Friday, December 31, 2010

Complementary/Alternative Medicine in the Family

I generally spend the week between Christmas and New Year's catching up with many of my old friends from home - it's one of the few times when we're all in Toronto (where I'm from). Yesterday, as I was catching up with 2 old friends, several topics of conversation led me to ponder more deeply about the relationship between family medicine and complementary/alternative medicine (CAM).

One friend told me that he was thinking about applying to a Doctorate program in Traditional Chinese Medicine (TCM). As he shared more about it, I realized the irony of myself, an ethnic Chinese and incidentally an allopathic medical student, being told about TCM by a Caucasian and traditional Chinese medicine student-hopeful.

Later, my other friend shared her ongoing struggle with depression and her attempts to explore CAM. In her ongoing relationship with her family doctor, she had repeatedly discussed CAM potential treatments only to have them ignored by her doctor.

Personally, I have often found a range of physician attitudes from disengagement to active hostility towards complementary-alternative treatment modalities. What brings this attitude?

Is it lack of knowledge leading to this attitude whether hostile or dismissive?
Is it because there lacks evidence in many cases regarding the efficacy of CAM?
Or is part of it from racist and superior attitudes (whether consciously recognized or not) that Western, white medicine must necessarily be better than anything that could come from other cultures, whether Chinese, Ayurvedic or others?

From my perspective, family medicine, based on its comprehensive and holistic approach to the body, seems ideally matched to act as a partner to complementary-alternative medicine. CAM can particularly be important to offer to patients in areas where western allopathic medicine is limited. This areas often include pain management, psychiatric illnesses, quality of life management and others. If family physicians are to effectively create patient-centered medical homes, they must be educated about and open to complementary-alternative medicine since many of their patients may be using them. An open dialogue must happen between patients and their personal physicians - this starts with
(a) physicians being open to dialogue and actively asking questions about CAM, and
(b) being educated enough about CAM to engage in an effective dialogue.

There are a few problems with complementary-alternative medicine before it can be an effective partner with family medicine:
1) Evidence-based practices: much of CAM remains word-of-mouth and "expert opinion-based." If CAM is to become a credible partner and treatment, it must produce credible clinical studies for physicians to embrace it.
2) Regulation: CAM for the large part is unregulated and practitioners can vary in terms of the amount of training they receive. To receive more credibility and standardization of practices, CAM practitioners must become regulated.

As we work towards these goals, both from the CAM and physician side, it will provide better patient management and ultimately work towards caring for each and every individual in the ideal, multi-faceted manner. Happy New Year!

Tuesday, December 21, 2010

'Family Medicine is a Waste of Your Talent'

There are many things medical students interested in family medicine hear from other students, residents, and attending physicians when bringing up their desire to go into the specialty.

Here are some things I have heard recently
"Family Medicine is a Back-Up Plan"
"Sub-specialize until you can't specialize anymore"
"The IOM sold out on primary care & now want ARNPs to pick up the slack"
"Aww family medicine? That's so nice of you."
"You're Too Smart For Family Medicine"
"The ship may have already sailed on primary care"
First, I will start out by saying that every time I hear this or read it, I get an acidic taste in my mouth, probably signifying vomit encroaching on my pharynx (5-yard penalty on the vomit).

When I look back on reasons for going into family medicine, I would consider myself a student who was "on the fence" about the specialty. In its current state, going into primary care is a decision that my financial planner would probably strangle me over.
The primary care loan forgiveness programs provide financial relief over several years that could be made up over 1/2 to 1 year in most specialties. Nursing leaders are advocating that they can provide the same care just as good as I will while lobbying for equivalence in pay but deny they are trying to replace primary care physicians. Then there is the SGR, the RUC, hospital network/ACO-wannabes taking over private practice....
I initially wanted to go into orthopaedics - not because I wanted to hit the "ROAD" (though it must be nice), but because of my love for sports and desire to have a niche in something. It was not until my first time rotating with a family medicine physician with a CAQ in sports medicine that I realized it was possible to help athletes and non-athletes with musculoskeletal issues, not go through an ortho residency that could potentially ruin my marriage, and continue to see patients without sports medicine issues as a primary care physician.

