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Demystifying Medicine One Week at a Time

Category: health care work force (page 1 of 5)

Brigham Braces for Uncertain Future

If you’re interested in healthcare, health finance, and technology, consider adding STAT to your favorites. It’s a smart, online-only publication from the Boston Globe that features a great mix of seasoned health care journalism and many new voices (including an excellent first-person column).

This recent article by Ron Winslow (recently retired from 30+ years at the Wall St. Journal) is a great case in point:

Winslow adeptly takes readers though some of the tough decisions around budgeting at the august Brigham and Women’s Hospital in Boston. “The Brigham,” as it’s known, is a mecca for advanced specialty care, medical research, and a major affiliate of Harvard Medical School.

Teaching hospitals are complex economic engines, both bringing in and spending hundreds of millions (billions, in some markets) of dollars.

Such academic centers have long had a reliable flow of federal dollars through Medicare for patient care and resident training, as well as research grants though the National Institutes of Health.

But both of these resources are challenged as the federal budget for research and development grows ever more uncertain.

In addition, hospitals are under tremendous cost pressure (and deservedly so!) from insurers, who bargain to get beneficiaries better rates–and make the health care dollar stretch further.

Take a look a Winslow’s piece. If you’re at all interested in business, finance, economics, and/or health care, you will learn a lot about process in complex organizations. I’m guessing we will be seeing a lot more of this in the health care world.

Kudos to Winslow and STAT for a great investigative piece and to the Brigham for providing transparency into their finances and decision-making processes.

The ‘One Stop Shop’

“How can you expect patients to look after their health, when they don’t know where they will be living next week? You can not separate people’s physical health from their psychological, social and spiritual health.”

So asked community health nurse Ruth Chorley, in an article by Rachel Pugh in the Guardian.

The story reported on a local program in Oldham, one of the UK’s National Health Service districts, in which nurse specialists work to help people whose social and economic problems prevent them from managing their health.

From the story:

Chorley is a focused care practitioner – one of four employed by Hope Citadel Healthcare, a not-for-profit community interest company, to lead a pioneering approach to delivering healthcare to the most needy families in its four Greater Manchester NHS GP practices, by filling in the gaps between health and social care.

I think this small scale NHS experiment is one right way to truly improve a  community’s health.

Match Day 2017

Click on the link below to see an essay from NPR on learning from and working with foreign medical graduates.

All in honor of St. Patrick’s Day, which this year is also Match Day — when medical students learn where they will match for residency — the next chapter in their training.

Berkeley’s Budget Blues

berkeleycampusLisa Aliferis of KQED wrote a nice explainer on the budgetary threat to a niche program that trains California students in both medicine and public health.

Known simply as ‘The Joint Medical Program,’ and founded in 1971, it’s a combined effort between the University of California’s flagship campus in Berkeley, and the prestigious medical school across the bay at the University of California San Francisco.

The program accepts 16 students per year, and half of the graduates over the years reportedly enter primary care fields like Family Medicine or Internal Medicine.

With the national rate of medical school graduates entering primary care fields hovering near 10%, a program that offers dual degrees (such as MPH or MBA on top of the MD) and still churns out practitioners and scientists committed to primary care is noteworthy.

Now the Joint Program is threatened with closure. Due to budget deficits, the university’s Chancellor has decreed that all campus programs must be examined top-to-bottom for savings. Some programs will be cut or consolidated, and the Joint Program is one such program as deemed by the administration of Berkeley’s School of Public Health.

Students and alumni are upset by the program’s threatened closure, and an online petition to save the program has started.

As a primary care physician, it saddens me to think that a program producing dually-degreed doctors interested in systems (public health, organization, business, etc.) beyond ‘just’ direct patient care is under threat. It seems that the Joint Program is valuable and has a successful track record in producing physician leaders.

On the other hand, now in the role of a full time campus administrator facing severe budget cuts, I also empathize with the Berkeley executives who are in a no-win situation.

Aliferis’ article stated the School of Public Health needs to cut $900,000 from its budget — which is why the Joint Program is such a ripe target.

Is there a Silicon Valley donor willing to step in to save (or even grow!) the program?

Health Care Predictions Re-Visited

Luciano Lozano. 'Be the bonsai.'

Luciano Lozano. ‘Be the bonsai.’

Happy New Year, one and all! I hope that it’s a healthy one for you.

Since we’re here at the beginning of 2016, it’s time again to look at some predictions I made about health care in the U.S way back in 2013 (also revisited a year ago).

  1. Obamacare will move ahead. Despite 2 different hearings before the Supreme Court and dozens of repeal challenges, the Affordable Care Act stands.
  2. Medicine will enter the era of ‘Big Data.’ Anyone seen those TV ads for ‘Optum,’ (to name just one big data player)? We are already here.
  3. Big data will lead to targeted medical marketing. This wasn’t even a prediction. It’s already been happening for years.
  4. Greater price transparency will come to health care. Not really close to cracking this nut, but a lot (a ton!) of attention is now focused this way.
  5. By 2020, all states will have expanded Medicaid. We are already to 30 states plus the District of Columbia. More on the way.
  6. The number of uninsured will be cut in half within four years. Not quite there yet, but the number of uninsured is the lowest since 1972.
  7. The number of NPs and Physician Assistants will continue to grow, as will the field of community health workers. Yes and yes.
  8. We will see the first nationwide health plans. Yes — the key word here is consolidation — insurers, hospitals, etc.
  9. Finally, a continuous doctor-patient relationship will become a luxury that can be purchased. Everything keeps pointing in this direction.

I’m giving myself a solid seven out of nine this year, up one from last year — and the remaining two predictions are also likely to prove true over time.

One area not covered here that will continue to see explosive growth: Telemedicine. It’s the Wild West. Which company will emerge as a market leader? Stay tuned.

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