Abstract
The New York City (NYC) Department of Health and Mental Hygiene (Health Department) surveyed practicing NYC physicians to quantify Health Department resource use. Although the Health Department successfully reaches most physicians, and information is valued in practice, knowledge of several key resources was low. Findings suggested 3 recommendations for all local health departments seeking to enhance engagement with practicing physicians: (1) capitalize on physician interest, (2) engage physicians early and often, and (3) make interaction with the health department easy. Also, older physicians may require targeted outreach.
Collaborative relationships can help health departments and physicians advance shared goals of health promotion and protection.1–5 The New York City (NYC) Department of Health and Mental Hygiene (Health Department) regularly interacts with physicians through communications, publications, and clinical guidance. Certain Health Department programs target specific NYC physician populations and have evaluated these efforts.6–8 However, the Health Department has not systematically assessed the effectiveness of engagement with NYC physicians overall. We conducted a survey to quantify physician knowledge and use of Health Department resources.
METHODS
From November 2009 through February 2010, we surveyed physicians selected from an American Medical Association Physician Masterfile list.9 The Health Department interacts mostly with primary care physicians, approximately 30% of the NYC physician population. To ensure an adequate sample of this population, we randomly selected 840 primary care physicians and 360 non–primary care physicians.
The questionnaire took approximately 15 minutes to complete, and an electronic version was created with Survey MonkeyTM.10 We mailed paper copies of the survey with a cover letter from the Commissioner of Health; a preaddressed, stamped envelope; a card for 1 subway or bus ride; and 2 optional forms: 1 for entrance into a lottery for 1 of 5 one-year subscriptions to MD Consult,11 and 1 for future focus group participation. Physicians could participate by paper or through a provided Web link. (Detailed methods and the questionnaire are included in supplements to the online version of this article at http://www.ajph.org.)
Respondents were eligible if they reported seeing patients at least 10 hours a week and practiced primarily in NYC. Univariate analyses described respondent demographics and practice characteristics compared with all NYC physicians.12 Bivariate analyses examined differences among respondents by demographic and practice characteristics.
RESULTS
We received 626 unique surveys and 105 focus group participation forms. We removed 82 invalid records (not practicing or not in NYC) from our original sample for a response rate of 56%. There were 128 ineligible respondents, leaving 498 eligible records in the final data set. (A flowchart detailing the survey sample and response is available as a supplement to the online version of this article at http://www.ajph.org).
Survey respondents were more likely to be female and to work in community health centers but were comparable to all NYC physicians on age and location of medical school (Table 1). Nearly half (49%) provided direct patient care at least 40 hours per week; 38% reported that most patients in their practice were uninsured or only covered through Medicaid, and 53% used electronic health records.
TABLE 1—
Descriptive Characteristics of Physician Survey Sample, Overall and Compared With New York State Physician Profile of NYC Physicians: November 2009 to February 2010
| Characteristic | NYC Health Department Survey, No. (%) | NYC Physician Profile,a No. (%) | P |
| Mode of completed surveys | |||
| By mail | 383 (77) | … | NA |
| By Internet | 57 (11) | … | |
| By telephone | 58 (12) | … | |
| Primary practice focusb | |||
| Primary care | 300 (61) | 9435 (29) | NA |
| Specialty | 192 (39) | 22 930 (71) | |
| Age, y | |||
| < 45 | 190 (38) | 10 357 (32) | .63 |
| 45–64 | 245 (49) | 16 830 (52) | |
| ≥ 65 | 63 (13) | 5178 (16) | |
| Gender | |||
| Female | 232 (47) | 11 004 (34) | <.01 |
| Male | 266 (53) | 21 361 (66) | |
| Location of medical school | |||