After $280,000 of student loan debt it may seem crazy but with these past 4 years of medical school with a graduate degree thrown in-between an undergraduate degree, I feel like specializing would only hurt the non-financial gains I have made in my education. I have learned so much about pathology, disease-processes, prevention and clinical practice, that specializing would only end up wasting all of the talent I have accumulating along the way. Family medicine allows me to continue to provide healthcare to everybody - newborns, children, women regardless of hCG status... what we usually refer to as "womb-to-tomb" or "all stages and all ages".

It also allows me to "specialize" in any area at any point no matter where I am in my career. The CAQ in sports medicine is going to be a given in my case - but if one day I decide that I want to be more proficient in cardiac health, I do not need to take a pay cut to do a fellowship in cardiology to focus my attention on that area. If I want to have a niche in diabetes management, I do not need to do a fellowship in endocrinology. And even though those with fellowships are getting paid more to provide these services (note: current tense), this flexibility will keep me from burning out, maintain my interest and desire to further my education as a life-long student, and keep me from losing the huge investment I made which I will be reminded about each month as I make my student loan payments.

Family Medicine - Make the Most of Your Talent, Make the Most of Your Investment - It Is Impossible To Be Too Smart For Family Medicine

Monday, December 13, 2010

What Is Family Medicine?

Going into medicine from a suburban community in the northeast, I never really knew exactly what family medicine was as a specialty. I had heard of it before, but did not see it in action until going to undergraduate school in the middle of Pennsylvania. It was there when I began to understand that family physicians could do a little bit of everything...

But what really is family medicine? I needed an exact definition... as one to memorize for an exam.

Before medical school began, I went to Honduras with a group of family physicians and general internists. It was there where we delivered 2 babies, sutured small wounds, treated rare infectious diseases, helped children in an orphanage, and provided acute and chronic care to people of all ages and stages. This is not something I experienced in my suburban community in the northeast. Family physicians providing comprehensive care in obstetrics, treating obscure infectious disease, all while taking care of pediatric and geriatric patients? What IS this specialty??

I searched for the truth early on in medical school - a difficult task considering I go to a school in a large city in the northeast. It was here where I learned that family medicine physicians were very undervalued, overlooked, overworked, and underfunded. Although competent in all areas, family physicians mostly taught public and community health, physical exam skills, and patient communication skills... interesting since family physicians also provided care in all of the other subject areas during the first two years of medical school, but did not give lectures in any of the core content areas. (sidebar - I would argue that the entire family medicine faculty had better presentation and communication skills than several of the proceduralists that lectured us.)

Later on during my clinical years, I traveled to family medicine conferences, networking with a variety of family physicians throughout the country. I have also spent time on a number of clinical rotations in family medicine away from the big cities, traveling to the subrural community 45 minutes away as well as venturing to the south for an away elective. It is amazing how different family physicians practice depending on the location and proximity to specialist-driven care.

One of my future colleagues, a family physician in the rural midwest, practices in a small community located more than an hour away from most of the specialists located in an academic center within a small city. He does full-scope family medicine, providing full scope care in obstetrics, performs C-Sections, colposcopy and gynecological care, performs colonoscopy, ultrasound, helps in the emergency department, rounds on patients in the hospital/taking call, takes house calls, and by the way, sees patients in the typical northeast fashion - outpatient practice. He does all of this mainly because it is too much of a hassle for the patients and specialists to get together at the specialty-driven academic center located over an hour away. Is this family medicine?

My conclusion is that you cannot really define family medicine.

Another family medicine colleague said that you, as the family physician, are defined by the needs of your patients.

Furthermore, we are defined by the number of specialists required to refer to in order to practice proper defensive medicine when involved in a malpractice case when asked
"'x' specialist was located in close proximity as an 'expert' for 'y' condition. Why did you choose to follow evidence-based medicine instead of referring your patient to 'x' specialist to follow the same evidence-based medicine?"
When it comes down to it, a family physician can do whatever they want to do, as long as they are flexible in their location for practice and are providing services that others are not willing to practice within that given area. The most important thing to remember is knowing when to refer to that academic center - inconveniently located in an area that already has at least 2 other of its kind within walking distance.

