AEM Early Access 24: Gender Differences in Faculty Rank Among Academic Emergency Physicians

Welcome to the twenty-fourth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

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DISCUSSING (CLICK ON LINK FOR FULL TEXT, OPEN ACCESS THROUGH MARCH 31):

Gender Differences in Faculty Rank Among Academic Emergency Physicians in the United States. Christopher L. Bennett MD, MA, Ali S. Raja MD, MPH, Neena Kapoor, MD, Dara Kass, MD, Daniel M. Blumenthal MD, MBA, Nate Gross, MD, Angela M. Mills MD

LISTEN NOW: FIRST AUTHOR INTERVIEW WITH Christopher L. Bennett MD, MA

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Christopher Bennett, MD, MA

Board of Directors, Society for Academic Emergency Medicine

Resident Physician, Harvard Emergency Medicine (MGH/BWH)

Twitter: @cleebennett

ABSTRACT

Background: The purpose of this study was to complete a comprehensive analysis of gender differences in faculty rank among U.S. emergency physicians that reflected all academic emergency physicians.

Methods: We assembled a comprehensive list of academic emergency medicine (EM) physicians with U.S. medical school faculty appointments from Doximity.com linked to detailed information on physician gender, age, years since residency completion, scientific authorship, National Institutes of Health (NIH) research funding, and participation in clinical trials. To estimate gender differences in faculty rank, multivariable logistic regression models were used that adjusted for these factors.

Results: Our study included 3,600 academic physicians (28%, or 1,016, female). Female emergency physicians were younger than their male colleagues (mean [±SD] age was 43.8 [±8.7] years for females and 47.4 [±9.9] years for males [p < 0.001]), had fewer years since residency completion (12.4 years vs. 15.6 years, p < 0.001), had fewer total and first/last author publications (4.7 vs. 8.6 total publications, p < 0.001; 4.3 vs. 7.1 first or last author publications, p < 0.001), and were less likely to be principal investigators on NIH grants (1.2% vs. 2.9%, p = 0.002) or clinical trials (1.8% vs. 4.4%, p < 0.001). In unadjusted analysis, male physicians were more likely than female physicians to hold the rank of associate or full professor versus assistant professor (13.7 percentage point difference, p < 0.001), a relationship that persisted after multivariable adjustment (5.5 percentage point difference, p = 0.001).

Conclusions: Female academic EM physicians are less likely to hold the rank of associate or full professor compared to male physicians even after detailed adjustment for other factors that may influence faculty rank.

Hey Kiddo, Take a Seat…

Case 1:

A 13-month-old boy arrives by EMS after a motor vehicle accident. He was a rear passenger, restrained in a front-facing car seat when the vehicle struck a utility pole at high speed. Initially, he was responsive and crying, but became unresponsive and lost vital signs en-route to the ED. In the trauma bay, ROSC is achieved after a brief period of CPR and airway management. His imaging is notable for significant fractures at C1/C2 as well as complex ligamentous disruption; he requires emergent surgical intervention for his spinal injuries, and suffers a severe anoxic brain injury.

Case 2:

Two boys, a 4-month-old and a 3-year-old, arrive by EMS after a low speed, T-bone motor vehicle accident with airbag deployment. Both patients were restrained rear passengers, the 4-month-old in a rear-facing seat, and the 3-year-old in a front-facing seat. In the ED, exam is significant only for some mild abrasions, and both are discharged after a period of observation. The car seats involved in the accident are brought to the ED, and family attempts to use them to transport the children home.

Case 3:

A 5-year-old girl arrives by EMS unresponsive after a front-end collision. She was restrained in her front-facing car seat, when the vehicle struck a telephone pole. Per EMS providers, the seat was not properly restrained within the vehicle. She is apneic with obvious, severe head injuries and asymmetric pupils, with imaging confirming multiple skull fractures and intracranial hemorrhage. Despite maximal interventions, she succumbs to her injuries.

