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Will The Next Generation Of Physicians Save Healthcare Or Abandon It?

The old joke in medicine goes, ‘don’t get sick on July 1st.’ That’s because it’s the day when new resident physicians, freshly graduated from medical schools across the land, begin their training programs. Although they have spent four years in undergraduate school and four years in medical school, it’s residency where physicians are made from the raw material of knowledge-rich, experience poor high achievers.

However, even in residency physicians are seldom told the entire story of how the practice of medicine, and their lives, will look and feel as their careers evolve and they enter the medical work-force.

Since our profession changes from year to year and administration to administration, it seems a good time to mention some of the things upcoming young physicians will face. Sadly, these are things seldom mentioned by pre-med advisors or academic medical educators.

You see, physicians are struggling. Due to falling reimbursements and the ongoing federal mandate to see non-paying patients on call, it is increasingly difficult for physicians to cover costs like malpractice insurance, licensure, professional memberships and office overhead. (Well, if they want to have a house, family and food, that is.)

Many physicians are Read more »

*This blog post was originally published at edwinleap.com*

The Relationship Between Hospitalists And Primary Care Doctors

The following post is by Jamie Newman, FACP, editorial advisor of ACP Hospitalist:

I read the April 6 Annals of Internal Medicine with great interest. In it, many readers responded to Howard Beckman’s previously published essay on the relationship between hospitalists and primary care physicians. Many physicians bemoan their loss of inpatient control of patients, and perceived lack of communication.

I think back to my own private/university hybrid practice. When my patients were admitted to the resident services, I never heard a word. There was absolutely no communication. I would say that most hospitalists do a much better job of communicating with the outpatient physician then any resident team. It’s a double standard. Read more »

*This blog post was originally published at ACP Internist*

ABC’s Private Practice Takes On Teen Pregnancy

Last night, ABC’s Private Practice took on the very challenging issue of teenage pregnancy in a story arc that began with last week’s show when 15 year old Maya announced to Addison that she was pregnant. The show well depicts the shock, the emotion and the difficulty of handling the pro-choice/pro-life discussion when a teenager is at the center of the discussion.  It was a raw episode at times and in the end we are left with a 15 year old opting to keep her pregnancy.  It’s tempting to criticize the writers for not focusing enough on Maya but, in truth, the show was more realistic than you may realize.

In the episode, Maya’s mom, Naomi, basically freaks out from the start. This pro-life mom first storms out of the room then tries to force an abortion onto her daughter. When that doesn’t work, she shows Maya a woman in labor only to have Maya entranced by the sight of a baby and determined to keep the pregnancy even more. The show concludes with Naomi leaving the building not talking to anyone, in tears. True to life? You bet. Read more »

*This blog post was originally published at Dr. Gwenn Is In*

Quality-Based Medicare Payments: Will They Kill Private Practice?

It’s the holy grail of physician payment reform: ending fee-for-service payments to doctors and, instead, pay doctors based on the quality of care they perform. Remarkably, Congress feels they’ve found the answer:

Thus, the new language in the Senate Finance bill would finally connect Medicare reimbursements to quality, as opposed to volume.

The measure gives the secretary of Health and Human Services, working with the Centers for Medicare and Medicaid Services, the power to develop quality measurements and a payment structure that would be based on quality of care relative to the cost of care. The secretary would have to account for variables that include geographic variations, demographic characteristics of a region, and the baseline health status of a given provider’s Medicare beneficiaries.

The secretary would also be required to account for special conditions of providers in rural and underserved communities.

Additionally, the quality assessments would be done on a group-practice level, as opposed to a statewide level. Thus, the amendment would reward physicians who deliver quality health care even if they are in a relatively low quality region.

The secretary of Health and Human Services would begin to implement the new payment structure in 2015. By 2017, all physician payments would need to be based on quality.

Wow. That sounds great! But there’s just one problem…

… how do we define “quality?”
Read more »

*This blog post was originally published at Dr. Wes*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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