News Updates for a Changing Profession

Check out these two interesting medical news blurbs on nytimes.com:

Harvard Neurosurgeon Awarded $1.6 Million in Harassment Suit

A jury awarded $1.6 million to a female neurosurgeon at Boston's Brigham and Women's Hospital after determining she had been exposed to a hostile work environment and been the subject of retaliation after she complained. The Boston Globe says Dr. Sagun Tuli sued the hospital and her boss, Dr. Arthur Day, chairman of neurosurgery. Dr. Tuli, 39, an assistant professor at Harvard Medical School, testified that Dr. Day repeatedly made demeaning statements to her while she was operating, once telling her, "You are just a girl. Are you sure you can do that?" On another occasion, during a dinner, asking her to get "up on the table and dance for us."

Medical Device Maker to Report Doctor Payments Online

The medical device maker Medtronic will start publicly disclosing its payments to doctors online, reporting anyone who receives payments of $5,000 or more a year in consulting and other fees, The Wall Street Journal health blog reports. The action comes as some United States senators push for what they're calling a "physician payment sunshine act" that would require all companies to disclose their financial arrangements with doctors. Medtronic has been accused of paying kickback to physicians who use its products.

--I think the lessons here are this: the future of medicine has no room for the macho crap and that you'd better be careful with your relationships with device makers and big pharma.

Cuomo, Fighting for Docs

New York Attorney General Andrew Cuomo has made fighting health insurance companies his forte. Check out the article HERE. A third industry giant Wellpoint, has voluntarily come forward to reform their payment practices. This followed Aetna and Cigna; both companies paid fines and hired third parties to rebuild their out-of-network payment database. Cuomo has now established for himself a legacy of fighting insurers' outdated and unethical payment schemes as well as other abuses in the health care industry.

It is about time that someone start policing these companies. For years health care spending in this country has skyrocketed, physician pay has remained fairly stagnant, and the financial burden of health care on the average person has increased dramatically (even serving as a leading reason for bankruptcy.) Yet somehow, the insurers are sucking up enormous profits. This industry has been given a free ride for a long time. Especially with the attempt at medicare privatization, when the federal government wasted tax dollars in trying to alleviate the medicare beauracracy. It has been revealed in various reports that these privatization plans lead to higher patient cost burden. That is not, I assume, what was intended.

I am glad to see that Cuomo has begun fighting insurers. Profiting off our health care system is a privelege that they have, and that privelege must be retained through responsible behavior in the marketplace.

Thank You Mr. Attorney General.

Med School - No Longer a Social Ladder?

It seems apparent that in the United States the increasing costs, debt burden, and the economic crisis has limited the number of poor and lower-income families to send their kids to medical school. This is not an isolated American problem, as pointed out in this article the British system is experience the same limitations on social mobility through medical education. However, I must point out that their average debt is approximately only $53,ooo as opposed to the U.S. which is around $140,000!

When the economy gets its feet back on the ground, we need to really push for more grants, tuition caps and other strategies to rein in the costs. We also must press the government to return the interest deferment during the first 3 years of residency.

This country used thrive off of opportunities provided with hard work, diligence, and a good professional education. If medical school becomes an educational luxury of the upper middle class and rich only, then this country will lose a large -and hard earned- reputation of having an economic ladder and opportunity for all.

Entrepreneurs: the missing link in the training of medical scientists

I found this great article from the journal Nature. It talks about how academia, particularly in medicine tries to shield young, impressionable students from the private sector. The idea for this makes sense from a superficial observation. I mean, if all of my fellow students took notes with Viagra pens I would be worried about the future! But, honestly I think we have to approach this issue with more pragmatism. The greatness of medicine in this country has come when the research world and academia bridged itself to private industry, in a harmonious way. The article says,

"the major reason universities are reluctant to engage the private sector stems from a deep-seated feeling that their students represent a particularly vulnerable population, and must be protected from corrupting industry influences."

If students were taught more explicitly how to embrace the entrepreneurial spirit and to translate their knowledge into the private sector - then their more pure aspirations of helping people are much more likely to come to fruition. I think essentially it must be a safe but encouraging balance between medical scientists in training and the private sector. Under the proper supervision and armed with a healthy reality of how business works, we can bridge the gap.

