On The Coming Doctor Shortage

Wall Street Journal

None of the health-care reform proposals advancing in Congress address a fundamental problem that will soon face this country: a critical shortage of doctors. There were reform ideas put forward in Congress that would have addressed this problem. Most notably, Rep. Joseph Crowley (D., N.Y) and Sen. Bill Nelson (D., Fla.) have proposed training an additional 4,000 new physicians to add to the 25,000 entering the profession each year. But their proposals haven't made it into the bills on which congressional leaders hope to vote.

If the doctor shortage is not addressed and health-care reform is signed into law, millions of Americans will likely find themselves able to obtain insurance for the first time—but may be unable to find a doctor without a long delay. Why? Because expanding the number of insured patients but not the number of doctors will only increase the demand for services that already must meet the demands of an aging population. We must make sure there are enough health professionals to meet those new demands.

Even in the absence of health-care reform, according to the American Association of Medical Colleges, the U.S. will face a shortage of at least 125,000 physicians by 2025. We have about 700,000 active physicians today. One factor driving this shortage is that the baby-boomer generation is getting older and will require more care. By 2025 the number of people over 65 will have increased by about 75% of what it is today—to 64 million from 37 million today.

Doctors are also aging. By 2020, as many as one-third of the physicians currently practicing will likely retire. If health-care reform adds millions of people to the health-care market, the shortage of doctors will be even greater than it is projected to be now.

It is important to note that the shortage the country will soon face isn't just of primary-care physicians. It is true that there aren't enough primary-care doctors and nurse practitioners. But it is also true that we need more cardiologists, neurologists, general surgeons, pediatric subspecialists, urologists and other highly trained specialists.

Nonetheless, the few ideas to address the coming doctor shortages that were briefly considered in Washington treated the problem merely as a shortfall of primary-care doctors. One idea is to shift unused federal training funds to hospitals that need more positions, but only if those funds are used for primary care. Another is to move primary-care physician training out of hospitals and into federally qualified health centers. A third idea is to take training dollars away from doctors and instead use it to train nurses and other professionals.

None of these ideas would actually increase the number of doctors. At most the first two ideas would increase the number of primary-care doctors at the expense of the number of specialists.

But that's not likely to happen either. The fundamental reason why medical students are not entering primary care on their own is that they can't afford it. Medical-school tuition can cost a student as much as $50,000 a year. Some doctors start out owing hundreds of thousands of dollars before they are even able to open a practice. Going to medical school is a little like taking out a mortgage, only without getting a house in return.

Once doctors do start treating patients, they are squeezed between what they earn from government programs and insurance companies on one side and escalating malpractice insurance rates on the other. Meanwhile, specialists can often charge more and pay less in other costs than primary-care doctors. The reality is that many physicians cannot afford to go into primary care.

To address the shortage of doctors and the incentives that compel young doctors to eschew primary care, Congress needs to think about how to increase doctor pay, institute malpractice reform, and provide subsidies to reduce the amount of debt doctors have to take on. Residency caps should also be raised so teaching hospitals can train more doctors. Without these actions new doctors would be foolish to enter primary care, and thankfully our medical schools do not recruit foolish people.

Reaching A Verdict On Magnetic Therapy For Pain

NY Times

For people with arthritis who seek an alternative to painkillers, magnetic straps and bracelets have become a popular option.

The devices are said to work by stimulating the release of the body’s natural painkillers or by increasing blood flow to tissue. They are generally considered safe (if expensive), but in recent years a number of studies have found little evidence that they provide any real benefit.

One that did find some benefit was published in 2004 in BMJ and involved 194 people with osteoarthritis of the hip and knee. The scientists found that subjects randomly assigned to wear a full-strength magnetic bracelet for 12 weeks had greater improvements than those wearing a dummy bracelet.

But an analysis of several studies, also in 2004, found that the evidence swung against magnetic therapy for arthritis pain relief, and added that while it could not exclude “a clinically important benefit” in the treatment of osteoarthritis, more research was needed.

Then, in a well-designed 16-week study published this year, British scientists compared the effects of a popular magnetic device, a weak magnetic wrist strap, a demagnetized device and a copper bracelet in people with osteoarthritis. Their findings were blunt.

