Category Archives: Doctors

For doctors who take a break from practice, coming back can be tough

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Family practitioner Kate Gibson checks 4-year-old Ashley del Torro’s throat for an infection at the Eisner Pediatric Medical Center in Los Angeles, California, on Friday, June 5, 2015. Gibson completed a re-entry program in order to return to practice medicine after a 10-year break to raise her four children (Photo by Heidi de Marco/KHN)

Family practitioner Kate Gibson checks 4-year-old Ashley del Torro’s throat for an infection at the Eisner Pediatric Medical Center in Los Angeles, California, on Friday, June 5, 2015. Gibson completed a re-entry program in order to return to practice medicine after a 10-year break to raise her four children (Photo by Heidi de Marco/KHN)

By Anna Gorman
KHN

After taking a 10-year break from practicing medicine to raise four sons, Kate Gibson was ready to go back to work.

The family practitioner had been reading about a shortage of primary care doctors and knew she could help. But when Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members or to recover from their own illnesses. Some want to return from retirement or switch from non-clinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Molly Carey, 36, an Ivy-League educated doctor who recently enrolled in a Texas retraining program after four years away from patients.

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is a clearly a dearth of those kind of training programs.”

Policymakers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors. Continue reading

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One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013

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Three red and white capsulesBy Charles Ornstein
ProPublica

This story was co-published with the Boston Globe, the Miami Herald and Health News Florida.

In 2012, Medicare’s massive prescription drug program didn’t spend a penny on popular tranquilizers such as Valium, Xanax and Ativan.

The following year, it doled out more than $377 million for the drugs.

Screen Shot 2015-06-10 at 8.59.21 AMWhile it might appear that an epidemic of anxiety swept the nation’s Medicare enrollees, the spike actually reflects a failed policy initiative by Congress.

More than a decade ago, when lawmakers created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications.

Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them.

When Congress later reversed the payment policy under pressure from patient groups and medical societies, it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows.

Generic versions of the drugs 2014 alprazolam (which goes by the trade name of Xanax), lorazepam (Ativan) and clonazepam (Klonopin) 2014 were among the top 32 most-prescribed medications in Medicare Part D that year.

And it appears these were not new prescriptions. Continue reading

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Doctor’s office research – What is it? What’s it to you?

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SEATTLE COMMUNITY CONVERSATION SERIES JUNE 9, SEATTLE.

“DOCTOR’S OFFICE RESEARCH. WHAT’S IT TO YOU?”

Facilitated by Benjamin Wilfond MD, Seattle Children’s Research Institute

speech-bubbleJoin us for an engaging and intimate discussion about research that happens in your doctor’s office.

What? You thought research only happened at universities or hospitals, right?

It turns out that plenty of decisions, like which hand gel to use or which blood pressure medicine to prescribe, vary by a lot without much rhyme or reason.

Doctors want better evidence for these decisions.  But how much should patients know and be able to agree to?

Learn more at rompethics.iths.org

Each Conversation in the series explores a topic in biomedical science and its role in society, connecting people to the biomedical research community

Details  and REGISTRATION

WHEN?

Tuesday June 9
5:45 – 7:30 PM

WHERE?

Kakao Chocolate + Coffee
415 Westlake Ave. N.
Seattle, WA 98109

HOW MUCH?

$5 NWABR members| $10 General admission, Includes discussion, appetizers, espresso and first glass of beer or wine if 21+

Everyone is welcome.  No science background necessary.

SUGGESTED READINGS AND RESOURCES

Description of research in your doctor’s office

Influence of doctors’ demographic on their medical practice

Making evidence-based medicine doable in everyday practice

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Bring doctors to patients who need them most

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Jennifer Vargas, a second year resident at Riverside County’s Regional Medical Center, treats patient Maria Sanchez, 54, at Riverside County’s Regional Medical Center on April 21, 2015.    Sanchez says she feels comfortable with Vargas because she speaks Spanish (Photo by Heidi de Marco/KHN).

