Rounds Online

Do you remember those B grade sci-fi movies where aliens visit the earth and take on the appearance of normal human beings? At some point in the flick, an unsuspecting citizen surprises the alien while they are removing their human skin and get a glimpse of the monster beneath.

Well, I don’t want to get carried away here, but I believe I just got a glimpse of the creature beneath the skin of our president. And the view was not pleasant. I stumbled across vidio from a recent visit by President Barack Obama to the Illinois community of Quincy to give a speech promoting his financial reform legislation. Nothing new or unusual here. He seems always to be on the stump.

And his message was the usual pabulum praising the passage of health care reform and financial reform legislation. “I just want people to be able to not go bankrupt and lose their house when they get sick,” the President stated reasonably. “We need good old, common sense, Wall Street reform.”

Now, his idea of good old common sense and mine differ a bit. But I’ll agree that common sense is a pretty good starting point. It was at this point that the President made an unscripted comment and to at least some of us, we got a glimpse of his true political philosophy. “We’re not trying to push financial reform because we begrudge success that’s fairly earned.” (continue reading…)

Universal healthcare insurance is now the law of the land. The GOP threat to revisit the reform legislation and repeal it is pie-in-the-sky nonsense. The chances of a major entitlement program being repealed by Congress are about as great as the chance of a rural Iowa citizen finding a doctor. And access to primary care is the issue that will dominate the ongoing dialog about health care in America.

In an June 9th post to this blog I related some of the dismal statistics about the growing shortage of primary care physicians. In the coming decade this country will likely face a shortage of as many as 150,000 doctors. And there is little that our medical schools can do about the problem.

In the physician community, primary care physicians are the poor relatives. They pile up the same mountain of education debt as specialists but their income is a fraction of what their colleagues in glamorous sub specialties like spinal surgery earn. But even if the income and debt factors could be addressed there is a structural problem in the training pipe line that is going to be very difficult to solve.

In responce to the growing shortage of physicians, four new medical schools opened last year and enrolled 190 new students. According to a Wall Street Journal article twelve existing medical schools increased 1st year enrollments by an additional 150 slots. If we accept the industry’s own numbers, we are going to need to increase the output of our medical schools by 45,000 by 2020. The math just doesn’t work. (continue reading…)

A recent New York Times article pointed out that over 50% of Internal Medicine Residency Programs accepted financial support from drug companies. I thought this might have the seeds of a scandal so I looked into it a bit more.

I was disappointed. No potential Pulitzer Prize here. It seems that it was a fairly old study to begin with…circa 2006-2007. And, truth be told, the percentage of programs accepting any form of subsidy was down from 88 percent back in 1990.

Now, understand, we are not talking stipends or cash payments to students. We are probably in the area here of fountain pens, pocket protectors and free eats. I’m sure that Bic pens and lasagna could impact the judgment of a professional that has spent three years in medical school and another three years in Residency and is probably a couple hundred grand in debt.

It would appear that the most insidious area of drug industry influence peddling is in providing free meals at meetings, seminars and all day classes. Residents questioned indicated that they appreciated the perks, particularly the chow. “You can always tell when a sponsor is popping for the spread and when the residency program manager is footing the bill. Personally, most of us would choose the Chicken Marcella and Beef Stroganoff over the well balanced, sensible, nutritionally balanced rations produced in-house.” (continue reading…)

By: Mark Maurer, PhysicianInsure

Whether you’re just graduating or have your own established practice, the main driver behind most physicians’ purchase of life insurance is to ensure your loved ones are taken care of if you are no longer alive or, at the very least, to avoid being a financial burden on these loved ones at death.

The purchase of life insurance is typically for: (a) Income replacement — if you are alive, you can earn a salary, and at time of death leave a lump sum of money that will earn a similar amount annually to replace that income; (b) Income creation - if you never quite got enough savings for you and your loved one to live comfortably for the duration of both of your lives, life insurance creates an additional sum for the survivor since you’ll most likely spend down your savings together (nest egg renewal); and (c) Asset preservation — this is estate planning, where you spend your whole life building up assets in the form of a practice or real estate and you do not want it to be dismantled or depleted at death by Uncle Sam.

