This Week's News 6-10 June 2011

Fewer physicians move, a sign of career caution

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Fewer physicians move, a sign of career caution

American Medical News


By Emily Berry

Physicians changed addresses at a lower rate during the last year than in the previous three years, according to a survey of 253,000 medical offices.
Each year, SK&A, an Irvine, Calif.-based Cegedim firm that specializes in health care marketing information, compiles a database of 664,600 physicians who work in medical offices. Since 2008, the firm has published a report on the "move rate," which indicates how many physicians are no longer at a given office because they moved, retired or died.
Based on survey answers between March 2010 and March 2011, the firm calculated an 11.3% move rate for its most recent report, marking another year of decline. The move rate was reported as 12.4% in 2010, 15% in 2009 and 18.2% in 2008, according to SK&A.
Experts say the move rate, though an unscientific measure, could reflect the ways in which the economy is keeping physicians from changing jobs or retiring, including financial stress, the medical liability environment and licensure laws.
Physicians "don't seen to be motivated by the factors that in the past have caused a desire to move -- a big caseload, a better salary [elsewhere], or a better community with better amenities," SK&A spokesman Jack Schember said.
SK&A publishes its data for the benefit of pharmaceutical and medical equipment companies who want to sell to physicians, but the figures are one lens through which to view the economy's effect on physician practices.
Mark Doescher, MD, MSPH, director of the University of Washington Center for Health Workforce Studies, said a more stable work force could be good for areas facing a declining number of physicians and other health professionals, mainly outside major cities.
"I do think the down economy has actually caused stability in the work force, which is good for many rural locations," he said. "But when people do retire, we're going to see some difficult times ahead."
J. Deane Waldman, MD, a pediatric cardiologist at the University of New Mexico Children's Hospital in Albuquerque and an author who writes about the health care system, cautioned that the SK&A move rate isn't a scientific measurement of physician turnover or retirement.
But he said it makes sense that physicians would be unlikely to change jobs or retire now, given a long list of pressures: uncertainty about health system reform, declining income due to falling reimbursement rates, a constantly shifting medical liability environment, licensing regulations that make it difficult to relocate, and a shortage of physicians that makes it difficult to find someone to take over a practice.
"You add up all the uncertainty, financial losses, change in laws, and it's not surprising people are afraid to make any change at all," Dr. Waldman said.
For those who find a place to go, selling their homes might make it difficult or impossible to leave without taking a financial loss.
A report released May 19 by the Conference Board research group reinforced the difficulty many health care workers face as they reach retirement age. The health industry experienced the largest decline in retirement rates between a 2004-07 survey period and a 2009-10 survey period, according to an analysis of delayed retirement across all industries. Only 1.55% of full-time health care workers age 55 to 64 retired within 12 months of the 2009-10 study period, compared with 3.95% in 2004-07. The health care sector had the lowest rate of retirement, significantly less than the other industries studied.
The SK&A survey found that doctors in some specialties are much more likely to retire or move than their peers. Physicians specializing in aerospace medicine had the highest move rate at 27.9%, and plastic surgeons had the lowest, at 6.3%. Family physicians had an 11.4% move rate.