 

Case 4:

A new mother brings her 31-day-old infant for evaluation of vomiting. An exam is performed and is reassuring, consistent with likely reflux, and she is discharged home with close pediatrician follow up in the coming days. On the way out of the exam room, she asks if her car seat is safe to use, as it was a hand-me-down from another family member, and she is not sure if this seat is “expired.”

The Facts:

Unintentional injuries remain a leading cause of death in children. While the number of fatalities from motor vehicle collisions has declined, it remains the cause of death in 1 out of 4 children ages 1-13 [1]. Car safety seats (CSS) have been demonstrated to reduce the risk of injury and death in children, and are credited with saving the lives of 328 children under age 4 in 2016 [2]. Currently, laws exist in all 50 states and Washington D.C. governing the use of child safety seats. The use of car safety seats has been well studied by multiple agencies, including the National Highway Traffic Safety Administration, the Center for Disease Control and Prevention, the Insurance Institute for Highway Safety, and the American Academy of Pediatrics.

We have a duty to our pediatric patients and their families to be familiar with the current recommendations for car safety seats, and provide education and resources when necessary to help prevent morbidity and mortality. In two of the above cases, provider knowledge about these recommendations is critical, and allows rapid intervention on discharge to prevent possible further injuries. As unfortunately common to practitioners in the emergency department, the remaining two cases help reinforce the need for a high index of suspicion for injuries when children present with a history consistent with improper restraint.

 

Current Recommendations [3,10]:

The American Academy of Pediatrics recently released a policy statement published November 2018, highlighting the current recommendations for child safety seats. A summary of recommendations along with a useful flow chart is shown below*:

  • All infants and toddlers should ride in a rear-facing car seat as long as possible, until they reach the height or weight limit listed by the car seat manufacturer

    • It is important to check which type of seat is used rear-facing: infant-only seats have a much lower height and weight limit than convertible or 3-in-1 car seats

  • All children that have outgrown the height or weight limit on a rear-facing seat should ride in a forward-facing seat with a harness until they reach the height/weight limit listed by the manufacturer

  • When children outgrow the height or weight limit of a forward-facing seat, they should use a booster seat until the vehicle lap and shoulder belt fits appropriately, typically when they reach a height of 4 feet 9 inches, and between the age of 8-12

  • When children are old/tall enough to use the vehicle seat belt alone, they should always use both a lap and shoulder belt

  • All children under age 13 should remain restrained in the back seat for optimal protection

*Modified from Table 1: Summary of Best Practice Recommendations, Durbin and Hoffman, Pediatrics, Vol 145 No 5, November 2018

Algorithm to guide implementation of best practice recommendations for optimal child passenger safety:

From: Durbin and Hoffman,  Pediatrics,  Vol 145 No 5, November 2018

From: Durbin and Hoffman, Pediatrics, Vol 145 No 5, November 2018

For the visual learners, the CDC has a graphical representation of the seats with corresponding ages[9]:

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In Rhode Island, specific laws were enacted in 2017, outlining the proper restraint of passengers in vehicles, including children, with a pertinent summary below [4]:

  • All children under age 8, less than 57 inches in height (4 feet 9 inches), and less than 80 pounds should be restrained in a rear sitting position in an approved child restraint system

  • All infants and toddlers less than 2 years of age, or weighing less than 30 pounds, should be restrained in a rear-facing car seat

  • All children 2 years of age or older who outgrow rear-facing car seats should use a forward-facing car seat with harness, up to the maximum allowed by the car seat manufacturer

Frequently Asked Questions:

I have a car seat and am not sure it is installed properly, or am expecting a new baby and not sure how to install my car seat. Where can I go to make sure this is done correctly?

  • There are several options to ensure a child safety seat is installed correctly. The easiest way to do this is to simply search through the National Child Passenger Safety Certification webpage, listed below for a car seat check station. Several options exist, including locating a local agency that will perform a car seat check/installation teaching (most often a local police or fire department), attending a child safety event, or locating a specific inspection station not included in the above [5]. Many children’s hospitals, such as Hasbro Children’s Hospital, also have staff certified for safe car seat installation.

