RESIDENCY FACTS

prison medicine

Sun, 11 Sep 2011 11:22:20 -0700

Prison doctor gets paid for doing little or nothing
California surgeon has been on leave with pay, fired, fighting his dismissal or doing paperwork since '05.
July 13, 2011|Jack Dolan
The highest-paid state employee in California last year, a prison surgeon who took home $777,423, has a history of mental illness, was fired once for alleged incompetence and has not been allowed to treat an inmate for six years because medical supervisors don't trust his clinical skills.
Since July 2005, Dr. Jeffrey Rohlfing has mostly been locked out of his job -- on paid leave or fired or fighting his termination -- at High Desert State Prison in Susanville, state records show. When he has been allowed inside the facility, he has been relegated to reviewing paper medical histories, what prison doctors call "mailroom" duty.

For The Record Los Angeles Times Friday, July 15, 2011 Home Edition Main News Part A Page 4 News Desk 2 inches; 82 words Type of Material: Correction State pay: An article in the July 13 Section A said that prison doctor Jeffrey Rohlfing was the highest paid state employee in California last year, taking home $777,423. Although the government records that show his earnings cover all state departments, state agencies and the California State University system, they do not include employees of the University of California. Some UC employees were paid more, though UC Media Relations Director Steve Montiel said significant portions of their earnings came from non-taxpayer sources.

Rohlfing's $235,740 base pay, typical in California's corrections system, accounted for about a third of his income last year. The rest was back pay for more than two years when he did no work for the state while appealing his termination. A supervisor had determined that Rohlfing provided substandard care for two patients, according to state Personnel Board records.
Rohlfing won that case before the board and was rehired and assigned to "mailroom" work in late 2009.
"We want taxpayers to know we had no choice in this," said Nancy Kincaid, spokeswoman for the court-appointed receiver in charge of California's inmate healthcare. "If you are ordered to bring somebody back to work, and you can't trust them with patients, you have to find something for them to do."
Rohlfing, 65, could not be reached for comment. His attorney, Joseph Polockow, said his assignment is an attempt by prison officials to get him to quit.
"If you stick a doctor in a room for eight hours a day with no patients, you're making it very hard on him and trying to drive him away," Polockow said.
Rohlfing isn't the only doctor in California's cash-strapped prisons earning big money to shuffle paper. Dozens have been relegated to the chore in recent years, according to Kincaid, who said it's the standard assignment given physicians when questions arise about their clinical ability. Some eventually return to treating patients, some quit and others are ultimately fired, she said.
Last year, a prison doctor who was fired for letting his license expire and was later reinstated by the Personnel Board received $313,610 in back pay, records show. Another, fired for "extreme departure from the medically accepted standard of care," was reinstated and collected $298,787 in lost wages. And a surgeon who had been fired, then put on three years' probation, for missed diagnoses that led to the deaths of two inmates and treatment that robbed another inmate of vision, collected $193,779 in back pay.
California's corrections system has a history of employing troubled doctors. When a federal court installed the receiver in 2006, judges noted that "20-50% of physicians at the prisons provided poor quality of care," and 20% had a black mark on their record when hired. Their shortcomings contributed significantly to the fact that a prisoner died "needlessly" every six to seven days in a state lockup, the judges said.
Rohlfing's difficulties date to at least 1996, when he suffered a psychiatric crisis while working at a hospital in Fresno, according to Medical Board of California records. After he engaged in "bizarre, irrational and delusional communications," co-workers called police. Rohlfing fled when they arrived, led a car chase through the streets and was caught at his house.
Two involuntary 72-hour commitments to psychiatric wards followed. The medical board, which licenses all doctors in California, placed Rohlfing on probation for five years, the board's records show.
In August 2000, while still on probation, Rohlfing began working on a limited basis for High Desert State Prison in northeastern California. The state hired him full time in May 2003. Two years later, after the death of an inmate in his care, Rohlfing's clinical privileges were revoked, effectively removing him from the practice of medicine.
A review of his cases by a supervisor noted that two patients with histories of heart trouble, who had gone to Rohlfing with chest pains and other signs of cardiac distress, had not been sent to an outside emergency room. The supervisor determined that they should have been transferred because the prison clinic lacked the equipment to perform necessary tests, according to Personnel Board records.
Neither patient died or suffered permanent injury. But the supervisor, Dr. Robert Chapnick, found in both cases that Rohlfing's care had been "significantly substandard." Rohlfing was put on paid leave for 18 months. In 2007, he was fired.
Rohlfing appealed his termination to the state Personnel Board. It ruled that his examinations "may not have been textbook perfect," but they did not amount to the inexcusable neglect of duty needed to fire a prison doctor.
Rohlfing got his job back in November 2009, but medical supervisors decided he still was not ready to treat patients. Instead, he was put on records duty. He is also in a retraining program designed to "evaluate clinical skills and provide feedback to the physician and the employer," Kincaid said.
The receiver believed that decisions by the Personnel Board were being based on an overly strict reading of state service rules, not on what might be best for patients, and successfully petitioned the court to order the board to hire outside medical experts for help with future cases.
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jack.dolan@latimes.com
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(BEGIN TEXT OF INFOBOX)
Chronicle of problems
California prison doctor Jeffrey Rohlfing, who collected $777,423 from the state last year, has a troubled history:
1996: Placed on five years' probation by state medical board following psychiatric problems
2000: Still on probation, begins limited work at High Desert State Prison
2003: Hired full time at High Desert
2005: Clinical privileges revoked by prison medical staff. Put on paid leave.
2007: Fired from prison system
2009: Reinstated after state Personnel Board ruling. Assigned to "mailroom" duty, reviewing paper medical records. Not allowed to treat patients.
Sources: State medical board, California Prison Health Care Services, Times reporting

king drew off probation

Sun, 11 Sep 2011 11:21:37 -0700

Charles Drew medical school released from probation
July 13, 2011 | Cheryl Devall | KPCC
1. • 
A south Los Angeles County medical school has emerged from a probationary cloud after a review from a regional accreditation body. This development represents a step forward for an institution that’s weathered many ups and downs.
The private Charles Drew University of Medicine and Science represented a promise to the area affected by the 1965 Watts riots. Its founders set out to train healthcare professionals who could represent and serve neighborhoods that had long lacked access to quality medical treatment.
Drew aligned its mission with that of nearby L.A. County-run Martin Luther King-Drew Medical Center. When regulators shut down that hospital five years ago, the 350 student doctors, nurses and technicians at Drew had to complete their training elsewhere.
The university also lost financial support and shuffled its top leadership. New administrators and the prospect of a resurrected hospital factored into the end of its probationary status. The Western Association of Schools and Colleges never revoked accreditation; it determined after a two-year review that Drew’s governance, finances, academics and quality control systems are in good working order.
In a statement, the chairman of Drew's board proclaimed that declaration the start of "a new day" for the university.

The July Effect

Sun, 11 Sep 2011 11:20:27 -0700

The ‘July Effect’ is Alive and Well: Study

Conventional wisdom holds you should try to stay out of the hospital in July if at all possible, since that’s when new medical residents report for duty.
But while there have been studies looking at the question — like one published last year suggesting there are more fatal medication errors in July — until now, there hasn’t been a major review of the research on the topic.
Researchers at the UCSF School of Medicine looked at 39 published studies and concluded that while there is mixed evidence, “our analysis suggests that mortality increases during the changeover months,” says co-author John Young, associate program director of the residency training program in the school’s department of psychiatry. Lower efficiency, as measured by longer hospital stays and surgical times and higher hospital charges, also seem to be a particular problem during the seventh month of the year.
Looking only at the large, high-quality studies, about two-thirds suggest an effect, Young tells the Health Blog. The diversity of the studies analyzed, however, makes it impossible to quantify the size of the problem, or to figure out where it’s most likely to occur. The findings appear in the Annals of Internal Medicine.
The changeover of staff every summer includes at least two major elements — “an overnight drop in clinical experience, savvy and know-how” as the old guard leaves, and “a bunch of folks coming into a new hospital system,” says Young. He and his colleagues hypothesize that both are important. And it’s not just a lack of clinical knowledge in the newest residents that can pose a problem, but a general lack of experience in the particular hospital’s environment, he says.
For hospitals, the review suggests the need for better research, but there’s also “enough of a signal” so that hospitals should take steps to reduce potential risks now, Young says. That means assessing new residents to see what they know, and letting their responsibility match their skill level. Also, hospitals can “take a really close look at how they introduce and orient new folks into the system,” he says.
On a grander scale would be changes like staggered start schedules for residents, and more intensive clinical training during the fourth year of med school, particularly in the latter half of the academic year, he says.
An accompanying editorial says that measures such as enhanced supervision, slowly ramping up clinical responsibilities during the first few weeks, avoiding overnight work at first and pairing up experienced and less-experienced residents “require no future ‘test of concept’ studies; they require political will and financial support for implementation.”
So what are patients to do, many of whom have no choice over when they land in the hospital? “Patients shouldn’t delay care, but they should be aware,” says Young. It’s always helpful to have a family member or friend present to serve as an advocate, he says. And “know that every team does have an experienced attending” physician, he says. “You can always ask to speak with that physician.”

