policy

P Equals MD…But MD Does NOT Equal $$

A unique and attractive aspect of medicine is that it is a single, straightforward track to a comfortable, fulfilling life. One starts as a pre-med, makes it through medical school, works through a residency and finishes with a fellowship – continuing off into the sunset, I assume. Doctors do worry about money, but not really. Doctors don’t wake up in the middle of the night wondering whether or not they are making a difference. Doctors especially don’t wonder where they are going, because at the end of the day a doctor will be treating patients. That is, most doctors. The truth is, a few doctors – often residents – don’t make it. Whether they are fired or rejected, there is a always subset of individuals getting MDs that will not take care of patients. Though this doesn’t seem like a problem now, increased class sizes and a new batch of medical schools have been made to meet the increased demand of an aging population. The problem is, there has not been a proportional increase in residency positions for these new doctors. This looming reality could drastically change the physician profession, as we know it; so how can we prepare? Failing to finish one’s career as a practicing physician is generally not something that’s talked about. This shouldn’t be surprising in a field filled to the brim with type A...

Living With An Addict Made Me Question Medical Marijuana

First, a disclaimer: I do want medical marijuana to work out. Really, I do. But I think it’s valuable to maintain a little perspective on the topic moving forward. For some of us, marijuana is still a fairly unregulated drug with the potential to do real damage. This story, pulled directly from my own experience, is just one side of the argument around medical marijuana. My boyfriend of three years and I just split up. He’s been in rehab for 90 days. When I went down with his parents to visit, it became clear that we had to break up. John, as I’ll call him, had been spiraling into a deep web of marijuana, alcohol and prescription drug use for the last six months of our relationship. He had suffered an injury at work and, being someone who was really not interested in using narcotics, he used marijuana to cope with the pain. He had smoked pot, like a lot of young people, semi-regularly for several years. His daily use didn’t really begin until the last year, when it became apparent that whether it be physiological or emotional, he couldn’t get through a single day- or hour- without it. He was only focused on when he would be getting more, planned his entire life around smoking it and was willing to put himself, his friends and me — the...

Why Your Most Satisfied Patients are 26% More Likely to Die

Why do we want to become doctors? Many of us find a purpose and passion for the care of others. We want to be honest with ourselves, but even more so, with our patients. So how is it that some of the country’s best doctors could just as easily have the worst patient satisfaction scores? More than ever before, patient satisfaction has become a vital factor in evaluating physician and hospital performance. Press Ganey is one of the top providers of patient satisfaction surveys, with vast government funding and full administrative support for analyzing customer satisfaction data. However, not everything has gone according to plan. In fact, according to research at UC Davis, the most satisfied patients are 12 percent more likely to be hospitalized and 26 percent more likely to die. In an effort to boost patient satisfaction scores, more and more doctors are resorting to “overtreatment” and over-prescribing. It’s the key to making patients happy and in turn, getting better ratings. A recent Forbes article reported: In a recent online survey of 700-plus emergency room doctors by Emergency Physicians Monthly, 59% admitted they increased the number of tests they performed because of patient satisfaction surveys. The South Carolina Medical Association asked its members whether they’d ever ordered a test they felt was inappropriate because of such pressures, and 55% of 131 respondents said yes. Nearly half said they’d improperly prescribed antibiotics and narcotic pain...

Do Violent Video Games Have Today’s Youth Deranged?

Has America lost control over who can and can’t get their hands on a gun, or is there some other factor contributing to the disturbingly high rate of gun violence in the seemingly utopian United States? Guns seem to be everywhere in the U.S., and most frighteningly, in schools, where shootings seem to have become a shockingly regular occurrence. Amidst all the shootings, massacres, and gun violence, researchers are frantically trying to locate the root of these problems, as a plethora of articles questioning the mental health of the youth are being published and disseminated. By its harshest critics, video games have been denounced under the claim that they “rot kids’ brains,” but now, research from Canada’s Brock University shows that the more realistic a video game is, the less sensitive a child is to real-world violence. Chilling, isn’t it? Not as much as knowing that the Sandy Hook shooter Adam Lanza was a big fan of these games, and quite literally brought the game to life by massacring a local elementary school. For many, the correlation between violent video games and real-life violence is pellucid, but others, such as Almir Listo, manager of investor relations at Starbreeze Studios (maker of Payday 2) claim that in other countries, (namely, his native home Sweden) the same video games are played, but school shootings and other violent outbreaks seem to be...