Friday, December 3, 2010

Access to care following health care reform: Lessons from Massachusetts

In March of this year, President Obama signed into law the Affordable Care Act. In 2006, Massachusetts enacted state health reform that included some similar elements to decrease the number of uninsured in the state including increased coverage and the individual mandate.

We are now 4 years status-post the passage of the health care legislation in MA. What lessons can we learn for the national health care reform from Massachusetts?

430,000 uninsured Massachusetts residents have now been granted insurance since 2007 when the law came into effect. However, access to primary care remains a huge problem in Massachusetts especially in the more rural areas of Western Massachusetts. Data published by the Massachusetts Medical Society in October show that 54% of Family Physicians and 49% of General Internists in the state are not accepting new patients. The average wait time for an appointment with a new primary care provider is 44 days.

Anecdotally, as a medical student in Massachusetts, I have witnessed the family medicine clinic attached to the main teaching hospital (incidentally, where my personal PCP is) cut evening and weekend hours due to a shortage of physicians. Earlier this year when I called to make an appointment for an acute problem, I was offered a visit in 2 weeks. [Side note: I grew up in Canada and, when I was sick, I frequently called at 9 am when my family doctor's office opened to receive an appointment later that same morning. ]

I emailed my physician instead... but, how many people in the same situation, would go to the Emergency Room?

In Massachusetts, we have witnessed an increase in emergency room and urgent care utilization following the passage of health care reform. This not only increases costs but also undermines doctor-patient continuity and fragments care. This situation is even more acute in the rest of the nation. Massachusetts has the 3rd highest PCP to population ratio with 107.8 PCPs per 100,000 vs. an average of 79.4 per 100,000.

So, what can we do?

Can we rely on IMG grads to provide where US grads will not? How can we collaborate with other medical staff like nurses, MAs, and PAs, to increase efficiency and provide better care to more? Are PCMHs or ACOs the answer? We are increasing PCP payment and increasing PCP and underserved residency slots but is this enough and is it timely (given that it takes almost a decade to train a physician)? These are all questions we need to answer if national health care reform is to be effective...

Thursday, December 2, 2010

Incorporating PCMH/Patient-Centered Medical Education During Non-Clinical Years

Medical education, although increasing in price, is evolving to meet the demands of the Patient Protection and Affordable Care Act. The model most frequently referenced in the law to effectively carry out this legislation is a concept known as the Patient-Centered Medical Home - a model that is not a new concept. The PCMH was introduced by the American Academy of Pediatrics in 1967 and eventually reinvigorated in the past decade by the AAP, the American Academy of Family Physicians through TransforMED, and the American College of Physician as the Advanced Medical Home model. What does this mean for medical students?

Is this possible? Don't we already have enough to learn about during medical school?

The Pennsylvania State University College of Medicine at Hershey received a $1.46 million grant to incorporate PCMH training during the 3rd year of medical school. Other schools receiving grants to incorporate PCMH into clinical education include Tulane and Alpert Medical School of Brown University. When reading the details of these grants, it seems like they are going to implement a majority of PCMH training into the last 2 years of medical school.

Enter EVMS. They also received a grant, though their vision seems a bit different. The grant of $2.1 million over 5 years is intended to develop a project called Predoctoral Education for Advancing Community Health (PEACH). They plan to "create a simulated community-health center where medical students will learn how to manage complicated cases effectively within a busy practice."
The goal is to teach not just primary-care medicine, but to teach primary-care practice systems that are necessary to achieve success for the patients. Every week they're going to be going to their simulated medical office and taking care of patients as if they were interns in a family-medicine residency.

It's getting them ready for 21st-century primary care. If they go into primary care, they'll be better prepared. If they go into a specialty, they'll be better prepared to interact with the primary-care physicians that are in their community
A curriculum that allows for longitudinal training while incorporating the use of the PCMH seems like a no-brainer. Having a panel of patients of all ages, male and female, with a wide variety of biopsychosocial issues to "take care of" and coordinate care for during non-clinical years would really bring the basic science foundations learned concurrently to life. Providing clinical relevance is something that most medical students enjoy during the non-clinical years.

