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How to lure and keep Millennials in medicine



In a Med Page Today article, Colin Zhu, D.O., discusses how to lure and keep Millennials in medicine to deal with the oncoming physician shortage.

Among his observations:

“Society associates Millennials with negative connotations like entitlement and selfishness, but I beg to differ. My generation is known for our tech savvy, flexibility, and eagerness to produce results. We crave constant feedback and seek out continuous opportunities to improve. We find culture to be a greater attraction than compensation, look for new experiences in life, and want to pursue passions outside of our chosen fields.

“As more doctors cut back their hours or plan to retire, practices and hospital administrators will need to look in new directions to increase retention among young doctors. Keeping talented people within the practice of medicine will ultimately benefit everyone. Organizations that build strong cultures by providing career opportunities and encouraging people to pursue outside passions will be more likely to attract and keep Millennial physicians. ”

Dr Zhu is the creator of TheChefDoc and author of Thrive Medicine: How to Cultivate Your Desires and Elevate Your Life.


To read the article, please hit this link.

Osteopaths well trained to address population-health issues

A physician shows a spinal-manipulation technique at an osteopathic medical school.

David Ollier Weber writes, in Hospitals & Health Networks, about why now should be glory days for osteopathic physicians, among other reasons because they focus on the social determinants of health.

As he notes:

“This year marks the 125th anniversary of osteopathic medicine’s establishment as a structured discipline. More than 102,000 osteopathic physicians (DOs, or doctors of osteopathic medicine) practice alongside their 821,000 allopathic medical colleagues (MDs, or medical doctors) in every subspecialty — from pediatrics to cardiothoracic surgery — at clinics, hospitals and health systems throughout the nation.”

He writes that the “principles and practice of osteopathic medicine are fully aligned with the holistic, patient-centered care now valued in achieving the Triple Aim.”

He sees osteopaths as having a particular understanding of the social determinants of health because, in part “many osteopathic medical schools are in smaller towns, and many graduates, having gained experience in local clinics and hospitals, remain committed to  treating rural, diverse and medically underserved communities.”

He writes that William Burke,  D.O., dean and associate professor of family medicine at Ohio University Heritage College of Osteopathic Medicine in Athens says that “about 60 percent of our graduates stay in the state to practice” and “nearly one-third are serving in federally designated HPSAs — health professional shortage areas. We produce primary care physicians when there is such a need.”

Dr. Burke says: “DOs have been leaders in adopting population health and quality measures. This is a generation that grew up with a device in their hand, but we’re teaching them how to avoid letting technology get in the way of relating with patients. Our philosophy of mind, body and spirit means we think of you as someone not just complaining of back pain but as a whole person.”

To read more, please hit this link.


Pushing bundled payments for obstetrics


Assisting in childbirth.

The federally affiliated Health Care Payment Learning and Action Network (HCPLAN), looking to advance value-based care and save payers money, advocates using bundled-payment systems to address  the high-volume admissions related to maternity and newborn care. As well it would: Maternal and newborn stays  together  represent more than 20 percent of all hospital stays, says the Agency for Healthcare Research and Quality.

HCPLAN is a public-private collaborative network  trying to reach  the federal government’s goal that 50 percent of all healthcare payments be via alternative (value-based) payment models by 2018. The network’s clinical-episode payment work group has named maternity care,  elective knee and hip  replacement and coronary-artery disease  treatment (mostly involving bypass surgery)  as priorities for episode-based payments.

Work group members see  many ways to  improve care and cut costs in maternity and newborn care. Consider that the U.S. cesarean-section rate is high — more than 30 percent of births, says  the World Health Organization — despite the expense and potential danger to mother  and baby.  Cesarean deliveries are lucrative for physicians and hospitals.

Further, more  than 9 percent of births are pre-term, including many early elective deliveries, which  of course means more neonatal intensive care. All this with U.S.  infant-mortality rates higher than in most of the Developed World.

As Hospitals & Health Networks reports, Geisinger Health Plan, in central Pennsylvania, has used  bundled payments approach for obstetrics   for six years — and with good results, John B. Bulger, D.O., Geisinger’s chief medical officer for population health, told H&HN.

“Early elective deliveries almost immediately dropped to zero when the obstetrics department started to focus on processes of care. That resulted in fewer C-sections and reduced NICU use. ‘It is a win-win-win because the baby is healthier, happier, the mother is healthier and happier, and the population is healthier and happier because it is less costly to the system,’ he says.”

“Geisinger’s perinatal care bundle, available only for low-risk pregnancies, includes all prenatal, labor and delivery, and postpartum care for the mother only; the baby’s care is not covered in the bundle.”

H&HN says that “despite Geisinger’s success, its particular approach has not been widely adopted. A handful of payers and health systems are experimenting with maternity care bundles, but most are waiting for somebody else to figure out best practices. The first challenge is the sheer length of the episode.”

‘We feel pretty strongly that an episode should include prenatal, postpartum and — ideally — 30 days of newborn care,” Brynn Rubinstein, senior manager for Transform Maternity Care at the Pacific Business Group on Health, told H&HN. “It’s really hard to navigate all of the providers that a woman and baby might see, and all of the other conditions related to pregnancy, or unrelated to pregnancy, and how to include those in the episode.”

”Rubinstein, who is working with plans and purchasers to implement the recommendations outlined in HCPLAN’s white paper on maternity care episode payments, says purchasers are tired of the variation in cost and quality of maternity and newborn care.”

