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How widespread is physician suicide? What are the warning signs that colleagues
should not ignore? What more can the healthcare community do to help
practitioners who are at risk? This month’s survey provides some answers.
This edition of the Jackson & Coker Industry Report examines a reality that many
professionals in the healthcare industry might wish to ignore: physician
suicide. But the hard, cold facts are what they are.
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Yearly, from 300-400 physicians successfully commit suicide, according to an
article that recently appeared in Newsweek magazine entitled “Doctors
Who Kill Themselves” (04/28/08). This statistic does not include the number of
attempted suicides, often among female physicians. The article concludes:
“The unsettling truth is that doctors have the highest rate of suicide of any
profession.”
It’s not like the healthcare community is unaware of this tragic circumstance
that ends the lives of so many productive practitioners. If you Google
“physician suicide,” dozens of articles and professional studies pop up that
discuss some aspect of physician depression and suicide. Here are some
intriguing titles:
“Doctor kills self after malpractice verdict”
“Physician suicide: Risk Factors and Prevention”
“Female Physicians Face Higher Suicide Rate”
“Physician Suicide and Drug Abuse”
“Taking Their Own Lives—the High Rate of Physician Suicide”
“Physician Suicide: Searching for Answers”
“Encouraging Treatment in Depressed Medical Professionals.”
The healthcare community acknowledges the grim statistics, but a key question
remains: Is enough being done in terms of preventative measures? That question
prompted us to commission a Special Report on the subject prepared by our
research team, along with launching our latest survey: “Raising Awareness
Concerning Physician Suicide.”
The comments of survey respondents are particularly illuminative of the likely
causes of suicidal behavior, reasons why persons at risk are hesitant to seek
help, and steps that can be taken to address the problem more effectively.
Physician suicide is a sobering topic—but one that deserves the spotlight of
reasoned and compassionate attention by all those in the healthcare community.
Cordially,
Calvin Bruce
Managing Editor
Health Plans Embrace Retail Clinics
Source: Managed Care
Date: 03/01/2008
For time-constrained consumers with minor healthcare needs, retail clinics are becoming a fast-growing phenomenon as an alternative to primary care practices. Usually located in grocery stores, large retailers like Target, and other commercial spaces, retail clinics are an easy way for individuals to receive quick outpatient medical care in the span of about 15 minutes. For a small fee, consumers can access cures for very simple medical procedures like ear infections, strep throat, and poison ivy. Many clinics do not even have a full-time physician on hand. For more serious medical conditions, the clinics advise their patients to visit either a traditional doctor's office or else an emergency room. Insurance companies are jumping on the bandwagon and covering their customers' visits to these clinics as a cheap and easy solution to overburdened physician's offices and ERs.
At the beginning of 2007 there were just 150 retail clinics in the United States, and as of March 2008, this number has risen to over 900. With companies like Wal-Mart hoping to open 2,000 retail clinics in their existing stores within 7 years, these figures are expected to rise dramatically. As the new generation of healthcare seekers are increasingly accustomed to the consumer mentality, quick in-and-out health services for minor procedures are becoming more desirable. According to a 2008 Deloitte Survey of Health Care Consumers, 16 percent of American consumers claim to have used a retail clinic in the last year, and 34 percent of those said they would visit one again. Forty-eight percent of consumers said they would visit a clinic if the nurse practitioner were connected to a physician's office in the local area.
Some doctors are concerned that the rise of retail clinics will result in "fragmented care," and there are concerns about the quality of services that these for-profit offices can provide. Nevertheless, the traditional model of healthcare will need to adjust its practices to accommodate for this rapidly growing trend.
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From Red to Green
Source: Hospitals & Health Networks
Date: 04/22/2008
Employing nearly 5 million workers, U.S. hospitals are big operations that stay open 24 hours a day, seven days a week with lights on, kitchens running, and trash piles growing around the clock. Collectively, hospitals burn 600 BTUs of energy each year at a cost of over $5 billion, and they generate millions of tons of garbage with the majority of that being highly toxic waste. “Going green” has become an ethical, regulatory, and economic imperative for U.S. hospitals and thanks to a new initiative, Practice Greenhealth, it is getting easier for hospitals to be ecologically responsible.