melanoma treatment

Sun, 5 Jun 2011 14:53:16 -0700

2 new drugs a 'major breakthrough' in treating deadly skin cancer
Trials of vemurafenib and Yervoy deliver dramatic results in survival rates for those with metastatic melanoma

Yervoy, or ipilimumab, stimulates the immune system to fight off tumors and was approved by the FDA in March. (Business Wire)

By Thomas H. Maugh II, Los Angeles Times
June 5, 2011, 12:03 p.m.

Two new drugs can significantly increase survival in patients with metastatic melanoma, the advanced and generally lethal form of skin cancer, researchers reported Sunday.

Results were so dramatic in a trial of one of the drugs that the study was halted early, researchers reported at a Chicago meeting of the American Society of Clinical Oncology. Studies on both drugs also were published online by the New England Journal of Medicine.

The aborted trial is notable because the experimental agent called PLX4032, or vemurafenib, is the first chemotherapy agent that is directed at a specific mutation that is involved in the formation of skin tumors.

The development of the drug "is a major defining moment that will have an important effect on survival and quality of life," wrote Dr. Marc E. Ernstoff of the Dartmouth Medical School in Lebanon, N.H., in an editorial accompanying the report. But the mutation that is targeted by the drug occurs in only 47% of melanoma patients, and the drug appears to help only about half of them.

Many of the rest may benefit from the second drug, called ipilimumab, or Yervoy, which stimulates the immune system to fight off the tumors. Yervoy was approved by the Food and Drug Administration in March based on earlier results that showed it was more effective than a vaccine used to treat melanoma. The new findings reported Sunday showed that it also was better than the conventional chemotherapy.

The manufacturers of the two drugs are already planning trials to use both of the agents together to see if the combination can improve outcomes even more.

The new findings are "absolutely a major breakthrough for patients who have metastatic or unresectable melanoma," said Dr. Sylvia Adams, a melanoma immunotherapy expert at the New York University School of Medicine and a spokeswoman for ASCO.

The American Cancer Society estimates that about 68,000 new cases of melanoma are diagnosed in the United States each year, with 8,700 deaths. The incidence is increasing most rapidly among the elderly and among women ages 15 to 39, presumably because of excess exposure to ultraviolet radiation outdoors and in tanning salons. The conventional treatment now is with a drug called dacarbazine, which produces a median survival of 5.6 to 7.8 months after treatment is begun.

Vemurafenib targets the V600E mutation in a gene called BRAF, which is involved in cell growth. Small, early studies suggested the drug could be quite powerful.

In the new trial, a team headed by Dr. Paul Chapman of the Memorial Sloan-Kettering Cancer Center in New York enrolled 673 patients with the V600E mutation at 103 sites around the world. Half the patients took dacarbazine, and half were given vemurafenib.

At the first planned analysis at a median of three months, those receiving vemurafenib had a 73% reduction in progression of the disease and a 63% reduction in the risk of death. About 48.4% of the patients' tumors showed a response to the drug, compared with only a 5.5% response for dacarbazine.

The results were so powerful that the study's data-monitoring committee recommended halting the study and giving vemurafenib to all the patients.

The primary side effects were skin rashes, sensitivity to light and joint pain.

In the second study, a team led by Dr. Jedd Wolchok, also of Memorial Sloan-Kettering, enrolled 502 patients with metastatic melanoma who had never been treated before. Half received Yervoy plus dacarbazine, and half received dacarbazine and a placebo.

After one year, 47.3% of patients who received the combination of drugs were still alive, compared with 36.3% of those receiving only dacarbazine. At two years, the figures were 28.5% for Yervoy and 17.9% in the control group. After three years, 20.8% and 12.2%. The median survival for those taking Yervoy and dacarbazine was 11.2 months, compared with 9.1 months among those given only dacarbazine.

Side effects included elevated liver enzymes, diarrhea and rash.

The chief drawback of the drugs is cost. Yervoy, manufactured by Bristol-Myers Squibb, costs $120,000 for a course of treatment. Roche and Plexxikon, Inc., a biotechnology company in Berkeley, which developed vemurafenib, are expected to apply to the FDA shortly for approval to market the drug but have not yet announced a price.

The studies were sponsored by the drug companies.

thomas.maugh@latimes.com

10 most popular medical schools

Wed, 1 Jun 2011 22:44:11 -0700

10 Most Popular Medical Schools
These schools boast the nation's highest percentages of accepted students who opt to enroll.
By BRIAN BURNSED

The University of Kansas Medical Center is the nation's most popular medical school, according to an analysis of yield data by U.S. News.

A school's yield is the percentage of admitted students who opt to enroll in the program. At Kansas, 176—or 82.2 percent—of the 214 accepted students chose to attend the school in the academic year beginning in 2010, narrowly edging out the University of Nevada—Reno School of Medicine, where 62 students, or 81.6 percent of the 76 accepted, enrolled last year.
[See the medical schools that lead to the most debt.]
Of the top 10 most popular medical schools, only one—the University of Washington School of Medicine—placed in the top 10 of U.S. News's rankings of medical school research programs. Only two—Washington and the University of North Carolina—Chapel Hill School of Medicine—of the most popular schools cracked the top 50 of that ranking.
However, five of the most popular medical schools were ranked among the top 50 primary care programs, including 14th-ranked Michigan State University College of Osteopathic Medicine and the 41st-ranked University of Kansas Medical Center.
Each school on the list of most popular medical schools is a state institution, which likely contributes to the popularity of each, since tuition for in-state students at public medical schools is significantly lower than tuition for out-of-state students or at private schools. At the University of New Mexico School of Medicine, for instance, in-state tuition is $16,170 compared to $46,347 out of state.

Of the 10 most popular medical schools, all have yield percentages of more than 70 percent, while the national average among the 121 schools that provided yield data to U.S. News is 50.2 percent. Below is a list of the 10 most popular law schools, sorted by percentage yield among new students in 2010:
School Name
Students Accepted
Students Enrolled
Yield Percentage
U.S. News Research Rank
U.S. News Primary Care Rank
University of Kansas Medical Center
214
176
82.2%
71
41
University of Nevada--Reno School of Medicine
76
62
81.6%
Rank Not Published*
92
University of New Mexico School of Medicine
117
94
80.3%
87
28
University of Washington School of Medicine
272
216
79.4%
9
1
University of North Dakota School of Medicine & Health Sciences
79
62
78.5%
RNP
66
University of Oklahoma College of Medicine
213
165
77.5%
84
92
University of South Dakota Sanford School of Medicine
71
54
76.1%
RNP
58
University of North Carolina--Chapel Hill School of Medicine
215
160
74.4%
20
2
Medical University of South Carolina School of Medicine
211
156
73.9%
91
73
Michigan State University College of Osteopathic Medicine
435
318
73.1%
RNP
14
RNP denotes an institution that is ranked in the bottom one fourth of all medical and osteopathic schools. U.S. News calculates a rank for the school but has decided not to publish it.
For yield percentages for every medical school, as well as in-depth cost information, residency statistics, and more, access the U.S. News Medical School Compass.
U.S. News surveyed more than 140 medical schools for our 2010 survey of research and primary care programs. Schools self-reported a myriad of data regarding their academic programs and the makeup of their student body, among other areas, making U.S. News's data the most accurate and detailed collection of school facts and figures of its kind. While U.S. News uses much of this survey data to rank schools for our annual Best Medical Schools rankings, the data can also be useful when examined on a smaller scale. U.S. News will now produce lists of data, separate from the overall rankings, meant to provide students and parents a means to find which schools excel, or have room to grow, in specific areas that are important to them. While the data comes from the schools themselves, these lists are not related to, and have no influence over, U.S. News's rankings of Best Colleges or Best Graduate Schools.

the match for lawyers?