Jennifer Vargas, a second year resident at Riverside County’s Regional Medical Center, treats patient Maria Sanchez, 54, at Riverside County’s Regional Medical Center on April 21, 2015. Sanchez says she feels comfortable with Vargas because she speaks Spanish (Photo by Heidi de Marco/KHN).

By Andrew L. Wang and Heidi de Marco

MORENO VALLEY, Calif. — Jennifer Vargas’ path toward becoming a doctor took her from UCLA to Guadalajara before it ultimately led back home, to California’s vast Inland Empire east of Los Angeles.

“Today, our country is largely training the sons and daughters of wealthy people to be physicians… You wonder why we have a problem with people not serving in underserved communities; it’s because they don’t know what an underserved community looks like.”

When the Chino Hills, Calif. native graduated from medical school in Mexico, her first choice for residency training was Riverside County’s public medical center, which serves among the fastest growing and most medically deprived parts of California.

It was just what she wanted:  To serve a vulnerable patient population facing high barriers to care, particularly immigrant patients from Mexico who would benefit from a Spanish-speaking physician.

“It offered the best fit for me,” said Vargas, 32, a second-year resident in family medicine at Riverside County Regional Medical Center. Continue reading

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What patients gain by reading their doctor’s notes

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Shelves packed with medical records

By Shefali Luthra

During a recent physical, Jeff Gordon’s doctor told him he may be pre-diabetic. It was a quick mention, mixed in with a review of blood pressure numbers, other vital statistics like his heart rate, height and weight, and details about his prescription for cholesterol medication.

Normally, Gordon, 70, a food broker who lives in Washington, D.C., would have paid it little attention.

But his physician, who recently joined MedStar Health, uses the system’s Web portal that allows him to share his office notes with patients. For Gordon, seeing the word “pre-diabetic” in writing made it difficult to ignore, and he took action.

He contacted MedStar about joining a pre-diabetes clinical study. In the course of taking the tests required to participate, the otherwise healthy septuagenarian found out his blood sugar wasn’t elevated enough to qualify.

Still, the experience of seeing the term in his doctor’s notes was a “wake-up call,” inspiring him to pay more attention to his diet and exercise. “It’s harder to ignore when it’s in your face,” he said. Continue reading

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Top medical school revamps requirements — to lure English majors

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Dr. David Muller, a professor and dean at Mount Sinai Medical School, helps first-year students prepare to do physical exams on each other as part of a class called “The Art and Science of Medicine.” (Photo: Cindy Carpien for KHN)

Dr. David Muller, a professor and dean at Mount Sinai Medical School, helps first-year students prepare to do physical exams on each other as part of a class called “The Art and Science of Medicine.” (Photo: Cindy Carpien for KHN)

By Julie Rovner
KHN

NEW YORK — You can’t tell by looking which med students at Mount Sinai were traditional pre-meds in college and which weren’t. And that’s exactly the point.

Most of the class majored in biology or chemistry or some other “hard” science; crammed for the MCAT (the Medical College Admission Test) and did well at both.

But a growing percentage came through Icahn School of Medicine at Mount Sinai’s “Hu-Med” program, which stands for Humanities in Medicine. They majored in things like English, history or medieval studies. And they didn’t even take the MCAT because Mount Sinai guaranteed them admission after their sophomore year of college.

Adding students who are educated in more than science to the mix is a serious philosophy at Mount Sinai.

David Muller is Mount Sinai’s Dean for Medical Education.  One full wall of his cluttered office is a massive whiteboard almost totally full with to-do tasks and memorable quotes. One reads: “Science is the foundation of an excellent medical education, but a well-rounded humanist is best suited to make the most of that education.”