The FDA's Culture of Fear

In an article by the Wall Street Journal titled "FDA Scientists Ask Obama to Restructure Drug Agency" , they discuss a letter written by several FDA scientists to Obama's transition team. The letter explicitly tells of fishy business going on within the agency including a culture of fear among the honest employees. The "corrupt" agency employees have created an uncomfortable environment for those without their hands in the industry's pocket. It seems obvious that a regulatory group of an extremely profitable industry would have corrupt infiltrates, but to have such an openly sensed fear from those scientists who are truly trying to objectively analyze the data on drugs, devices, and other treatments, is a devastating reality.

Can we not find a balance between the profit incentives for innovation and public safety? The pharmaceutical industry as well as the device industry surely have developed some incredible, life saving and quality of life-improving things. At the same time that we embrace this and appreciate it, we must remember that regulation should do just as its name describes, regulate. Obama and Daschle need to work very hard to make sure the FDA remains as uninfluenced and corrupt-free as possible in order to maintain a scientifically objective regulatory body for the industry. This could mean reorganizing and self regulation improvements.

In return for record profits, all we ask is that the data these companies provide as proof for their product's success be scrutinized to the fullest extent- without worry that industry profiteers are letting them slide through unscathed.

Healthcare's Biggest Issue: What to do with Primary Care?

There is agreement among most healthcare officials and experts that the most important and challenging issue facing the future of the industry is the disintegration of primary care. The field has become underpaid, overworked, and has had some serious issues with recruiting its own next generation; the latter partly due to the former. Aside from the lack of medical students pursuing primary care, our current batch are bailing out of the field or opening boutique/alternative practices to keep the bills paid. It has become cliche to talk about "once the baby boomers start getting sick, forget it," but I personally repeat this to everyone I speak to about healthcare.

In the first days of of my first year of medical school I remember the professors taking a poll of who wanted to enter what specialty. Literally, I saw two hands go up for primary/family medicine and surely my school is not alone in these kinds of figures. I don't blame students for having the desire to earn more and its not just that, what we as students hear of primary care makes us cringe. Of course we want to help people (at least most of us) but who wants to spend half of their career on the phone dealing with managed care or insurance companies. We want to spend our time taking care of people, doing what we will be trained to do, and deal with less beauracracy. My point is this, we have a huge problem, and the problem lies within the system not within the physicians or students.

The discussion and debate rages on. Obviously politics and elections plays a big role, but aside from Obama's election and its affect on these issues there have been pushes from all sides to reform if nothing else how we deal with primary care. There needs to be incentive to go into the field and there needs to be reimbursement changes. Lots of good ideas are proposed, and again there needs to be a compromise as a change in payments has affects across the professional board. This is evident by the recent uprising of specialists toward the Baucus healthcare reform legislation. The specialists are insiting that this reform unfairly cuts their salaries to pay primary care doctors more. Surely this is a valid argument, any profession would be against legislation that literally cuts their salary the moment it is signed. So we need to do this carefully, patiently yet swiftly, and we need to compromise. But above all something needs to be done or the backbone of the system will start crumbling, or rather imploding.

Check out the NEJM debate on this issue HERE.

Pay-For-Performance, Setting Patients up for Higher Bills?

The letters to the editor, in response to the Times article I wrote about previously, viciously point out the inherent problems with a PFP reimbursement approach. You can read some of them HERE. A good point: "If hospitals are forced to provide free corrective treatment to victim patients, those costs will become part of hospital overhead, which we will all pay for anyway." Is that all that PFP does, skips the bill so that both providers and patients are left with the difference?

Another question we have to ask when debating PFP is whether this system demands no errors in an industry that cannot exist without some errors. Although we would love to avoid every preventable accident in medicine, it may be dangerous to punish an industry that relies on risk/benefit ratios, experimental treatments, and other efforts to treat diesease. From one of the letters:

"It is important to understand the context in which medical events like catheter-related urinary tract infections and pressure ulcers occur in hospitalized patients.

These patients have multiple chronic medical problems and are often immobile and institutionalized, having lost the ability to care for themselves because of diseases like Alzheimer’s or severe stroke. Others are in intensive care units suffering from multisystem organ failure and on the verge of death.

Therefore the analogy to use should not be one of an auto mechanic accidentally breaking the windshield while repairing the engine. Rather, it should be of the mechanic who is required to perfectly repair a vehicle that arrived at the shop totaled."