“Our results indicate that magnetic and copper bracelets are generally ineffective for arthritis pain management stiffness and physical function in osteoarthritis,” they concluded.

THE BOTTOM LINE The evidence supporting magnetic therapy for arthritis pain is limited, at best.

Ohio Grant A Reminder To Protect Your Eyes

Coshocton Tribune

The Coshocton County Career Center provides career-technical education, which means hands-on learning in many different industries and professions. The hands-on lessons often require safety precautions, including using the correct protective equipment so that students learn the importance of safety in their chosen field.

Recently, more than 35 programs at 18 Ohio schools received free eyewear protection equipment , such as eyewash cups and eyewash cabinets, through a partnership between the Ohio Association for Career and Technical Education (ACTE) and the Ohio Opthalmological Society with resources provided by the Ohio Department of Health Save Our Sight Fund. With the safety glasses, instructors also received information to share with students to encourage them to protect their eyesight when participating in activities outside the classroom. The overall goal of the program is to encourage eye safety at all times, not just in technical and industrial programs that require eye protection.

Metal Fabrication instructor Nick Baughman researched the program and completed the application for the grant on behalf of the school. He received about 300 glasses with eye lubricant, which were provided though the program and are now being used by students in his program as well as students in Building Trades, Electronics, Natural Resources, Automotive degrees and Health Careers programs. Students in a number of science courses at the school also are making use of the glasses.

BCBS of Michigan Grants Awards To Free Health Clinics

Reuters

Blues contribution to free clinics makes health care accessible to the uninsured and underinsured.



DETROIT -- Blue Cross Blue Shield of Michigan is awarding free clinics throughout the state a total of $1 million in grants that will provide health services to individuals and families without Michigan health insurance. With the Michigan unemployment rate currently at 15.3 percent more Michigan residents than ever are going without health insurance.

"In these difficult times, free clinics are putting health care in reach for people who need it," said Lynda Rossi, Blues vice president for Social Mission and Public Affairs. "Free clinics are a place for uninsured people to turn to for quality health care. Uninsured residents who get care in free clinics often otherwise would delay seeing a physician because of the cost. Delay
often leads to more expensive care in emergency rooms and even hospital stays."

The Blues have contributed $5 million to free clinics since 2005. This year's grant program aims to help clinics provide important services like primary care and behavioral health care, case management, dental services, specialty and diagnostic care, and prescription drugs.

"Most of our patients are dealing with one or more long-term diseases such as diabetes, high blood pressure and asthma," said Dave Law, executive director of the Joy-Southfield Health and Education Center in Detroit. "We also supplement our primary care with preventive health education and disease management strategies."

About 2.5 million Michigan residents under 65 years old went without health insurance at some time between 2007 and 2008. Many of these individuals, along with the underinsured, are able to seek medical care from these clinics instead of making a trip to the emergency room or forgoing care. Access to free clinics also helps curb the rising cost of health care. In 2008, Michigan free clinics were able to provide an estimated 122,000 patient visits combined. Most other residents over 65 are covered under Michigan medicaid or Michigan medicare.

"With this grant from Blue Cross Blue Shield of Michigan we will be able to expand our scope and quality of services while using health information technology to efficiently measure health outcomes. As a result, we will be able to deliver high-quality, low-cost health care to our patients at no cost to them," said Law.

Blue Cross Blue Shield of Michigan has a unique mission that is different from other health insurance companies. The company is committed to focusing on reducing health care costs and improving quality, increasing access to health care coverage and services, and improving the health status of Michigan's residents, particularly children.

BCBS of Michigan is also concerned with senior services, including:
Assisted Living in Dearborn
Retirement Facilities in Dearborn
Senior Living in Wayne County

Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to 4.7 million members residing in Michigan in addition to members of Michigan-headquartered groups who reside outside the state.

Medicare's Point Man: Barry Straube

from the Wall Street Journal

When Modern Healthcare magazine came out with its list of the "100 Most Powerful People in Healthcare" earlier this year, Barry Straube was No. 8, behind President Barack Obama at No. 1 but just ahead of White House budget chief Peter Orszag.

Barry who?

