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New Doctor Considering Primary Care? Show Me The Money

There are plenty of reasons why medical students aren’t choosing primary care as careers. Lack of role models. Perception of professional dissatisfaction. High burnout rate among generalist doctors. Long, uncontrollable hours.

But what about salary? Until now, the wage disparity between primary care doctors and specialists has only been an assumed reason; the evidence was largely circumstantial. After all, the average medical school debt exceeds $160,000, so why not go into a specialty that pays several times more, with better hours?

Thanks to Robert Centor, there’s a study published in Medscape that shows how money affects career choice among medical students. Here’s what they found:

Sixty-six percent of students did not apply for a primary care residency. Of these, 30 percent would have applied for primary care if they had been given a median bonus of $27,500 before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000.

And in conclusion:

U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.

Money matters. There should be no shame for new doctors to admit that. After all, they’re human too, and respond to financial incentives just like anyone else. And when most medical students graduate with mortgage-sized school loans, salary should be a factor when considering a career. Read more »

*This blog post was originally published at*

“Whoop-De-Do!” To The Medicare Physician Pay Cut Problem

After months of dithering, delaying, denying, and defaulting on a decision, Congress ended up…doing as little as possible to address the Medicare physician pay cut problem.

Thursday night the House of Representatives acceded to the Senate’s bill to provide physicians with a 2.2 percent update retroactive to June 1. This respite, though, lasts only through the end of November, when physicians and patients will again face another double-digit cut. And if the past is prologue, a lame-duck Congress then will wait until the very last minute to enact another short-term patch, or worse yet, allow the cut to go into effect on December 1 and then pass some kind of retroactive adjustment.

You know that the situation has gotten ridiculously bad when the President says this about the bill he just signed into law:

“Kicking these cuts down the road just isn’t an adequate solution.”

And when Speaker Pelosi (D-CA) calls it “inadequate” and a “great disappointment” and the best that any had to say about it was this from SFC ranking member Charles Grassley (R-IA):

“This action was critically needed so there’s no disruption in services for anyone.”

But it’s too late. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Philadelphia College of Pharmacy and Science Is Planning To Honor Quackery

David Kroll, Ph.D. and I share more than an appreciation for bibs and crab legs (pictured at left during our recent “academic” rendezvous) – we are pro-science bloggers who want to understand the evidence for (or against) health treatment options, both in the natural product world and beyond. At our recent meet up at The Palm we discussed homeopathy – a bizarre pseudoscientific approach to medicine often confused with herbalism. Homeopaths believe that “like cures like” (for example, since an onion causes your eyes to water and nose to run, then it’s a good cure for a cold) and that homeopathic remedies become more potent the more dilute they are. So if you want a really strong medicine, you need to mix it with so much water that not even a molecule of it is left in the treatment elixir. Of course, homeopathy may have a placebo effect among its believers – but there is no scientific mechanism whereby tinctures of water (with or without a molecule of onion or other choice ingredient like arsenic) can have an effect beyond placebo.

David graduated with his B.S. in toxicology from one of the most prestigious schools in the country, the Philadelphia College of Pharmacy and Science (PCP&S). In the early 1900s PCP&S graduates were critical players in combating snake oil hucksters and establishing chemical standards, safety, and efficacy guidelines for therapeutic agents. So it was with utter amazement that he received recent news that PCP&S was planning to award an Honorary Doctorate of Science to a major leader in homeopathy – on Founders’ Day, no less.

“Our founders would be rolling in their graves,” David told me. And he wrote a letter of complaint to the University president which you can read here. This is a choice excerpt:

Awarding Mr. Borneman an Honorary Doctor of Science is an affront to every scientist who has ever earned a degree from the University and, I would suspect, all current faculty members who are engaged in scientific investigation. Homeopathy is a fraudulent representation of pharmacy and the pharmaceutical sciences that continues to exist in the United States due solely to  political, not scientific, reasons. Indeed, homeopathic remedies are defined as drugs in the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 321] Section 201(g)(1) as a result of the 1938 actions of U.S. Senator Royal Copeland (D-NY), a noted homeopath of his time. But scientifically, homeopathic remedies are nothing more than highly-purified water misrepresented as medicine based upon an archaic practice that is diametrically opposed to all pharmacological principles.

Honoring people who actively promote pseudoscience is wrong in many ways as David points out. I would also add that doing so confuses the public. If academic institutions committed to scientific integrity lend their names to cranks, then it makes it more difficult for the average person to distinguish quackery from science. I have the utmost sympathy for the patients out there who are trying to figure out fact from fiction in medicine. That is why I have a “trusted sources” tab on my blog – please click on them for guidance regarding health information you can trust.

As for PCP&S, if they value their academic principles (as no doubt many within the organization do) the president should rescind his offer to honor Mr. Borneman’s “entrepreneurial spirit” on founder’s day (February 19th, 2009). Finding a way to sell water to people as cures for their diseases is certainly entrepreneurial – but I see nothing honorable about it. I hope that President Gerbino sees the light before founder’s day.

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