Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio.
This item has nothing to do with OpenNotes itself –- it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.
Here’s the story.
In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note “primary,” not specialists. I imagine they needed to keep the study design simple.
So here I am in the study, going through life. Five weeks ago I wrote my first realization: After the visit I’d forgotten something, so I logged in. Read more »
With medical students graduating, on average, with almost $160,000 of debt, it’s a major reason why they’re choosing more lucrative specialty practice, which can offer salaries multiple times more than those of primary care fields.
In this clip from The Vanishing Oath, medical economist Amitabh Chandra, Professor of Public Policy at the Harvard Kennedy School of Government, discusses that influence, which contributes to a drastic decline of primary care residency slots being filled by American medical graduates.
Of course, it’s not only money. Primary care practice has a litany of obstacles that can contribute to rapid physician burnout, compounded by the fact that good primary care role models are largely absent from academic settings.
But there’s no denying that the salary disparity is an influential factor, and for many students, often a deciding one.
Hospitals today are aggressively buying physician practices in their local markets. Why? Hospitals want to solidify their referral base for inpatient and outpatient referrals as well as increase their negotiating power with insurance companies.
Over 50% of physician practices are now owned by hospitals according to the Medical Group Management Association. As such, many one-time private practitioners are now hospital employees.
Having done physician recruitment in a prior life, I know that before buying a practice that hospitals look at a variety of things including the practice’s patient volume, number of hospital referrals, estimates of patient turnover, and so on. One of the things we did not consider years ago in evaluating and buying a physician practice was the quality of the physician’s patient communication skills and supporting practices. I doubt that things have changed much since. Read more »
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