I think that everyone who wants a leadership role in a residency program should be permitted one.
A residency isn't just a group of doctors in training, it's a group of leaders in training, as well.
These individuals will be faced with challenges and in leading the clinics at which they work.
Academic Chief is a start. Creating roles for leaders who can act independently and who can act to provide honest feedback to influence the course of a residency program are important to fostering a flexible training program.
Initiative in any form should be met with encouragement.
Friday, December 18, 2009
Tuesday, December 15, 2009
Health Care Reform
Health Care Reform
original 7/10/2009, updates are in {RED}
After all of this is over and the dust has cleared, these sites may help to figure out "what just happened?"
#1 http://www.rwjf.org/files/research/chart1.pdf
Non-partisan interactive chart with a comprehensive list of health care reform ideas (Republican, Democrat, and In-between)
*that link doesn't work anymore
Here's an excellent report on controlling costs which notes the benefits of the "episodes of care system":
http://www.rwjf.org/files/research/nrhiseriesbettewaystopay.pdf
#2 http://www.rwjf.org/healthreform/product.jsp?id=40713
Discusses some of the proposals in #1
#3 http://mayoweb.mayo.edu/newsbulletin-rst/documents/PDFPerspective.pdf
Mayo perspective. You might have read it in a recent email from the head office. (and there have been others)
#4 http://healthreform.kff.org/
Non-partisan, non-profit called the Kaiser Family Foundation with analysis of this issue (not connected to Kaiser Permanente)
#5 http://www.kff.org/healthreform/sidebyside.cfm
A really good comparison of all the current legislative proposals out there.
this is still really good and it's updated. when things are this complex, it's nice to have it in chart form.
and
http://www.kaiserhealthnews.org/Stories/2009/July/10/exchangesQA.aspx
Health insurance exchanges explained (kind of a big deal)
#7 http://www.rwjf.org/healthreform/
Non-partisan, non-profit called the Robert Wood Johnson Foundation with analysis of this issue
the best thing on this site is "The Cost of Dying" the 60 Minutes story on this used this article as a source: http://www.rwjf.org/healthreform/product.jsp?id=52311
#8 http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf
Non-partisan Congressional Budget Office (CBO) report on the issue (it's long, but you could get the gist of it by skimming a few pages)
OK, so you're not going to read that. The most important piece here is that just about everybody (republicans and democrats) agrees that the CBO is coming up with reasonable estimates. The two reasons to reform health care are to increase coverage and to lower the costs of that coverage. Both are important. For more information on cost, this is a great document: http://www.kff.org/healthreform/upload/8022.pdf
#9 http://healthreform.gov/index.html
President Obama's web page devoted to the issue. (Note: his stated aim is to let congress take the lead in developing a plan, but he does list some key principles.)
#10 http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf
Democratic Senate Finance Chair Baucus's proposal for health care (the main Democratic proposal right now)
If you're trying to figure it out from the list on #1, I think it's mostly "Singer/Garber/Enthoven" + the ability to have early Medicare buy-in for those age 55-64.
See also #6
If you'd like to see the House Bill that passed in November, you can. It's here in all of its 2000+ page splendor:
http://thomas.loc.gov/cgi-bin/bdquery/z?d111:H.R.3962:
If you'd like to see the Senate Bill as it is up to the moment, you can. It's also more than 2000 pages: http://www.senate.gov/pagelayout/legislative/b_three_sections_with_teasers/active_leg_page.htm
#11 http://wyden.senate.gov/issues/Legislation/Healthy_Americans_Act.cfm
Democratic Senator Wyden's proposal. (Google: Healthy Americans Act)
If you're looking at the list on #1, this one is mostly "Wicks/Meyer/Silow-Carroll"
Right wing resources
Republican Senate and House of Representative proposal. (Google: Patients' Choice Act)
If you're looking at the list on #1, this one is also (more loosely) based on "Singer/Garber/Enthoven" but it's the states that run the exchanges, not the federal government.
