Critics of the American Medical Association argue that the organization's ranks have shrunk to the point where it can no longer claim to be the voice of the nation's doctors. Now new demographic information suggests that, not only might the AMA no longer represent doctors, but its membership and leadership may not be representative of the U.S. physician population.
According to two newly released reports on the U.S. physician population and the AMA's leadership and membership demographics, the country's oldest and still-largest physician organization is doing OK in some respects at matching the changing gender demographics of the nation's physician workforce. But the age distribution of AMA members and leaders doesn't come close to mirroring the age range of physicians currently in practice.
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A doctor who died 12 years ago is having an influence on healthcare debates all across the country.
Some 200 bills relating to certificate-of-need laws have been introduced in state legislatures this year. According to Kara Hinkley with the National Conference of State Legislatures, the trend is toward limiting CON by repealing pieces or including moratoriums on CON requirements.
Despite this opposition to the CON process, a new study concluded that certificate of need has done what it set out to do: Control healthcare costs.
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Membership in many physician associations had been flat or declining in recent years, but now appears to be on the upswing. This could be the result of better times, better marketing or the fear generated by the regularly repeated threats of precipitous Medicare pay cuts.
Membership dues are often the first things to be sacrificed when the economy stalls. Docs rejoining groups like the American Medical Association or state medical societies could be a sign that better financial times lie ahead. It could also be a sign of a growing interest among physicians to advocate for their profession. Or, according to a theory put forth by Princeton University economist Uwe Reinhardt, it may not be a positive development at all.
According to a California Medical Association news release, there are between 60,000 and 70,000 physicians in the state of California, and 37,222 are CMA members—which represents a more than 4% increase from the year before. The growth is significant, according to the release, because membership had been “relatively flat” for nine years.
“The increase in membership is due to outreach to medical groups and more targeted recruitment and retention activities,” the release said. (The release didn’t mention that CMA dues for medical student, resident and fellow members were eliminated last year and that the CMA asked county medical societies to do the same.)
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Everyone, it seems, wants in on the medical home business, but the medical home practice implementation consulting service TransforMED got in on the ground floor.
A subsidiary of the American Academy of Family of Physicians, TransforMED was launched in June 2006 as part of the AAFP’s two-year, 36-practice national demonstration project. Eighteen of the demonstration practices were on their own, and 18 received help from TransforMED—which has since gone on to help guide almost 700 practices in adopting the medical home model. The model calls for coordinated care, a “whole-person orientation,” and increased patient access, which includes providing secure electronic doctor-patient messaging and offering same-day scheduling options.
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Here's an interesting statistic from the American Academy of Family Physicians: In areas where there are few physicians, there are still usually more doctors than nurse practitioners.
I was sent that stat and more after writing a blog post responding to the AAFP's and the American Medical Association's (PDF) insistence that in the drive toward team-based healthcare, physician leadership is an absolute requirement for any healthcare team.
While physicians have presented a unified front, they stand in isolation.
Nurse practitioners criticized the AAFP and called it "misdirected and out of step” on the issue. With a nod to the idea that the care-coordination-focused medical-home practice model is the new foundation of team-based care in the U.S., the NPs noted that none of the organizations that recognize practices as medical homes requires practices to be physician-led to earn the organization's seal of approval. (I had trouble believing that last part, so I called the National Committee for Quality Assurance, the Joint Commission and the Accreditation Association for Ambulatory Health Care, and they all confirmed it was true.)
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Go team! Or, more accurately, “Go physician-led team” was one of the battle cries of the American Medical Association House of Delegates interim meeting.
But what if there are no physicians around to lead the team? Would the AMA be willing to call for a draft where doctors are pulled from comfortable suburban practices and dragged to the rural hinterlands like a professional athlete picked by a new team in an expansion draft?
OK. No more sports analogies. But there is a definite trend of physicians calling for physician-led teams without addressing the realities of the projected physician shortage and the existing “maldistribution” of doctors.
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Election Day has finally come and gone, and although it's true that the number of Democrat doctors in the U.S. House of Representatives will have tripled once the new Congress is sworn in, the statistic isn't all that significant—their numbers grew from one to three. In the Senate, Democrat docs saw no gain in ranks.
On the Republican side, there are currently 15 doctors in the House. Dr. Ron Paul of Texas ran unsuccessfully for president and didn't seek re-election to Congress, and New York ophthalmologist Dr. Nan Hayworth lost her re-election bid. Dr. Charles Boustany, a cardiovascular surgeon, won his race but faces a run-off against fellow Republican Jeff Landry on Dec. 8. No new GOP physicians were elected.
In the Senate, the only incumbent physician running, the GOP's Dr. John Barrasso, won handily with 75.9% of the vote. The only Democratic doc in a Senate race, Dr. Richard Carmona—a general surgeon and the former U.S. Surgeon General—lost his bid to win Arizona's open seat by a 50.4% to 45.2% vote to Republican Rep. Jeff Flake. Republican Senate Drs. Tom Coburn of Oklahoma and Rand Paul of Kentucky were not up for re-election.
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UPDATED 5:15 p.m.: If you can still find a telephone booth in Washington, it could probably serve as an adequate meeting room for the Democratic Congressional Physician Caucus, but that could change after the Nov. 6 election.
