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Publications, |
Jerry Sobieraj,MD |
Triple-negative breast cancers are increased in black women regardless of age or body mass index.
Stead LA, Lash TL, Sobieraj JE, Chi DD, Westrup JL, Charlot M, Blanchard RA, Lee JC, King TC, Rosenberg CL.
Breast Cancer Res. 2009;11(2)
Queing Analysis of a General Medical Practice
Declined by Journal of the American Medical Information Association
Posted 27 October 2006
Science 5 March 1999:
Vol. 283. no. 5407, p. 1455
Physician-Scientists at Risk
Like many clinicians, I have identified common problems that are easily definable, but not easily treatable. I would like to have the opportunity to research some of these issues, but do not have the time as a full-time clinician. When I have discussed this with my boss, he has told me if I could produce some promising data, he would give me protected time to develop them. However, I can't get protected time to get the initial data with my busy clinical schedule. Thus, I am in a "Catch- 22." If I get the data, I can get protected time. Yet, without the protected time, it will be very difficult to get the data.
Despite these obstacles, I am trying to pull some of the early pieces together in my "off hours." This is difficult and may ultimately not be fruitful. I would love the opportunity to be able to apply for a starter program for mid-career clinicians who would like to research a clinical issue. I believe that I have insights into disease processes that are worth exploring. Yet, they will remain at the level of a hypothesis or an anecdote unless I am able to have the time to systematically develop an approach to study them.
Jerry Sobieraj
Boston Medical Center,
Boston MA 02118, USA.
New England Journal of Medicine
Volume 339:410-412
August 6, 1998
Truth or Consequences
To the Editor: Many primary care physicians are salaried employees of group- or staff-model practices. As salaried employees, we need to maintain a certain level of productivity in order to support our salaries. Our productivity contributes not only to incentive pay but also to our base salary. When we stop patients from telling us about the last issue they want to discuss that day, or when we avoid probing too deeply into an issue because of time constraints, we do not openly acknowledge what is driving the process.
At times, our haste is driven by a waiting room full of patients. They may be waiting because of a policy that requires a patient to be booked every 15 or 20 minutes in order to support a six-figure salary. Some days, we cover all issues with our patients, including time-consuming education. As a result, our day may end quite late, causing some patients to wait more than an hour before being seen. Other days, we keep the discussion short, so that we can stay on time.
To support our salaries, we need to see a certain number of patients per year. To fit these patients into our schedules, we need to have them slotted at a particular frequency. Yet we do not tell our patients the ultimate reason we are unable to spend sufficient time with them to discuss all their issues. Shouldn't we be disclosing this information? Shouldn't we as physicians acknowledge that we tacitly support abbreviated discussions with our patients in order to maintain a certain level of "productivity," and thus, a certain salary level? When we finally acknowledge the impact of our behavior on our salaries, then and only then will we be able to take an ethical stand.
Jerry Sobieraj, M.D.
Boston University Medical Center
Boston, MA 02118
New England Journal of Medicine
Volume 336:510-513
February 13, 1997
Appetite-Suppressant Drugs and Primary Pulmonary Hypertension
To the Editor: The recent report by Abenhaim et al. for the International Primary Pulmonary Hypertension Study Group (Aug. 29 issue)1 has received considerable attention in the media. Patients were excluded who had pulmonary hypertension due to many causes, but not obstructive sleep apnea. Since there were approximately twice as many case patients as controls who had body-mass indexes (the weight in kilograms divided by the square of the height in meters) of 30 or higher (35.8 percent vs. 18.3 percent), one would expect the incidence of pulmonary hypertension due to obstructive sleep apnea to be higher in the case patients.2
The authors attempted to control for obesity by citing in their Discussion section an odds ratio of 1.0 for the interaction between obesity and the use of appetite-suppressant drugs. Yet without sleep studies to evaluate possible obstructive sleep apnea, it becomes speculative to use the term "primary" in describing the case patients with pulmonary hypertension.
Jerry Sobieraj, M.D.
Boston Medical Center
Boston, MA 02118
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