Congress passed the Medical Waste Tracking Act in 1988 in response to incidents in which large amounts of medical waste washed ashore in New York and New Jersey. Three years later, hospitals were responding. Many were monitoring waste bags, winnowing energy consumption, phasing out polystyrene products, recycling, and experimenting with eco-friendly waste disposal technologies. Unfortunately, these trends did not catch on with a majority of hospitals. Due to high federal costs of waste tracking and medical waste disposal, many hospitals built incinerators and started burning everything. These incinerators had huge impacts in lowering the quality of air and water in surrounding areas.
In 1997, the EPA began enforcing stringent air emissions standards for hospitals and their medical waste incinerators, vowing to cut mercury, particulates, hydrogen chloride and dioxin pollution by 90 percent. The EPA also joined with the American Hospital Association and formed Hospitals for a Healthy Environment (H2E). Since then, thousands of clinics and health care facilities have joined H2E, and 80 percent of U.S. hospitals have implemented some form of waste reduction policy. Currently, nineteen health care facilities have been built in the U.S. and British Columbia to meet the standards of the U.S. Green Building Council.
As a successor to H2E, Practice Greenhealth offers the educational resources of H2E but also makes available its guide for safe, efficient, environmentally friendly design, construction and operations, “The Green Guide for Health Care,” plus a promising new approach to major savings in electricity procurement through the Internet-based reverse auction technology of the Healthcare Clean Energy Exchange.
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Leavitt Pitches Urgency, Tougher Stance on Value-Driven Healthcare
Source: Healthcare Finance News
Date: 04/24/2008
The Department of Health and Human Services’ continued efforts to drive transparency into the U.S. healthcare system will not wane in the concluding months of the Bush Administration. HHS Secretary Michael Leavitt, speaking at the Fifth Annual World Health Care Congress event on April 23rd in Washington, announced his intentions to proceed with the plans for change in the healthcare system with “a continued sense of urgency.”
One of the initiatives that Leavitt will continue to push is the consolidation of all healthcare quality standards used across its agencies. The HHS intends to publish these standards and make them available for market-wide use. HHS is also testing an initiative involving competitive bidding for bundled services, beginning with a Medicaid demo that officials hope to expand. The value-driven healthcare plan depends on “healthcare IT adoption to record quality measures and aggregate and provide cost and quality information to consumers,” but adoption is not nearly as widespread in small physician practices as Leavitt would hope. Still, in his final 272 days left as HHS secretary, Leavitt has no intentions of slowing down his crusade for change in the healthcare system.
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Some Operators Closing Retail Clinics, Scaling Back Expansion Plans
Source: Medical News Today
Date: 05/08/2008
Walk-in health clinics at pharmacies, supermarkets and retailers are not doing as well as they once did according to a Wall Street Journal report, even though the numbers of such clinics have grown steadily over the past few years. There are currently 963 retail clinics in the U.S., compared with only 125 in 1995. Some retail clinic operators are starting to notice the shifting trend and scaling back. At least 69 clinics in 15 states have been closed, and others are scaling back expansion plans. Part of the problem is that financiers for many of the clinics did not appreciate how complex and costly such clinics are to operate, and patient acceptance of the clinics has been slow. Clinics have been spending a large percentage of resources on marketing to increase awareness. Some clinics, however, are still doing well. Walgreen’s, for example, plans to add 240 new health clinics this year.
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Eastern and Western Medicine Come Together at New San Diego Center
Source: BusinessWire.com
Date: 04/14/2008
A brand new, state-of-the-art medical facility for integrative care of arthritis and autoimmune disorders has recently opened in San Diego, California. The Institute for Specialized Medicine is the first medical center of its kind to be opened in the San Diego area. The institution was founded by Dr. Alexander Shikhman, who is also the medical director for Restorative Remedies, a newly developed nutraceutical company in San Diego. The Institute for Specialized Medicine’s main objective is to use all possible treatment methods available, including Western medicine, historic Eastern medicine, and a patient-centered approach from Europe.