California's Physician Shortage Likely to Get Worse

The Bay Citizen, California

By Annette Fuentes
Retiring doctors, low Medi-Cal reimbursement rates, and the federal health care reform law are exacerbating California's shortage of primary care physicians, Bay Area health care providers and medical associations say.
Already, only a quarter of California's counties meet the recommended ratio of 60 to 80 primary care doctors for every 100,000 residents, according to the California Medical Association. (In the Bay Area, there are 78 primary care physicians for every 100,000 residents.)
“We are very much worried about the shortage in general,” said Callie Langton, health care workforce policy expert at the California Academy of Family Physicians. “Twenty years ago, a lot more physicians were going into primary care, and the replacement rate is not high.”
Nearly a third of doctors are 60 or older and are close to retirement, but only 42 percent of medical students are going into primary care. According to the California Medical Association and the California Healthcare Foundation, the number of young doctors pursuing primary care decreased over the past decade because the it's one of the lowest paid medical specialties.
Family practitioners earn an average of $143,000, while anesthesiologists and surgeons can earn well over $200,000, according to the Bureau of Labor Statistics.
"Payment is a big concern," said Langton. "Primary care physicians have lot of debt. They earn a respectable salary, but coming out of medical school with as much debt as you’ll earn in a year, some students are encouraged to choose sub-specialties so they can pay off debt faster. So, we have a shortage of primary care physicians because of that."
Eighty percent of medical school graduates begin their careers in debt; on average, doctors graduating from public medicals school leave owing $150,000, while those graduating from private medical schools have, on average, $177,500 in debt, according to the Association of American Medical Colleges.
While the number of primary care doctors is shrinking, the demand for the care they provide is about to soar, thanks to the federal health care reform law.
Under the law, known as the Affordable Care Act, as many as 6 million more Californians will be able to obtain health insurance coverage, with nearly half eligible for coverage under Medi-Cal. Many of the newly insured will try to seek treatment from primary care physicians and family practice doctors, who provide the kind of cradle-to-grave, coordinated care that emphasizes preventive medicine, which can help reduce health care costs.
But fewer physicians than ever — just 57 percent — say they are now willing to accept new Medi-Cal patients, according to the California Healthcare Foundation. Many doctors say the reimbursement rate — that is, the amount of money the state pays them for treating patients — is too low. California sets the rate, which is the fourth lowest among all 50 states, according to the California Medical Association….Continued

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If Health Care Is A Basic Human Right, Can Doctors Be Rationed?


An increasing number of policy planners are sounding the alarm over the shortage of primary care physicians, a problem destined to grow as Obamacare adds millions to the subsidized medicine rolls. As if the influx of new patients wasn’t challenging enough, baby boomer docs are increasingly opting for early retirement.

Why work into your sixties if it means accepting reduced incomes from aggressive price controls designed to rein in health care spending? And then there is the new generation of salaried staff physicians who want no part of the 80 hour work weeks that used to be standard fare when doctors ran their own private practices. Add it all up and the numbers look ugly.
What’s a health care czar to do?
Balancing supply and demand in centrally planned economies is never an easy task. Even with the smartest price fixers and toughest quota captains, shortages will pop up here just as surpluses accumulate there. And if you think managing inanimate commodities is tricky, try assuring an adequate supply of highly skilled personnel that take ten years to train, particularly when these human resources have numerous personal options, along with minds of their own.
How long will it be before those options have to be curtailed for the good of society? As waiting times for a simple doctor’s appointment grow, voters are going to start wondering whether the U.S. really needs more plastic surgeons. Doesn’t the need of the people come before the greed of privileged professionals? After all, of the fifteen highest-paid professions in the U.S., all but two are in medicine or dentistry.
Given the fact that all medical specialties have to be licensed, can’t imbalances be addressed by limiting the number of new licenses granted for specialties and geographies judged to be overstaffed? Municipalities limit the number of taxis in a city, what principle stops the government from doing the same for orthopedic surgeons? And transportation isn’t even a basic human right.
As doctors slowly surrender their position as independent professionals and become public servants, with ever larger portions of their billings funneled through Uncle Sam, why should they expect to be given more choice in the way they are deployed than, say, members of the National Guard?
The U.S. has about 350,000 primary care physicians (PCP), a little more than a third of the 950,000 practicing doctors in the country. That leaves one PCP to care for every 900 Americans, less in some places and more in others. U.S. medical schools graduate about 20,000 doctors every year, a number that can only grow slowly if standards count for anything. In the 1960s and 1970s twice as many new doctors were being trained as were retiring. Today we barely break even. Tomorrow we fall below the replacement rate. Demographic trends have no mercy.
The total number of new doctors being trained has long been politically determined, throttled by the number of residency slots available. Medicare, the Veterans Administration, and Medicaid subsidize the lion’s share of these to the tune of about $13 billion per year. Even foreign trained doctors have to pass through this gateway before they can practice in the U.S. This gives the government a great deal of clout it is only beginning to use.
Basic medical school education is expensive, leaving young doctors so deep in debt that many are driven toward the more lucrative specialties just to get out of hock. If planners hope to get the numbers right, incentives have to shift.
Health care policy experts are increasingly recommending that medical school should be free for students that agree to forgo the specialties and become primary care physicians. While this will no doubt add to the nation’s health care bills, it’s just a matter of time before the PCP shortage gets bad enough that political pressure will make this a reality. And why stop there? What about paying for college for undergraduate pre-meds?
Pay for education. Pay for residency. Pay for patient treatment. Dictate best practices through centralized boards. Control the licensing process. Fix prices. Don’t forget all the creative ways the tax code can be used to mold behaviors. Are there any levers of control that can’t be pulled to solve this looming crisis?
Loss of freedom won’t come suddenly, after all doctoring is still a highly respected profession. And much of it will be voluntary, just like the National Guard. But as long as voters outnumber doctors and ever larger swaths of our health care system come under government sway, there is an inexorable logic to the process. It won’t just be health care services that gets rationed. Doctors will be too.