I received a car seat as a hand-me down from another family member, but heard car seats expire. Is this true, and how can I tell if this seat is okay?

  • This is an important, sometimes overlooked fact of child safety seats. While both vehicle and car seat technology have dramatically improved the safety of children riding in vehicles, there are limitations of the seats. Most car seats carry an expiration date 6 years after the manufacture date (although this may vary slightly based on seat construction) [6]. The primary reason for this is the wear and tear placed on the seats themselves, including temperature variation, spills, and physical wear from use of the seat. It is also important to recognize that new technology is continually being produced, which quickly makes older seats less superior in safety. Find the label on the child’s seat, which will list both the manufacture date and expiration date. An example of a label can be found below, as seen in a blog post about this topic from Cincinnati Children’s Hospital [7]:

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  • An additional checklist is provided in the “Additional Resources” section below that should be reviewed before purchasing, and using a used car seat

My child was involved in a car accident in a car seat. Is this seat safe to use after the accident?

  • The National Highway Traffic Safety Administration has some guidelines for when a car seat should be replaced. In cases of minor accidents, a car seat does not necessarily have to be replaced, but the accident must meet all of the following criteria [8]:

    • Vehicle was driven away from crash site

    • Vehicle door nearest car seat was not damaged

    • No passengers in the vehicle sustained injuries

    • No airbag deployment in the vehicle

    • The car seat has no obvious damage

  • If there is any doubt about the severity of the accident, or of the integrity of the car seat, the safest option is to replace the seat

Is there anything else I should do after purchasing a car seat to help ensure it remains up-to-date?

  • Like all new technology, product failures sometimes happen, requiring replacement parts or adjustments. After purchasing a car seat, it is important to register the seat with the appropriate manufacturer to ensure prompt notification of any recall notices in a timely manner. Most manufacturers provide a card that can be submitted, which can also be done online through the specific manufacturer’s page, or using the finder link on the National Highway Traffic Safety Administration website.

Additional Resources:

 

* A special thank you to the providers, nurses, staff, and most importantly, patients/families at Hasbro Children’s Hospital, and to my faculty reviewer, Dr. Jane Preotle

Faculty Reviewer: Jane Preotle, MD

References:

  1. Insurance Institute for Highway Safety, Highway Loss Data Institute, accessed at: https://www.iihs.org/iihs/topics/t/child-safety/fatalityfacts/child-safety, posted December 2017.

  2. US Department of Transportation, National Highway Traffic Safety Administration, “Quick Facts 2016”, accessed at: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812451

  3. Durbin, DR, Hoffman, BD; “Child Passenger Safety”, AAP Council on Injury, Violence, and Poison Prevention Policy Statement, Pediatrics, Volume 142, No. 5, November 2018

  4. Rhode Island State Police, Department of Public Safety, “Seat belt laws and car seat recommendations”, accessed at: http://risp.ri.gov/safety/vehiclesafety/seatbelts.php

  5. National Child Passenger Safety Certification webpage, accessed at: https://cert.safekids.org/get-car-seat-checked

  6. National Safety Commission Alert, published October 2011, accessed at: http://alerts.nationalsafetycommission.com/2011/10/child-safety-seats-have-expiration-date.html

  7. Cincinnati Children’s Blog, “Car seat expiration dates: have you checked yours?”, published online June 22, 2015, accessed at: https://blog.cincinnatichildrens.org/safety-and-prevention/car-seat-expiration-dates-have-you-checked-yours/

  8. National Highway Traffic Safety Administration, “Car seat use after a crash”, accessed at: https://www.nhtsa.gov/car-seats-and-booster-seats/car-seat-use-after-crash

  9. Centers for Disease Control and Prevention, Child  Passenger Safety summary page, accessed at: https://www.cdc.gov/features/passengersafety/index.html

  10. Car Seats: Information for Families, accessed at: https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx

Money Minutes for Doctors #12 - Market Updates

The market is up…the market is down…the sky is falling…the best year ever!!