Income Replacement:

The concept is fairly straightforward. If you are not alive to earn income, there is a sum of money earning it in your place. How large that sum of money is depends on some key factors: the amount of other liquid assets already in place; how long you want this income replacement provided (usually until normal retirement age, but sometimes people feel their loved one can/should go back to work after a period of time); a reasonable rate of return this money can earn; and whether or not inflation should be taken into consideration.

(continue reading…)

Guest Contributor, Gwen Francis

Relocating to a new home and a new city represents a dramatic change in one’s life. It involves more than buying and selling real estate, although that is a big part of any move. Quality of life issues, lifestyle preferences, and the special needs of spouse and children - all are elements of such a move. Therefore, when moving to any new location, it pays to put your family in the hands of a relocation professional that can ease the way.

Choosing such a specialist requires some research. A good start is to evaluate potential residential real estate companies via their websites and the depth of information they provide, paying particular attention to their relocation services, credentials and affiliations.

Utilize a company that has relocation specialists with a long track record in assisting physicians who should have the contacts and resources to focus on their particular needs. Once you’ve identified the company with the experiential history you require, make certain that company is a member of the area’s Multiple Listing Service. (continue reading…)

It was oh so very civilized. 12,000 Minneapolis area nurses went on strike for one day on Thursday demanding a new contract. But as labor disputes go, this was more theater than confrontation. Nurses left their posts as scheduled by the union. The 14 hospitals affected have been planning for the one day “event” for weeks. Replacement nurses were in place having gone through a one day orientation. Compensation for the temps was generous…between $1,600 and $2,224 for the one day of work.

The union takes the noble position that it’s all about patient safety. They want to control nurse staffing levels through their contract and take management out of the hands of…well, management. They are also demanding a 3 to 4% salary increases per year over the next three years. A full time union nurse currently makes $79,000 a year plus benefits (more than $10,000 over the national average). I’m sure there are a lot of primary care physicians who are giving serious thought to joining the nurse’s union and changing jobs. (continue reading…)

If your auto insurance policy covered routine maintenance and had a modest deductable, wouldn’t you change the oil more frequently and demand the premium brand of synthetic oil? At the slightest tick from under the hood wouldn’t you schedule a comprehensive check up…regardless of the cost?

If your homeowners insurance covered routine maintenance with a modest deductable, wouldn’t you demand a window and door transplant when the old parts didn’t work any more? And if the roof leaked and you were not responsible for the cost of repair, wouldn’t you schedule the work before the leak became a major problem?

With all the furor over healthcare reform and with general agreement that something needs to be done, isn’t it odd that 70% of Americans are satisfied with their current healthcare arrangement? It isn’t odd at all if you consider that health insurance is our guarantee of access to comprehensive quality care at a predetermined monthly cost that has little to do with the cost of delivery.

Without getting into economic terminology like “healthcare wedges” and “benefit disconnects” it’s really not all that hard to understand why healthcare costs continue to climb. Insurance separates us from the medical transaction. We don’t actually buy a medical procedure or pay for a doctor visit. We pay a premium, a flat monthly fee, which, with some restrictions, allows us to demand whatever we think we need, or whatever our doctor tells us we need, or whatever the pharmaceutical companies convince our doctor’s that we need. If someone else is paying for it, we don’t care what it costs. And prices keep going up. (continue reading…)

Although you don’t see it in the headlines, and you don’t hear it from the “talking heads” on the evening news, and there doesn’t appear to be a great deal of time being spent by politicians searching for solutions,

WE DON’T HAVE ENOUGH PRIMARY CARE DOCTORS IN THIS COUNTRY!

And healthcare reform plans to put 46 million new patients into the system.

