Physicians Relatively Happy with Their Careers

 

How happy are physicians with their careers?

In a recent survey of 1001 physicians,

• About 84% said they like being a physician.
• Nearly as many were happy with their choice of specialty.
• Yet, two-thirds said they used to enjoy being a physician much more than they do today.

More than half do not regret anything about their choice of a career path. However, one-in-five would choose a career outside of medicine if they could go back and do it all over again.

What bugs doctors?

• Four-in-ten believe there is too much interference by third-parties;
• Nearly 14% believe their ability to practice independently is slipping.
• Nearly three-quarters have no interest in becoming a patient-centered medical home.

About 10% are working in a direct-pay practice, while 43% are considering it. Yet, nearly 40% believe high deductible health plans and cost-sharing are a barrier to good health care for their patients.

Most docs are workaholics

• Only one-quarter work fewer than 40 hours per week,
• About 46% work more than 50 hours per week.
• Understandably, 70 percent don’t have as much personal time as they wish they had.

Only about half believe they have a good work/life balance. Just over half do not believe they can afford to sacrifice income to work less.

Health Facilities Lag Booming Building Market

 

This morning’s release of a booming construction report from the Census Bureau once again shows lagging spending on new health facilities, especially in the public sector (see Table I).

20150901 TI

A Welcome Break – Moderate Health Spending Growth in Q2 GDP

 

Last week’s second estimate of Gross Domestic Product for the second quarter confirms that growth in health spending took a welcome break. Unfortunately, it is not a clear break in the trend of health spending consuming an increasing share of our national income.

When we compare 2015 Q2 to 2014 Q2 annualized spending, health care is still consuming a slightly disproportionate share of GDP. Health spending grew $106 billion, comprising 17 percent of the $632 billion change in GDP. GDP only grew 3.66 percent, while health spending grew 5.47 percent.

The Big Box Retailer in Health Care

 

Back in the 1950s, department stores were the big box retailers of their day. Rather than go to different specialty stores for shoes, hats, coats and bed linen, one only had to stop by Macy’s. About that same time, discount stores like Walmart began to crop up around the country. As time went on, the size of discount stores increased to the point that super centers are now common. Other companies began to copy this retail model. Home Depot and Lowes reinvented the lumber yard and combined it into a big hardware store/home center. Sam’s Club and Costco began to sell food, electronics, clothing and merchandize in bulk — all under one big roof. Big Box retailers provide the convenience of one-stop-shopping, at prices that are lower than specialty stores. By contrast, consider the Big Box retailer in health care: hospitals.

The FDA Wants to Regulate Feces Like a Drug

 

Slang words describing human feces are often used to denote products of poor quality or that have absolutely no value whatsoever. A product that is substandard is sometimes derisively referred to as “crap” — or worse. Now, a company in Massachusetts is collecting fecal material into a “stool bank,” and selling the screened preparations to hospitals for $385 apiece. The material is later injected into sick patients’ digestive tracts infected with Clostridium difficile.  These are difficult-to-treat bacterial infections that kill an estimated 14,000 people annually. The donated feces are obtained from healthy donors, who are paid $40 per donation. The average donation is screened and divided into four preparations, enough to treat four patients. In a clinical trial, the results from using donated fecal material were superior to using antibiotics.

Physicians Report Declining Satisfaction with EHRs

 

This post is excerpted from an article, Physicians Report Declining Satisfaction with EHRs, from the American Academy of Family Physicians. The report was sent to us by Dr. Larry Pivnick, who authored a report on electronic health records.

“During the past decade, America’s physicians — particularly, family physicians — have invested lots of money and countless hours in implementing electronic health record (EHR) systems. Some physicians eagerly dived into the EHR pond; others were pushed by government initiatives, such as meaningful use, that were intended to spur technology uptake but that have become increasingly burdensome to physicians.”

[I]n 2010, 61 percent of respondents said they were “satisfied” or “very satisfied” with their EHRs, compared with just 34 percent in 2014.
Of physicians who responded to the 2014 survey,

  •  55 percent said it was difficult or very difficult to use their EHR to improve efficiency,
  •  72 percent said it was difficult or very difficult to use their EHR to decrease workload,
  •  54 percent indicated that their EHR system increased their total operating costs, and
  •  43 percent said they had not yet overcome productivity challenges associated with implementation of their EHR.