Dr. Straube, a kidney specialist and a former insurance executive, is Medicare's point man on which drugs, devices and medical procedures the $400 billion-plus program will cover. He might not have the president's ear like Mr. Orszag, but as Medicare's top medical official, he has a big influence over health-care spending -- and the fortunes of health-care companies.

Under health-care legislation taking final shape in Congress, many lawmakers and the Obama administration want Medicare -- the nation's biggest purchaser of health care -- to more closely tie payments to the quality of care.

That is likely to mean more work for Dr. Straube and his staff within the Centers for Medicare and Medicaid Services, the Department of Health and Human Services agency that oversees Medicare and Medicaid. Before joining CMS in 2000, Dr. Straube had worked as chief of nephrology at the California Pacific Medical Center in San Francisco and later as vice president for quality improvement at a major insurer, Health Net Inc.

In deciding what treatments Michigan Medicare will cover, Dr. Straube's office looks at what is considered "reasonable and necessary" for beneficiaries. It is up to Dr. Straube and his staff to interpret that phrase in federal law because Congress never spelled out what it meant and industry groups don't agree on a definition.

Dr. Straube said his unit takes pains to make sure its decisions are based on scientific evidence and include public comments. The agency isn't allowed to deny treatments based on cost, and it doesn't appear likely Congress will allow that in the health-overhaul legislation. In at least one recent case, Medicare officials said they considered cost as a factor in their decision, though they said cost didn't have a big impact on the outcome.

But Dr. Straube, 60 years old, said it would make sense to consider the cost of treatment. "Given the rapidly rising cost of health care and the effects on our health care as we already see, this country will have to deal with cost one way or another," he said in an interview.

Drug and device makers are opposed to weighing cost as a factor in coverage decisions. "I think there are far better alternatives for CMS to look at" to reduce costs, such as basing payments on quality of care, not volume, and rewarding health-care providers for coordinating care, said Randy Burkholder, associate vice president for policy at the Pharmaceutical Research and Manufacturers of America, the drug-industry trade group.

As part of the evaluation process, Dr. Straube's office includes research that compares medical treatments. He said he often seeks input from the Agency for Healthcare Research and Quality, one of the federal agencies that conduct such research. Dr. Straube said he hopes to get more help from comparative research being funded with $1.1 billion from the economic-stimulus package.

Comparative research also could increase under the health-overhaul legislation. The version of the bill passed by the Senate Finance Committee would set up an independent institute to study the effectiveness of drugs, medical devices and other treatments, and CMS could use that research to help determine coverage. The provision is expected to be in the bill headed to the Senate floor.

PhRMA and the trade group representing medical-device companies support the plan for the independent institute. That step, they say, could help patients and doctors make medical decisions.

Dr. Straube's group touched off an uproar earlier this year with a decision that Medicare wouldn't pay for so-called virtual colonoscopies, which use medical imaging -- instead of inserting a tube into the colon -- to look for signs of abnormal growths. It cited insufficient scientific evidence that the procedure would benefit "average-risk Medicare beneficiaries."

Supporters, including oncologists and medical-imaging companies such as General Electric Co. and Siemens AG, say the less-invasive procedure saves lives. But some physician groups say the technique isn't cost effective -- a point Dr. Straube's group used in its decision-making, though it stated that "cost and cost effectiveness didn't greatly influence this decision."

In Pennsylvania: More Injuries After Repeal Of Helmet Law

from Pittsburgh Tribune

A leading trauma center in Pittsburgh says greater numbers of motorcyclists with more serious facial and head injuries are seeking emergency medical treatment since Pennsylvania repealed its helmet law.

The volume of patients brought to Allegheny General Hospital for treatment of facial injuries after motorcycle crashes nearly doubled in the past five years, doctors there say.

An increasing number of cyclists require care and sometimes lengthy hospital stays for facial trauma, including bone fractures. AGH reports the number of riders without helmets brought in for motorcycle-related facial injuries was 122 from September 2003 to August 2008, up from 10 from 1998 to September 2003.

"Riding a motorcycle without a helmet is just risky behavior," said Dr. Joseph E. Cillo, an AGH oral and maxillofacial surgeon.

Pennsylvania repealed its universal motorcycle helmet law in 2003. Only motorcyclists under 21 and riders with less than two years of experience who have not taken a safety course are required to wear helmets.

