate medical education, has threatened the viability of many residency programs. Several family practice programs are in the process of struggling for survival, while others have been forced to close. A new Residency Assistance Program (RAP) consultation has been developed to help programs "justify their existence " to sponsoring institutions. This paper discusses the signs that a program's viability may be in jeopardy and offers recommendations to reduce the risks of closure. For those residencies forced to cease operations, 11 recommendations are provided to minimize the negative impact of closure on the program's residents, faculty, and staff. Those include steps to assure that current residents receive full credit for the training time completed and the importance of notifications to the Residency Review Committee for Family Practice, the American Board of Family Practice, and the Association of Family Practice Residency Directors. Decisions must be made about whether the option exists to permit current residents to complete their training in the same facility or whether assistance is available to facilitate resident transfers to other programs. Open and honest communication among affected parties is emphasized to minimize the emotional consequences of such an important event.
Western Journal of Medicine
ⅷ Objectives To explore the nature of managed-care hassles in primary care physicians' offices an... more ⅷ Objectives To explore the nature of managed-care hassles in primary care physicians' offices and to determine the feasibility of practice-based research methods to study the problem. ⅷ Methods 16 internists and 10 family physicians volunteered to collect data about managed-care hassles during or shortly after the office visit for 15 consecutive patients using preprinted data cards. ⅷ Outcome measures Number of hassles, time required for hassles, and interference with quality of care and doctor-patient relationship. ⅷ Results Physicians adapted easily to using data cards. Before the pilot study, participants estimated a hassle rate of 10% and thought that interference with quality of care and the doctor-patient relationship was infrequent. Of 376 total visits for which the physicians completed data cards, 23% of visits generated 1 or more hassles. On average, a physician who saw 22 patients daily experienced 1 hassle lasting 10 minutes for every 4 to 5 patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both. ⅷ Conclusions The high hassle rate, in addition to the interference of hassles with quality of care and the doctor-patient relationship, suggests the need for further investigation into managed-care hassles using practice-based research methods.
Changing Health Care Systems from Ethical, Economic, and Cross Cultural Perspectives, 2002
ABSTRACT
Family medicine, 2012
This study determined the demographic and practice characteristics of current Pennsylvania family... more This study determined the demographic and practice characteristics of current Pennsylvania family medicine residency faculty. Surveys were sent electronically to program directors to distribute to their faculty members. Participants were surveyed for age, race, gender, current and completed residency training program, fellowship completion, practice track, and current practice characteristics. Survey response rate represented 35.3% of residency faculty in Pennsylvania. The majority represented full-time faculty (83.7%), were male (53.8%), were Caucasian (84.8%), did not enter their faculty position following residency (65.9%), had completed their residency training in Pennsylvania (57.9%), and did not complete a fellowship. While most faculty have continued inpatient and outpatient care, less than half participate in other surveyed elements of comprehensive family medicine care. The environment within academic family medicine and changing cultures have created a shift that the futur...
Family medicine
There has been declining interest by US medical students in the specialty of family medicine. Sim... more There has been declining interest by US medical students in the specialty of family medicine. Simultaneously, new data suggest that the length of training may be related to the decline in student interest. The new data have created a national debate over the appropriate length of training for family physicians. The Future of Family Medicine Report recommends conducting experiments with 4-year residency training programs. Since 1999--2000, the University of Arizona Family Medicine Residency Program has offered three fourth-year options: a fourth-year fellowship in sports medicine, an integrated third- and fourth-year experience in complementary and alternative medicine, and an option for a master's in public health degree. Data on applications to the residency program have been monitored to measure the effect of these options on the applicant pool. National Resident Matching Program statistics, and the interest in the program expressed by US graduates, have improved for the Unive...