Got Meds? Not Necessarily, Say U.S. Hospitals

The New American


Written by Beverly K. Eakman

Over the Memorial Day weekend, while many were getting their first taste of summer — ergo, not reading the news — it was reported that U.S. hospitals were experiencing shortages of both common and specialized drugs, so much so that they are looking for substitutes and combing the globe for overseas suppliers. An Associated Press story announced that some “89 drug shortages occurred in the first three months of this year, according to the University of Utah’s Drug Information Service (UUDIC)…which tracks shortages for the American Society of Health-System Pharmacies.”
Turns out, this is not a new problem. According to Linda S. Tyler, Pharm. D., FASHP, Pharmacy Manager, Drug Information Services, University of Utah Hospitals and Clinics, the first drug shortages in the United States occurred in 1996, during the Clinton Administration, when data collection on the topic began. At the time, there were only five drugs affected, but that number rose swiftly to 20 drugs between 1997 and 2000, according to UUDIC tracking. In 2001 the number of shortages grew to 120, most of which were resolved by the following year because they didn’t rise to the level of adversely affecting hospitals and patient care. Today, that has changed.
Shortages are not only inconvenient, but expensive. Tyler wrote that “[c]hanges in drug supply can alter the way medications are prepared in the pharmacy, the way they are administered to patients, and, in some cases, whether patients receive medications at all.” She estimates that “many organizations spend between one-half and three full-time equivalent (FTE) personnel on the management of drug shortages. These extra FTEs spend their time investigating the reason for the shortage, finding alternative agents, working with wholesalers, finding alternative suppliers, compounding a replacement product internally, or communicating with other practitioners.”
The knee-jerk public response to this news is along the lines of: Do we make anything in this country anymore? Is there anything that is not still outsourced, imported, or subject to rationing?
The real factors are more complicated, and more disturbing. In 2003, Tyler categorized several reasons for shortages, summed up as regulatory issues (7 percent), product discontinuation (20 percent), raw materials issues (8 percent), manufacturing problems (28 percent), and supply-and-demand (10 percent). In her updated publication, Tyler notes that this leaves some 27 percent of shortages unexplained. Deeper, more hidden, reasons include “Grey” Market Vendors, Prime Vendors and Just-in-time Vendors, Industry Consolidations, Market Shifts, Manufacturer Rationing, Restricted Distribution, Manufacturer Discontinuation — and the fact that sometimes drug companies are loathe to reveal the details of shortages for fear of a public, legal or other backlash.
Most of these categories appear to be self-explanatory, although the motives pretty much revolve around demand (read: money). Thus persons with legitimate, but rare, disorders who rely on particular drugs may find their doctors hard-pressed to locate a new source or alternative (the National Association for Rare Disorders helps), while well-hyped, trendy complaints (like attention-deficit “disorder” and depression) see a new pill on the market several times a year. War is certainly a factor, when soldiers require an unexpectedly large quantity of a certain product, creating temporary shortages in the U.S.
But “grey market vendors” are more troublesome. Tyler explains that “the profitability of [certain] pharmaceuticals attracts vendors who [then] create artificial shortages by selectively purchasing excessive quantities of products, … thereby depleting the available stock. These vendors then re-sell the products back to the users at inflated prices.”
“Prime Vendors and Just-in-Time Inventories” are another development that makes for concern. Tyler explains:
The increased use of prime vendors may have contributed to the drug shortage situation by reducing the amount of product available in the supply chain. It is no longer easy to weather shortages by relying on stockpiled inventories because both wholesalers and health systems maintain minimum levels of stock. As a result, manufacturer supply issues are transmitted directly to the user without the benefit of an inventory buffer, thereby increasing the number of short-term shortages that may impact [larger] institutions.
The practice of maintaining minimum supply levels could be disastrous, especially as we contemplate bio- and chemical weapon attacks, not to mention out-sized, super-toxic strains of E. coli that have now killed some 18 Europeans and sickened 1,600 via an unknown, salad-vegetable-borne contaminant. Persons who get any E. coli infection can suffer horribly (somewhat reminiscent of Hemorrhagic Fever (Ebola)/Renal Syndrome [HFRS]), as this one attacks the kidneys, too, and is apparently drug-resistant.
Furthermore, many of the drugs that are ubiquitous and easy to get are also the most misleading (e.g., Exedrin Migraine and Extra Strength Exedrin contain identical ingredients, including the percentages of each compound; Eli Lilly’s antidepressant Prozac gets only a new color (pink) and a new name (Sarafem) for treatment of so-called premenstrual dysphoric disorder (PMDD), dubbed a mental illness in women.
Warehousing medicines are not in the same category as warehousing books. A case can be made for no longer warehousing books, as computerized printing and the Internet have made doing so unnecessary, given easy on-demand operations. Warehousing medicines, however, is critical, even as a stop-gap measure until a better drug can be researched.
Moreover, the medical and pharmaceutical community may need to work to get a handle on the supply-and-demand problem quickly, giving the heave-ho to misrepresented drugs and quick approval and distribution for critical ones, including those for rare diseases. Shortages are not an option.
Beverly K. Eakman began her career as a teacher in 1968. She left to become a science writer for a NASA contractor and went on to serve as a former speechwriter and research-writer for the heads of Voice of America and two other federal agencies, including the U.S. Dept. of Justice. She has penned six books, and scores of feature articles and op-eds covering education policy, mental-health, data-trafficking, privacy and political strategy. Her most recent works include Walking Targets: How Our Psychologized Classrooms have Produced a Nation of Sitting Ducks and the 2011 Edition of her blockbuster manual, How To Counter Group Manipulation Tactics (Midnight Whistler Publishers). Mrs. Eakman can be reached via her website at


