policy

Would You Pay $1,000 Per Day For a Medication?

Sovaldi, the newest FDA approved antiviral for treating Hepatitis C, has been shown to cure patients in as little as three months. That’s right: not prevent, cure. Touted as a miracle drug, Sovaldi has been on the market since December and patients have been scrambling to get their hands on it. That is, until they get a look at the price tag: $1,000 per day for a three-month course. Who are the patients? By and large, Veterans, prisoners and those who are uninsured or insured by Medicare. The lowest income patients are the ones with the greatest need, and such, the taxpayers are the ones who are picking up the tab. The tab, in this case, is almost as much as the United States spends on all prescription drug coverage annually: for one year of funding for every one Hepatitis C patient in the United States, the tab is $227 billion dollars. Spending for all prescription drug coverage in a single year? $260 billion. Even so, the company that manufactures the cure, Gilead, is not unsympathetic to the cost of the drug: in worldwide distribution they have begun offering the drug to countries based on their per capita income. So, when Gilead offered the drug at a 99% discount to Egypt, the United States couldn’t understand why patients here were still paying $1,000 per day. The answer is simple: Gilead’s...

An Addendum: It’s Time to Get Real About Suicide in the Healthcare Field

Yesterday I wrote an article about two former UPenn athletes who took their lives. The message resonated with our followers, my peers, my friends, even with my grandfather (Poppy) who, at 82 years old is still a practicing physician. There is this unusual thing about my Poppy: he is 82, has been practicing medicine for over 50 years, and is seemingly unfazed by the “physician burnout” that has plagued our generation. In today’s state of affairs, it just seems different from the norm. It gave me a reason to dig a little deeper into the prevalence of mental health disorders among students and attempt to understand the barriers to seeking proper mental healthcare, especially, and quite paradoxically, for students in the healthcare field. Madison Holleran and Owen Thomas inspired me to do some research in the field into which I am about to venture. What are suicide and depression rates like in physicians? What about in medical students? As an entering med student this upcoming fall, the results were truly frightening. I started where most “almost” docs typically would – with a literature review. A study published by New England Journal of Medicine found that male physicians were 40% more likely than males in the general population to commit suicide; Female physicians, a staggering 130% more likely. Additionally, depression is at least as common in the medical profession as in the general population,...

Let’s make ‘Domestic Health’ as Cool as Global Health

Medical schools can better mobilize students to fix U.S. healthcare problems. U.S. healthcare is undergoing a sea change of transformation. The ACA (how ever you feel about it) was a major step in focusing our attention on issues like streamlining care, improving value, and expanding access. Yet, as these issues of domestic healthcare come front and center in the minds of many Americans, an increasing number of U.S. medical students are looking to solve health problems in countries abroad. This is not only manifesting as a shortage of physicians interested in practicing in underserved populations of the U.S., but also a dearth of innovation in our healthcare, compared to what we’re seeing in global health. The way our medical schools are currently going about cultivating and mobilizing student interest in innovating solutions to domestic health issues is misguided and can be improved to follow a similar model of global health. Student interest in global health has been rising for at least a quarter of a century. Compared to 1978 when only 5% of medical students participated in international health experiences, 30.5% of graduating medical students now participate in a health project abroad. When polled in 2013, 63% of matriculating medical students said they expected to participate in global health education or service experiences at their medical schools, and 46% talked about global health issues in their applications. Medical schools...

#NotMatched2014: Number of Residency Slots Hasn’t Changed in 17 Years

The Balanced Budget Act of 1997 capped residency slots at 100,000. As more students graduate from medical school, there are many left unmatched and without the proper training to become practicing physicians. So, how will America address the physician shortage? Learn more at...

The Underlying Message of the MEDemoiselles’ Sexy Calendar

It’s not uncommon to see women in satin corsets, sporting fishnet stockings held up by garter belts, draped in feather boas for a calendar spread. Burlesque is a genre known to celebrate beauty, with an appreciation for the curvy female figure, deviating from the mainstream ideal of beauty. Dance revues and calendars are so common in today’s society, that people hardly blink an eye when they pass by a flyer for a show or see a calendar with scantily clad women on display. Except when the cover of that calendar involves a group of female medical students. Last year, 10 Canadian medical students from the Université de Sherbrooke in Quebec, posed in a fundraiser calendar to benefit a multiple sclerosis charity and to partially fund their prom. The MEDemoiselles, as they called themselves, wanted to create a sexy, yet tasteful calendar to raise money for a worthy cause, just as their male counterparts (Sexy Calendar Docs) did the year prior. Within 4 days, the group raised over $2,000. Despite the rapid monetary success, slut-shaming ensued on social media and the girls eventually withdrew their calendar from publication, returning a portion of pre-purchase funds to the would-be buyers.   Whereas the MEDemoiselles were heavily scrutinized for being photographed wearing more clothing than can be seen on a pool deck, nobody bat an eyelash the year prior when the “Sexy Calendar Docs”...

Last Year 1,700 Students Didn’t Match, And The Numbers Are Only Getting Worse

Every year, more and more graduating medical students are not matching. This is a huge problem not only for these medical students who are without jobs, but also for America’s growing physician shortage. Learn more at...

The Unsustainable SGR

So I must apologize.  Amidst my destroying your medical school innocence with posts about student debt, floundering federal GME, and the reality of the government shutdown, I referenced SGR but never actually shared that horror.  Maybe it was regression to a happier time, or a little folie à deux (can you tell I’ve had my Psych rotation?), but SGR has been the bane of my time in policy.  And I want it to be yours. SGR, formally known as the Sustainable Growth Rate, was a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians.  And because the universe loves a good cosmic joke, SGR had been developed to replace a flawed payment system.  At a basic level, the theory of this formula was that a conversion factor could be used to balance yearly spending in healthcare. Here’s how the formula works.  Each year CMS projects their spending on healthcare for the coming year.  At the end of the year, if there is money left over, it gets rolled over to the next year’s budget by changing the conversion factor (guess how many times that has happened).  And if, by some unforeseeable tragedy, spending outstripped the projection, the deficit is taken from...