Cillo and three other AGH physicians authored a review detailing the spike and presented it last month during the American Association of Oral and Maxillofacial Surgeons' annual meeting in Toronto.

Mick Morrow, president of the Pittsburgh-based War Dogs Motorcycle Club, said his group supports riders' rights to choose whether to wear motorcycle helmets. He doesn't think helmets are always effective in preventing injuries. A helmet's weight can add pressure to the neck if the head is hit a certain way, he said, and helmets can restrict some riders' vision and limit their ability to turn their heads - especially full-face motorcycle helmets.

"The rider is unable to see potential problems as quickly as they might without the helmet," Morrow said. "A split-second can make the difference between an accident and avoiding an accident."

The Pennsylvania chapters of the Alliance of Bikers Aimed Toward Education, or ABATE, helped persuade lawmakers to change the restriction. David Tuschel, spokesman for ABATE's Pittsburgh chapter, said riders should be free to decide whether to go helmetless, but he conceded safety instruction can be improved.

"More emphasis needs to be more on avoiding crashes than on injuries and on who's wearing what," Tuschel said.

Last year, 239 motorcyclists in Pennsylvania were killed in crashes, up from 158 in 2004, the first full year of the repeal, according to the National Highway Transportation Safety Administration. Of those who died last year, 113 were wearing helmets, compared with 117 who were not.

In 2003, 153 people died in motorcycle accidents. Of them, 121 wore helmets and 29 did not. Authorities were unsure if the others had head gear. Hospital officials say helmetless riders usually require medical helicopter flights from crash scenes because their injuries are more severe than those riding with helmets.

State officials said they are studying exactly how much treatment for such head injuries has impacted public health costs since 2003.

Ukraine Pleads For Help As H1N1 Epidemic Spreads

from Russia Today

Ukrainian President Victor Yushchenko has called on the international community to help the country combat the swine flu epidemic which hit the country last week. Kiev is taking emergency measures to stop the outbreak.

The president has sent letters to the European Commission, NATO’s Secretary General, and the heads of Belarus, Hungary, Moldova, Poland, Romania, Slovakia and the US asking for humanitarian aid, said the presidential press service. Ukraine needs antiviral medicine, medical masks, lung ventilators and other equipment. Several countries have already agreed to help, while Russia offered aid on its own initiative.

Ukrainian government has made an emergency purchase of Tamiflu medicine from Switzerland. A shipment of 300 million doses, worth $2.5 million, was airlifted on Sunday night. According to the president’s press service, the seller offered a discount price for Ukraine. Given that it could be the only remedy for those infected, Prime Minister Timoshenko took a hard line on its distribution:



"These medications have been imported at a wholesale price of 67 Hryvnia (about $8 USD) per pack. And what I'm holding now in my hand now is what our Foreign Minister purchased in a pharmacy the other day for 6000 Hryvnia, and this package contains 10 packs,” she exclaimed.

“This means that 1 pack is sold at 600 Hryvnia (about $73 USD)! These swindlers in privately-owned pharmacies sell it to people at ten times the price,” she added.

The medicine will be delivered to hospitals and medical emergency service to treat flu patients. It will not be sold in drug stores to prevent speculative trade. Timoshenko added that a second purchase of a similar amount of medicine is being considered.

Meanwhile, the epidemic is spreading over the country. The Health Ministry said Monday that of the 70 victims of flu and acute respiratory diseases who died over the last two weeks, 22 have been confirmed to have had the A/H1N1 strain.

Earlier it had been estimated that almost 185,000 people were suffering in Ukraine, and more than 7,000 have been admitted to hospitals. Of those, 123 were in critical condition.

As the death toll from respiratory diseases continues to rise, panic spreads among the population. In Kiev, a city so far untouched by the virus outbreak, roughly every third citizen wears a protective mask, at times a self-made one.

Anti-flu drugs and related paraphernalia are increasingly difficult to come accross. Angry people point fingers at everyone, from drug store owners to the authorities, However, officials say that it's the people who are responsible for the problem. Denis Shevchenko, the head of Ukraine's pharmaceutical union, explained:

"The medication is ordered based on a calculation of adequate supply of treatment and preventive therapy drugs per person," he said.