| New York State | 194 (39) | 11 328 (35) | .15 |
| Other United States | 112 (22) | 8091 (25) | |
| Foreign | 192 (38) | 12 946 (40) | |
| Practice type | |||
| Solo | 139 (30) | 10 033 (31) | .01 |
| Partnership or group | 97 (21) | 8415 (26) | |
| Community health center or hospital | 227 (49) | 13 917 (43) | |
| Time spent providing direct clinical care, h/wkc | |||
| 10–19 | 59 (12) | … | NA |
| 20–29 | 79 (16) | … | |
| 30–39 | 114 (23) | … | |
| ≥ 40 | 246 (49) | … | |
| Proportion of patients in practice uninsured or only covered through Medicaid | |||
| All | 20 (4) | … | NA |
| ≥ half, but < all | 165 (34) | … | |
| < half, but > none | 172 (35) | … | |
| None | 81 (16) | … | |
| Don't know | 54 (11) | … | |
| Uses electronic health records in practice | |||
| Yes | 259 (53) | … | NA |
| No | 233 (47) | … |
Note. Health Department = Department of Health and Mental Hygiene; NA = not applicable; NYC = New York City. Survey totals may not add to 498 because of missing values (n = 6 for primary practice focus; n = 35 for practice type; n = 6 for proportion of patients in practice uninsured or only covered through Medicaid; and n = 6 for use of electronic medical records). Percentages are calculated based on nonmissing data.
Information on all NYC physicians was obtained from the Center for Health Workforce Studies 2009 Annual New York Physician Workforce Profile.12
Primary care physicians included those who indicated a specialty in general pediatrics, general internal medicine, obstetrics/gynecology, family medicine, and general practice in the American Medical Association's Physician Masterfile list used to select our sample. This group was intentionally oversampled.
Respondents providing less than 10 hours per week of direct patient care were excluded.
Most respondents (82%) reported receiving any Health Department communication, but only 37% had received information specifically through the Health Alert Network (HAN),13 with primary care physicians more likely than specialists to have received any communication and the HAN specifically (Table 2). Less than a third (31%) of respondents were aware of the universal reporting form14 with higher awareness among primary care physicians compared with specialists. Few (14%) were aware of the Health Department on-call physicians after hours.13 Overall, 47% preferred to receive Health Department publications by e-mail, and this was inversely associated with age. Younger respondents, particularly those younger than 45 years, were more likely to prefer to receive e-mailed publications.
TABLE 2—
Interactions Between Physician Survey Respondents and the NYC Department of Health and Mental Hygiene: November 2009 to February 2010
| NYC Health Department Outreach to Physicians |
Physician Communication to the NYC Health Department |
||||||||||
| Respondent Characteristic | Total, No. | Ever Received Communication From NYC Health Department,a No. (%) | P | Ever Received Information Through Health Alert Networkb Communications, No. (%) | P | Prefer to Receive NYC Health Department Publications by E-mail, No. (%) | P | Aware of the Universal Reporting Form,c No. (%) | P | Contacted NYC Health Department for Information or Advice,d No. (%) | P |
| Overall | 498 | 403 (82) | … | 178 (37) | … | 180 (47) | … | 149 (31) | … | 303 (61) | … |
| Primary practice focus | |||||||||||
| Primary care | 300 | 268 (90) | <.01 | 123 (42) | <.01 | 114 (44) | .23 | 112 (39) | <.01 | 215 (72) | <.01 |
| Specialist | 192 | 134 (70) | 55 (29) | 66 (53) | 37 (20) | 87 (45) | |||||
| Age, y | |||||||||||
| < 45 | 190 | 144 (77) | .05 | 53 (29) | .06 | 79 (57) | <.01 | 49 (27) | .01 | 120 (63) | .14 |
| 45–64 | 245 | 207 (86) | 102 (43) | 90 (45) | 88 (38) | 152 (63) | |||||
| < 65 | 63 | 52 (84) | 23 (37) | 11 (22) | 12 (20) | 31 (50) | |||||
| Practice type | |||||||||||
| Solo | 139 | 115 (84) | .63 | 46 (34) | .64 | 38 (34) | <.01 | 48 (36) | .18 | 85 (62) | .02 |
| Group | 97 | 79 (84) | 38 (41) | 36 (49) | 30 (34) | 68 (72) | |||||
| Community health center or hospital | 227 | 182 (81) | 78 (35) | 93 (53) | 60 (27) | 126 (56) | |||||
Note. Health Department = Department of Health and Mental Hygiene; NYC = New York City.
