Fewer US med students choosing primary care - Yahoo! News

Fewer US med students choosing primary care - Yahoo! News


The reality of Workforce Shortage hit home for me by this article whose findings basically highlighted the issue. I was astonished by the fact that only 2% of graduating Medical Students in this study have interests in going into primary care. There are alot of rigours associated with primary care that turns off many physicians (who are they to blame, I mean, the opportunity of more money and less work is attractive even to the most noble of us).

Although the issue is problematic as it is, the continuation of this trend will be catastrophic especially to underserved communites. As we all know, many of these communities provide physicians an even lower incentive to practice due to the low reimbursement and complexities that Medicare and Medicaid (which are most often used) provide.

So my question is, how do we address this problem? I personally like the "Robinson's Theory" ( a number of us shoould already be familiar with this from our Economics class), which basically suggest to create a system in which med school is made to be much more expensive (as if it isn't already expensive enough, right?), but physicians who choose to actually practice medicine/primary care would have their outrageous medical school expenses paid for by the Govt. My memory might be failing me, but I think a similar system is used in Cuba in which med school is free for individuals who commit to working in underserved communities for a number of yrs.

I am sure there a plethora of arguments against this plan (heck, I can think of a few myself), but I'm putting it out there because as future health leaders, it is necessary to start brainstorming on ways to tackle pertinent problems such as this. Anyway feel free to offer your thoughts.

Sarah and Emma go to Washington...well, sort of...

Last night Emma D. and I attended the Northern California Chapter of AIHA (American Industrial Hygiene Association) to meet our professional development requirement for class. You might be thinking that this sounds like an *unusual* meeting for HPM students to attend, but we were drawn by the speaker: Aaron Trippler, AIHA Director of Government Affairs. And to be fair, although we do not use it in OUR everyday academic lives, Industrial Hygiene (IH) plays an important role in workplace health and safety and covers workers' rights and other policy-related issues of interest to us wonkly-types. (And as it turns out, there are a lot of jobs available in this industry; to find out more, visit: http://www.aiha-ncs.org/.)

Trippler, who was extremely animated and an excellent speaker (which DOES make a big difference at long meetings!) addressed a crowd of IHers and described the current political climate in DC, especially as it related to important issues in IH, such as baryllium, asbestos, combustable dust, and other ergonomics and workplace safety issues. Perhaps the most important information gleaned from this talk was that, due to the nature of Washington around election season (i.e., kind of a slow mess regarding passing new legislation, especially when it deals with environmental health and safety regulation, which tends not to be high-visibility), the states are taking up a lot of environmental health and safety issues and running with them.

What kind of issues? (See, I knew you were going to ask that question...) Right now ergonomics is entering the scene and making it onto the agenda of more and more state legislatures. Also, regulations for things like combustible dust (Google: Georgia sugar factory explosion) are becoming important since states can often quickly enact safety legislation to protect citizens.

But this meeting (to us!) was so much more than an update about the status of IH in DC; Emma and I also gained more insight into the world of health policy and management. We were able to see how a professional association and interest group (a very well organized one at that!) interacts with legislators and states but also with its own members in different chapters around the nation. And, for an evening, we were able to step off the HPM "beaten path" and meet some interesting and influential public servants and other IH professionals, whom we often overlook because they are behind-the-scenes, but they are the ones keeping us safe at work and in public places :).

Addendum: Perhaps the most amusing part of the evening was when a hotel worker came into the meeting to close the window and in doing so, had to use a ladder. Immediately, members of AIHA began shouting out ladder safety information and two members jumped up to hold the ladder for the worker. While definitely funny, it was also great to see people so passionate about their work!

SF Chronicle: State budget impasse threatens health services

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/09/06/MN6V12OVN5.DTL

State budget impasse threatens health services

San Francisco Chronicle, Sept 6

"...Many service providers, who gathered Friday outside the Capitol, said they've already received loans, maxed out their credit cards and even poured in personal funds to keep their centers open - and they are running out of time, money and options. Among them was Sarane Collins, 44, who in her own words is a 'chief financial officer of a sinking ship' that cares for 18 adults with disabilities in three homes in Santa Rosa. After cutting paychecks Friday to about 40 employees, her nonprofit will be broke, she said. Collins is hoping she can get a loan from the North Bay Regional Center, one of 21 nonprofit centers in California that administer funds to centers serving people with disabilities... Collins last received payment from the state on July 10. Since then, her nonprofit, called Slow Sculpture, has taken out a $60,000 line of credit and maxed out its credit cards at $50,000. The pharmacist who works with her clients has loaned $30,000 of his personal funds, and Collins has also poured in $15,000 of her own money... She is considering telling her board of directors to shut down the nonprofit. Two or three of her 18 clients have family members who can take them in, while the rest would have to find skilled nursing care elsewhere, she said. 'Some of our guys need constant oxygen,' she said. 'Five people are tube-fed. We have people with seizure disorders. Some have as many as 20 medications each day. We have people who have stage-4 sarcoma cancer, and 90 percent of our clients are in wheelchairs.'..."