Thu, 12 May 2011 17:53:42 -0700

The LB Unproven but Intriguing Idea of the Day: JD Match

It’s not often that we write about just-announced products designed for the legal industry.
(Frankly, we typically prefer to wait until all the initial public-relations hoo-ha dies down and the marketplace has had a chance to react to the product.)
But we’re going to make an exception this morning for a product whose very idea has piqued our interest.
The service is called JD Match, and its premise is to link law students looking for jobs with hiring law firms without a lot of the wasted time, effort, expense and overall agony brought on by the current law-school hiring process, with its interviews and fly-backs and courtship and disappointment.
JD Match, which is largely the brainchild of law-firm consultant and writer Bruce MacEwen, who will serve as the company’s president, will “match” law students with firms, much in the way matching services pair up medical students and residency programs.
It’ll work like this: law students will pay $99 per recruiting season to sign up. From there, they’ll upload their information, including a resume, etc., and will then rank the law firms they’d like to work for. On the other end, the firms will rank students who’ve signed up.
Then comes “match day.” Using a “proprietary algorithm,” the service will match the firms and students based on their own preferences. Matches will be run three times during the recruiting period: in August, September and again in October.
Already, the service has landed one large firm: K&L Gates. The firm will use JD Match to help recruit summer associate positions this fall.
“It’s about time someone took the bull by the horns to address the antiquated method firms are forced to use to recruit students,” said Peter Kalis, the firm’s chairman, in a statement. “Change is a necessity, and I, for one, am looking forward to this 21st century solution.”
Now, a few caveats to mention here. JD Match is unlikely to revolutionize law-school hiring, at least not yet. Unlike the matching process for medical students, the results of the JD Match search are not binding on anyone. Students don’t have to commit to go to a firm; the firms don’t have to commit to giving an offer.
That means, at least initially, little will change. On-campus interviews will still take place, as will callbacks. This is not the magic bullet that will forever end the Byzantine hiring process.
But the service could expose students to firms that they might not otherwise consider, and expose firms to students that they might have a hard time otherwise recruiting.
Of course, the dustbin is littered with good law-related business ideas that never got off the ground. A year from now, there’s a decent chance that nobody will be talking about JD Match. But were we a 2L this year, we’d sure give it a shot. After all, once you’ve dropped $150,000 to help you get a plum law job, what’s another $99 — especially for the thing that just might open just the right door?

caribbean stigma underserved

Sun, 8 May 2011 20:14:35 -0700

Stigma of attending Caribbean medical schools is undeserved

by Mahesh Yaragatti
Published April 27, 2011

Admission to U.S. medical schools can be a game of musical chairs, as each year a surplus of qualified individuals is left standing. Over the last 30 years, however, offshore Caribbean schools have provided an outlet for many of these students, giving them the opportunity to study overseas and then practice in the United States.
In 2011, U.S. hospitals offered over 23,000 residency positions for American and international medical graduates, according to the American Medical Association. More than a quarter of U.S. medical residents are international medical graduates, as reported by the Education Commission on Foreign Medical Graduates. More than one-third of these IMGs are U.S. college graduates who go to Caribbean medical schools.
Critics claim that medical schools in the Caribbean provide an inferior training program for students who are already lower in academic caliber than their American counterparts. Recent articles in The New York Times (in December 2010 and August 2008) have also discussed the financial issues that U.S. medical schools, particularly those in New York State, are facing because of the wave of offshore students. And the American Medical Association aligns itself with New York medical schools by supporting the idea that American hospitals should not be used as core clinical rotation sites for Caribbean medical students and that each school should have its own hospital for training students.
But consider the following. New York State has one of the nation's largest concentrations of teaching hospitals and is a popular destination for offshore students. The New York State Education Department has approved 14 offshore medical schools for doing clerkships and licensure. And because these schools administer U.S. Board Exams, passing the United States Medical Licensing Examination ultimately depends on the individual's ability, just like in any U.S. medical school.
As such, private medical schools in the Caribbean should be able to compete with private medical schools in the United States for clinical clerkship spots in a hospital. Although a New York State approval is not as thorough as the national accreditation process for U.S. medical schools, IMGs are still required to pass the same set of exams as their American counterparts to practice within the United States. In theory, there should be no correlation between medical school prestige and a person's ability.
Ultimately, clinical clerkship spots become a bottleneck in medical education since there are simply not enough doctors to train medical students at these hospitals, which is the real problem that should be addressed. In addition, the New York State Education Department could always enforce tougher standards when accrediting offshore schools. There are a large number of highly qualified American IMGs and U.S. hospitals that can benefit financially and encourage academic diversity by accepting these students.
Mahesh Yaragatti is a contributing columnist. Email responses to opinion@nyunews.com.

umc is stepchild to unr medical school

Sun, 8 May 2011 19:39:03 -0700

County officials say UMC is ‘stepchild’ to UNR medical school

TIFFANY BROWN
University Medical Center, which is Clark County’s only publicly funded hospital.
By Joe Schoenmann (contact)
Tuesday, May 3, 2011 | 4:20 p.m.
Medical residents presented a unified feel-good message to Clark County commissioners, talking about the good they do for Southern Nevada while working at University Medical Center.
But county commissioners were unmoved by the physicians, who arrived en masse to the meeting wearing white lab coats. Commissioners said they are tired of empty promises and expressed frustration that while Clark County pours up to $80 million a year into UMC, the medical school at UNR, which is in partnership with UMC, and the university system’s Board of Regents all but ignore UMC’s needs.
Commissioner Steve Sisolak, who sat for 10 years on the Board of Regents, said over that time “not one time did (UNR or the Board of Regents) spend 50 cents in Southern Nevada.”
“I’m talking about (out of) hundreds of millions of dollars that was allocated to UNR,” he said.
That said, he added, UMC and Clark County have "an obligation" to seek out relationships and potential partnerships with other medical schools. He encouraged University Medical Center chief Kathy Silver to seek out those schools, which he said might show more commitment to the hospital than the medical school in Reno.
“We are no longer going to be treated by the medical school or the regents as the stepchild,” said Commissioner Chris Giunchigliani.
For many months, commissioners have complained about the fact that the connection between University Medical Center and the medical school has been weak, at best. Then UNR announced the hiring of a dean who will spend most of his time in Reno, despite the fact that commissioners had already said they wanted a dean to live in Southern Nevada. When it was announced that the vice dean would live in Las Vegas, Sisolak called it “insulting.”
But Sisolak stressed his complaint was “never about the dean living here … this is about commitment. And you simply cannot understand Southern Nevada by being here for 24 hours a week, then heading back up to Reno. It just doesn’t work.”
He was supported by former university system Chancellor Jim Rogers, who said that during his five years as chancellor, and for the 35 years before, “that medical school has not made any effort to increase what it’s done in Southern Nevada. And I don’t think you can take their word that with the new dean (that record will improve).”
Though complaints have arisen in the last few years about the so-called lack of commitment, Rogers added, “why the hell haven’t they (the medical school) had a plan for the last two, three, four years to solve their needs? They solve their needs in Northern Nevada, but they don’t solve the needs of Southern Nevada.”
He concluded by saying that if commissioners continue on with their current relationship and how it works with the medical school, “they will back off again, because they don’t understand what the needs of Southern Nevada are.”
Discussion of the medical school/UMC relationship will continue at the next commission meeting in two weeks, when university Chancellor Dan Klaich is expected to speak.

intern year makes you healthier?