Corporations Commit to Sustainable Social Impact at UN Social Innovation Summit

The Huffington Post


Gabi Zedlmayer. Vice President of HP’s Office of Global Social Innovation

Today, I had the pleasure of attending the United Nations Social Innovation Summit, a forum where corporate, government and nonprofit leaders gather to discuss opportunities for positive social change. Economic development, environmental sustainability and global health were some of the issues addressed at today's summit.
Much of today's discussion around health focused on how to infuse technology and innovation to provide better quality and access to health care around the world. Often said to be the "last frontier for IT," health could potentially be the industry sector with the most to gain from technology.
As the head of the social innovation group at HP, I've seen firsthand the impact technology has on global health through our partnerships with several organizations, including the Clinton Health Access Initiative and nonprofit mothers2mothers. At the summit, we discussed a new collaboration that demonstrates the impact technology can have on health systems.
According to the World Health Organization, 75 million people, or 10 percent of Africa's population, are at risk to contract malaria. In order to combat this, we are partnering with Botswana-based nonprofit Positive Innovation for the Next Generation (PING) on an initiative that has the potential to aid in preventing major disease outbreaks in Botswana through mobile health monitoring technology. Harnessing the power of HP webOS and cloud technology, we are collaborating to develop a mobile disease surveillance system that significantly leapfrogs the quality and efficiency of malaria surveillance over previous paper-based methods.
We are currently three months into a year-long pilot program that equips health care workers in Botswana with Palm Pre 2 phones to collect malaria data via a webOS app, notify the Ministry of Health about an outbreak and tag both data and disease surveillance information with a GPS coordinate. This data will contribute to a first-ever geographic map of disease transmission in the country, enabling faster response times and better measurement of malaria cases to monitor treatment and scale-up net coverage.