On the subject of P4P...

After reading the NYT article that Kim posted on the pitfalls of P4P, I started wondering how Great Britian's P4P system is structured.  For anyone who watched the Frontline video of the primary physician that was interviewed, he seemed pleased with the bonuses he received from producing better health outcomes for his patients.  The video presented what seemed like a flawless view of the P4P system in Great Britain.  From what I gathered, the way P4P works in countries like Great Britain and New Zealand is that the P4P goals are adjusted by economic status of the surrounding community in which the clinic is located.  This is predicated on the knowledge that lower socioeconomic patients have poorer health than patients with higher socioeconomic status.  In this way the P4P system does not create disincentives for physicians to work in underserved communities if they're not meeting their P4P goals.  Any thoughts of whether this aspect of P4P could work in the U.S.? 

Here is the article that talks about this:   

http://www.minnesotamedicine.com/PastIssues/April2006/CommentaryApril2006/tabid/2386/Default.aspx

TIME article: "Thinking Long Term"

I noticed this article in TIME that talks about a method to reduce the burden of the upcoming baby boomer’s reaching retirement age. One way insurers are trying to address to the high cost of anticipated assisted living and other elder care is with “life style” planning similar to mutual funds. The plans allow you start with small investments and then start adding more coverage as get closer to actually needing the elder care.
I wonder if enough people would buy these plans to make a significant difference in the expected influx of elder when the baby boomers retire? I would lean towards people being scared about Medicare not being able to cover this influx with all the attention the issue has been getting, but there are also statistics out there how people grossly underestimate their actual end of care needs and the idea that baby boomers are in denial of their own aging and economic burden. Although the plans have an inherent social economic exclusivity that doesn’t really present them as a solution to the problem, maybe it could help.

http://www.time.com/time/magazine/article/0,9171,1838769,00.html

Recommended Reading

Quint Studer starts his book Hardwiring Excellence with a discussion of what he calls “Fire Starters.” These are people who have had a great effect on the lives of others, or, in the health care field, those “who are committed to transforming health care through compassion, imagination, and often, sheer determination.”* The author’s description of “Fire Starters” immediately made me think of a book that I read over the summer entitled Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World, by Tracy Kidder. I know that each of you is very, very busy with course readings and assignments, but I would recommend that during your time at the School of Public Health, you read this book.

Dr. Paul Farmer is a physician, a professor at Harvard University, and currently the Executive Vice President of Partners in Health (PIH), an organization he helped found in 1987. Mountains Beyond Mountains tells the story of Farmer’s life and the formation of PIH, which began in 1983 when a community-based health project called Zanmi Lasante was established by Farmer and others in Cange, Haiti to deliver quality care to residents of the country’s Central Plateau. Since the establishment of PIH, the organization has expanded, and is now involved in projects in nine countries around the world.** If any of you would like more information about PIH, their website is http://www.pih.org/home.html. This site is full of information on the organization itself and the projects it is carrying out, and also has a comprehensive “Recommended Reading” list for issues of interest related to PIH and its activities, as well as a listing of jobs available with the organization.

Mountains Beyond Mountains is an amazing book about a truly inspirational individual; Dr. Farmer’s determination to ameliorate the health conditions of those in Haiti, and later in countries around the world, is remarkable. Kidder’s description of the man is almost hard to believe, and at times, Farmer seems super-human. He is a man who puts the well-being of his patients above all else, and who has contributed immensely to building an outstanding organization dedicated to ameliorating the health outcomes of the world’s less fortunate. This book gave me renewed hope that global health disparities can be tackled, and reaffirmed my desire to pursue a degree in public health. If, over the next two years, any of you find some spare time, reading Mountains Beyond Mountains would definitely be a good way to use it up.

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* Quint Studer, Hardwiring Excellence (Gulf Breeze: Fire Starter Publishing, 2003): 1.

**PIH has projects in Haiti, Peru, Russia, the United States, Rwanda, Lesotho, and Malawi, and “supported projects,” to which it contributes monetary resources, in Mexico and Malawi. For more information on PIH’s projects, click on the “Where We Work” link on PIH’s website (http://www.pih.org/home.html).

Welcome to Fall 2008 HPM Class

Hi everyone - here is the class blog.....I hope you all will find it a useful forum to share ideas, react to articles, postings etc. Please review the blog posting guidelines handed out in class (and in Resources area on bspace).

To kick things on a content front, I attach a link to a recent article in the NYT http://www.nytimes.com/2008/09/09/health/09essa.html?ref=health
that touches on P4P - something we surfaced in class last week. As you can see it can look very different depending where you come at this from. This essay from a cardiologist points out some very real pitfalls.

Kim