There are 19 physicians serving in Congress along with Dr. Donna Christensen, the nonvoting delegate representing the U.S. Virgin Islands. Christensen and Dr. James McDermott, a Washington state psychiatrist, are the only Democratic doctors in Congress—though they may soon have a lot more company. Of course, they both have to be re-elected first.
With the exception of Rep. Ron Paul, the Texas OB-GYN and erstwhile presidential candidate, all of the GOP doctors in the House are running for re-election. They are: Dan Benishek (Michigan, general surgeon); Charles Boustany (Louisiana, cardiovascular surgeon); Paul Broun (Georgia, family medicine); Larry Bucshon (Indiana, thoracic surgeon); Michael Burgess (Texas, OB-GYN); Bill Cassidy (Louisiana, gastroenterologist); Scott DesJarlais (Tennessee, family medicine); John Fleming (Louisiana, family medicine); Phil Gingrey (Georgia, OB-GYN); Andy Harris (Maryland, anesthesiologist); Nan Hayworth (New York, ophthalmologist); Joe Heck (Nevada, emergency medicine); Tom Price (Georgia, orthopedic surgeon); and Phil Roe (Tennessee, OB-GYN). Heck, by the way, is the only D.O., or doctor of osteopathy, in Congress.
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To defend against malpractice suits, one speaker at the recent MGMA-ACMPE annual conference in San Antonio recommended, practices must maintain constant vigilance of their health information technology systems. Another speaker said lawsuits can be avoided by showing patients courtesy and respect.
They are probably both right, though the second speaker's message was more inspiring.
Ronald Sterling, an electronic health-record consultant based in Silver Spring, Md., gave a presentation titled "Malpractice Discovery in the Age of EHR" and warned his audience that he was about to address a "depressing" subject.
Sterling said the good news was that mitigation efforts in the area of malpractice discovery could best be described as "good housekeeping," and he warned against "ceding clinical control to the techno geeks."
Sterling sprinkled his talk with horror stories such as the pediatric practice whose patient immunization records were not transferred into the EHR, and his main message seemed to be: Test systems; verify data; train staff; and document what you did.
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It's not uncommon these days for newly elected physician association leaders to hop on the social-media bandwagon, but the American Academy of Family Physicians' new president-elect, Dr. Reid Blackwelder—a.k.a. @blackweldermd—is an old pro.
Blackwelder has sent 3,429 tweets to 690 followers since joining Twitter in May 2011, but he has been on Facebook a lot longer. First elected to the AAFP board in 2009, Blackwelder is the director of the medical student educational division within the James H. Quillen College of Medicine's family medicine department at East Tennessee State University in Johnson City, Tenn. He first joined Facebook as a way of connecting with his students.
The 2004-2005 president of the Tennessee Academy of Family Physicians, Blackwelder said he stepped up his Facebook activity as he became more involved with the state and national academy chapters. Now he cross-posts everything on both Facebook and Twitter.
Blackwelder said he discovered live-tweeting while attending a meeting and seeing the AAFP's medical resident representative, Dr. Kevin Bernstein (@BernieMD31), pecking away at a keyboard. He learned that Bernstein was "taking notes in Tweet form" for the benefit of a colleague who couldn't attend that session and wanted to find out what happened.
Except for live-tweeting from an event, Blackwelder said he usually keeps to three to five tweets a day: an opening inspirational tweet, around three educational or informational tweets with links to source material, and an evening "thought for the day to allow people to wind down." The tweets are buffered so they're sent out several hours apart, which allows him to "maintain a presence" even while he's seeing patients, teaching or tending to AAFP matters.
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It's not uncommon these days for newly elected physician association leaders to hop on the social-media bandwagon, but the American Academy of Family Physicians' new president-elect, Dr. Reid Blackwelder—a.k.a. @blackweldermd—is an old pro.
Blackwelder has sent 3,429 tweets to 690 followers since joining Twitter in May 2011, but he has been on Facebook a lot longer. First elected to the AAFP board in 2009, Blackwelder is the director of the medical student educational division within the James H. Quillen College of Medicine's family medicine department at East Tennessee State University in Johnson City, Tenn. He first joined Facebook as a way of connecting with his students.
The 2004-2005 president of the Tennessee Academy of Family Physicians, Blackwelder said he stepped up his Facebook activity as he became more involved with the state and national academy chapters. Now he cross-posts everything on both Facebook and Twitter.
Blackwelder said he discovered live-tweeting while attending a meeting and seeing the AAFP's medical resident representative, Dr. Kevin Bernstein (@BernieMD31), pecking away at a keyboard. He learned that Bernstein was "taking notes in Tweet form" for the benefit of a colleague who couldn't attend that session and wanted to find out what happened.
Except for live-tweeting from an event, Blackwelder said he usually keeps to three to five tweets a day: an opening inspirational tweet, around three educational or informational tweets with links to source material, and an evening "thought for the day to allow people to wind down." The tweets are buffered so they're sent out several hours apart, which allows him to "maintain a presence" even while he's seeing patients, teaching or tending to AAFP matters.
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