David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
This study shows that the widely recognized physician gender compensation gap extends to hospital medicine.
The gaps were larger for physicians who were practice owners, who were older, and who spent most of their time in administration (as opposed to direct patient care). Gaps were largest between physicians in solo practice and smallest in those working in a government setting.
An editorial notes that these disparities have been well established by other studies and refers to them as an “unfortunate and unconscionable norm.” The editorialists call for action, including more intense organizational efforts to achieve income equity, higher levels of income transparency, and better negotiation training for women in medicine.
NAFLD comprises 2 distinct disorders: nonalcoholic fatty liver (NAFL), which is a benign condition in more than 80% of patients with NAFLD; and nonalcoholic steatohepatitis (NASH), which is characterized by progressive liver injury, inflammation, and fibrosis and occurs in fewer than 20% of patients with NAFLD. Eleven percent of patients with NASH will progress to cirrhosis over a 15-year period.
NAFLD is usually suspected in the setting of mild liver enzyme elevations. Diagnosis of NAFLD requires either biopsy or confirmation of steatosis on imaging, plus exclusion of significant alcohol use, other causes of steatosis, and other causes of chronic liver disease. Therefore, the evaluation requires a significant battery of laboratory tests, which are summarized in the article.
NASH is diagnosed when fibrosis is present. Although risk for fibrosis can be estimated by clinical calculators and noninvasive studies of liver elasticity, liver biopsy remains the gold standard.
There are no approved drug therapies for NAFLD, and weight loss is the primary proven treatment. However, cardiovascular disease is the leading cause of death in patients with NAFLD, so cardiovascular risk modification has a role in the management of these patients.
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Wesorick DH, Chopra V. Annals for Hospitalists - 20 November 2018. Ann Intern Med. ;169:HO1. doi: 10.7326/AFHO201811200
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Published: Ann Intern Med. 2018;169(10):HO1.
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