Published CommPro.biz 2014.03.25

Congress Blocking Doctors

Last Friday (2014.03.21) was “Match Day.” On that day thousands of mostly young doctors opened an envelope that confirmed their acceptance into a residency program. In many cases it defines the path their medical career will take for the rest of their working life. In most cases they knew they were in and just awaited final confirmation. For some it was their first choice and this was the first year they had been down this path. For others, they settled for what they could get. Others were back for another try, having missed the cut in earlier years. Still others missed the cut this year and will have to wait for next year, or perhaps the next, or the next, often while staring at a massive student loan debt.

For a nation facing a massive physician shortage –100,000+/- by the end of this decade– this is insanity. The number of residency openings is controlled by the United States Congress. Why there should be a problem with supporting this vital aspect of our healthcare system escapes us. However, we are living under a nearly two decade old cap put in place by the Congress. Given those in that body who are focused on anything but serving the people of the United States, it’s not likely that we’ll see a change.

On the other hand there’s good news. The number of bright young people –split about evenly between men and women– who applied to medical schools and the number enrolled as first-year students hit record highs this year. Add to that a dramatic increase in young doctors choosing family medicine. Five years ago it was under 60% with more than four in ten opting for specialties. This year it’s over 66% with less than one in three aiming for the specialties. That indicates a growing awareness among young doctors that the team-based comprehensive care ACA encourages is where the future lies. Primary care doctors will head-off serious illness in the future, saving lives, improving the lives of their patients and reducing healthcare costs.

There’s a new day dawning; young people entering medicine see it. Beat illness to the draw, make prevention the goal. The old model, treat people after they get sick is on the way out. Paying doctors based on the number of patients they run through their practice is so over. Payment needs to be focused on outcomes, on the overall health of the patients under a doctor’s care. America spends more per patient than any country on this planet. Yet we rank among third world countries when it comes to outcomes. The ACA is a baby step in the right direction.

Our lawmakers need to do the job they were elected to do, to serve the interest of all the people of the United States. They can begin by opening up more residency slots for young doctors who have fought their way into medicine, and are ready to go to work.

 Published CommPro.biz 2014.02.10

Legally But Not Medically Necessary

Depending on whose numbers you look at, somewhere between 5% and 40% of the cost of healthcare in America is spent on “Defensive Medicine.”  In 1994 the Congressional Office of Technology Assessment defined it: “Defensive medicine occurs when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability.”

The body formally known as the Trial Lawyers Association, the barracuda bar that strikes fear into the hearts of all in the medical world, says that defensive medicine does not exist. They see it as a big scam that the medical types use as an excuse to ratchet up their income. And while we don’t buy that, there is a certain amount of truth in what they say. Testing facilities owned by doctors, hospitals and others in the game certainly benefit. As do those who consult to affirm the decisions made by their colleagues.

The leading solution is Tort Reform, restrictions on the legal profession. And/or limitations on the amount those harmed by the medical system can collect. Some of those reforms have been set up by state governments, however, and they don’t seem to help. That either means the lawyers are right, that unnecessary medical stuff reflects greed among medical providers, or that the practice is so ingrained that fear makes it near impossible for them to stop.

A totally different approach is now under consideration in Florida and Georgia, a concept that eliminates the possibility that any medical player could be sued. The Patients’ Compensation system would take medical errors out of our legal system entirely. Panels of experts would be tasked with evaluating claims and awarding the injured party funds to cover their losses. It would be quick and fair.

We spend more per-capita than other countries on healthcare but our outcomes rank below third world nations. We fail to make it into the top twenty-five in most cases. On the other hand our VA Health Care system provides excellent care at 40% less per patient than the national average. That’s an impressive number made even more impressive when you look at their patients. Mostly a bunch of beat up old folks, with some really beat up younger folks from our recent wars. Compare that to the national patient base; it includes all those folks under forty who are in relatively good health.

Oh yes, the VA enjoys a few other advantages. Their people don’t have to worry about lawsuits. And they don’t have to spend a lot of time filling out paperwork for insurers. They were among the first to go digital; any Vet can go into any VA facility in the world and they can pull up their records in seconds. All this allows them to focus on prevention. And the VA can negotiate to hold down drug costs, unlike Medicare that is prohibited by Big Pharma who has our Congress bought and paid for.

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