Sun, 8 May 2011 19:29:37 -0700

HEALTH POLICY, PATIENT AND PRACTICE ISSUES
Posted on April 14, 2011
Lipid levels not adversely affected by stress during first-year medical residency

SAN DIEGO — Despite drastic lifestyle changes in physical activity, diet, stress level and sleep habits that typically occur during the first year of internship, researchers for a new study found that first-year medical residents experienced significant decreases in total cholesterol, LDL and exercise units.

“The results of our study are unexpected and the opposite of our initial hypothesis,” according to Susan Delange, MD, and colleagues at Georgetown University. The researchers hypothesized that decreased physical activity, disrupted sleep habits, diet changes and increased stress levels would adversely affect cardiovascular risk factors in young physicians.
Instead, data indicate that after 1 year of internship total cholesterol decreased by 16 points (P=.0007) and LDL decreased by 10 points (P=.0172). The researchers also noted significant increases in stress level (P=.0082) and C-reactive protein. The amount of exercise among residents decreased by about half during the intern year (P<.001); however, the researchers said the participating interns may have underestimated the amount of physical exercise in a typical hospital workday, including stairs and walking. BMI and nutrition level were unchanged.
The study included 57 first-year medical residents recruited at Georgetown University Hospital. To examine changes in lipid levels during 1 year, the researchers used CARDIA questionnaires to assess self-reported sleep, stress, physical fitness and nutrition; performed fasting blood draws to measure HDL, LDL, total cholesterol and C-reactive protein; and measured each participant’s weight and BMI. Twenty-six residents (62% men) provided data at enrollment and at the end of the intern year.
“These results indicate that interns continue to have time to maintain a healthy lifestyle during residency,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
Delange S. Abstract 400. Presented at: American Association of Clinical Endocrinologists 20th Annual Meeting; April 13-17, 2011; San Diego.

nurses vs doctors

Sun, 8 May 2011 19:07:08 -0700

Nurse Theresa Brown Bites Back UPMC Doctor in NY Times Op-Ed

An oncology nurse penned a blistering Op-Ed in Sunday's New York Times venting against doctors for creating a culture of disrespect in hospitals. No doubt about it, there are curt and haughty doctors out there, behaving rudely to fellow physicians and nurses alike. The real news lies in the fact that in today's considerably more comfortable climate, even giants of general surgery with reputations to the contrary are brought low by a single ill-considered, vaguely misogynistic commentary.

So in 2011 a New York Times Op-Ed blaming doctors for sparking negative hospital cultures is rather passé and makes you wonder what makes it worth running such a ho-hum opinion, especially on a Sunday.

What gives Theresa Brown's gripe its urgency is the way her established voice as a thoughtful Times contributor contrasts with her personal experience. Recently an asinine physician dressed her down in front of a patient:
It was morning rounds in the hospital and the entire medical team stood in the patient's room. A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.

Turning and pointing at the patient's nurse, the doctor replied, "If you want to scream at anyone, scream at her."

...I felt stunned and insulted.

The anecdote spices up the essay, driving home her bland, well-worn generalization about all those omnipresent, omniscient Doctor Deities. She reinforces our disdain with other pearls:
A nurse I know, attempting to clarify an order, was told, "When you have 'M.D.' after your name, then you can talk to me."

Point well taken (since at least the 1980s). What's concerning and ethically dubious about Brown's personal anecdote is its specificity.

It took me about two minutes of Google sleuthing to learn that the author and New York Times Well Blog contributor Theresa Brown practices on the oncology floor at UPMC Shadyside, despite the fact that she carefully keeps this detail off her personal website, her NY Times bio, and in today's Op-Ed.

She gives enough detail in the column that many people at her hospital, especially "the entire medical team" present at the time, will know precisely whom she's making an example out of. Using her platform at the Times, Brown just succeeded in royally bullying back the physician she's just publicly accused. The lack of his name in print? Meaningless.

University of Pennsylvania bioethicist Arthur Caplan, like me, was aghast this morning. Brown tells her readers she asked for the doctor's permission, whose quick quip back suggests he had no idea how slighted she actually felt by the comment or her intentions for its wide dissemination. Caplan tells me that consent in the heat of the moment "is not the same as asking later for permission to portray someone in a widely disseminated story where the person is put in a negative light."

"Retribution against workplace colleagues as a result of anger when it is easy to retrospectively identify who is who in a health care setting can adversely impact patient care," Caplan adds.

There's little question Nurse Brown just used the New York Times Op-Ed page to vent in a workplace spat. Politicians use the page that way, so why shouldn't doctors and nurses go at each other about their behavior last month, for our reading pleasure?

I'd never consider attacking one of the physicians, nurses or therapists I work with on The Atlantic, even if I was doing so as part of a broader lesson for the public good. Health writers like myself and Nurse Brown should use our personal expertise and experiences to inform our commentary about the practice of medicine without adulterating our workplace relationships.

That's why you won't see Arthur Caplan, Director of the Center for Bioethics at Penn, saying much about Penn colleagues on MSNBC or any of his other platforms. "I try very hard not to succumb to the temptation to use cases from Penn and Children's Hospital of Philadelphia since I want my colleagues to trust me and be able to freely approach me for comment and feedback about difficult matters," Caplan says.

Kevin Pho, a New Hampshire internist who regularly contributes Op-Eds for USA Today, took to his popular blog KevinMD and his Twitter account to defend physicians against what he saw as an unfair full-scale assault on physicians. He refers to the piece as pandering to an anti-physician audience at the Well, the Times blog where Theresa Brown has been contributing for over two years.
Perhaps her workplace environment is particularly toxic, but the doctors I know harbor nothing but the greatest respect for nurses and the rest of the medical staff. They don't deserve to be painted with such broad strokes as was done here.

Brown's Op-Ed lays ultimate blame for inhospitable hospitals at the feet of physicians whose rap sheet even includes nurse-to-nurse bullying, a topic she's written about before. To Dr. Pho, Brown's tone is vicious and over the top.
Attacking physicians so personally only serves to drive a bigger wedge between doctors and nurses, when in fact, we need to be working together to solve this issue common to both professions.

Theresa Brown argues that MDs set the tone and that their behavior trickles down. That's true, and it's hard to see how anyone can feel good about working on the oncology floor at UPMC Shadyside when doctors are behaving the way Brown describes. Shaming one's colleagues draws attention Caplan says, but does little to cure the culture. As Caplan points out, hospitals are instituting courses about bullying, reporting systems are increasingly in place, and punishment is happening. "If you want to improve the culture then narratives have to be drawn carefully to protect personal and institutional anonymity," Caplan told me.

Drawing and quartering your coworkers in the Sunday New York Times might be run-of-the-mill for politicians. I'd like to see something better out of doctors and nurses.

I believe Theresa Brown's anecdote is true. I've seen such behavior myself even if I can't imagine committing it. That said I do have some sympathy for the doc she wrote about. That's no doubt because I'm a doctor too, and I don't know how I'd feel about working with Theresa Brown if she's ready to turn around and head to her blog, Twitter, Facebook or the New York Times Op-Ed page if I were to step out of line in one comment one day. Who in medicine doesn't fear for something they say being taken the wrong way? I hope I'm safe so long as I'm not as callous as Dr. X, but does the Brown factor mean I can't frankly disagree with or question a nurse or another doctor, lest I risk seeing them Twittering away about our disagreement in a thinly veiled way?

It's this potential chilling effect that I fear as the unfortunate outcome of this airing episode at UPMC. Like Caplan, I'd never want to make colleagues at my hospital uncomfortable about working with me by earning a reputation as their own in-house Mike Wallace.

So it's in that sense that I'd like to see this doctor offer his excuses or, more likely, his apologies. Can he cite any conceivable mitigating factors for his behavior towards Brown that day a few months ago, so demeaning her in front of that patient? Is there any other side to the story? I doubt it, but I'll listen to what he has to say and report it. Maybe he'd simply like to offer an abject apology?