See also #6
N/A
#13 http://blunt.house.gov/HealthCare/DearColleague.pdf
Republican Representative Health Care Solutions Group Chair Blunt's letter outlining goals (there's also an associated web site)
It was a little difficult to find, but I think this is the main republican page for health care reform (includes senate and house and ...)
http://www.gop.gov/solutions/healthcare
#14 http://www.cato.org/health-welfare-entitlements
Conservative think tank called the Cato Institute's ideas on the subject of health care
Here's another interesting article:
http://www.cato.org/pub_display.php?pub_id=11054
#15 http://www.cato.org/pubs/handbook/hb111/hb111-15.pdf
Cato Institute's ideas how to make medicine better, safer, and cheaper (it might make you cringe, or not)
#16 http://www.politico.com/healthcare/
Daily updates on the issue in Washington, DC
#17 http://www.ama-assn.org/amednews/site/topic.htm#reform
The AMA's newsroll.
#18 http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine.html
All doctors aren't the same. The AMA has a tough road trying to represent a varied bunch. Our organization's take on things. (Wouldn't it suck if health care reform screwed us and gave the urologists more Porsches?)
Friday, December 11, 2009
the trouble with email
the trouble with email as a "push" form of communication is ...
...if you send it to everyone you're not sure if anyone is going to read it or act on it {and the race to the bottom of a stack of emails (or to the trash bin) is pretty quick for most people.}
...if you send it to one person you are almost certainly excluding someone who has opinions, knowledge, or a stake in the issue
...if try to go the middle route and pick a few people it seems to both exclude and go unread by those you'd like to read it. {and the serial nature of a thread can really hamper having a robust discussion}
blogging, as a "pull" form of communication helps with this problem. but it can simply go unread.
and that's fine because people have a right and a need to triage all the information flying at them.
but there needs to be a better way (or better use of existing mechanisms) to help people triage the "push" that they're receiving. Flags, marking "priority", and similar are commonly used (and overused) but within organizations (and beyond) it would be nice if there was some convention to it.
We all have our own organization scheme for our inbox (and no organization scheme is still one). It'd be interesting to see what's the most efficient scheme we use to save and retrieve the emails we RECEIVE and tailor some prioritization scheme to the emails we SEND.
this is the kind of thing an electronic resources committee could ponder.
not to try and be a whole new IT department. instead as an organized group to brainstorm, liaison, and advise.
Other issues could be considered:
Departmental and residency web pages
Individual and departmental blogs
Intranet and internet resources for care and patient education
Electronic health record
Webcasting and other ways of disseminating educational information
...if you send it to everyone you're not sure if anyone is going to read it or act on it {and the race to the bottom of a stack of emails (or to the trash bin) is pretty quick for most people.}
...if you send it to one person you are almost certainly excluding someone who has opinions, knowledge, or a stake in the issue
...if try to go the middle route and pick a few people it seems to both exclude and go unread by those you'd like to read it. {and the serial nature of a thread can really hamper having a robust discussion}
blogging, as a "pull" form of communication helps with this problem. but it can simply go unread.
and that's fine because people have a right and a need to triage all the information flying at them.
but there needs to be a better way (or better use of existing mechanisms) to help people triage the "push" that they're receiving. Flags, marking "priority", and similar are commonly used (and overused) but within organizations (and beyond) it would be nice if there was some convention to it.
We all have our own organization scheme for our inbox (and no organization scheme is still one). It'd be interesting to see what's the most efficient scheme we use to save and retrieve the emails we RECEIVE and tailor some prioritization scheme to the emails we SEND.
this is the kind of thing an electronic resources committee could ponder.
not to try and be a whole new IT department. instead as an organized group to brainstorm, liaison, and advise.
Other issues could be considered:
Departmental and residency web pages
Individual and departmental blogs
Intranet and internet resources for care and patient education
Electronic health record
Webcasting and other ways of disseminating educational information
medical student loans and forgiveness
I had a 2 year Navy scholarship when I was a medical student. So I have less debt than I would have otherwise. But I still have more than $100K racked up.
I've been in repayment for the loans since 2004.
In the last few months I found out about a new repayment plan that really lowered my monthly payment. It's called the "Income Based Repayment Plan" and it cut my monthly payment in half.
Also, there's 2 new loan forgiveness scenarios that I wasn't aware of.