“From the physicians’ perspective, it appears that the significant investment in EHR system(s) over the past few years in the United States is failing to offer significant returns. Far from helping physicians to operate efficiently and have more time to spend with patients, the opposite appears to be the case.”

Source: Physicians Use of EHR Systems 2014

More than 40% of Employers will be Exosed to the Cadillac Tax in Coming Years

 

A controversial part of Obamacare imposes an excise tax on high cost health plans. Beginning in 2018, the so-called Cadillac Tax will impose a penalty of 40 percent of all costs in excess of $10,200 for employee-only coverage and $27,500 for family coverage. The threshold increases annually with inflation; that is regular inflation, not medical care inflation which rises at more than double the rate of general inflation.

Employers have a few options to avoid the tax. But all are things workers dislike, such as increasing cost-sharing, eliminating covered services, eliminating tax-free dollars for HSAs, HRAs and FSAs and adopting narrow networks.

The Kaiser Family Foundation looked at the proportion of firms offering health benefits plans that are expected to reach the threshold.

 

 

kaiser1

If you only look at large firms employing 200 workers or more, nearly half (46%) will have health plans subject to the tax in 2018. More than two-thirds (68%) will have health plans subject to the tax by 2028.

The tax exclusion for employee health insurance is worth approximately 40% to 45% (25% marginal tax rate, 15.3% payroll tax and maybe 5% state and local tax). What the Cadillac Tax does is impose a 40% tax on the excess costs over the threshold. What that basically means is the open-ended tax exclusion for employer sponsored health plans has been limited to $10,200 per individual and $27,500 per family.

Pro: Limiting the tax exclusion may encourage health plans to look for ways to reduce medical spending.

Con: Over time more and more people will be subject to the tax.

Should the Cadillac Tax be repealed?   Let me know what you think!

Study: Kids are Tossing Mandated Fruits and Veggies in Trash

 

A controversial federal lunch program — mandating healthier school lunches — is up for reauthorization in the coming weeks. The Healthy, Hunger-Free Kids Act of 2010 set minimum nutritional standards for school lunches — the first major change in 30 years. The Act mandated smaller portion sizes and required the addition of fruits and vegetables.

So what are school kids doing with all those healthy fruits and vegetables they’re required to accept? A new study looked at fruit and vegetable consumption before and after the Act using a video camera footage. Kids are tossing their healthy snacks straight into the trash – otherwise known as File 13 in my grade school! According to research in that was published in Public Health Reports, school kids are consuming fewer fruits and vegetables than before; boosting food waste by more than one-third.

Doctors and Guns

 

By Lawrence N. Pivnick MD JD

Something is rotten with the state of medicine today. Well, more than one thing actually, but today’s complaint concerns the fact that your doctor has been conscripted by the federal government to spy on your gun closet. This has occurred despite the fact that as Obamacare moved its way through Congress, gun rights proponents, fearing the establishment of a federal firearm registry, acted to ensure that the program could not be used as a legal basis for mandating inquiries about gun ownership.

Money for Nothing: California’s Reckless Medicaid Expansion

 

(A version of this Health Alert was published by the Riverside Press-Enterprise on August 14, 2015.)

California has enrolled three times as many people as originally projected in Medi-Cal, the welfare program that subsidizes low-income Californians’ access to health care. The total is now 12 million, about one third of the population.

The current over-enrollment is provoking yet another fiscal crisis for the state, which is in a downward spiral of tax hikes and welfare dependency that is crushing job growth. Californians should be outraged that the state has condemned one third of their neighbors to dependence on this poorly performing welfare program.

Medi-Cal’s costs have jumped from $91.5 billion to $115.4 billion since Obamacare was passed in 2010. These costs are partially disguised because the federal government picks up much of the tab. However, federal handouts only camouflage real fiscal pain for the state. Legislators reconvened on August 17, in the hopes of finding $2.3 billion dollars to pony up the state’s share.  $1.3 billion is needed to increase fees to doctors and dentists who are paid so little that they are increasingly unwilling to see Medi-Cal patients. Another $1 billion has to be found to replace a deceptive “tax” that manipulates the formula to calculate federal funding, which the Obama administration has declared illegitimate.