When an outbreak is detected, health care workers can immediately upload specific case and location information from their mobile device in the field. All health officers in the area and members of the Ministry of Health then receive a text message alerting them of the outbreak, enabling rapid deployment of preventative measures to reduce disease transmission.

As business operations move toward cloud and connectivity, we're seeing some of the most amazing innovations come from applying mobile services to health. Together with the mPedigree Network for example, HP has developed a service that saves lives by enabling patients to validate the integrity of their medicine by sending a free text message. Counterfeit medicine is a significant problem in developing countries, causing more than 700,000 deaths each year. HP has applied its technology expertise in cloud-based services plus intellectual property in anti-counterfeiting to design and build the Global Authentication Service which powers the anti-drug counterfeiting service in Ghana and Nigeria.
As the size and global span of corporations have grown over the years, so has the importance of their commitment to social good. At HP, we believe in the "creating shared value" approach, driving economic and social value simultaneously by applying all of our assets -- employee expertise, technology and partner network -- to evaluate problems and provide innovative solutions to the world's biggest problems.
We're committed to using our problem-solving expertise to provide innovative solutions to social issues affecting these regions. By applying the same strategic thinking that makes HP a successful business, we believe we can both "do well" and "do good."


Pieces of a U.S. Maternal Health Plan Take Shape

Women eNews


By Melinda Tuhus

(WOMENSENEWS)--Eleanor Hinton Hoytt knows all about negative U.S. maternal mortality statistics and she hopes that health reform--with help from a bill in Congress--can do something about it.
"Until recently we haven't had a national plan for addressing maternal health," says Hinton Hoytt, CEO of the Washington-based Black Women's Health Imperative. "We deal only with morbidity and mortality rather than putting in place a way to make sure that people have what they need."
Hinton Hoytt spoke with Women's eNews by phone following her participation at a May congressional briefing on a bill--separate from health reform--that would prod states to study the rising problem of U.S. women dying from causes related to pregnancy and childbirth.
That bill, she says, will provide the means to collect data to make health reform programs for women--such as home visits during pregnancy and community health centers--more responsive to women's needs. Called the Maternal Health Accountability Act, the bill would give states funding to research their own maternal mortality statistics.
Hinton Hoytt said the bill would also help reveal underlying causes of maternal mortality for which she gives many examples: domestic violence, unemployment, discrimination in the workplace and "environmental toxins in which black women and poor women live."
"Those social determinants of health are real," says Hinton Hoytt. "This bill deals with that indirectly because once you have a way of collecting data then you can identify some of those social factors that impact what is going on and, therefore, begin to understand and address some of the assumptions that we have about these kinds of health disparities."
Hinton Hoytt added that even among women who have health insurance and good pre-natal care, some die or experience severe complications.
$10 Million in Funding

The Maternal Health Accountability Act (HR 894) authorizes $10 million in new funding annually between 2012 and 2018 to help states pay closer attention to the reasons why women die from causes related to childbirth and pregnancy.

States would have the option to participate. Only about half the states currently collect some of the data the act would require.
The funding would pay for state review committees composed of health professionals, social workers and members of affected communities to recommend prevention strategies and disseminate findings and recommendations. The bill would also create a program aimed at eliminating disparities in maternal deaths and negative health impacts.
The Maternal Health Accountability Act draws on a report, "Deadly Delivery: The Maternal Health Care Crisis in the USA," that Amnesty International released in 2010 and updated this year. It found that women living in low-income areas are twice as likely to suffer maternal deaths as women living in high-income areas.
Black women are three to four times more likely to die from pregnancy-related causes than white women, a statistic that Nan Strauss, lead researcher of the Amnesty report, says hasn't changed in the past 60 years.
The report also notes that problems are tied to well-known barriers to care, such as financial constraints, lack of medical professionals where the women live, lack of transportation to doctors' appointments and lack of child care. But it also targets issues such as jobs that don't offer women the flexibility to make health care appointments…Continued

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