If you work at UPMC Shadyside and know who Brown wrote about, please ask him to get in touch with me. Sorry I can't offer space in the Sunday edition of the Times. I'm willing to grant anonymity, given these circumstances.

family doc can’t give away solo practice

Sat, 23 Apr 2011 15:05:12 -0700

Family Physician Can’t Give Away Solo Practice
By GARDINER HARRIS
CROFTON, Md. — “So there we are, miles from shore, fishing since 11 o’clock at night, and we haven’t gotten one single bite until finally we gaff one that’s about this big.”
Dr. Ronald Sroka held his hands about three feet apart, and John Mayer — fishing buddy and patient — smiled from the examination table. Dr. Sroka shook his head, glanced at a wall clock and quickly put his stethoscope to his ears.
“All right, deep breaths,” Dr. Sroka said. It was only 10 a.m., but Dr. Sroka was already behind schedule, with patients backed up in the waiting room like planes waiting to take off at La Guardia Airport. Too many stories; too little time.
“Talking too much is the kind of thing that gets me behind,” Dr. Sroka said with a shrug. “But it’s the only part of the job I like.”
A former president of the Maryland State Medical Society, Dr. Sroka has practiced family medicine for 32 years in a small, red-brick building just six miles from his childhood home, treating fishing buddies, neighbors and even his elementary school principal much the way doctors have practiced medicine for centuries. He likes to chat, but with costs going up and reimbursements down, that extra time has hurt his income. So Dr. Sroka, 62, thought about retiring.
He tried to sell his once highly profitable practice. No luck. He tried giving it away. No luck.
Dr. Sroka’s fate is emblematic of a transformation in American medicine. He once provided for nearly all of his patients’ medical needs — stitching up the injured, directing care for the hospitalized and keeping vigil for the dying. But doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat.
The share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970. Many of the provisions of the new health care law are likely to accelerate these trends.
“There’s not going to be any of us left,” Dr. Sroka said.
Indeed, younger doctors — half of whom are now women — are refusing to take over these small practices. They want better lifestyles, shorter work days, and weekends free of the beepers, cellphones and patient emergencies that have long defined doctors’ lives. Weighed down with debt, they want regular paychecks instead of shopkeeper risks. And even if they wanted such practices, banks — attuned to the growing uncertainties — are far less likely to lend the money needed.
For patients, the transition away from small private practices is not all bad. While larger practices tend to be less intimate, the care offered tends to be better — with more preventive services, better cardiac advice and fewer unnecessary tests. And the new policies that may finally put Dr. Sroka out of business are almost universally embraced — including wholesale adoption of electronic medical records and bundled payments from the federal Medicare program that encourage coordinated care.
“Those of us who think about medical errors and cost have no nostalgia — in fact, we have outright disdain — for the single practitioner like Marcus Welby,” David J. Rothman, president of the Institute on Medicine as a Profession at Columbia University, said of the 1970s TV doctor.
Dr. Sroka has not taken a sick day in 32 years. After his latest partner left in September, he was unable for five months to schedule any time off until another local doctor volunteered to cover for him. His income and patients depend upon his daily presence. This resiliency is part of a tough-minded medical culture — forged in round-the-clock residency shifts, constant on-call schedules, and workplaces in which revered doctors made decisions and staff members followed orders — that is fast disappearing.
Had he left a decade ago, Dr. Sroka might have been able to persuade a doctor to pay $500,000 or more for his roster of 4,000 patients. That he cannot give his practice away results not only from the unattractiveness of its inflexible schedule but also because large group practices can negotiate higher fees from insurers, which translates into more money for doctors.
Building Relationships
Handsome, silver-haired and likable, Dr. Sroka is indeed a modern-day Marcus Welby, his idol. He holds ailing patients’ hands, pats their thickening bellies, and has a talent for diagnosing and explaining complex health problems.
Many of his patients adore him.
One of them, Alicia Beall, 53, came in for a consultation after a pain in her foot grew worrisome. She has been seeing Dr. Sroka for 30 years, and he quickly guessed that she was suffering plantar fasciitis, a painful inflammation.
“So take off your shoe,” Dr. Sroka said. She did, and Dr. Sroka lifted her foot.
“If it’s plantar fasciitis, it’s usually right there,” Dr. Sroka said and pressed his thumb into her heel.
“Ow! Don’t do that,” Ms. Beall said and smacked him with a magazine. They both laughed.
They discussed possible treatments for her foot and for swelling in a hand, including steroid injections. But he settled on a prescription for diclofenac, an aspirinlike pain pill. While writing his notes, Dr. Sroka asked Ms. Beall how her husband liked his new job. He told her to return if the pills failed.
“We’ll do the steroid injections another time,” Dr. Sroka said. “We never would have gotten the insurance company to pay for them all. When you bill for both a medical and a surgical visit, they always deny one.”
Patients and doctors often complain that appointments are rushed, but the time that doctors spend with each patient — 16 to 20 minutes, on average — has remained largely unchanged for years.
Instead, patients have gotten sicker and treatments more complex. Half of American citizens have a chronic disease like high blood pressure or diabetes, and a quarter have two or more such conditions. For diabetes alone, the American Diabetes Association’s recommendations for basic medical care extend for nine single-spaced pages. For many of their patients, doctors must increasingly rush through a blizzard of questions and tests, leaving little time for the kind of intimate chit-chat for which doctors and patients alike yearn. Some patients must schedule two or three office visits to have all of their medical issues addressed.
In a later interview, Ms. Beall said that Dr. Sroka “has real conversations with you, and he remembers what’s going on in your personal life. I really like that.” At appointments, she is assured of seeing him and not a colleague she does not know. Even his assistants know her on sight.
“At some medical offices, you feel like you should pull a number like at the deli,” she said. “But Dr. Sroka’s office is small-town medicine, and I like that. I’m dreading the day when he retires. I know it’s coming.”
Two Paths
Dr. Tim Biddle, 43, worked with Dr. Sroka between 2001 and 2005, making about $120,000 annually. Born and raised in Eastern Maryland, Dr. Biddle had intended to become a country doctor. But more than $100,000 in school debt and a desire to attend his four children’s soccer games led him to reconsider. Doctors in less populated areas tend to work longer hours seeing patients than doctors in more populated areas, according to government studies.
“Ron was working his butt off during the day seeing patients, and then he has the business of the practice to run at night,” Dr. Biddle said. “He’s got to balance the books, pay his employees and negotiate the reimbursement rates.” Like many doctors who own small practices, Dr. Sroka relies on his wife, Nancy Sroka, for much of his bookkeeping.
Instead of taking over the practice, Dr. Biddle left for a job as a physician at the Defense Department, where his salary is higher, his hours fewer and his vacations more frequent.
“I don’t work nights, weekends or holidays,” he said. “I get all the government holidays, and whether I see 3 or 30 patients a day, I get paid the same thing. And I never get stuck at the office because I’ve got too many patients, too much paperwork or because I have to go to the E.R. to see a patient.”
Dr. Biddle said that he missed the intimacy he once had with patients but suspected that he provided better care now because he practiced near other doctors, many of them specialists, whom he can consult on difficult cases. “When I was with Ron, we didn’t have 10 other doctors pulling the charts and providing the level of peer review that we have here,” he said.
Dr. Sroka was once deeply idealistic about his profession and used to speak with great feeling about a higher purpose to his work. He still fondly recalls standing on his front porch and stitching up neighborhood kids injured in evening ball games. But when insurers stopped paying extra for after-hours care, he started telling those kids to go to nearby emergency rooms. Like so many in his generation of doctors, the nickel-and-dime efforts of insurers have left him deeply bitter.
Dr. Sroka estimated that he was making about $250,000 annually in the 1990s — high for a primary care doctor — because he practices in an affluent region and his patients had generous insurance plans. Even as late as 2006, his income was $324,000, according to records he provided for this article — double the median income for family practice doctors that year.
But in 2008, his income dropped to $97,000. It rose last year to $130,000, but only because he worked about a third more hours. Growing practice expenses played a significant role in this decline.
Walking into Dr. Sroka’s practice, it is easy to see why. On most days, visitors are greeted by Betty Alt, a sweet 68-year-old who knows many patients intimately. Patients’ medical folders — many bulging with decades of aches and test results — are retrieved by Jennifer Simmons, a 41-year-old office assistant who spends much of her day faxing. Before appointments, patients often give a urine sample to Chris Minner, 58, a medical technician.
Altogether, Dr. Sroka employs 10 part-time employees, or the equivalent of five full-time workers. He does not provide his staff members with health insurance. His expenses amounted to $420,000 last year, or about $200 an hour. Most of his patients have either Medicare or CareFirst, the local Blue Cross Blue Shield plan, which pays him $69 (including a $20 co-pay) for most consultations. At that rate, he breaks even at three visits an hour and needs a fourth to turn a profit.
While Medicare reimbursements have been unchanged for 10 years, private reimbursements have declined twice in that period while his costs — and those of family practices across the country — rose steadily.
Keenly aware of these numbers, Dr. Sroka is decidedly cheap. When the toilet in his office broke recently, he went to Home Depot to get the replacement parts himself. When his office flooded, he spent the weekend mucking it out. His weight scale for patients is a battered, ancient disk that he kicks out from under his desk. The posters lining the walls are yard-sale Norman Rockwell reproductions.
Dr. Sroka said that he did not deserve anyone’s sympathy. Frugality and wise investments have left him with a net worth of about $5 million, which includes his office building, he said. He cannot bring himself to join a large group practice or work for a hospital because he opposes their growing use of nurse practitioners for primary care.
His eldest son, Ron Jr., sells group health insurance plans — the kind of product that is putting his father out of business.
“My dad’s way of delivering medicine is going to be extinct very soon,” Ron Sroka Jr. said in an interview. “He’s a dinosaur.” The money and time needed to buy and master an electronic health record system will alone be too much for his father, he said.
“My honest opinion is that one day he is going to lose it and just walk off the job,” Ron Sroka Jr. said. “There will be a final straw, a new mandate, and he’ll just say, ‘I’ve got to close my doors.’ He wants to maintain contact with his patient base because they’re like family to him, but he’s not going to be able to do it.”
The Personal Touch
Mary Pat Dorsey, 64, came in for an appointment after having heart palpitations, a pain in her jaw and a bad headache. A friend was concerned that she might be suffering a heart attack, so she called Dr. Sroka. He told her to come to his office instead of going to the emergency room.
Dr. Sroka gave her an electrocardiogram, took her pulse and blood pressure, and listened to her heart with his stethoscope. After a series of questions (was she at rest or active, sweaty, light-headed, fatigued or still taking estrogen replacement therapy?), he learned that she had been taking Excedrin for migraines.
“That has caffeine in it. It helps with the headache problems, but can bring on heart ones. That may be the thing that’s setting this off,” Dr. Sroka said. Still, he insisted that she soon get a stress test “because in this day and age, we’ve been ignoring too many women with symptoms of ischemic heart disease.”
He counseled her to go to the hospital in the future if she got chest pains with drenching sweat, light-headedness, or nausea and fatigue. “But I think you’re good for another 100,000 miles,” a line he used countless times that day.
In a later interview, Mrs. Dorsey said that she passed the stress test “with flying colors” and that Dr. Sroka had on several occasions over the previous 32 years saved her from unnecessary trips to the emergency room and thousands of dollars in medical bills “because he knows me.”
“I’m having trouble with menopause and having weird things happen to me, and he knows that,” she said. “He takes the time with me. He knows my family. He talks about fishing, and that makes me comfortable. He lives around the corner from my daughter. He grew up and came right back and did his practice around everybody he knows.”
“He’s just special.”

