September 11th, 2011 by Happy Hospitalist in Health Policy, Opinion
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Missed Diagnosis Lawsuit and the Dynamics of Age Related to Risk
Years ago I had the opportunity to care for Mr Smith, a 101 year old man who presented to the hospital with chest pain and shortness of breath. Besides having 101 year old heart and lungs that tend to follow their own biological clock, this man also had a massive chest tumor filling 85% of one side of his thorax.
Whoah really? What does that mean in a 101 year old man? Most folks this age have exceeded the normal bell curve distribution of life and disease. When you reach 101 years old, there isn’t a lot of chronic anything you can catch with the expected time you have left on earth.
Every now and then, however, we find patients who are the exception to the rule, such as the 101 year old guy that present with a new cancer diagnosis. That’s where being an internist comes in handy. Read more »
*This blog post was originally published at The Happy Hospitalist*
August 30th, 2011 by Happy Hospitalist in Opinion
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The total debt cost of medical school has become obnoxious. When I started medical school 15 years ago this month, I took out approximately $2,000 a month in loans. $1,000 a month for all living expenses, including food, rent, utilities and entertainment and $1,000 a month for tuition and related expenses. I got out of medical school with just under $110,000 in loans for which I am currently paying back at a rate of $500 month for 30 years.
I learned the other day that a family medicine resident recently completed medical school with almost $250,000 in medical school loans. Family medicine? $250,000? Are you crazy? If that resident can lock in a 30 year loan at 3.5%, they’re looking at monthly payments of $1,200 a month for the rest of their lives. With current tax rates, this family resident will need to earn at least Read more »
*This blog post was originally published at The Happy Hospitalist*
August 16th, 2011 by Happy Hospitalist in Opinion, Research
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Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study.
That’s the title of the latest medical study making the viral rounds. I had an opportunity to read the study in full. I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours. Now, that’s amazing. Thanks Judy for a job well done. You deserve a raise.
Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.
In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher. These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.
OK fair enough. Let’s come to that conclusion. Let’s say Read more »
*This blog post was originally published at The Happy Hospitalist*
July 27th, 2011 by Happy Hospitalist in Health Policy, Opinion
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A physician asked me a question regarding what should be the role of hospitalists in carrying out discharge orders written by other physicians.
I have been following your blog since I was a resident and recommend it to a lot of people. Thank you so much for enlightening me on so many day to day hospital issues. I wanted to know your opinion about something that puzzles me. When a specialist changes a medication or requires a lab to be done as outpatient after a discharge order is written (for example you write: okay to D/C if okay with cardiology, and they change a dose or request stress test out-pt) who is required to write the new scripts and arrange that test? Is it the hospitalist’s responsibility to do it? Or is the specialist who changed the dose after you rounded required to handle it? It was easier during residency due to abundance of residents/fellows and the fact it was electronic RX access. What are your thoughts? As so far I always return back and make the adjustments needed for the patient welfare, and the fact I don’t know whether I should take stance and request that physician to do their job.
Dear physician, there is nothing puzzling here. It’s black and white. Read more »
*This blog post was originally published at The Happy Hospitalist*
June 25th, 2011 by RyanDuBosar in Health Policy, Research
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Primary care physicians are getting paid more, two surveys agree, while hospital employment is rising.
Internists earned $205,379 in median compensation in 2010, an increase of 4.21% over the previous year, reported the Medical Group Management Association’s (MGMA’s) Physician Compensation and Production Survey: 2011 Report Based on 2010 Data. Family practitioners (without obstetrics) reported median compensation of $189,402. Pediatric/adolescent medicine physicians earned $192,148 in median compensation, an increase of 0.39% since 2009.
Among specialists, anesthesiologists reported decreased compensation, as did gastroenterologists and radiologists. Psychiatrists, dermatologists, neurologists and general surgeons reported an increase in median compensation since 2009.
Regional data reveals primary and specialty physicians in the South reported the highest earnings at $216,170 and $404,000 respectively. Primary and specialty-care physicians in the Eastern section reported the lowest median compensation at $194,409 and $305,575. This year’s report provides data on nearly 60,000 providers.
Recruiting firm Merritt Hawkins reported that general internal medicine was one of its top two most requested searches for the sixth consecutive year. Family physicians were the firm’s most requested type of doctor, followed by internists, hospitalists, psychiatrists, and orthopedic surgeons.
Average compensation for internists Read more »
*This blog post was originally published at ACP Hospitalist*