Imagine sitting in lecture during your first year of medical school and receiving an email from one of your "patients" from your longitudinal panel of patients asking for your opinion on an acute or chronic condition. Should they go to the hospital or see you at their "medical home" that is conveniently open after they are finished with work. Between lecture, you log onto your medical home's EMR and access your patient's information to figure out what should be done and promptly email them back to see you in the office. Later that day, a standardized patient is waiting for you at the clinical skills center to discuss their current issue. You are unsure about a few things during that patient encounter, so you "tweet" a question to your professors and classmates that follow you on your professional Twitter account. Later that evening, you also receive a video with commentary by faculty about your encounter....

Imagine setting up a video-chat with other students in nursing, physician assistant, nutrition, behavioral health, and future social workers that are part of your medical home to discuss your patient panel's coordination of care.

Suppose one of your patients were to have a procedure or surgery - the student would go to their school's simulation center to learn how to "drive the camera" and use other laparascopic tools as well as learn how to suture. Maybe one of your patients are in labor? - Back to the simulation center for a simulated birth. You then see the standardized patient for follow-up care with their "simulated newborn" to learn the newborn well-child exam.

The possibilities of revolutionizing medical education are endless. By learning how to use the PCMH concept with simulation centers, standardized patients, EMR, social media, and coordinating with other future members of our medical homes, we will develop the communication and coordination of care necessary to breed quality physicians. This does not only help our future primary care physicians, but also those who specialize, so that they understand the amount of communication and coordination they will also need to have with their primary care counterparts to improve the care of our patients.

Monday, November 22, 2010

Newsflash: Medical Students Assist in Medical Care at Teaching Facilities

About a week and a half ago, The Dallas Morning News published an unfortunate case of medical mismanagement, mainly dealing with a lack of oversight from attending physicians over residents and medical students.
"Even students – who have yet to graduate from medical school – provide key care, sometimes without direct supervision....
...(the) surgical consent form had warned that (the patient) could face 'blood vessel or nerve injury' complications. It also noted that students might be involved in (their) 'surgery and surgical care'."

They also released a spin-off article stating that ethicists generally feel that patients around the country are not made aware of medical student involvement in their care.
Many hospital patients don't know who's caring for them at any given moment, said Dr. Lisa Soleymani Lehmann, a Harvard Medical School assistant professor who runs the Center for Bioethics at Brigham and Women's Hospital. Many don't distinguish between residents, who are degreed doctors getting paid, on-the-job training, and students, who are unlicensed and still in medical school.

"There's a tremendous amount of confusion," Lehmann said.

She has surveyed about 200 Boston-area patients who underwent operations in which students participated. Half of the patients didn't even realize that medical students had been in the operating room, she said.

Lehmann said many hospitals' consent forms have improved in recent years and now tell patients that medical students will be "involved" in their care. But patients "don't know what that means," and many don't even read the forms, she added.
Over the past week and a half, I have had an internal struggle about what to write about this event. The specifics of this case are quite tragic and should never happen anywhere. At first I was rather annoyed that the author of the original article happened to release the spin-off right away while generalizing all medical students and implying a general lack of communication around the country. Could the author use such an unfortunate case as a stepping block to create generalized anxiety throughout the nation?

As previously mentioned in my burnout blog post, our medical education is already compromised by a feeling of uneasiness from our attending physicians with their practice of defensive medicine. If we place further restriction on our medical training because of a select number of medical mismanagement cases, will we continue our travel down the slippery slope and overall loss of educational opportunities? Will intern year be the new 3rd and 4th year of medical school? (not to mention the possibility of increasing the number of years of residency!?)

Take a look at AMA Opinion 8.087 - Medical Student Involvement in Patient Care. It basically states that medical students need to be identified and patients need to be disclosed as to how the students will be involved in their care, whether it is in the community health center taking an H&P or simply "driving the camera" in surgery.

After taking some time to settle down and think about my own medical training experiences, I have realized that there are definitely ways to improve communication with all members of the team towards patients.

From attending physicians to medical students, it is quite helpful to know the extent of our involvement, especially in surgery. This is not an easy task, as some attending physicians may provide student opportunities during procedures on the fly at their own discretion. Again, this is a difficult task as there is always a first time for doing something and assessing ability is impossible unless the task actually occurs in real-time.