Here is a primer for our leaders in Washington:
• The American Academy of Family Physicians predicts that, if current trends continue, the shortage of family doctors will reach 40,000 in a little more than 10 years.
• The average wait to see a primary care physician can run up to 30 days in many cities.
• 50 years ago half of our physicians were primary care providers.
• By 2000 14 percent of U.S. medical school graduates were entering family medicine.
• By 2005 the figure was 8 percent.
• A recent survey of students interested in internal medicine showed that 98 percent wanted to become specialists.
• When Massachusetts added 340,000 citizens to their universal healthcare program the wait to see a primary care physician in Boston jumped to 61 days.
• The four categories of primary care, Family Medicine, Internal Medicine, OBGYN and Pediatrics are the lowest paid averaging about $175,000 while medical specialties such as cardiology demand salaries over $400,000.
• Medical education debt can run up to $200,000.
• Politically correct or not, within a few years over 50% of our medical students will be women and they are far more affected by lifestyle issues than their male colleagues.
• It takes from 8 to 10 years to build a doctor from scratch so there are no quick fixes.
• To the same degree that our general population is aging, our supply of practicing doctors is aging and approaching retirement. In fact the physician shortage would be far more severe if thousands of physicians had not delayed their retirement do to the recent economic calamity. (continue reading…)

Fact: Heart disease is the world’s number one killer. And as third world countries become more affluent heart disease becomes more prevalent. And sociologists and scientists are quick to point to fast food, cigarettes and a soft lifestyle. Western decadence, they would have us believe, is clogging the arteries of simple cultures around the globe.

But now a new study has called into question those critics of all things American…like Big Macs, Wide Screen TV’s and escalators. Researchers in Cairo have found evidence of atherosclerosis in 22 mummies from the Egyptian national Museum of Antiquities. A team of cardiologists with too much time on their hands, flew to Cairo and conducted CT scans of the mummies looking for signs of heart disease.

According to their report they were actually able to find the hearts in only 16 of the 22 mummies…hmmm. It would seem that the stereotype of the heartless Pharaohs may be more accurate than thought. But I digress. When they could find the heart or arteries they found definite signs of heart disease. A couple of the old guys were as young as 45 and had signs of heart problems.

So, it would seem that one of two conclusions can be drawn. First and most likely, heart disease is part of the human condition, Or, the Pharaohs spent a good deal of time sitting around on their butts, chewing on two all beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun, puffing away at some form of weed and generally stressing out on the business of running an empire.

Just what we need…one more healthcare issue to ponder.

Don’t get sick during July. A recent study by a pair of researchers with too much time on their hands reviewed 62 million death certificates and concluded that medical errors in teaching hospitals rose by roughly 10% each year during July. The study as reported in the Journal of General Internal Medicine concluded that the “July Effect” was probably a result of newly graduated medical residents taking on more autonomy and writing scripts without direct over sight.

Every year your author contributes to the Susan B. Coleman walk to cure breast cancer. I even can be seen wearing a pink shirt from time to time. The contribution was made in the hope that at some indefinite point in the future some progress will be made in controlling this terrible affliction. It would appear that my expectations were far too pessimistic. Researchers at Cleveland Clinic have developed a vaccine that targets the proteins that are only present in breast tumors but not in healthy breast tissue. They hope to begin human clinical trials within the year. In lab results on mice the vaccine was 100% effective!

When was the last time you read an article about the H1N1 swine flu? You may be surprised to learn that the World Health Organization has left the alert level at 6 (the highest possible alert level) and considers that the swine flu is still a pandemic. They plan to re-visit their view in mid-July.

Here is a novel new game that America’s youth seems to have embraced…”Sack Tapping.” In this game victims are slapped or punched in the groin. It is unclear how one determines who has won this game or how one keeps score. But, doctors are reporting cases of blunt force trauma to the testicles where the organ has twisted up to 360 degrees. Anyone for a nice game of lawn croquet?