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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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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Without hesitation, Dr. Allan Korn, the Blue Cross and Blue Shield Association's chief medical officer and senior vice president for clinical affairs, declared that the patient-centered medical home has the potential to transform the U.S. healthcare system.
"The things you want going up are going up, and the things you want going down are going down," said Korn in an interview following his appearance Monday on a panel assessing the state of the healthcare industry presented in San Antonio at the MGMA-ACMPE's annual conference. "There's no question that the medical home is working, and that's what's gratifying to me."
While speaking on the panel, Korn said he thinks steps could be taken to improve the patient-centeredness of the medical-home practice model. Still, he said later, medical homes—which use information technology to coordinate care and track the treatment of patients who have chronic diseases—have led to double-digit declines in patients' exposure to radiation from diagnostic tests, in "ambulatory-sensitive" hospital admissions, and in unnecessary and costly healthcare episodes.
They have also boosted physician satisfaction.
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As evidenced by library shelves stacked with medical journals, the science of medicine can be measured in countless ways, but Dr. Richard Levin, the new president and CEO of the Arnold P. Gold Foundation, believes the art of medicine—or at least its effects—can be measured as well.
I spoke with Levin recently during the Gold Humanism Honor Society's fifth biennial conference and 10th anniversary celebration, held in Rosemont, Ill. He told me about the foundation's roots and its work creating an institute for research on humanism in medicine that will be dedicated to studying the role of compassion, altruism and respect in healthcare.
The foundation was co-founded by Dr. Arnold Gold, a professor of clinical neurology and clinical pediatrics at Columbia University's College of Physicians and Surgeons, and his wife, Sandra, who served as president and CEO until August. Levin said Dr. Gold was motivated by seeing how "physicians, seduced by new technology, turned away from the tenets of the profession," such as Sir William Osler's words: "Listen to the patient. He is telling you the diagnosis."
"We got so caught up with the idea that technology could take us out of suffering," Levin said.
To instill professionalism, Dr. Gold initiated Columbia's white-coat ceremonies welcoming new medical students into the field of medicine. Levin said the ceremonies are now an annual ritual at 90% of U.S. medical schools—and he notes that the Golds were able to spread this practice without spending money to promote it.
"There was no endowment," he said. "They did it through sheer will and passion."
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Even with a presidential election coming up and healthcare budgets being threatened by the sequestration-driven cuts mandated by one law and the sustainable growth-rate formula cuts mandated by another, the big question on everyone's mind at the four healthcare conferences filling the convention halls of Chicago just might be, "Who's having the most fun?"
The American Health Information Management Association and the American College of Surgeons have taken over separate halves of the McCormick Place Convention Center; folks at the Healthcare Facilities Symposium and Expo are taking in Lake Michigan breezes at Navy Pier; and the American Urogynecologic Society is meeting in between at the Hilton Chicago on Michigan Avenue.
Along with exhibit-hall receptions, the facilities symposium is hosting a mixer at the Merchandise Mart and offering a riverboat architecture tour as well as field trips to the North Park University School of Nursing simulation center and Chicago's newest healthcare facilities: the Ann & Robert H. Lurie Children's Hospital and Rush University Medical Center's new 14-story tower.
The AUGS will host exhibit-hall receptions as well as an "AUGSome" Friday night party and foundation fundraiser at the Art Institute of Chicago. The event will be capped by the AUGS Karaoke Challenge, an event I'm sure you won't want to miss.
Only AHIMA could feature an ICD-10 Refreshment Bar in its exhibit hall. But the fun doesn't stop there. Five universities are holding alumni events, and a "1920s speakeasy" party was set for the Excalibur nightclub (for you old-timers, that's the former Limelight).
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Predictably, the doctor-nurse scope-of-practice turf battle reignited after the American Academy of Family Physicians issued a report that said, essentially, nurse practitioners and other healthcare professionals play vital roles in team-based care that's provided under the patient-centered medical home practice model—but the team needs to be led by a physician.
The American Academy of Nurse Practitioners, in response, issued a statement declaring the AAFP to be "misdirected and out of step with today's environment."
The extra education physicians receive is at the heart of the debate, but Tamara Zurakowski, a practice associate professor at the University of Pennsylvania School of Nursing, said in response to the AANP's reaction: "A nuclear physicist knows a great deal more about the production of electrical energy than a licensed electrician does, but when I need the wiring in my house fixed, I don't hire a physicist."
Though it was the AAFP that fired the initial salvo—and then took the heat for doing so—it should be noted that the AAFP news release included words of support from the presidents of the American Academy of Pediatrics and the American Medical Association and the executive director of the American Osteopathic Organization.
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Predictably, the doctor-nurse scope-of-practice turf battle reignited after the American Academy of Family Physicians issued a report that said, essentially, nurse practitioners and other healthcare professionals play vital roles in team-based care that's provided under the patient-centered medical home practice model—but the team needs to be led by a physician.
The American Academy of Nurse Practitioners, in response, issued a statement declaring the AAFP to be "misdirected and out of step with today's environment."
The extra education physicians receive is at the heart of the debate, but Tamara Zurakowski, a practice associate professor at the University of Pennsylvania School of Nursing, said in response to the AANP's reaction: "A nuclear physicist knows a great deal more about the production of electrical energy than a licensed electrician does, but when I need the wiring in my house fixed, I don't hire a physicist."
Though it was the AAFP that fired the initial salvo—and then took the heat for doing so—it should be noted that the AAFP news release included words of support from the presidents of the American Academy of Pediatrics and the American Medical Association and the executive director of the American Osteopathic Organization.
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