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Demystifying Medicine One Month at a Time

Category: health care work force (page 2 of 6)

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.

White Coat Vote

ared_trailer_fpoDoes your doctor/health professional wear a traditional white coat?

Do you favor it? Or do you think it creates a barrier that makes it harder to connect with or question her?

What about infection? Studies show that health professionals in general don’t launder their white coats often enough. Other studies show that the garments harbor potentially pathogenic bacteria. But no studies or reports have yet demonstrated specifically that white coats have been a vector of transmission.

There’s been a flurry of media around the topic recently: At various Infectious Diseases society meetings, many member physicians have been advocating for a change in our white coat culture — trying to get health care workers to remove their white coats and go “bare below the elbows.”

I won’t rehash the points of view here; instead, there are several links you can peruse if you’re interested in this topic that I will provide below.

Philip Lederer, an infectious diseases doctor in Boston, has been one of the main advocates against white coats: He wrote about it here, then blogged about it here.

I interviewed Dr. Lederer about the topic for Tulsa Public Radio here; then the Boston Globe ran a front page story about the debate here.

I tried to summarize the viewpoints (and offered a bit of personal narrative) for NPR here; then Dr. Lederer wrote a response here. His website provides a fine array of information about this issue.

What are your thoughts? Vote by leaving a comment here or tweeting me @GlassHospital. If you’re not a tweeter, send a SnapChat (just kidding….kids these days!).

Being Black and a Doctor in America

Imagine you’ve a new medical student. You’re trying to prove yourself among your professors and your peers. You dress the part, you work hard, and early on you start feeling like you can do it.

Then one morning as you enter the lecture hall, the professor says, “Oh — you’re here to fix the lights. What took you so long?”tweedybook

You turn around, thinking he can’t be talking to you. But there’s no one behind you. He has simply assumed that you’ve come to answer his maintenance request, because of the color of your skin.

Now imagine you’re a resident, a doctor-in-training, working in hospitals to diagnose and treat patients at all hours of day and night. You enter a cubicle in the Emergency Department to evaluate your next patient, and he blurts out, “I don’t want no n**ger doctor.” Welcome to the profession.

Such are the experiences of many African-American medical students and doctors in the U.S. Not only must minority medical students excel with the content of medical science, they must develop strategies for coping with people’s pre-conceived notions about them based on their race.

A new memoir by one black doctor, Damon Tweedy, recounts his journey through these travails to become a faculty member in psychiatry at Duke University.

I was fortunate enough to interview Dr. Tweedy recently, and I found him to be just like the self he presents in the book — thoughtful, warm-hearted, and very open and engaging. His memoir is an excellent read, one that I would strongly recommend to anyone thinking about joining the health care field — or anyone who likes memoir, recent U.S. history, or the study of race relations.

His book has generated reviews in major news sources, and while all of them laud his candor and writing, some criticize Dr. Tweedy for not fully addressing the policy questions surrounding the dearth of blacks (particularly black males) in the medical profession. I think this is an unfair criticism, because in telling his story, Tweedy moves the discussion forward and teaches Americans not in the medical profession something that the folks in charge of medical education already know.

Tweedy’s book will move us forward in creating more inclusivity in Medicine. It’s incumbent on all of us in health and education to think through ways of improving this imbalance.

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