Edited by Robert Golub, MD
Family physicians are trained to provide comprehensive primary care; however, narrowing of the scope of practice of US family physicians is well documented. In an analysis of cross-sectional data from 3038 family medicine residents and 10 846 practicing physicians who were applying to take the 2014 American Board of Family Medicine maintenance of certification examination, Coutinho and colleagues compared intended scope of practice among residents seeking initial board certification with actual practice reported by physicians seeking recertification. The authors report that compared with family physicians currently in practice, graduating family medicine residents reported intentions to provide a broader scope of practice—including prenatal care, inpatient care, nursing home care, home visits, and women’s health procedures.
Physicians in training are at high risk of depression. To provide a summary estimate of the prevalence of depression or depressive symptoms among resident physicians, Mata and colleagues completed a systematic review and meta-analysis of data from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals) that were published between January 1963 and September 2015. The authors report an overall pooled prevalence of depression or depressive symptoms among resident physicians of 28.8%, with a range from 20.9% to 43.2% depending on the diagnostic instrument used, and an increase in prevalence over time. In an Editorial, Schwenk discusses the high prevalence of depression among physician trainees, outlines factors that may contribute to depression and depressive symptoms, and suggests potential solutions.
Continuing Medical Education
Increasing health care costs are a burden for patients and the health care system. To inform development of effective programs to train physicians to deliver high-value, cost-conscious care, Stammen and colleagues reviewed findings from 79 studies of interventions designed to foster provision of high-value patient care. The authors found that learning to deliver high-value, cost-conscious care is promoted by combining specific knowledge transmission, reflective practice, and a supportive environment. In an Editorial, Korenstein discusses what is needed to educate physicians to practice high-value care.
Editorial and Patient Page
An article in JAMA Psychiatry reported results from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III, which found that alcohol use disorder defined by DSM-5 criteria is highly prevalent, commonly associated with psychiatric and physical comorbidities, and often goes untreated in the United States. In this From the JAMA Network article, Compton discusses opportunities for integrating addiction services in general medicine.
Rosacea, a chronic facial skin disease, affects 10% of the population. This JAMA Clinical Evidence Synopsis by van Zuuren and Fedorowicz summarizes a 2015 Cochrane review (106 randomized trials; 13 631 patients total) of treatments for rosacea. The review found high-quality evidence that several topical and oral medications are associated with improvements in rosacea. Moderate-quality evidence supports laser and light-based therapies.
This JAMA Diagnostic Test Interpretation article by Palmer and Clegg presents a 64-year-old man with type 2 diabetes, hypertension, and chronic kidney disease who was recently prescribed oral trimethoprim-sulfamethoxazole for cellulitis. The patient presented with new-onset weakness. A basic metabolic profile revealed several abnormal values, including an elevated serum potassium level. How would you interpret the test results?
Highlights. JAMA. 2015;314(22):2323-2325. doi:10.1001/jama.2014.12131