The Journal of clinical psychiatry, 1997
Most patients with panic disorder have their initial contact with the health care system in a gen... more Most patients with panic disorder have their initial contact with the health care system in a general medical setting. Only 35% of patients have their first contact in a mental health care setting, and of these, only 22% are evaluated initially by a psychiatrist. Thus, family practitioners, cardiologists, gastroenterologists, and other specialists need to become familiar with the signs, symptoms, and differential diagnosis of panic disorder. Early diagnosis of panic disorder by nonpsychiatrists-before unnecessary tests are ordered-would substantially decrease the costs associated with this condition.
Archives of Family Medicine, 1999
Objective: To evaluate the usefulness of the horizontal transhymenal diameter as a screening para... more Objective: To evaluate the usefulness of the horizontal transhymenal diameter as a screening parameter to differentiate between prepubertal girls with and without other definitive signs of sexual abuse.
Annals of family medicine
Family Medicine, Sep 1, 2012
This study determined the demographic and practice characteristics of current Pennsylvania family... more This study determined the demographic and practice characteristics of current Pennsylvania family medicine residency faculty. Surveys were sent electronically to program directors to distribute to their faculty members. Participants were surveyed for age, race, gender, current and completed residency training program, fellowship completion, practice track, and current practice characteristics. Survey response rate represented 35.3% of residency faculty in Pennsylvania. The majority represented full-time faculty (83.7%), were male (53.8%), were Caucasian (84.8%), did not enter their faculty position following residency (65.9%), had completed their residency training in Pennsylvania (57.9%), and did not complete a fellowship. While most faculty have continued inpatient and outpatient care, less than half participate in other surveyed elements of comprehensive family medicine care. The environment within academic family medicine and changing cultures have created a shift that the future of academic practice may need to depend on new graduates. Current demographics suggest a poorly diverse faculty with private practice experience and limited full-spectrum mentors that may have contributed to family medicine's difficulties within the academic marketplace. Creating a strong primary care workforce demands ensuring a sustainable faculty.
The Journal of the American Board of Family Practice, Sep 1, 1991
The Journal of the American Board of Family Practice, Jul 1, 1991
The Journal of family practice
This review discusses the factors responsible for problems incurred by family physicians in the p... more This review discusses the factors responsible for problems incurred by family physicians in the process of applying for hospital privileges. They include issues such as local unfamiliarity with family practice as a specialty, regional needs for primary care providers, reluctance to "make waves," and the breadth of privileges sought. Major areas of contention center on the utilization of obstetrical, surgical, and critical care facilities. If a request for privileges is denied, the applicant does, however, possess the right of due process. This right is substantiated in law and includes appeal procedures consisting of an enumeration of specific justifications for denial, adequate notice of a hearing, and the opportunity to be present, rebut the evidence, and present a defense. When dealing with such conflicts, the family physician will recognize the importance of training-content documentation, a willingness to demonstrate competence, and resources for professional assistance through both local and regional offices of the American Academy of Family Physicians.
JAMA The Journal of the American Medical Association
The Journal of clinical ethics
Family medicine
First brought to the attention of the medical education community in 1977, the "one-and-... more First brought to the attention of the medical education community in 1977, the "one-and-two" program was designed to improve the relevance of residency training by using both a university teaching hospital and a smaller community hospital as training centers. This paper reviews the progress of implementing this format over the past ten years, and cites some of the advantages and disadvantages encountered from doing so.
Family medicine
The turbulent health care environment, combined with recent reductions in federal support for gra... more The turbulent health care environment, combined with recent reductions in federal support for graduate medical education, has threatened the viability of many residency programs. Several family practice programs are in the process of struggling for survival, while others have been forced to close. A new Residency Assistance Program (RAP) consultation has been developed to help programs "justify their existence " to sponsoring institutions. This paper discusses the signs that a program's viability may be in jeopardy and offers recommendations to reduce the risks of closure. For those residencies forced to cease operations, 11 recommendations are provided to minimize the negative impact of closure on the program's residents, faculty, and staff. Those include steps to assure that current residents receive full credit for the training time completed and the importance of notifications to the Residency Review Committee for Family Practice, the American Board of Family Practice, and the Association of Family Practice Residency Directors. Decisions must be made about whether the option exists to permit current residents to complete their training in the same facility or whether assistance is available to facilitate resident transfers to other programs. Open and honest communication among affected parties is emphasized to minimize the emotional consequences of such an important event.
