policy

Dear Girl Scouts, I Love Your Cookies, But That’s The Problem

Dear Girl Scouts of America, I love your cookies. Samoas, Thin Mints, you name it, we love it. But that seems to be the problem. This morning I came across an article in MedCity News written by a cardiologist, Dr. John Mandrola, which acted as a sort of open letter to The Girl Scouts. Dr. Mandrola explains: “It happened while I was leaving a grocery store in the southeastern United States. The young girl who asked me if I wanted to buy Girl Scout cookies was strikingly perfect. She was thin, happy, and well spoken. So were her colleagues. The moms, too, were of healthy weight and cheer. It was as if they were English-speaking transplants from the Netherlands. They did not appear to be regular consumers of their own product.” According to the CDC, obesity costs this country about $150 billion a year, or almost 10% of the national medical budget. Approximately one in three adults and one in six children are obese. Obesity is an epidemic in the United States today and a major cause of death, attributable to heart disease, cancer, and diabetes. Our country has made great strides in the past decade or so to address this issue, especially in our youth. In fact, a study recently published in JAMA found that obesity rates among children between the ages of 2 to 5 decreased 43% between 2003...

Do You Know How Much a Blood Test Costs?

If the answer is no, look it up! I admit, I had no idea how much a blood test cost. But I bet most of you reading this article—aspiring docs and almost MDs—did not either (otherwise, why would you open this article?). Don’t worry. You are not alone. Study after study shows that the overwhelming majority of physicians and residents are in the dark when it comes to the price of care. This gaping hole in our medical knowledge is a big problem, especially in the changing landscape of U.S. healthcare. You’ve probably heard that our healthcare system is making a big push away from ‘fee-for-service’ and more towards ‘pay-for-performance’ or ‘quality-based care.’ This sounds nice on paper and it should– let’s hope– curb costs in the long-term, but it will pinch in the short-term. Whether we (future physicians) like it or not, conversations on costs will likely become a fixture as we step into the hospital. In the short-term, quality-based care is essentially a euphemism for cutting costs, which means pressure on physicians from patients and administrations. Our future patients will see insurance policies that have higher deductibles, larger co-pays, and more restrictions on care. They will be forced to pay more up-front and out-of-pocket. There are plenty of arguments for why this is good, but the bottom line (no pun intended) is that patients will increasingly question...

Wait! I Need Some Time To Think About It

Dear Adam, Ideally speaking, I should say that I am happy to hear back from you. However, I am genuinely sorry to hear about your newfound condition of Hereditary Sensory Neuropathy Type I (HSN Type I). Based on what I know about the disorder, which is obviously quite limited due to the ailment’s nature, the best treatment is indeed symptomatic therapy coupled with optimism for your health. The questions that you posed in your letter bring up crucial points. I agree with you that while we have funds from national institutes devoted towards the development of therapies for disorders commonly found in the populace, the rarest of medical conditions often go unnoticed due to the overshadowing influence of diseases such as diabetes and coronary artery disease. The study of the most unique of disorders serves the dual purpose of helping a select group of individuals suffering from incurable as well as unmanageable diseases and of expanding our knowledge about the intricacies of the human body. There are many scientists out there who are passionate about pursuing a career in finding out more about these rare medical conditions. However, national and government institutes that provide the funds for their work would rather boost their public image by providing their financial support to investigations of widespread diseases. It is a reality that is hard to face yet inescapable. Whether one looks...

To Tweet or Not to Tweet?

A while back, a very active tweeter/blogger, who just graduated medical school and was about to begin a residency, suddenly disappeared from the Internet. A few of us who followed him discussed the situation online but no one knew what had happened. After hearing that we were concerned, he emailed me that the administration of the hospital in which he was training had announced at his orientation that tweeting and blogging were prohibited, citing fears of information leaks, HIPAA concerns and nebulous “liability” issues. I am somewhat ambivalent about this. While I certainly support freedom of speech, I also recognize the hospital administration’s position. I believe discussing patients [even disguised] on line is potentially dangerous. Even an anonymous blogger can be unmasked if he is not careful or if someone is determined to discover the blogger’s identity. There is the famous case of a Boston blogger known as “Flea,” who was “outed” on the witness stand during a malpractice trial. He had been blogging about the trial while it was in progress. [Digression: Interesting interview with “Flea” after the trial.]     Another problem is the tone of some medical tweeters/bloggers. As some have commented, the output of many medical tweeters/bloggers does not pass the “elevator test” [would you say what you just tweeted in a hospital elevator?]. In fact, a lot of it doesn’t even meet the standards...

Upper Class or Upper Crust? The Cost of Med School

Recently I came across a young man who was promoting his campaign to pay for his medical school applications via online donations. He had created a page on a popular site for crowdfunding that detailed why he felt the need to reach out for support in realizing his dream of becoming a physician. My reaction to this was complicated. I personally felt that I could understand some of the hardships that this guy had been through and the difficult decisions that he was faced with when he realize the enormous cost of applying to medical school. I have never had much in the way of disposable income and I was incredibly grateful when I qualified for an AMCAS fee waiver, without which I wouldn’t have been able to apply to schools at all. Maybe it’s because of this understanding that I found it difficult to get on board with this particular campaign. I had been in this individual’s proverbial shoes, and in my case, had struggled through it on my own. I felt a responsibility to manage the costs without asking for help, and in this guy’s case I didn’t feel he had done the necessary research needed to take advantage of the fee assistance available (which he later found out he qualified for). To me this felt negligent. I argued to myself that this applicant was basically asking...

The Shortage of Primary Care Physicians: Causes and Solutions

For at least the last 20 years, graduates of U.S. medical schools have resisted pleas from organized and disorganized medicine to become primary care physicians (PCPs). Since there is already a severe shortage of PCPs, pundits are wondering who is going to take care of the hordes of the newly insured by 2015. Many have speculated about the possible reasons for this dilemma, such as the relatively paltry earning potential of PCPs, the amount of debt incurred by graduates of medical schools, the perceived lack of prestige of a PCP career, etc.   I have some theories of my own. To start, primary care can be boring. It has been estimated that 90% of patients appearing in PCP offices have no treatable illnesses. This leads to the issue that a physician assistant or nurse practitioner can treat most of these patients, often without input from a physician. PCPs function as triage officers. If an interesting case should somehow happen along, the PCP refers the patient to a specialist who deals with the problem. Since the advent of hospitalists (physicians who restrict their practices to hospitalized patients only), PCPs are never seen in hospitals, which almost guarantees that they will not be involved with anything interesting.   What is the solution? About 20 years ago, medical schools in the New York City area were scrambling to climb aboard the family practice bandwagon. (Grant money was available for schools to establish departments of family practice.) This was a real problem for...

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...