Ever received a NYC Health Department publication, including the Health Alert Network.
The Health Alert Network is an electronic notification system that provides information on urgent and emergency public health situations.13
The universal reporting form is used to report notifiable diseases or conditions to the NYC Health Department.14 This form may be submitted through mail or fax, and can be submitted electronically through the Health Department's online application, Reporting Central (available since the summer of 2009).
Visited NYC Health Department Web site or contacted NYC Health Department for clinical guidance in the past year.
Most (61%) respondents contacted the Health Department for information in the past year, particularly those in primary care and in solo or group practices. Most respondents who used Health Department resources agreed that the information was useful in their practice: 87% of those who had contacted the Health Department for clinical guidance in the past year, 82% who had visited the Web site in the past year, 75% who ever had received the clinical guidelines bulletin for primary care physicians,15 and 70% who ever had received the HAN.
DISCUSSION
This survey confirmed that the Health Department successfully reaches many physicians, particularly primary care providers. Findings also provided surprising insights into NYC physicians. First, physicians were receptive to engagement with the Health Department, as indicated by the high response to the survey and the reported value of Health Department resources in practice. Second, many physicians remain unaware of important Health Department resources, particularly the universal reporting form. Third, older physicians preferred to receive printed publications.
Our study had several limitations. Generalizability may be limited because of deliberate oversampling of primary care physicians. In addition, our sample size was not large enough to assess differences by practice location. Also, this survey relies on self-reported data so it may over- or underestimate physician awareness. Despite these limitations, our findings prompt the following recommendations.
Capitalize on physician interest.
Many physicians want to be engaged in public health initiatives. Health departments should direct topical and timely resources to physicians, taking their media preferences into account, and increase awareness of existing resources.
Engage physicians early and often.
Health departments should enhance outreach to physicians, providing clinician-friendly materials that emphasize the application of public health in clinical practice. In addition, collaborations with clinical residency programs can make regular communication habit rather than requirement among future community providers. Such collaborations can also enhance public health curricula during training and promote mutual understanding of and respect for each partner's roles and responsibilities. Establishing and maintaining physician contact registries, including e-mail addresses, can also facilitate more frequent and rapid communication at minimal cost.
Make interaction easy.
Health departments should use new technology to facilitate communication with physicians. As more physicians adopt technologies such as electronic health records and social media, health departments should use these tools to engage physicians and promote public health. Outreach strategies should account for physician preferences, such as providing print materials to older providers.
Collaborative relationships between health departments and physicians are mutually beneficial and enhance each group's ability to effectively promote health. Physician surveys enable assessment of physicians’ interactions with their local health department and represent an important step in increasing physician engagement in public health.
Acknowledgments
The authors would like to thank Lorna Thorpe of the City University of New York, Joseph Egger of SciMetrika, and Katherine Bartley of the NYC Health Department for their support on the initial design of this project. The authors would also like to thank Carlos Espada and the NYC Health Department Call Center staff for their assistance with data collection. Finally, the authors would like to thank the following staff from the NYC Health Department Bureau of Public Health Training, who were instrumental in the survey distribution and processing: Janice Blake, Kimsue Bryan, Tsering Choden, Peter Ephross, Tanya Fareira, Berton Freedman, Calaine Hemans-Henry, Raymond Jimenez, Bridgette Parrish, Jennifer Rose, Deloris Sands, Rhoda Schlamm, Nilsa Torres, and Verliene Wade.
Human Participant Protection
The NYC Health Department Office of the General Counsel deemed this study a nonresearch public health activity not subject to institutional review board review.
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