‘“While there are many obstacles to navigate, they are all challenges that can be overcome. It may take a few years, but they can absolutely be overcome, and we need to start today.”

To read the article, please hit this link.


The future of hospitalists in ACOs


Bradley Flansbaum, D.O.,  a hospitalist at Lenox Hill Hospital, in New York City, told Medscape that  hospitalists’ financial life generally hasn’t changed because of the arrival of Accountable Care Organizations.

“There is no difference in the way they get paid in an ACO. I don’t know of any hospitalist group that has changed its financial incentives for members in response to ACOs.”

He said that a hospitalist might not even know whether a  patient is part of an ACO at the time of admission.

But that will change.

“In 10 years, we’ll all be in the population health business,” says Ron Greeno, M.D.,  senior adviser for medical affairs at Team Health, North Hollywood, Calif., and  president-elect of the Society of Hospital Medicine.

“Hospitalists today are most involved with bundled-payment models. But in all models, they’ll see higher percentages of their revenue tied to performance metrics. Every healthcare organization in America is getting ready for this change,”  Dr. Greeno told Medscape.

To read the Medscape article, please hit this link.


‘Choosing Wisely’ may not win some malpractice suits


18th Century Statute of Lady Justice, at Castellania,  Italy. Her sword signifies the coercive power of a court,  her scales represent an objective standard by which competing claims are weighed, and her blindfold indicates that justice should be impartial and meted out objectively without fear or favor.

William Sullivan, D.O., and also a lawyer, discusses why “Choosing Wisely” won’t necessarily protect providers from malpractice suits.

He concludes:

“{Treatment} guidelines are created for many purposes. The intent of a guideline significantly affects whether the guideline will protect a physician against medical malpractice risk. Guidelines relating to payment issues should not be used for clinical or medicolegal purposes without strong clinical research supporting their conclusions. While clinical practice guidelines may be useful for both clinical and medicolegal purposes, the recommendations should be compared with current medical literature to determine whether the guidelines constitute appropriate medical care.

“Statutory guidelines and safe harbors significantly reduce a practitioner’s malpractice risk and also provide a strong deterrent to frivolous lawsuits. However, the decreased risk must be weighed against the inference of negligence that occurs if a statutory guideline is not followed, and against the potential transition of medical practice from a healing art to an exercise in checking all of the appropriate boxes to avoid liability.”

Investigating physician-owned distributorships


The U.S. Senate Finance Committee held a meeting Nov. 17 to discuss if physician-owned distributorships (PODs) hurt patients and payers.

A POD is a medical-device business that physicians invest in and operate,  Critics argue that they can create a conflict of interest that hurts the healthcare system if physicians use the devices they sell in their own practice.

But John Steinmann, D.O., an orthopedic surgeon, testified  for PODs. citing a model he has developed for surgeon ownership in PODs “that reduces conflicts of interest, ensures cost savings and protects patient safety,” Becker’s Hospital Review reported.



Turning good physicians into strong leaders


Julius Caesar.

This Medical Economics piece notes that among all the groups in healthcare, physicians are “the most likely candidates to be agents of change” in these transformative times.

So it has convened this round-table discussion of three experts to discuss how good physicians can be turned into strong leaders. The panelists are:

  • Peter B. Angood, M.D., chief executive officer and president of the American Association for Physician Leadership;
  • Maria Chandler, M.D., MBA, founder of the Association of MD-MBA Programs and the University of California, Irvine MD-MBA Program, a practicing pediatrician, and a member of the Medical Economics Editorial Advisory Board; and
  • Robert Juhasz, D.O., immediate past president of the American Osteopathic Association, a board-certified internist affiliated with the Cleveland Clinic, and an associate dean at Ohio University Heritage College of Osteopathic Medicine.

New guidance on end-of-life care


Herewith a discussion with Ferdinando L. Mirarchi, D.O., and Robert Glatter, M.D., about what providers need to know about end-of-life care considering new CMS reimbursement rules.

Video: Getting it right at the end of life


The differences among Do Not Ruscitate (DNR), Advanced Directive (AD) and Physician Orders for Life-Sustaining Treatment (POLST) are looked at in this video parody.

The idea is to help physicians better navigate end-of-life care forms.

That was the idea of Ferdinando Mirarchi, D.O., of UPMC Hamot, in Eerie, Pa., when he approached Michael Barton, M.D., of Heritage Valley Health System ,in Beaver, Pa., an emergency department physician known for his video parodies.

MedPage Today reports that Dr. Mirarchi is the principal investigator of the Realistic Interpretation of Advance Directives (TRIAD) studies, which have long been investigating perceptions and outcomes around common end-of-life care documents.


Answering 10 questions about being a physician


Michael Ritt Jaff, D.O., medical director of the Fireman Vascular Center and of the Center for Specialized Services at Massachusetts General Hospital in Boston answers 10 questions about healthcare posed by MedPage Today.

They are:

1. What’s the biggest barrier to practicing medicine today?

2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds, tests, etc.) and how did you respond?

3. What do you most often wish you could say to patients, but don’t?

4. If you could change or eliminate something about the healthcare system, what would it be?

5. What is the most important piece of advice for healthcare providers just starting out today?

6. What is your “elevator” pitch to persuade someone to pursue a career in medicine?

7. What is the most rewarding aspect of being a healthcare provider?

8. What is the most memorable research published since you became a physician and why?

9. Do you have a favorite medical-themed book, movie or TV show?

10. What is your advice to other physicians on how to avoid burnout?



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