Are Medical Residents Getting the Same Deal as Star NCAA Athletes?

Medical school is expensive. It’s a costly, life-defining investment, and one that carries no guarantee of fiscal security. It’s a depressing fact: resident compensation hasn’t changed much in the past 40 years. In fact, a new article from Slate calculates that even with inflation-adjustment, “first-year residents are paid a bit less than they were in 1974, even as the costs of housing, child care, and medical school debt have skyrocketed.” The author, Jacob Sunshine, explains: One reason all resident contracts are nearly the same is that training hospitals share data and use it to help set wages, which in any other industry would be considered anti-competitive. Twelve years ago, residents filed a massive class action lawsuit asserting as much. Shortly after they filed, however, President George W. Bush (supported by many in Congress with training programs in their districts) signed specific language into law exempting teaching hospitals from antitrust litigation. The class action case was dismissed, and all subsequent appeals, including to the Supreme Court, failed. National policy thus enables hospitals to treat resident physicians not unlike the way big-time college athletic programs treat their athletes: as reliable and significant revenue sources, yet shielded from ordinary commercial regulation. Hospitals benefit from this transaction twofold: 1) Residents are paid about the hourly equivalent of hospital cleaning staff. Yet, these are highly-trained professionals that generate a considerable amount of revenue. 2) Hospitals receive significant federal subsidies, an annual lump sum of about $112,000...

Cleaning the Graffiti in Healthcare

I just left the most unusual conference I have ever attended. First, it was small – 25 people. Second, it was all women. Third, it was all senior healthcare leaders who have done amazing things…make that trail-blazing things. Moreover, I found myself surrounded by women who were journalists at major news outlets, retired military officers from the highest ranks, senior leaders (in some cases the senior most leader!) at major federal and state healthcare agencies, Fortune 500 companies, large health systems, healthcare foundations, national advocacy organizations. It’s no surprise the name “Amazon warrior” resonated with this group! Finally, the conference was all about identifying our “living legacy”. Legacy seems like a strange word when you are living…it’s even stranger when you feel like you haven’t done anything yet! So, how did I get invited you (and I) are wondering? After all, I was the youngest person in the room, which as an aside, is a very unusual context when you work with students and residents for big chunks of the day. So, believe it or not, I was invited by in large part due to my… social media presence! After reviewing the list of participants, the organizers realized something was missing, and that something was someone younger who also had a social media presence. And whoever said tweeting is a waste of time? While there is much I could say,...

‘Medicine’s Top Earners Are Not the M.D.s’…Yeah, And?

​I recently took a new position in the healthcare system where I work–a big change that would place me right at the heart of a nationwide initiative toward patient-centered care. My first day at the new, larger, sparklier hospital, all the new hires were taken down the long hallway of the administrative building and encouraged to gaze upon the Wall of CEOs, pictures stretching back, down the hall, to the beginning of the hospital’s history. All men. All middle-aged. All white. I made the decision a few years ago to switch medical tracks and head toward a degree in hospital administration, hopefully getting a master’s in public health and, eventually, a PhD. When I first started working in healthcare in ernest, I realized right away that the medical professionals themselves had a frustratingly small effect on change when it came to hospital system politics. Each year it seemed they spent more times with their hands tied than on patients they were treating. I want, perhaps naively, to be an agent of change, a force in healthcare reform, and I realized that I couldn’t do that and practice as a physician – if I really wanted to devote myself to reform, I had to be an administrator. The trouble is up at the top and trickling down, negatively affecting the way physicians and nurses practice, the health of patients and...