"If, in a fir of panic, people buy ten times more than they require, any forcast of this process becomes useless," he concluded.

It is difficult to say how many of the people affected have A/H1N1. Ukraine has too small a number of laboratories to be able to identify the swine flu virus and has to rely on foreign services, which makes the testing process even longer. The government plans to purchase more equipment to monitor the epidemic more efficiently. A mission of the World Health Organization is to arrive in Ukraine soon to help combat the outbreak.

So far quarantine has been declared in nine regions that are most affected by the disease. Schools and universities have been closed until further notice, and people are advised to stay at home and keep away from crowds.

There are some fears that the epidemic will harm the presidential election campaign which is currently underway in Ukraine. The election is scheduled for January 17, and with restrictions on public assembly, which some politicians have suggested imposing due to the outbreak, campaigning may become difficult for candidates. However, Deputy Prime Minister Aleksandr Turchinov assured that the outbreak will not stop the election. “Despite temporary difficulties with the spread of the infection, the election will go smoothly,” he said.

How Can Being Grouchy Be Good For You?

BBC News

In a bad mood? Don't worry - according to research, it's good for you.

An Australian psychology expert who has been studying emotions has found being grumpy makes us think more clearly.

In contrast to those annoying happy types, miserable people are better at decision-making and less gullible, his experiments showed.

While cheerfulness fosters creativity, gloominess breeds attentiveness and careful thinking, Professor Joe Forgas told Australian Science Magazine.

'Eeyore days'

The University of New South Wales researcher says a grumpy person can cope with more demanding situations than a happy one because of the way the brain "promotes information processing strategies".

He asked volunteers to watch different films and dwell on positive or negative events in their life, designed to put them in either a good or bad mood.

Next he asked them to take part in a series of tasks, including judging the truth of urban myths and providing eyewitness accounts of events.

Those in a bad mood outperformed those who were jolly - they made fewer mistakes and were better communicators.

Professor Forgas said: "Whereas positive mood seems to promote creativity, flexibility, co-operation and reliance on mental shortcuts, negative moods trigger more attentive, careful thinking, paying greater attention to the external world."

The study also found that sad people were better at stating their case through written arguments, which Forgas said showed that a "mildly negative mood may actually promote a more concrete, accommodative and ultimately more successful communication style".

His earlier work shows the weather has a similar impact on us - wet, dreary days sharpened memory, while bright sunny spells make people forgetful.

Swine Flu Confirmed In Iowa Cat

AP

DES MOINES, Iowa — The swine flu virus has been confirmed in a cat treated at the Iowa State University College of Veterinary Medicine.

Officials said Wednesday it's the first known case of the virus to be diagnosed in a cat. Veterinarians say the virus has also been confirmed in two ferrets, one in Oregon and the other in Nebraska.

The 13-year-old cat was treated in Ames, Iowa, and is recovering.

The veterinarian who treated the cat, Dr. Brett Sponseller, says two of the three people in the same house had flu-like symptoms before the cat became ill.

The case was confirmed at both Iowa State and the U.S. Department of Agriculture.

Sponseller says the flu is known to spread from humans to pets, but this is the first case of swine flu to spread to a cat.

GE Ready To Enter The EHR Business

from Daily Tech

GE hopes to work its way into a developing market

More time must pass before the United States can entirely switch to a digital health record system, but additional companies are hoping to accelerate the adoption of e-health records by offering new technologies and solutions.

General Electric is the latest to become involved in e-health, as the company unveiled the eHealth health care division.

Doctors and hospitals have more than $19 billion in incentives to switch to digital health records -- which should help accelerate the process -- but format, cost, and security issues remain.

GE's first monetary investment will be $90 million -- eHealth has a web portal, storage security software, and the LifeSensor personal health record program.  The company will offer eHealth to international doctors and hospitals, allowing people outside the U.S. to also offer e-health records.

Future features planned include patient health updates that alert doctors when their patients have been admitted to or released from the hospital.

Even though the federal government and some doctors strive to go digital, many patients still want to be assured the files will remain secure while in the cloud.  There have been several high-profile medical record data compromise cases in the past 12 months that highlighted security issues with healthcare data migration.

The Department of Veterans Affairs is now putting together a national e-health record database, which may outline how other companies modify their e-health systems.