Welcome back to our monthly financial podcast, Money Minutes for Doctors. This month we talk with Ms. Katherine Vessenes, JD, CFP®, RFC, Founder and President of MD Financial Advisors, about the rollercoaster that was the world of finance in 2018 and where the market appears to be headed in the coming months.

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About Ms. Vessenes:

Ms. Vessenes works with over 300 physicians and dentists from Hawaii to Cape Cod. Her firm uses a team of experts to provide comprehensive financial planning to help doctors build their wealth and protect their wealth while reducing taxes now and in the future. Katherine is a longtime advocate for ethics in the financial services industry; and has written three books on the subject of investment strategies. She has received many honors and awards including: numerous tributes from Medical Economics as a top advisor for doctors, multiple 5-Star Advisor Awards, honored as a Top Woman in Finance, in addition to being selected to be on the CFP® Board of Ethics. Katherine can be reached at: Katherine@mdfinancialadvisors.com or 952-388-6317. Her website: www.mdfinancialadvisors.com.

Quick Summary:

By now you’ve probably seen nerve- racking headlines in the news about the stock market.  Not to worry, we wanted to give you a short update to let you know what’s going on and how it might impact your portfolio.

  • Here’s the short version. : In While in 2017, both Emerging markets and International markets were the largest performers in your portfolio, in 2018 they are were the biggest losers. 

  • Bonds are the only positive asset class for 2018, which is a great reminder as to why a balanced portfolio is needed.

Below is a graph of the loss value of $1 in 2018 in the markets for various key benchmarks sectors.  The blue line is the entire US Market, the green is the International markets, and the teal is Emerging markets. You will notice all three were down by the end of December.

2018 Sector Returns

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Why are the markets down in 2018?

  • There is never one reason why the market behaves the way it does. Thousands, if not millions of factors, go into changing market prices.

  • Two key things to remember when thinking about stock markets; (1) markets are predictive, meaning they are looking at what’s coming in the future & (2) market prices can be summed up as the present value of all the future cash flows these companies expect to make. Thus, if markets go down, it means the millions of people participating in the market expect the companies being traded on stock exchanges to make less in the future.

Most economists would agree that there are three main reasons as to why the stock market has been down in 2018.

  1. Many economists believe world growth is slowing down.

  2. There is uncertainty as to what central banks will do with interest rates. The largest being the United States Federal Reserve.

  3. Trade uncertainty - There’s a standoff going on b/w China & US.  Multinationals that do business with China are currently evaluating whether they will need to move their manufacturing operations and this uncertainty is causing businesses to wait to spend money.

Avoid Market Timing

  •  We don’t think it benefits you to try and time the market

  • Studies show it is impossible to predict market returns therefore, we highly discourage trying to flee to cash while you wait for a recovery.

What can you do? Control the things you can control.

  1.  Fund a Roth IRA in 1st Quarter - The stock market is currently down, which is perversely good news for savers.

  2.  Switch to a Roth Option at Work in Your 401-k/403-b - Not all doctors have a Roth option through their retirement plan through work, but if you do, we suggest switching to funding a Roth option ASAP. 

  3.  Do a Roth Conversion - If you’ve already maxed out your other tax advantaged savings options and have IRA money that is eligible to do a Roth Conversion, you might convert some funds while the market is lower.

  4.  Review your Risk Tolerance - If the volatility in the stock market is keeping you up at night, it means we should review your risk tolerance again to see if you’re investing with the appropriate amount of risk.

  5. Update Your Retirement Plan - markets should be looked at through the context of your goals and dreams

  6. Save, Save, and Save - When markets are down, perversely this is the best time to save b/c your dollars buy more shares

  7. Have Hope - With proper planning and adjustments you will be fine.

The chart below describes the value of a dollar invested globally from 1970 to 2017 and the impact of world events. Over time the market goes up so don’t let short term set backs derail your long-term goals!  

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