top 5 medical apps at harvard med

Wed, 20 Apr 2011 14:33:47 -0700

Top five medical apps at Harvard Medical School
By: Brian Dolan | Apr 19, 2011 11:22am EST
Tags: Android Medical Apps | Dr. John Halamka | Harvard Medical School | iPad medical apps | iPhone medical apps | medical student apps |

Harvard Medical School encourages its students to take advantage of the growing number of mobile medical apps. While the school does not distribute devices to its students, they are instructed to bring their favorite devices to campus and HMS maintains licenses for apps that might be useful to its students.
So which apps are most popular with HMS students? The school’s CIO just conducted a survey to find out.
The MyCourse Learning Management System where med students can access their course materials online also sports a tab for mobile applications students can download–many now for the iPad. Here are the top five mobile apps for Harvard Medical School students according to Chief Information Officer of the Beth Israel Deaconess Medical Center as well as CIO and Dean for Technology at Harvard Medical School, Dr John Halamka:
Dynamed – Students and physicians can use this clinical reference tool created by physicians for point-of-care situations
Unbound Medicine uCentral – This apps serves as a portal bringing popular medical publications to students’ iPad with the tap of the screen. The app includes 5 Minute Clinical Consult, A to Z Drug Facts, Drug Interaction Facts, and others.
VisualDx Mobile – VisualDx provides physician-reviewed clinical information with thousands of medical images showing the variation of disease presentation through age, stage, and skin type.
Epocrates Essentials – The app is an all-in-one mobile guide to drugs and disease with an integrated disease database with conditions, plus over-the-counter medications and hundreds of diagnostic and laboratory tests.
iRadiology – A learning tool for medical students and residents, iRadiology provides quick reviews of classic radiology cases and images.
Interestingly, when HMS surveyed its students in 2008, the web version of VisualDx was among the most popular tools access via the MyCourse Learning Management System.
Halamka plans to release more info from his survey of Harvard Medical School students soon, read more at his blog.

most popular drugs in america

Wed, 20 Apr 2011 13:25:38 -0700

Americans consume a lot of prescription drugs. And they seem especially fond of those to lower their cholesterol, relieve their heartburn, cheer them up and take away pain. Overall, however, their spending on such drugs is slowing.

A new report from consulting firm IMS Health offers a quick, but thorough, look at Americans' consumption of, and spending on, prescription drugs. In 2010, the report says, we spent more than $307 billion on medication. That’s up over 2009, but only by 2.3%.

The report’s introduction frames the trend nicely: “A number of factors contributed to this comparatively and historically low growth, including fewer patient visits to doctors’ offices, patent expirations for branded products, expanded usage of existing generic products and less spending on new products.”

Now, drum roll, please...Here are the top five classes of drugs prescribed in America:

- Lipid regulators, called statins by most people. These drugs manage cholesterol to lower the risk of heart disease. (The top-selling drug, by the way, is Lipitor, a statin)

– Antidepressants. The selective-serotonin reuptake inhibitors, or SSRIS, are the most popular, but a range of drugs are used to improve mood, sleep and concentration in depressed patients.

- Narcotic analgesics, also known as pain medications.

- Beta blockers. These drugs lower blood pressure by blocking norepinephrine and epinephrine thereby reducing the heart rate.

- Ace inhibitors. These drugs also lower blood pressure, but by dilating blood vessels.

Here are the top five drugs by sales:

- Lipitor – used to treat high cholesterol. Lipitor lowers “bad” LDL cholesterol while raising “good” HDL cholesterol.

- Nexium – prescribed for heartburn relief. Nexium is in a class of drugs called proton-pump inhibitors that reduce acid produced in the stomach.

- Plavix – used to reduce the risk of heart attack or stroke. Plavix keeps platelets in the blood from coagulating, preventing blood clots in people who have already had a heart attack or stroke, or for those at high risk.

- Advair diskus – an inhaled medication to treat asthma symptoms or chronic obstructive pulmonary disease (COPD). It is made of two substances: fluticasone, a steroid to prevent inflammation, and salmeterol, to relax muscles in the airway to improve breathing.

- Abilify – an antipsychotic. It’s used to treat conditions such as schizophrenia and bipolar disorder, and has been heavily marketed.