Western Journal of Medicine
ⅷ Objectives To explore the nature of managed-care hassles in primary care physicians' offices an... more ⅷ Objectives To explore the nature of managed-care hassles in primary care physicians' offices and to determine the feasibility of practice-based research methods to study the problem. ⅷ Methods 16 internists and 10 family physicians volunteered to collect data about managed-care hassles during or shortly after the office visit for 15 consecutive patients using preprinted data cards. ⅷ Outcome measures Number of hassles, time required for hassles, and interference with quality of care and doctor-patient relationship. ⅷ Results Physicians adapted easily to using data cards. Before the pilot study, participants estimated a hassle rate of 10% and thought that interference with quality of care and the doctor-patient relationship was infrequent. Of 376 total visits for which the physicians completed data cards, 23% of visits generated 1 or more hassles. On average, a physician who saw 22 patients daily experienced 1 hassle lasting 10 minutes for every 4 to 5 patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both. ⅷ Conclusions The high hassle rate, in addition to the interference of hassles with quality of care and the doctor-patient relationship, suggests the need for further investigation into managed-care hassles using practice-based research methods.
Changing Health Care Systems from Ethical, Economic, and Cross Cultural Perspectives, 2002
ABSTRACT
Family medicine, 2012
This study determined the demographic and practice characteristics of current Pennsylvania family... more This study determined the demographic and practice characteristics of current Pennsylvania family medicine residency faculty. Surveys were sent electronically to program directors to distribute to their faculty members. Participants were surveyed for age, race, gender, current and completed residency training program, fellowship completion, practice track, and current practice characteristics. Survey response rate represented 35.3% of residency faculty in Pennsylvania. The majority represented full-time faculty (83.7%), were male (53.8%), were Caucasian (84.8%), did not enter their faculty position following residency (65.9%), had completed their residency training in Pennsylvania (57.9%), and did not complete a fellowship. While most faculty have continued inpatient and outpatient care, less than half participate in other surveyed elements of comprehensive family medicine care. The environment within academic family medicine and changing cultures have created a shift that the futur...
Family medicine
There has been declining interest by US medical students in the specialty of family medicine. Sim... more There has been declining interest by US medical students in the specialty of family medicine. Simultaneously, new data suggest that the length of training may be related to the decline in student interest. The new data have created a national debate over the appropriate length of training for family physicians. The Future of Family Medicine Report recommends conducting experiments with 4-year residency training programs. Since 1999--2000, the University of Arizona Family Medicine Residency Program has offered three fourth-year options: a fourth-year fellowship in sports medicine, an integrated third- and fourth-year experience in complementary and alternative medicine, and an option for a master's in public health degree. Data on applications to the residency program have been monitored to measure the effect of these options on the applicant pool. National Resident Matching Program statistics, and the interest in the program expressed by US graduates, have improved for the Unive...
The Journal of clinical psychiatry, 1997
Most patients with panic disorder have their initial contact with the health care system in a gen... more Most patients with panic disorder have their initial contact with the health care system in a general medical setting. Only 35% of patients have their first contact in a mental health care setting, and of these, only 22% are evaluated initially by a psychiatrist. Thus, family practitioners, cardiologists, gastroenterologists, and other specialists need to become familiar with the signs, symptoms, and differential diagnosis of panic disorder. Early diagnosis of panic disorder by nonpsychiatrists-before unnecessary tests are ordered-would substantially decrease the costs associated with this condition.
Archives of Family Medicine, 1999
Objective: To evaluate the usefulness of the horizontal transhymenal diameter as a screening para... more Objective: To evaluate the usefulness of the horizontal transhymenal diameter as a screening parameter to differentiate between prepubertal girls with and without other definitive signs of sexual abuse.