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PROFESSIONAL ISSUES Med school seniors headed for primary care see a challenging future
Classmates Mark Anderson and Marlana Li clasped their envelopes on Match Day, full of hope and uneasiness about their future in medicine. Like other graduating seniors at Loyola University Chicago Stritch School of Medicine, the two on March 19 learned where they will spend the next several years of residency training. They chose primary care at a time when family medicine is struggling to attract new physicians. There were 101 fewer family medicine positions available in the Match this year, and the number of U.S. seniors selecting the specialty decreased by 85 from 2008. Since 1997, the number of U.S. seniors matching in family medicine has dropped by more than half. Lower pay and longer hours are among the reasons cited for avoiding the specialty. Yet Anderson, Li and others say they want to be family physicians, in part because of the lifelong relationship formed with patients and the satisfaction that comes with it. "I didn't go into medicine for the money," said Li, w [Read more]
Challenging your rating: You don't have to accept what the health plan says
Like many doctors practicing in Massachusetts, Cambridge pediatrician Michael Yogman, MD, MPH, had an early and unhappy experience with physician ratings. Beginning in July 2006, after a mandate from the state's Group Insurance Commission, which handles benefits for public employees, physicians who contracted with Tufts, Unicare or Harvard Pilgrim were ranked for quality and cost. The rankings meant more than a gold star or lack of one in a physician directory -- they meant a higher co-pay for patients to see doctors who were not in the highest tier. When one of the three plans didn't rate him in the highest tier, Dr. Yogman said he first got mad. Then he got busy with an appeal. "I took it as a personal assault on my integrity," he said. "I was not about to stand for being considered a less-than-optimal physician on anybody's ranking." Many physicians either upset with health plan rankings in general, or particularly upset at, what they feel is an unfairly low ranking shar [Read more]
Changing history: The questions you ask patients keep expanding
After Martin Duke, MD, retired as director of medical education and chief of cardiology at Connecticut's Manchester Memorial Hospital, he found himself more often the patient than the physician. As a result, he spent more time giving his medical history than taking someone else's, and he noticed significant changes in how the task was accomplished. The time spent on it was shorter. It often was taken by an allied health worker. And, sometimes it didn't even involve a face-to-face conversation. Instead, he simply checked "yes" or "no" boxes on a questionnaire. In a paper he authored in the November-December 2008 Connecticut Medicine, he bemoaned this shift. "If this trend were to continue, it is conceivable that one day patients and doctors may not even be speaking with each other," he wrote. "Technology has changed the whole approach, and technology does add something," said Dr. Duke in an interview. "But it cannot stand by itself. It needs the person-to-person interaction for so [Read more]
Self-insured companies going after doctors to recover
When Snellville, Ga., internist Joel Fine, MD, read a note from a company called Health Research Insights, he thought it sounded a little bit like a chain letter -- vaguely threatening, insistent on a quick response, with few details. The letter, addressed "Dear Health Care Professional," accused Dr. Fine of upcoding four claims for treating Georgia-Pacific employees. The earliest dated back to February 2005. "Of course, I was offended," Dr. Fine said. HRI's letter offered him two choices: pay $347 to "immediately settle this issue" or send complete records proving he did not incorrectly bill for the visits in question. The letter warned that if Dr. Fine did not pay HRI or contact them with records to prove his innocence, his case could be turned over to federal authorities. "The intimidation is really strong here," he said. "They are working under the guilty-until-proven-innocent philosophy." HRI, which sent Dr. Fine the letter in February, works on behalf of large compani [Read more]
1 in 5 Medicare patients readmitted within a month after hospital release
Nearly 20% of Medicare patients discharged from hospitals were readmitted within 30 days, costing taxpayers $17.4 billion, according to an April 2 study in the New England Journal of Medicine. About 10% of rehospitalizations were planned to continue needed care, the study found. But as many as 40% of them -- or about 1 million readmissions -- were preventable, said Stephen F. Jencks, MD, MPH, lead author of the study (content.nejm.org/cgi/content/abstract/360/14/1418/). "It is very clear that high rehospitalization rates are not ordained," Dr. Jencks said at a news conference. "When it is preventable, rehospitalization is a terrible waste of money, and many are preventable." Dr. Jencks and his co-authors analyzed Centers for Medicare & Medicaid Services claims data on hospital discharges of Medicare patients in 2003 and 2004. The rates varied widely among states and individual hospitals. The top five states -- Louisiana, Illinois, West Virginia, Kentucky and Mississippi -- had [Read more]
Pharma support of medical societies raises conflict-of-interest concerns
The American Psychiatric Assn. in March said that to erase the risk of bias, it will phase out the $1.5 million in drugmaker money it uses to fund continuing medical education. The same month, the American College of Cardiology declined to distribute nearly half a million dollars in industry-funded, logo-branded tote bags, lanyards and badges at its annual scientific session. The moves reflect physician organizations' growing sensitivity about potential conflicts of interest. And if an expert panel has its way, the actions will mark the start of a shift toward reducing medical societies' reliance on financial support from pharmaceutical companies, drugmakers and industry firms. In an April 1 report in the Journal of the American Medical Association, a group of 11 researchers and doctors -- many with experience as medical society leaders -- said physician organizations should strive for zero dollars in industry funding of their activities. In the short term, the group said, any me [Read more]
Making sure your patients know what you're saying
When Richard Sagall, MD, had a deaf patient request that he provide a sign language interpreter for the initial visit, he was left scratching his head. "From what I read, the law didn't say you had to provide an interpreter. It just said you had to have good communication," said Dr. Sagall, a family physician who is now retired in Boston. He turned to a nearby hospital for help, where he found an emergency department orderly who knew sign language to assist in the conversation. Despite Dr. Sagall's efforts, however, the patient insisted that he pay for an interpreter of her choosing. After the initial visit, the patient never returned. The encounter left Dr. Sagall unsettled. "There was some ambiguity in the law, and the problem came up as to who was going to define effective communication. Was it just the patient or not?" he said. "I felt I was meeting the letter of the law." Doctors frustrated with picking up the tab for interpreter bills that can exceed reimbursement con [Read more]
Lowest Blood Pressure, Cholesterol Levels the Best
MONDAY, March 23 -- The tightest control of the major risk factors for heart disease seems to provide the greatest protection against cardiovascular trouble, a new study shows. And so the current guidelines for risk factors such as blood pressure and LDL cholesterol might need to be tightened even further, said Dr. Stephen J. Nicholls, an assistant professor of molecular medicine at the Cleveland Clinic, and author of the report, which appears in the March 31 issue of the Journal of the American College of Cardiology. "It is clear that each benefit we have in terms of lowering LDL cholesterol and blood pressure is going to be important, and the lower you get those measurements, the better," Nicholls said. Nicholls and his colleagues looked at data on the arteries of 3,437 men enrolled in seven different trials at the Cleveland Clinic. The arteries were examined by ultrasound probes that provided information on the volume of the fatty deposits in the linings of the blood vessel [Read more]
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