Monthly Archives: July 2014

More (or less) Hope and Change (for the worse) In Healthcare: Are Doctor Shortages Really All Due To Training Bottlenecks?

There is no doubt that Affordable Care Act has changed the landscape of medicine in the US.  Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive.  As a result, medicine today is more about increasing patient volumes, completing reams of paperwork and administrative duties than it is about interacting with patients and providing superior care.  The American Academy of Family Practice (AAFP) estimates that there will be a significant shortage of primary care physicians in the next several years unless we increase the number of primary care trainees by more than 25% over the same time period.  In fact, the AAFP suggests that the primary care workforce must increase to 260K physicians by the year 2025–which translates to an additional 52K primary care doctors.

Given the need for more physicians and the pending shortage (particularly in primary care), many analysts have suggested that the reason for the shortage is a lack of training slots in primary care.  The ACA will add an additional 32 million patients to the pool of insured and primary care doctors will be at a premium.  In the New York Times this week, the editorial board collectively penned an article discussing their thoughts concerning the doctor shortage.  The NYT editorial board suggests that the shortage is all about an imbalance between Residency training slots and medical school graduates and can be easily corrected by federal funding of a larger number of training positions.  However, I think that the issue is much more complex and the solution is far from simple.

Primary care is an incredibly challenging specialty and requires a broad knowledge of much of medicine.  Reimbursements for primary care work continue to lag and physicians are now spending more time with administrative duties than they are with patients.   I do not believe that the so called post graduate training “bottleneck” will come into play.  I would suggest that many primary care training slots will go unfilled over the next 5-10 years even without increasing the numbers of available positions.  Increasing training slots for primary care specialties may do nothing to alleviate shortages if there are no students who wish to train.  While medical school enrollments have increased over the last decade, much of this increased enrollment may be due to a lack of jobs available to recent college graduates.  Moreover, as the ACA continues to evolve, physicians are now realizing lower compensation rates, increased work hours, more administrative duties and LESS time spent caring for patients.  Many physicians are forced to double the number of patients seen in a clinic day–resulting in less than 10mins per patient–in order to meet overhead and practice expenses.  In a separate article in the New York Times, author and cardiologist Sandeep Jauhar discusses the increased patient loads and subsequent higher rates of diagnostic testing that is required in order to make sure that nothing is missed–ultimately increasing the cost of care.

For most of those who have entered medicine, the attraction to the profession is all about the doctor-patient interaction and the time spent caring for others.  I would argue that the primary care shortage (and likely specialist shortage) will worsen in the future.  Many bright minds will likely forego medicine in order to pursue other less government-regulated careers.  In addition, many qualified primary care physicians will opt out of the ACA system and enter into the rapidly growing concierge care practice model.  The answer to the physician shortage may be more political than not–politicians must realize that laws and mandates only work if you have citizens willing to devote their time, energy and talents to the practice of medicine.  Going forward, more consideration must be given to physician quality of life and autonomy must be maintained.  In order to make healthcare reform sustainable, those in power must work with those of us “in the trenches” and create policies that are in the best interest of the patient, physician and the nation as a whole.  Cutting costs must be approached from multiple angles–not simply reducing the size of the physician paycheck.

Medicine remains a noble profession.  Those of us that do continue to practice medicine are privileged to serve others and provide outstanding care.  In order to continue to advance, we must continue to attract bright young minds who are willing to put patients and their needs above their own–at all costs.  I think that there is still HOPE to save medicine in the US.  It is my HOPE that our government will soon realize that in order to continue to propagate a workforce of competent, caring physicians we must provide time for physicians to do what they do best–bond with patients and treat disease.  (as opposed to typing into a computer screen and filling out endless reams of electronic paperwork).  It is my HOPE that those physicians in training  that will follow in my generation’s footsteps will realize the satisfaction that comes from impacting the health and lives of patients over time.  It is my HOPE that the ART of medicine can be saved before it is too late….

 

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Privacy in the Era of Mobile Tech and Social Media: Facebook Fallout and New Innovations for Protecting Your Privacy

Did Facebook cross the line when conducting human behavior social experiments last year?  I think so.  When conducting scientific research on human subjects investigators are held to very high standards.  Currently there is global outrage over the experiment and government regulators from several countries are currently looking into the matter a bit more closely.  As I described in my blog a few days ago, Facebook recently published a paper in the Proceedings of the National Academy of Science reporting on a study that they conducted in September 2013.  In this study, researchers purposefully manipulated the News Feeds of randomly selected users in order to determine effects on mood and emotion.  None of the subjects were aware of the experiment and none had provided specific informed consent.

Many academic investigators as well as social media experts from across the globe have taken issue with the lack of specific informed consent and the utilization of subjects without any notification–until the paper was published in a well respected academic journal this last week.  Some groups have petitioned the Federal Trade Commission (FTC) and Facebook has had very little to say–other than “we are sorry…and we are adopting stricter internal review standards for future research.”

How can we avoid situations like this in the future?

Obviously, with the Facebook situation, public outrage and potential regulatory action by governments in many parts of the world may help limit these types of activities by social media platforms in the future.  Currently, several countries including both the US and many throughout Europe are discussing ways to limit privacy incursions such as the Facebook experiment in the future.

Unfortunately, the utilization of data by large social media platforms and organizations may not be the biggest threat to you and your privacy.  Hackers and other criminals are grabbing data from consumers–without their knowledge–from mobile devices such as tablets and smartphones.  These devices are placed in the hands of children, and often lie around the house and are frequently left “on” and unattended.

One inventor from New York City–Michael Sorrentino– has created a new device that can help keep you, your family and your data a little safer.

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Called the iPatch case, this device may change the way you think about your mobile device and its self contained camera.  Hackers and other criminals can actually utilize your own smartphone camera to take pictures of your home or office and can even build a 3D model of your house.  This can result in identity theft, theft of real property or utilizing your images without consent for whatever purpose the criminals deem necessary.  Disguised as a harmless camera application that is often downloaded, these programs can access your camera and obtain images without your knowledge or consent.  Other malware programs have been developed and innocently disguised as harmless games or apps for download.  Software has been developed (and sold by hackers for less than $50 dollars) that can infiltrate your device and control your cameras–stealing sensitive documents, creating models of a home or office or even snapping shots of your children.

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The device–called the iPatch is now in development.  Mr Sorrentino is currently working on the prototype and will be marketing the device once produced.  WIth the iPatch device one flip of a switch will cover and eliminate photo functionality from both the front and back camera of your smartphone.  The device is being developed through crowd-sourcing efforts and is expected to enter production this year.

Mobile technology is changing the way we interact and how we share information.  Issues such as the Facebook “experiment” should give us all pause to consider our safety as we continue to embrace social media, mobile technology and information sharing.  In the future, innovations such as the iPatch are likely to continue to emerge and will ultimately provide us with more options for staying safe while staying engaged and connected in our busy technology driven lives.  Most importantly, as parents, we must set good “mobile behavior” examples for our children and take measures to improve the security of our devices and our information.  Social Media is embedded in the fabric of our lives–and this is a good thing–we must, however, take care to continue to be vigilant and protect ourselves and our families from the new world of cyber-crime.