The facility was designed with aging Baby Boomers in mind. The institute specializes in helping people who suffer from “arthritis, inflammatory and metabolic disorders, autoimmune diseases, and immune system issues driven by foods and chronic infections.” A recent study showed that by the year 2030, the average Baby Boomer will be suffering from diabetes, cardiac disease, and arthritis. The institute has been designed to provide patients with individualized therapy programs that combine Eastern and Western medical practices for an all encompassing health treatment. The facility provides specialists in every field ranging from dieticians and nutritionists to physical therapists, from orthopedic surgeons to acupuncturists.
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Sarbanes-Oxley on the Not-for-Profit Horizon
Source: Trustee Magazine
Date: 04/01/2008
The Sarbanes-Oxley Act is currently setting its sights on not-for-profit hospitals to change the way they report profits and losses. This “Sarbanes Creep” is occurring at a time when focus is shifting from financial compliance to corporate compliance on issues of quality, finance, billing, coding and safety. Not-for-profit hospitals, such as Beth Israel Deaconess Medical Center in Boston, are being held accountable for including losses from bad debts and other sources as part of charity care calculations in past financial reports.
While this new world of heightened scrutiny on the role of boards and corporate governance has led to changes ranging from slight to vast restructuring, nearly all not-for-profit hospital boards have taken action and are, at the very least, investigating what they must do in order to become compliant with Sarbanes-Oxley. Most agree that the Sarbanes-Oxley enforcement lodged against not-for-profit organizations will not be nearly as pervasive, costly, and time-consuming as the federal regulations against corporations and for-profit businesses, as small not-for-profits simply do not have the resources to comply with such demands.
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A Team Approach to Cost Commitment
Source: Healthcare Financial Management
Date: 04/01/2008
Hospitals across the country have been developing new techniques and methods for cutting costs while keeping the volume of patients high and avoiding rising expenses. In several cases, clinicians are turning to finance agencies for strategies to reduce labor expenses and supply chain costs. For example, Bristol Hospital in Bristol, Connecticut, recently turned to a finance company for assistance in reducing expenses without cutting FTEs while maintaining a commitment to high-quality care. So far the results have been positive, as last year Bristol saw over 2,000 more patients than in the previous year, and patient and employee satisfaction have been improving as well.
A recent survey of healthcare finance specialists, HFMA’s Healthcare Finance Outlook 2008-2013, concluded that cost control is the biggest challenge facing healthcare CFOs and other executives. According to the report, labor expenses, such as salaries and benefits, make up the largest component of a hospital’s costs. This is fueled by a lack of talent (nurses and other healthcare professionals) and constantly increasing benefit costs. Managing labor and supply costs also rank among the top 10 challenges to healthcare executives, according to the report.
Collaborations between healthcare facilities and financial agencies have tried to combat these challenges while primarily focusing on quality improvement. In the majority of cases, the teaming of healthcare and finance has resulted in enhanced productivity, lowered agency and overtime costs, and employee satisfaction. Effective collaborative efforts between hospital staffs and their finance departments can reduce labor costs which subsequently can enable a hospital to successfully provide high-quality patient care and augment the hospital’s bottom line.
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Is the Medicine You Depend On Made in a Place You Trust?
Source: Los Angeles Times
Date: 03/30/2008
In mid-March of this year, batches of a Chinese-made medicine were recalled worldwide for causing hundreds of allergic reactions and at least 19 deaths in the United States alone. The drug was a blood thinner named heparin used most commonly to prevent clots for patients during surgery or for those with heart trouble. The Food and Drug Administration discovered that some of the ingredients used to produce heparin had been contaminated with the chemical oversulfated chondroitin sulfate. This man-made drug acts similarly as the blood-thinning effects of heparin but is significantly cheaper to produce.
The problem is that the F.D.A. has no regulations that require drug companies to make known where their prescription medicines are produced. The billion-dollar pharmaceutical industry obviously benefits from producing medicines in countries with lower costs. Although the heparin case is still under investigation, it is at least a possibility that a Chinese supplier replaced the heparin ingredients with the deadly but cheaper chemical in an effort to increase the total profit.
As a result, patients are left with an undesired level of distrust and fear, though in many cases, as with heparin, refusing a vital treatment is simply not an option.