The basic skinny is: (1) if you make 25 years of payments, whatever is left gets forgiven and (2) if you make 10 years of payments and you're doing some sort of service, whatever is left gets forgiven.
It's hard not to pay even a big loan off in 25 years (think mortgage), but 10 years is a real bargain.
There is a lot of ambiguity about what would constitute a "public service job" even though they try to lay it out pretty specifically:
you qualify if you...
...are employed by any nonprofit, tax-exempt 501(c)(3) organization;
...are employed by the federal government, a state government, local government, or tribal government (this includes the military and public schools and colleges); or
...serve in a full-time AmeriCorps or Peace Corps position.
--or--
A private organization that is not a for-profit business, a labor union, a partisan political organization, or an organization engaged in religious activities (unless the qualifying activities are unrelated to religious instruction, worship
services, or any form of proselytizing) and that provides the following public services –
Emergency management;
Military service;
Public safety;
Law enforcement;
Public interest law services;
Early childhood education (including licensed or regulated health care, Head Start, and state-funded pre-kindergarten);
Public service for individuals with disabilities and the elderly;
Public health (including nurses, nurse practioners, nurses in a clinical setting, and full-time professionals engaged in health care practioner occupations and health care support occupations);
Public education;
Public library services; and
School library or other school-based services.
here's the fact sheet from the government: http://studentaid.ed.gov/students/attachments/siteresources/LoanForgivenessv4.pdf
From what I can tell in looking over the IRS website (search section 78 for the word "clinic" here: http://www.irs.gov/app/pub-78/) it seems like there's a lot of places that would qualify as employers.
The Cleveland Clinic
Emory Clinic
Johns Hopkins
Kaiser Permanente
Massachusetts General & The Brigham and Women's Hospital
The Mayo Clinic
I may be missing something, but from what I can tell these are all 501(c)(3) organizations.
The implication is that there are a lot of places for a family physician to work which would qualify as a 501(c)(3) organization. And would this work qualify for the 10 year forgiveness?
I've been in repayment for the loans since 2004.
In the last few months I found out about a new repayment plan that really lowered my monthly payment. It's called the "Income Based Repayment Plan" and it cut my monthly payment in half.
Also, there's 2 new loan forgiveness scenarios that I wasn't aware of.
The basic skinny is: (1) if you make 25 years of payments, whatever is left gets forgiven and (2) if you make 10 years of payments and you're doing some sort of service, whatever is left gets forgiven.
It's hard not to pay even a big loan off in 25 years (think mortgage), but 10 years is a real bargain.
There is a lot of ambiguity about what would constitute a "public service job" even though they try to lay it out pretty specifically:
you qualify if you...
...are employed by any nonprofit, tax-exempt 501(c)(3) organization;
...are employed by the federal government, a state government, local government, or tribal government (this includes the military and public schools and colleges); or
...serve in a full-time AmeriCorps or Peace Corps position.
--or--
A private organization that is not a for-profit business, a labor union, a partisan political organization, or an organization engaged in religious activities (unless the qualifying activities are unrelated to religious instruction, worship
services, or any form of proselytizing) and that provides the following public services –
Emergency management;
Military service;
Public safety;
Law enforcement;
Public interest law services;
Early childhood education (including licensed or regulated health care, Head Start, and state-funded pre-kindergarten);
Public service for individuals with disabilities and the elderly;
Public health (including nurses, nurse practioners, nurses in a clinical setting, and full-time professionals engaged in health care practioner occupations and health care support occupations);
Public education;
Public library services; and
School library or other school-based services.
here's the fact sheet from the government: http://studentaid.ed.gov/students/attachments/siteresources/LoanForgivenessv4.pdf
From what I can tell in looking over the IRS website (search section 78 for the word "clinic" here: http://www.irs.gov/app/pub-78/) it seems like there's a lot of places that would qualify as employers.
The Cleveland Clinic
Emory Clinic
Johns Hopkins
Kaiser Permanente
Massachusetts General & The Brigham and Women's Hospital
The Mayo Clinic
I may be missing something, but from what I can tell these are all 501(c)(3) organizations.