The report also tells us what we’re spending the most money on. At the top of the list -- oncologics. Otherwise known as cancer drugs.

healthkey@tribune.com
SPENDING $BN 2010 2009 2008 2007 2006
Total US Market 307.4 300.3 285.7 280.5 270.3
1 Lipitor® 7.2 7.6 7.8 8.1 8.6
2 Nexium® 6.3 6.3 5.9 5.4 5.1
3 Plavix® 6.1 5.6 4.8 3.9 2.9
4 Advair Diskus® 4.7 4.7 4.4 4.2 3.9
5 Abilify® 4.6 4.0 3.0 2.3 1.9
6 Seroquel® 4.4 4.2 3.8 3.4 3.0
7 Singulair® 4.1 3.7 3.5 3.4 3.0
8 Crestor® 3.8 3.0 2.1 1.7 1.3
9 Actos® 3.5 3.4 3.1 2.9 2.6
10 Epogen® 3.3 3.2 3.0 3.0 3.2
11 Remicade® 3.3 3.2 3.0 2.7 2.5
12 Enbrel® 3.3 3.3 3.1 3.1 3.1
13 Cymbalta® 3.2 2.8 2.4 1.9 1.2
14 Avastin® 3.1 3.0 2.5 2.2 1.7
15 Oxycontin® 3.1 2.9 2.3 1.0 0.8
16 Neulasta® 3.0 3.0 3.0 3.0 2.8
17 Zyprexa® 3.0 2.7 2.5 2.4 2.4
18 Humira® 2.9 2.5 2.1 1.5 1.2
19 Lexapro® 2.8 2.8 2.7 2.6 2.4
20 Rituxan® 2.8 2.6 2.4 2.2 2.0
21 Aricept® 2.5 2.3 1.9 1.6 1.4
22 Lovenox® 2.3 2.8 2.6 2.3 2.0
23 Atripla® 2.2 1.9 1.4 0.9 0.2
24 Copaxone® 2.2 1.7 1.4 1.1 1.0
25 Spiriva®Handihaler® 2.0 1.7 1.4 1.1 0.7

University of Nevada REsidency

Wed, 6 Apr 2011 20:00:40 -0700

Fifty-four University of Nevada, Reno medical students in the class of 2011 matched with 30 different residency institutions across the nation and will enter specialties ranging from anesthesiology to urology, university officials recently reported.
Eight graduates, or 15 percent, will stay in the state to enter into residency programs offered through the University of Nevada School of Medicine.
Twenty-one graduates, or 39 percent, will enter primary care specialties including internal medicine, pediatrics and family medicine.
Nationwide, and especially in Nevada, there is a shortage of primary care physicians.
Nearly 60 percent of physicians completing their residency training in Nevada remain in the state to practice.
Nearly 40 percent of this year's graduating class are matched with residency programs not offered within the state.
Students matching with some of the most competitive residency training programs include placements with the Mayo Clinic, University of Southern California, University of California at Davis and Howard University in Washington, D.C.
In addition to today's match results, two students from this class received their match notification in January.
These students participated in the San Francisco Match and Military Match, which were developed to accommodate the most competitive of residency programs.
Students placing in the early matches will enter the dermatology and ophthalmology fields of medicine.
The University of Nevada School of Medicine includes 16 clinical departments -- family medicine, pediatrics, obstetrics and gynecology, internal medicine, surgery, and psychiatry and behavioral sciences -- and five nationally recognized departments in basic science including microbiology and biomedical engineering.
For more information, visit www.medicine.nevada.edu.

residency match results

Sun, 20 Mar 2011 20:07:57 -0700

Match Day' reveals many future doctors favor family medicine

March 18, 2011|By Mary Forgione, Tribune Health
"Match Day" is a sort of March Madness for med students. It's the time of year when seniors in medical schools throughout the country are matched with residency programs. Though the fine points of the process likely only matter to those craving a spot, the residency offerings do offer a glimpse of our future specialists, if not our general practitioners.

The not-for-profit National Resident Matching Program on Thursday placed more than 16,000 U.S. medical students in a record 26,000 residency programs. The group reports an 11% rise over 2010 in the number of family medicine positions; seniors filled half the 2,708 slots available nationwide.
Pediatrics and internal medicine are specialties that became more popular among students, as well as emergency medicine, anesthesiology and neurology.
And here are some other trends noted in this statement:
Dermatology, orthopaedic surgery, otolaryngology, plastic surgery, radiation oncology, thoracic surgery, and vascular surgery were the most competitive fields for applicants. At least 90 percent of those positions were filled by U.S. medical school seniors.
The number of U.S. medical school seniors in emergency medicine increased by 7 percent and grew for the sixth year in a row, as they filled 1,268 of the 1,607 first-year positions available.
Anesthesiology offered 44 more positions and matched 45 more U.S. seniors who filled 671 positions of the 841 offered."
From the sounds of it, we need these new doctors because we could be facing a shortage. Here's what this Los Angeles Times story says:
"The Assn. of American Medical Colleges has warned of a deficiency of up to 125,000 doctors by 2025. And it isn't the only group voicing concerns. The Health Resources and Services Administration, a federal agency that works to improve healthcare access for the uninsured, has projected that the supply of primary-care physicians will be adequate through 2020, at which point there will be a deficit of 65,560 physicians. The American Academy of Family Physicians estimates the need for almost 149,000 extra doctors by that year."
Now back to the people affected directly by Match Day. This Baltimore Sun story explains howone university, Johns Hopkins' medical school, incorporated a St. Patrick's Day vibe with the event:
"They dipped their hands into the plastic pots at the end of a rainbow made of balloons. The coins they pulled out were made of cardboard but bore secrets more precious than gold. Where would they spend the next three to 10 years of their lives?"

what do hospitals really charge?

Sun, 20 Mar 2011 20:02:36 -0700

What Do Hospitals Really Charge? No One Knows, Even With Posted Prices
By Ken Terry | March 14, 2011

An increasing number of hospitals — along with health plans — are posting the prices of common medical procedures and tests on their websites. What’s not clear is whether this is helping consumers or confusing them. While the ability to shop online should help uninsured patients and those in high-deductible plans most, it may not matter if they can’t afford to pay those prices in the first place.
Under the Affordable Care Act, all U.S. hospitals will have to publish prices for their most frequently performed services by 2014. In addition, not-for-profit hospitals will have to limit charges to patients who qualify for financial assistance to those they typically bill to insurers. So the evolution and impact of the new pricing transparency has broad implications across the country.
In Michigan, three hospital systems — Henry Ford in Detroit, Oakwood in Dearborn, and Spectrum in Grand Rapids — are publishing their average prices for common procedures and tests. Spectrum has been posting the average prices paid by major payers for 250 services since 2006, adding Medicare and Medicaid in 2008.
It’s an advance, just not much of one
This approach is a significant advance beyond the publication of hospital “charge master” prices in Arizona, California, Florida and a few other states. Those prices represent what hospitals charge payers before discounts, which is often several times higher than what they actually get paid. The only people who pay the charge master price are the uninsured.
In the wake of some well-publicized cases in which people unable to pay these high prices had their wages garnished or declared bankruptcy, many hospitals began to change their approach to the uninsured. Today, in fact, some hospitals offer deep discounts and financial counseling to patients who are uninsured or underinsured. Letting people know how much their care will cost and what their financial responsibility will be upfront is considered a smart way to reduce bad debt while enhancing community relations.
A lot of people are interested in how much hospital care costs. The Henry Ford Health System says that 2,000 people a day visit its pricing website. Many of them belong to the high-deductible plans that more and more employers are offering. Similarly, Spectrum Health reports that 1,000 people a day visit its site for price information alone.
When a price isn’t really a price
But there remain problems with the cost data, even if it’s the average payer prices. First, these prices include only the facility fees, not the doctor fees, which may vary considerably. Second, the average price doesn’t tell an individual consumer what he or she will pay, since Medicare and Medicaid pay so much less than private insurers do for the same procedure in most areas of the country. Moreover, a particular health plan’s rate — which members pay up to their deductible — is directly related to its leverage in the market.
There is payment estimation software that enables institutions to calculate a patient’s bill in advance, depending on its contract with that patient’s insurer and the patient’s deductible and copayments. But few hospitals are currently using it.
Hopefully, more hospitals will get beyond the charge master stage and begin to post average payments for big-ticket procedures and tests. But at this point, it’s still not clear whether patients will use this information to pick a hospital. At the end of the day, when someone is facing a major medical procedure, they’re still more likely to listen to their doctor and their friends and relatives than to base their decision on a cost figure that they may not understand.
Image supplied courtesy of Wikimedia Commons.