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Women Increasingly Fill Medical Director Role
Source: Managed Care Magazine
Date: 02/01/2008
According to a survey conducted by the American College of Physician Executives (ACPE) and Cejka Search, there has been a 30 percent increase in the share of physician executive jobs held by women in the last 10 years. In 1997, 10 percent of physician executive jobs were held by women, while in 2007, that number rose to 13 percent. Many women get into physician executive positions through the medical director role. In 2007, 17 percent of medical directors were women, up from 16 percent in 2005 and 12 percent in 1997.
Average pay for physician executives has also increased 7.5 percent according to the survey, from $240,000 in 2005 to $258,000 in 2007. Of the 7,796 ACPE members who received the survey, 27 percent responded to produce these results.
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Employment & Compensation
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Accident Highlights Long Hours for Doctors in Training
Source: Chicago Journal
Date: 10/12/2005
Questions surrounding overworked residents continue to be a problem for hospitals across the country. In September 2005, an Illinois court ruled that Rush-Presbyterian-St. Luke's Medical Center was not liable for damages when a resident crashed his car following a 30-hour shift at the hospital, seriously injuring another motorist. Though the court was careful to draw a line saying that hospitals are not responsible for injuries caused by overworked physicians and residents, the Accreditation Council for Graduate Medical Education in 2003 developed standards outlining acceptable working conditions for residents in U.S. hospitals.
According to the ACGME, all hospital residents are prevented from working more than 80 hours a week (calculated over a 4-week period) and more than 30 hours in a given shift and are required to have at least 10 hours between shifts and at least 1 day off a week. Yet though these standards are in place, many residents admit that they are not following regulations and working more hours than they are allowed. Other residents are complaining that the regulations prevent them from performing all of their duties sufficiently.
The American Medical Student Association argues that the regulations are not restrictive enough, and the group is lobbying the federal government in order to install national regulations that are protected by law.
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Reality Check for Joining a Group
Source: Unique Opportunities
Date: 04/01/2008
When jumping into a practice out of medical school and residency, there are many considerations that a newly certified physician needs to consider before signing any contracts.
Location is a primary concern, as any physician needs to decide if a different city or rural area would be an acceptable place to live for the next 25 or 30 years. Finding out all of the details of a practice - including financial data, doctor-physician assistant ratios, number of patients served, the potential for future salary raises and bonuses, and patient satisfaction levels - should be a major priority as well. Going into the practice during office hours can be a useful way to tell whether or not everything is going smoothly. Speaking to non-physician employees or even patients can be a great way to learn inside information about how the practice is functioning.
Overall, joining a practice can turn into a serious commitment, and new physicians need to do serious research in order to determine whether the practice will be a good fit. Asking a lot of questions to several different parties is one of the best ways to accomplish this. Additionally, financial and other information on the practice can be retrieved from online databases like the Medical Group Management Association (http://www.mgma.com) and the National Society of Certified Healthcare Business Consultants (http://www.nschbc.com).
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Part-Time Doctors
Source: American Medical News
Date: 05/05/2008
Results of a March survey of members of the American Medical Group Association showed that the proportion of doctors engaged in part-time work has gone from 13 percent in 2005 to 19 percent in 2007. Survey respondents included forty-three groups who gave several different reasons for requesting abbreviated schedules, including the onset of academic research or teaching (<3%), administrative or leadership duties (25%), family responsibilities including pregnancy (80%), health issues (7%), and retirement preparation (33%), along with various unrelated professional or personal pursuits (53%).
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Judge Strikes Down Cap on Malpractice Suit Awards
Source: Atlanta Journal-Constitution
Date: 05/01/2008
A Fulton County Judge decided that Georgia’s legislative cap of $350,000 for noneconomic damages in medical malpractice cases is unconstitutional because it provides too much protection for the medical profession. Due to the cap, people injured by doctors have less protection under the law than those injured by other things such as manufacturers’ products (for which there is no legal cap on noneconomic damages).
The case under review involved a 60-year-old retiree who fell from a ladder and was left a quadriplegic due to injuries to his neck and spine that were missed by doctors. The $350,000 cap was approved as part of tort reforms in 2005. Another part of those reforms was struck down in 2006 when the Georgia Supreme Court ruled that defendants couldn’t decide where malpractice cases were tried. If upheld, the decision could undercut a number of the state’s tort reform laws.
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Baby Boomer Time Bomb: Too Many Aging Patients, Too Few Geriatricians
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