The implication is that there are a lot of places for a family physician to work which would qualify as a 501(c)(3) organization. And would this work qualify for the 10 year forgiveness?
Tuesday, December 1, 2009
Consumer reports info on Medicare part d and trazodone
Click here for a mobile version. If you are having trouble viewing images, Click here.
NEWS UPDATE
ConsumerReportsHealth.org/BestBuyDrugs
Dear Mark Morgan,
Are Your Prescription Drugs Safe?
The Food and Drug Administration approved them, your doctor prescribes them, and you see them advertised on TV — so your medications must be safe, right?
More than half of all prescription drugs cause adverse effects — some serious or fatal — that aren't detected until after the FDA approves them, sometimes many years later. In 2008 alone, the FDA received more than 100,000 reports of serious injuries related to adverse drug events, an increase of about 25 percent over the previous year, according to the Institute for Safe Medication Practices.
In addition, the U.S. system for identifying drug risks before approval is flawed — and the one for spotting them afterward is even worse. Take a closer look at why you face these unexpected dangers, and what you can do to protect yourself.
Prescription Drug Insurance
How to pick the best Medicare Part D plan
It's that time of year again. Open enrollment for 2009 for the Medicare Part D drug benefit takes place from Nov. 15 through Dec. 31, 2009. You should enroll by Dec.15, though, to avoid potential coverage lapses and problems filling your prescriptions. Your coverage will be in effect from Jan. 1 through Dec. 31, 2010.
Whether you are enrolling for the first time or considering switching, you might have dozens of private plans to choose from, with differing premiums, co-payments, and levels of coverage — including which drugs are covered. As a result, we strongly urge Medicare beneficiaries to:Premiums are projected to increased by an average of 11 percent next year, with some of the biggest plans charging an estimated six to 22 percent more than they did in 2009. The average monthly premium for basic benefits is estimated to be about $37, according to a Kaiser Family Foundation report, but premium ranges will vary widely, from around $9 per month for some plans to more than $120 for other plans. There are a number of factors to consider in choosing a plan. Read on for more details on how to choose a plan, avoid the doughnut hole and what you can do if you think you may enter it next year.
- Understand the drug coverage you already have, if any.
- Get information on the Part D benefit in advance.
- Set aside time to study your choices and compare plans in detail.
- Seek independent outside information and advice, if needed.
- Pick a plan carefully.
Off-label Prescribing
The most common insomnia drug is one you've probably never heard of
What's among the most widely prescribed drug for insomnia—Ambien? Lunesta? Yes, but there's also another: a nearly 30-year-old generic antidepressant called trazodone, which causes drowsiness as a potentially useful side effect.
Trazodone is not approved by the Food and Drug Administration for treating insomnia (though doctors can legally prescribe it for this and other treatments). There's very little clinical trial evidence on whether it's effective for that purpose when there's no accompanying depression, and only modest evidence when there is. But numerous doctors use it because they believe that trazodone is the best sleep medication for many people.
Here's why trazodone has become so popular—and what to do if your doctor suggests you try it.
For additional information on more than 200 prescription drugs, alternatives to high-priced drugs and Best Buy selections for the most common, chronic medical conditions, visit ConsumerReportsHealth.org/BestBuyDrugs.
About the Consumer Reports Best Buy Drugs™ Project
Consumer Reports Best Buy Drugs™ is an educational and outreach initiative that compares a variety of prescription drugs on price, effectiveness and safety to help consumers and their doctors identify the most effective and affordable medicines.
The project combines evidence-based research on the comparative effectiveness and safety of prescription drugs with comprehensive nationwide data on drug prices. The information on drug effectiveness is derived from the Drug Effectiveness Review Project (DERP), a 14-state initiative. Price information is based on average retail prices paid in cash by consumers at the pharmacy. Every drug report is peer-reviewed by medical experts in the particular drug category.
For information on other drug categories we have examined to date — heartburn and acid reflux drugs, high blood pressure, depression, arthritis and pain — visit ConsumerReportsHealth.org/BestBuyDrugs.
Thanks for visiting,
The Consumer Reports
Best Buy Drugs™ Team
Resources
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