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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The brave new worlds of healthcare and healthcare economics got me thinking about legendary University of Alabama football coach Paul "Bear" Bryant.
First I was assigned to write an article on voters' approval of a local ballot measure in California that capped executive pay at the public healthcare institution in Google's hometown, El Camino Hospital in Mountain View, Calif., at twice that of the state's governor.
The El Camino Hospital pays CEO Tomi Ryba a $695,000 base salary to run its 361-bed, two-campus institution, and—eight days after the election—its board approved a $137,815 performance bonus (PDF) for her.
In contrast, Gov. Jerry Brown makes almost $174,000 as the state's CEO, but the California Citizens Compensation Commission—as part of state austerity measures—has knocked that down to $165,000 starting next month.
The hospital board has authorized taking legal action to challenge the ballot measure's directive, which would reduce Ryba's salary to $330,000.
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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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