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Physician supply trends for primary care doctors and specialists

Health Policy

April 30, 2010

Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care.

To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).

Physician supply has been growing during this period. In 1990, there were …

Internal medicine is dead, will concierge physicians thrive?

Kevin

Physician

April 29, 2010

by Steven Knope, MD

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.

Paraphrasing a recent …

Cardiac arrest resuscitation, with wife as witness

StorytellERdoc, MD

Physician

April 29, 2010

The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV.

His wife was with …

Statins for heart disease prevention, is the luster fading?

MedPage Today

Medications

April 29, 2010

by Peggy Peck

First, my disclosure: I’ve written at least one news article about every major statin trial since 4-S, and I’ve been mightily impressed with almost all of the statin data. So, I was also impressed when the JUPITER results were reported about a year and a half ago — although I became a little less “impressed” as JUPITER continued to …

Hospital practice can come with pitfalls for doctors

Victoria Rentel, MD

Physician

April 28, 2010

I read recent New York Times and KevinMD.com items about the migration of doctors to hospital-owned practices. The benefits are obvious: guaranteed salary, regular hours, malpractice coverage, paid benefits, school loan repayment.

I worked for a hospital system in a small suburban practice in a large Midwestern city for almost four years. I did indeed enjoy the subsidized salary. Who can argue with vesting? I had a terrific group …

VA information technology saves billions of dollars

MedPage Today

Health Technology

April 28, 2010

by John Gever

The Department of Veterans Affairs’ long-term investment in healthcare information technology paid off at a rate of more than $500 million in net annual benefits from 2001 to 2007, researchers said.

That added up to more than $3 billion in benefits for the Department of Veterans Affairs (VA) during the study period, after an initial billion-dollar loss.

In particular, the department’s computerized patient record system “was the dominant contributor to …

Primary care is burdened by excessive paperwork

Kevin

Physician

April 28, 2010

by Charles R. D’Agostino, MD

We’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care.

But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked …

Questions for doctors are powerful patient tools

Kevin

Patient

April 27, 2010

by Toni Bigby

Our Federal Government is investing in a consumer education campaign called, “Questions are the Answer.” The idea is to encourage people to watch out for themselves a little better and be their own advocate by asking their doctors questions like, “Why do I need this surgery?” and “Are there any side effects from this drug?”

Why are we as health care consumers, who collectively spend trillions of dollars each …

Primary care shortage solutions after health care reform

Toni Brayer, MD

Physician

April 27, 2010

The new reform law which is called the Patient Protection and Affordable Care Act (PPACA) will be a huge disappointment to the millions of previously uninsured people who finally purchase insurance policies when they try to find a doctor.

Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come …

Sleep apnea increases stroke risk in men

Charles Bankhead

Conditions and Diseases

April 27, 2010

by Charles Bankhead

Severe obstructive sleep apnea almost tripled stroke risk in men, data from a prospective cohort study showed.

Among men with mild or moderate apnea, each one-unit increase in the obstructive apnea hypopnea index (OAHI) raised stroke risk by 6%. Obstructive sleep apnea did not have a significant association with stroke risk in women, investigators reported online in the American Journal of Respiratory and Critical Care Medicine.

“This study provides compelling …

Aneurysm as a cause of the Bret Michaels brain hemorrhage

Kevin

Conditions and Diseases

April 26, 2010

Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage.

According to his road manager, “further testing this week will help locate the source of the bleeding.”

What exactly does that entail?

As I mentioned previously, aneurysms are responsible for the majority of brain bleeds. Finding that source is critical. Angiography, or …

Texas Medical Association: Stop the Medicare meltdown

Kevin

Health Policy

April 26, 2010

A guest column by the Texas Medical Association, exclusive to KevinMD.com.

by William H. Fleming III, MD

So we have this new health law that’s intended to provide better health care access for most Americans. Many of the reforms rely upon the sustainability and effectiveness of Medicare.

Medicare, however, is doomed to failure unless Congress fixes a fundamental problem existing within the current program — the Sustainable Growth Rate (SGR) formula. The …

Undocumented individuals make hospital discharge difficult

John Schumann, MD

Physician

April 26, 2010

Working in the hospital this month, my team has been caring for Mr. M. He was here when we started on service at the beginning of the month, and unless his planned transfer to another facility goes through, he’ll be here when we sign off to the next team at the end of the month.

Mr. M is in his fifties. He speaks Spanish. He is an undocumented immigrant from Central …

Quality care requires open clinical transparency

Paul Levy

Physician

April 26, 2010

Let’s face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense does it represent other markets, in which transparency of these elements reigns and which therefore have a better chance of reaching the “efficient market” described by economists.

In such an environment, …

Alternative medicine isn’t taught to doctors in medical school

Crystal Phend

Medications

April 26, 2010

by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).

And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, …

Health reform won’t help the ER

Chris Rangel, MD

Health Policy

April 26, 2010

Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according to a new review of 25 studies on ER use published since 1990.

Frequent users account for about 8% of ED patients but 28% of visits. Although frequent …

Read more…

Health reform won’t help the ER

ADHD needs more than drugs to appropriately treat

Claudia M. Gold, MD

Conditions and Diseases

April 25, 2010

I consider my most successful cases to be the ones that do not seem me any more. Not that they are “better”, but they and their families have come to realize the full complexity of the problems they are struggling with, and are getting appropriate help.

I inherited my “ADHD practice” from another pediatrician. He was wonderful man, a larger than life, toss babies in the air pediatrician with a hearty …

Don Berwick and whether he can change Medicare and Medicaid

Kevin

Health Policy

April 25, 2010

by Marianne Mattera

President Obama is planning to appoint Don Berwick — the Harvard pediatrician, recognized health policy expert, and head of the Institute for Healthcare Improvement (IHI) — as the new head of CMS.

Berwick’s nomination has been heralded by many as a terrific choice.

Our own health policy columnist, David Nash, said that “Berwick’s global following is a powerful political force …

C-section rates and its association with lawsuits

Amy Tuteur, MD

Physician

April 25, 2010

The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news.

Why is the C-section rate sky high?

The pervasive nature of the increase may hold some clues. The increase has …

St. Vincent’s Hospital closes, but who’s to blame?

Kevin

Physician

April 24, 2010

by Marie Cooper

St. Vincent’s Medical Center in Greenwich Village was founded in 1849, making it the third oldest hospital in New York City. It has been an occasional scene of notoriety but mostly it has witnessed countless episodes of anonymous compassion and care. My two sons were born there. As a major teaching hospital, it has over 1000 affiliated physicians. It is where generations of …

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