When is it appropriate to drill a pin into a broken bone? How do we know when a student is ready to suture? Are students more prepared to advance their skills on the last rotation of 4th year or as a resident during the first week of internship?

From attending physicians, residents, and medical students, we all need to communicate better towards patients in regards to our role in patient care. Consent forms that are vague and do not provide specific detail are not adequate for patient satisfaction or overall patient safety. We need to identify ourselves to our patients and not just disclose the side effects of medication or the risk of infection and bleeding, but each of our roles in providing safe and effective care.

Monday, November 15, 2010

The correlation between research and policy: not statistically significant

For years, research has shown us that more primary care physicians per capita leads to better population health outcomes. As a corollary, more subspecialists in a given geographic area leads to poorer health outcomes. A perfunctory look at specialty choice by medical students shows that decreasing numbers of students are choosing primary care.

Likewise, research shows that team based, patient-centered care creates better health outcomes and potentially higher patient satisfaction. We also know that this approach can decrease ER visits and ultimately decrease costs.

Then, why haven't we enacted policies and laws to support these and many other findings? Reporting live from the North American Primary Care Research Group Conference (NAPCRG) this week, I have attended seminars and seen posters with outstanding research in chronic disease management, health delivery/services, medical education, you name it. Early yesterday afternoon, I was in the paper session for Health Care Delivery/Health Services Research and it was standing room only. One of the co-authors to a paper couldn't even get into the room because it was so full. Then, I attended a workshop on "Advocacy Skills for the Primary Care Researcher." 10 people in attendance (not counting the 5 workshop leaders and 3 organization staff members in the room).

This disconnect is the fundamental problem with why our research doesn't translate into policy. Researchers do research; the majority never set foot in a legislator's office, don't understand and shun politics, and focus on the statistics. On the other hand, legislators generally don't make evidence-based decisions; most legislators don't understand what a p-value is (forget picking up "Health Affairs" or "NEJM"). They base their decisions on what their constituents want, personal stories, interest groups and media reports.

In my Community and Consumer Organizing class at Harvard School of Public Health, we learned about Kingdon's Open Window Model for change. People generally sit in 1 of 3 streams:
  1. Problem Stream: identifying and validating problems through research
  2. Policy Stream: identifying and narrowing down solutions to short list of technically feasible policies
  3. Political Stream: enacting laws during favorable political climate for solutions
In this model, those who are able to get things done are those who sit at the borders of the streams and can align the streams to create an open window of opportunity.

So, how can we get our researchers more interested in advocacy and politics? How can get legislators excited about the policy implications of research? Addressing these issues and creating more translational research will be fundamental as we pursue reform in primary care, in chronic disease management, in health systems... as we pursue a healthier and better America.

Sunday, November 14, 2010

Advocates of Independent Nurse Practitioner Practice Losing Focus Within Current Scope of Practice

One of the hot topics occurring in the health care debate deals with figuring out appropriate leaders of the Patient Centered Medical Home (PCMH). With the recent report by the IOM advocating for independent practice by nurse practitioners, many physician groups, including the AAFP and AMA, have come forth with strong statements advocating against the IOM report and independent practice by CRNPs.

A recent editorial by the AAFP, titled "Nurse Practitioners Are Team Members, Not Leaders, in the PCMH" points out some very disturbing numbers and trends. It begins by pointing out that the IOM and nursing organizations are correct in their analysis that there is a primary care physician shortage and that the role of CRNPs and the medical team could be increased to help with this shortage. However, it provides numbers produced by the American Association of Colleges of Nursing (AACN) that the IOM, CRNP advocates, and the media fail to mention when talking about the expansion of the current scope of practice and independent practice:
"the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025...U.S. nursing schools turned away 54,991 qualified applicants from baccalaureate and graduate nursing programs in 2009 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. In addition, almost two-thirds of nursing schools say faculty shortages are the reason they cannot accept more entrants into their programs."
When thinking about faculty shortages as a medical student, we look to attending physicians as our faculty to help us along our pathway in becoming physicians. In turn, nursing students look towards nursing leaders to help in their training to ultimately become nurses at all levels of nursing education. What better nursing leaders to help in this shortage than CRNPs? Better yet, the Doctor of Nursing Practice (DNP) was originally developed for nurses to have a PhD for academic and faculty purposes to educate future nurses. Are DNPs solely practicing academic nursing as faculty to the extent at which this degree was originally developed?