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Mount Sinai Dean of Medical Education Dr. David Muller stands in front of a whiteboard in his office filled with notes along side memorable quotes. (Photo: Cindy Carpien for KHN)

The Hu-Med program dates back to 1987, when then-Dean Nathan Kase wanted to do something about what had become known as “pre-med syndrome.” That’s the idea that the drive for straight As and high test scores was actually producing sub-par doctors. Students were too single-minded. Continue reading

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Facing death but fighting the aid-in-dying movement

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Stephanie Packer (Photo by Stephanie O’Neill / KPCC)

By Stephanie O’Neill
Southern California Public Radio

Stephanie Packer was 29 when she found out she has a terminal lung disease.

It’s the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of northern California, opted to end her life via physician-assisted suicide in Oregon last fall.

Maynard’s quest for control over the end of her life continues to galvanize the “aid-in-dying” movement nationwide, with legislation pending in California and a dozen other states.

But unlike Maynard, Packer says physician-assisted suicide will never be an option for her.

“Wanting the pain to stop, wanting the humiliating side effects to go away – that’s absolutely natural,” Packer says. “I absolutely have been there, and I still get there some days. But I don’t get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn’t have to be.”

A recent spring afternoon in Packer’s kitchen is a good day, as she prepares lunch with her four children.

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The Packer family gathers in the kitchen to cook dinner. From left: Jacob, 8; Brian Sr. ; Brian Jr., 11; Savannah, 5; Scarlett, 10; and Stephanie. (Photo by Stephanie O’Neill / KPCC)

“Do you want to help?” she asks the eager crowd of siblings gathered tightly around her at the stovetop.

“Yeah!” yells 5-year-old Savannah.

“I do!” says Jacob, 8.

Managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes. Continue reading

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How one hospital brought its C-sections down in a hurry

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In 2012, Hoag Hospital’s cesarean section rate was about 38 percent – five percent higher than the state average.  The Newport Beach hospital has been working to lower the amount of c-sections by stepping up data analysis and patient education (Photo by Heidi de Marco/Kaiser Health News).

In 2012, Hoag Hospital’s cesarean section rate was about 38 percent – five percent higher than the state average.(Photo by Heidi de Marco/Kaiser Health News).

By Anna Gorman
KHN

NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.

A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.

“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.

The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.

Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.

In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.

Continue reading

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The Doctor Will Video Chat With You Now: Insurer Covers Virtual Visits – NPR

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you can live stream movies, why not live stream medical care?

Insurance company UnitedHealthcare will start covering visits to the doctor’s office — via video chat. Patients and physicians talk live online — on smartphones, tablets or home computer — to get to a clinical diagnosis.

This move to cybermedicine could save insurers a ton of money — or have unintended consequences.

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Few using quality and price information to make health decisions

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Shopping cart redBy Jordan Rau
KHN

Despite the government’s push to make health information more available, few people use concrete information about doctors or hospitals to obtain better care at lower prices, according to a poll released Tuesday.

Prices for the health care industry have historically been concealed and convoluted, unlike those for most other businesses. The 2010 health law aimed to make such information more transparent.

Only one in five people say they had seen specific cost or quality information about a hospital, insurer or doctor.

People shopping for insurance can now compare the prices of competing plans through online marketplaces, including premiums, deductibles and their share of any medical expenses.

The federal government also publishes more than 100 quality ratings about hospitals, as do some large private insurers.

Private groups such as Consumer Reports and U.S. News & World Report also rate providers, and Internet forums such as Yelp are now littered with easily accessible opinions.

The poll from the Kaiser Family Foundation found that about two of three people say it is still difficult to know how much specific doctors or hospitals charge for medical treatments or procedures. (KHN is an independent program of the foundation.)

Only about one in five people said they had seen specific cost or quality information about a hospital, insurer or doctor.

The poll found that this information rarely makes a difference. About 6 percent of people ever used quality information in making a decision regarding an insurer, hospital or doctor. And fewer than 9 percent used information about prices, most commonly in relation to health plans. Only 3 percent said they used price information about physicians, the poll found. Continue reading

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Some states pay doctors more to treat Medicaid patients

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Blue doctorBy Michael Ollove
Stateline

Fifteen states are betting they can convince more doctors to accept the growing number of patients covered by Medicaid with a simple incentive: more money.