ross medical school founder dies at 92

Sun, 20 Mar 2011 19:57:03 -0700

Medical school founder Robert Ross dies at 92
March 19, 2011 4:09 PM ET
NEW YORK (AP) - The founder of Ross University and two other medical schools in the Caribbean has died at age 92.
Robert Ross' family said he died of cancer on Saturday at his home in New York.
Ross was a native of Detroit. He founded the Ross University medical school in the Caribbean island of Dominica (pronounced dom-inn-EE-kah) in 1978 and sold it in 2000. The university is now owned by DeVry Inc. It has its offices in New Brunswick, N.J. and clinical education centers in Miami and Saginaw, Mich.
Ross later founded the International University of Nursing and the University of Medicine and Health Sciences in St. Kitts. He also developed a homeopathic remedy for snoring called YSNORE.
Ross is survived by his wife, Anne, four children and two stepchildren.

residency directors against new work limits

Sun, 20 Mar 2011 19:53:57 -0700

Medical Residency Directors Don’t Think Work Limits Will Cut Fatigue
By Katherine Hobson

Proposed new work limits for medical residents were announced last summer and approved in the fall by the Accreditation Council for Graduate Medical Education. And that giant raspberry sound you hear is from the directors of residency programs who responded to a Mayo Clinic survey on the changes, which include limiting the workday of first-year residents to 16 hours.
The study, which appears in Mayo Clinic Proceedings, covered responses from directors of 464 internal medicine, pediatric and general surgery residency programs. They were asked how they thought the requirements — which weren’t finalized at the time of the survey — would affect different aspects of graduate medical education.
In a word: badly. A majority of respondents believe the limits will worsen residents’ ability to provide continuous care to patients, to coordinate patient care, to respond to patient needs, to communicate effectively with patients and each other, and to investigate and evaluate their own care. (There can be miscommunication, for example, when patients are handed off from one caregiver to another that can contribute to medical errors.)
Program directors weren’t too optimistic that residents’ fatigue will actually decrease, either; 65% said the rules would have no effect and 6% said they’d increase fatigue.
The one question that earned a slightly split decision was how the changes will affect patient safety and quality of care: 43% thought quality would decrease and 43% thought it would stay the same. Only 14%, then, thought there will be an improvement.
We asked Darcy Reed, a Mayo internist and co-author of the study, to speculate on why respondents might not think that fatigue, and therefore patient safety, will improve if residents are working fewer hours. She tells us that research suggests those changes don’t have a big effect on how much residents sleep. “Just because we schedule fewer hours doesn’t mean they’ll use them to rest,” she says.
Moreover, there may be a concern that residents will end up cramming more work into their shorter shifts. “There’s not enough research to know the effects of higher work intensity or workload” on patient safety, she says. She says programs are currently trying to figure out how to rearrange staffing to account for the changes when they take effect this July. That may include adding hospitalists or nurses –which of course, costs money.
Image: iStockphoto

Fewer US Medical students getting matched

Sun, 20 Mar 2011 19:51:15 -0700

Fewer U.S. medical students getting 'Match Day' residencies
Published: Friday, March 18, 2011, 8:00 AM
By Kelly Heyboer/ The Star-Ledger

John Munson/The Star-Ledger
Lissette Cespedes gets a hug from physician Ana Natale while holding her daughter Valerie, 20 months, after finding out she will be doing her medical residency at Robert Wood Johnson Medical Center next year.

NEWARK — Lissette Cespedes’ mind was racing as she waited to rip open the white envelope in her hand at the University of Medicine and Dentistry of New Jersey in Newark yesterday.
Would it tell the 27-year-old medical student she was spending the next few years of her life at Robert Wood Johnson University Hospital in New Brunswick? Cornell Medical Center in New York? Montefiore Medical Center in the Bronx? Or some hospital on the other side of the country?
"Robert Wood Johnson! My first choice," Cespedes, of Union City, said after tearing open the envelope as her family cheered.
Similar scenes took place during "Match Day" events at medical schools across the country as students learned the names of the hospitals where they will be spending the next three to seven years completing their residencies. Following tradition, students around the nation ripped open their envelopes at the same time in noisy campus ceremonies.
For some students, including Cespedes, it was a day for celebration. For others — including a classmate standing near Cespedes who crumbled in tears after opening her envelope — it was a day of despair as they learned they had been assigned to one of their last-choice hospitals in far-away cities.
U.S. medical students are facing growing competition for residencies from doctors trained at foreign medical schools. This year’s match was the largest in the 59-year-old history of the National Resident Matching Program, with nearly 38,000 applicants from around the world fighting for 26,000 positions at U.S. hospitals.
"Competition is tightening," said Mona Signer, the program’s executive director. "The growth in applicants is more than the increase in positions."

This year, the pool included 3,769 American medical students who trained in the Caribbean or other international schools, a 10 percent increase over five years ago, program officials said. The applicants also included 6,659 foreign doctors-in-training from overseas medical schools, a slight dip from last year.
Students from U.S. medical schools still have the best chance of landing a residency, with 94 percent of applicants getting an offer this year. About 40 percent of foreign students and 50 percent of American students who trained at overseas medical schools matched with a residency.
The program was created in 1952 to simplify the process of assigning future doctors to hospitals where they can complete their training. The students rank between one and 20 hospitals where they interviewed for a residency in their specialty. The hospitals also rank their top-choice students. Then, a computer algorithm crunches the numbers and matches medical students to hospitals.
At UMDNJ, only three of the 379 seniors at the university’s three medical schools failed to get an envelope this year, school officials said. The students learned early they didn’t match with any residencies so they did not have to get the news at the "Match Day" ceremonies. They will have a second chance in the "scramble," a brief period where applicants can apply to hospitals that still have openings.
Students who still don’t land a residency often take a year off and enter the match program again, hoping for better luck, school officials said.
At UMDNJ’s "Match Day" ceremonies in Newark, sheet cake and sparkling cider were waiting for the nervous students from New Jersey Medical School. Students wore green "Kiss me. I matched!" t-shirts in honor of St. Patrick’s Day.
Vidhi Kapoor, 25, trembled as her parents leaned in close to watch her open her envelope. She burst into happy tears when she read she would be staying in Newark, doing a residency in pediatrics at University Hospital.
"I was so scared and emotional," said Kapoor, of Edison.
Nina Gutowski, 26, handed her letter to her mother to open because she was so nervous. Her mother handed it back and forced the orthopedic surgeon-in-training to open it herself. It said she was going to Thomas Jefferson University Hospital in Philadelphia, her top choice.
Years of hard work had come down to one line on a piece of paper, she said.
"It was worth it in the end," said Gutowski, of Princeton.

march madness leads to more vasectomies

Thu, 17 Mar 2011 19:50:24 -0700

Doctor: Vasectomies Spike by 50 Percent During March Madness

Published March 16, 2011
| FoxNews.com

There will be approximately 50 percent more vasectomies this week, according to the Cleveland Clinic, and the reason has to do with the start of March Madness.
Dr. Stephen Jones, a urologist at the Cleveland Clinic, said men opt to get the surgery during the NCAA men’s basketball tournament so they can watch the games while recovering.
“They need at least a day with ice, keeping the area cool,” Jones said. “Not so much because it hurts, it really doesn’t hurt much – but it’s an area that swells very easily. So, if they’re going to spend a whole day doing nothing – it’s not hard to figure out that they’d want to do it on a day they’d like to be sitting in front of the television. There’s nothing that makes guys want to be in front of a television more than March Madness.”
Some urologists take advantage of the increase and offer incentives like coupons for free pizza delivery, sports magazines and “survival kits,” which are given to the men after surgery, USA Today reported.
Dr. Richard Chopp at the Urology Team in Austin, Texas, gives his patients a t-shirt that says “I Got Chopped at the Urology Team.”
There are approximately 600,000 vasectomies performed each year in the U.S. A vasectomy is elective form of male birth control that cuts the supply of sperm to the semen.
Click here to read more about this story from USA Today.

Jones said men can get back into their normal routine within a week after the procedure.

Read more: http://www.foxnews.com/health/2011/03/16/doctor-vasectomies-spike-50-percent-march-madness/#ixzz1GupvzIzh