Why focus so much effort on increasing scope of practice when there are such deficiencies within the current scope of practice? One of the issues that a CRNP or DNP faces by going into academic nursing is a pay decrease and that may keep potential academic nurses away from becoming faculty. I hope that is not the case, especially when encountering all of the physicians that are faculty at academic medical centers that take large decreases in salary to remain in academic medicine instead of private practice.

Let me offer a different and possibly refreshing argument against the independent practice of CRNPs which goes against the usual argument pointing out disparities in education and standardized training/certification.

Medical students, nursing students, physician assistants, physicians, nurses... the entire medical team can agree that patient care comes first. A lot of focus goes into resident working hours and sleep deprivation but what about the bedside nurses that take on extra shifts and patients all the time because there are not enough nurses for coverage?

Expanding the scope of practice for nursing without addressing the current shortage of nurses within the current scope of practice will only spread the nursing workforce even thinner - and in my opinion, will only compromise patient care further than it already does. Increasing advocacy efforts for independent practice and encouraging current nurses to pursue higher education to provide outpatient primary care in the PCMH without increasing the amount of resources and faculty to contribute to a larger nursing workforce will lead to adverse unintended consequences.

Monday, November 8, 2010

Medical Student Burnout and Unprofessional Conduct

Recently, AAFP News Now released an article titled
Unprofessional Conduct Among U.S. Medical Students Linked to Burnout
It focused on an article recently released in JAMA entitled
Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students

I had the opportunity to be interviewed for this article and was featured on an inset within the article that shared a minority of my interview. As I am currently rotating on inpatient medicine at a local community hospital, I am once again experiencing our health care system at its finest - a lot of wasteful spending and unnecessary testing. I am taking a look back at what I had wrote down for the interview and decided to paraphrase the majority of my response into the following blog post regarding the health care system and medical education.

When looking at the advances we have made in biochemistry, genetics, and molecular biology, we are being asked to know so much more information in much greater detail – and still within these 4 years worth of medical school.As more requirements are created and more scientific advances are brought forth, more time is needed in lecture and studying for tests like the USMLE and shelf exams. Most traditional programs are 4 years with 2 years of foundational science and 2 years of
clinical experience.

For one, I believe that medical school admissions do not do a good job
at identifying candidates that will provide an adequate workforce and/or will be good for medicine. It must be extremely difficult to screen applicants to figure out who is genuine about the profession – who is going into medicine because they truly want to go into medicine... on the other hand, who is going into medicine because they test well, and/or because their parents forced them into it throughout childhood. This is definitely a minority of students but nevertheless, takes away seats from other potential medical students who may choose to serve a better purpose and population within our health care system's needs.

Maybe we are not bringing enough students into medicine that come from
underserved areas; maybe we are not screening correctly in the
admissions process to accept students who display genuine altruistic views
and who do not fabricate an artificial personality in an interview
and/or on a personal statement. The 40 MCAT, 3.9 pre-med GPA and 5
publications may look good on paper but may fail miserably at
developing into an altruistic and compassionate physician.

It would be interesting to figure out specific determinants that make
students less altruistic and less likely to serve the medically
underserved. As medical students, we are molded by the experiences we
are faced with during clinical rotations. Were these students who had more
contact with patients who manipulate the health care system for
primary or secondary gain? In most cases, our attitude in respect to
patient populations trickles down from our attending physicians,
residents and interns.

With defensive medicine taking precedence in many situations, medical students take notice of the frustrations felt by our superior members of the team. Are these attitudes more likely to occur in underserved areas? If so, medical students are not only discouraged, but definitely overwhelmed at the amount of follow-up
required of the large volume of unnecessary testing that occurs. We spend so much time trying to cover our back that the amount of quality learning that actually occurs is dramatically reduced.