The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1.

Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, the 15 states are dipping into their own coffers to continue to pay the doctors more.

It seems to be working. Continue reading

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Coalition pushes for health care cost and quality transparency

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Twenty-dollar bill in a pill bottleBy Lisa Gillespie
KHN

As consumers increasingly are being asked to pay a larger share of their health bills, a coalition of insurers, pharmaceutical companies, and provider and consumer advocacy groups launched Thursday a new push for greater transparency regarding the actual costs of services.

The group includes AARP, Novo Nordisk, the National Consumers League, the Ambulatory Surgery Center Association, the National Council for Behavioral Health and Aetna.

Transparency means all consumers have the information they need to estimate cost and quality of health services.

Health care transparency, long a buzz word, means all consumers — whether they are covered by Medicare, work-based insurance or without coverage at all — have access to information enabling them to estimate accurately the cost of health services, and compare physician quality rankings and outcomes.

The initiative, “Clear Choices,”  will add to private and government efforts already underway to get more such information to patients, including Medicare’s Physician Compare, and the Health Care Cost Institute’s ‘Guroo,’ which culls data from private insurers to provide average prices regionally.

The group’s first priority is advancing the Medicare doctor payment legislationp ending in the Senate because it includes a provision requiring Medicare to release for broader use a substantial amount of data on claims at the provider level.

The group’s other objectives include:

  • Improving quality measures for doctors and hospitals so that patients will be armed with more comparative information.
  • Requiring hospitals to be clearer regarding what may or may not be included in their cost estimates for care.
  • Creating better tools for consumers to make medical decisions based on price, quality and safety of medical services.

Continue reading

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Medical schools try to reboot for 21st century

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By Julie Rovner
KHN
Medicine has changed a lot in the past 100 years. But medical training has not.

Until now.  Spurred on by the need to train a different type of doctor, medical schools around the country are tearing up the textbooks and starting from scratch.

Most medical schools still operate under a model pioneered in the early 1900s by an educator named Abraham Flexner.

“Flexner did a lot of great things,” said Raj Mangrulkar, associate dean for medical student education at the University of Michigan Medical School. “But we’ve learned a lot and now we’re absolutely ready for a new model.”

And Michigan is one of many schools in the midst of a major overhaul of its curriculum.

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Dr. Raj Mangrulkar and medical student Jesse Burk-Rafel (Photo by Leisa Thompson/For Kaiser Health News)

For example, in a windowless classroom, a small group of second year students are hard at work.

They’re not studying anatomy or biochemistry or any of the traditional sciences. They’re polishing their communications skills.

In the first exercise, students paired off and negotiated the price of a used BMW. Now they’re trying to settle on who should get credit for an imaginary medical journal article.

“I was thinking, kind of given our background and approach, that I would be senior author. How does that sound to you?” asks Jesse Burk-Rafel.

It may seem like an odd way for medical students to be spending their class time. But Erin McKean, the surgeon teaching the class, says it’s a serious topic for students who’ll have to communicate life and death matters during their careers. Continue reading

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These doctors want a choice in how they they die

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Hoping To Live, These Doctors Want A Choice In How They Die

Photo by Anna Gorman

Dr. Dan Swangard (Photo by Anna Gorman/KHN).

By Anna Gorman
KHN

SAN FRANCISCO — Dan Swangard knows what death looks like.

As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety.

He has watched dying drag on for weeks or months as terrified relatives stand by helplessly.

Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.

To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder.

The operation was successful but Swangard, 48, knows there’s a strong chance the disease will return. And if he gets to a point where there’s nothing more medicine can do, he wants to be able to control when and how his life ends.

“It’s very real for me,” said Swangard, who lives in Bolinas, Calif. “This could be my own issue a year from now.”

That’s one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard said, he can’t say for certain whether he would take them.

“But I want to be able to make that choice,” he said. Continue reading

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