If we took just half the amount of time we waste on defensive medicine
and documentation and shifted that towards more time for teaching
rounds and instructional time by attending physicians and residents, I
believe medical students would feel more satisfaction with their
education and clinical experiences. As it is, medical students spend
most of their time trying to help the interns and residents with
non-educational work (what we refer to as “scut work”) so that we may
eventually have time at some point for educational purposes.

Additionally, because there is so much more hand-holding by attending
physicians towards the residents and all the way down to the medical
students, it is difficult for medical students to convince themselves
that they are actually contributing to the care of patients. Taking
all of this together, it does not surprise me that studies are showing
that medical students are burning out, documenting non-factual
clinical findings, lacking altruism and altogether becoming
unprofessional throughout the process.

The medical community as a whole needs a “face-lift” in regards to everybody’s attitude towards health care delivery. I do not think this will be possible until the health care system undergoes a much more meaningful reform to address the issues that attending physicians, residents, and medical students face due to the current clinical environment. The current political environment is not going to alleviate any of these issues because nobody is willing to commit to long-term changes in health care delivery and tort law.

Without meaningful tort reform, proper emphasis and payment for primary care, and population education about meaningful health care reform and personal responsibility, we will not peel through the layers and fix any of the intended and unintended consequences that have accumulated throughout years of failed policy and legislation.

Wednesday, November 3, 2010

Understanding the impact of 2010 mid-term elections

Yesterday during the mid-term elections, the Republicans gained the majority in the House of Representatives and increased representation in the Senate (where they are still in the minority). As the Obama Administration spent ~1.5 yrs of the past 2 yrs implementing health care reform, the Affordable Care Act is (ACA) sure to be targeted. Here are some of the ways family medicine and health care reform may be affected:

One of the campaign promises that Republicans ran on was repealing health care reform, i.e. the Affordable Care Act. The full repeal of the ACA is unlikely since:
(a) any legislation that is introduced and passed in the House by a Republican majority would not pass the Senate and even if it did would be vetoed by the President.
(b) many Republicans were supported financially during the campaign and continue to be supported by special interest groups such as insurers and pharmaceutical companies who stand to benefit from the ACA since there will be increased numbers of individuals insured under ACA

Likely actions to affect the bill:
  • repeal of individual sections of bill that are unpopular with Republicans, moderate Democrats, independents
  • attempts to block funding for new programs and provisions of the ACA
  • attempts to delay implementation of parts of ACA

Other actions that may occur with the new House are:
  • attempt to pass comprehensive tort reform legislation (as promised during campaigning)
  • subpoenaing Don Berwick of CMS and Kathleen Sebelius, HHS Secretary to testify about health care reform process
  • implementing budget cuts to primary care research such as Title VII, NIH and AHRQ funding (Republicans have pledged to cut $100 billion from discretionary spending)

Many of my projections are informed by discussion in my Community Organizing Health Policy class at HSPH; my discussion with Bob Blendon, a health policy analyst; and a memo to members of the Academic Family Medicine Advocacy Committee (AFMAC).

What do other people think? Thoughts or predictions?

Impact of 2010 Elections on Health Care Reform

Check out this webcast on Friday, November 5 from 1:30-2:30 pm EST as three experts discuss the impact that this week's elections will have on health care reform.

Discussing will be:
  • Douglas Holtz-Eakin, President of American Action Forum and former Director of Domestic and Economic Policy for the John McCain Presidential Campaign
  • David Cutler, Harvard Professor of Applied Economics and former Senior Health Advisor to Obama's presidential campaign
  • Bob Blendon, Professor of Health Policy and Political Analysis at Harvard School of Public Health and Executive Director of the Harvard Opinion Research Program

Sunday, October 31, 2010

Doctor Anonymous: Med Students at #fmecnet

Doctor Anonymous interviews us at the FMEC NE Region Meeting in Hershey, PA. The panel on social media inspired us to start a family medicine blog for medical students interested in family medicine. We hope that you enjoy our blog and that we can provide a location for medical students to respectfully discuss issues related to medical school leading up to residency.

Doctor Anonymous: Med Students at #fmecnet: "It's always great talking with med students at the Family Medicine Education Consortium NE region meeting. At the 2010 meeting in Hershey, ..."