Category: Physicians

Are Doctors Too Optimistic?

Doctors were up front about their patients’ estimated survival 37 percent of the time; refused to give any estimate 23 percent of the time; and told patients something else 40 percent of the time. Around 70 percent of the discrepant estimates were overly optimistic.

This optimism is far from harmless. It drives doctors to endorse treatments that most likely won’t save patients’ lives, but may cause them unnecessary suffering and inch their families toward medical bankruptcy.

Source: The New York Times.

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May 09, 2013 | 12 comments | by

One More Reason Why We Are Going to Have Physician Shortage

Here’s something by Jeff Goldsmith that I missed a few weeks ago:

We will be replacing a generation of workaholic, 70-hour-a-week baby boom physicians with Gen Y physicians with a revealed preference for 35-hour work weeks. During this same period, we’ll be adding 1.5-1.7 million net new Medicare beneficiaries a year and enfranchising perhaps 25 million newly insured folks through health reform. “Train wreck” is the right descriptor of the emerging primary care supply situation.

What about doubling physicians’ patient panels to more than 5,000?

I’ve visited real-world group practices organized this way. They reminded me of nothing so much as “I Love Lucy’s” famous chocolate factory assembly line. It was exhausting simply watching the physicians sprint through their days. You wanted to install oxygen carrels for them to catch their breath. Gen Y docs aren’t going to practice 28-slot days, with intensive “break times” to answer their emails and make phone calls. Neither are Gen Y nurse practitioners.

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Apr 26, 2013 | 11 comments | by

Atlas is About to Shrug

Six in 10 physicians (62 percent) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years, a survey from Deloitte Center for Health Solutions found. That perception is uniform across age, gender, and specialty, it said.

Another 55 percent of surveyed doctors believe others will scale back hours because of the way medicine is changing, but the survey didn’t elaborate greatly on how it was changing. Three-quarters think the best and brightest may not consider a career in medicine, although that is an increase from the 2011 survey result of 69 percent.

Hat tip goes to David Pittman.

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Mar 26, 2013 | 12 comments | by

Obamactopus

It is estimated that by next year, about 50% of U.S. doctors will be working for a hospital or hospital-owned health system…physician productivity falls under these arrangements, sometimes by more than 25%…Often they see fewer patients and perform fewer timely procedures. Continuity of care also declines, since a physician’s responsibilities end when his shift is over.

More from Scott Gottlieb.

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Mar 18, 2013 | 11 comments | by

Why Physicians Make Mistakes

Drawing on his own clinical experience and on academic studies, Cohn explained that about one-third of these errors appear to be products of misdiagnosis, one cause of which is “anchoring bias”: human beings’ tendency to rely too heavily on a single piece of information. This happens all the time in doctors’ offices, clinics, and emergency rooms. A physician hears about two or three symptoms, seizes on a diagnosis consistent with those, and subconsciously discounts evidence that points to something else. Or a physician hits upon the right diagnosis, but fails to realize that it’s incomplete, and ends up treating just one condition when the patient is, in fact, suffering from several. Tools like Watson [the IBM computer] are less prone to those failings. As such, Cohn believes, they may eventually become as ubiquitous in doctors’ offices as the stethoscope.

Jonathan Cohn in The Atlantic. HT: Austin Frakt.

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Mar 06, 2013 | 10 comments | by

Why Doctors are Becoming Scarcer

This is from Bryan Caplan. Full post is worth reading:

If you peruse this table, you’ll discover that total number of new M.D.s per year has been virtually flat for 30 years. During this period, population increased over 30%. As a result, the new M.D./population ratio has declined for decades.

If you’re not horrified, consider that the senior population ― doctors’ best customers ― increased by over 50%. As a result, new M.D.s per senior fell by about a third over the last three decades.

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Mar 05, 2013 | 18 comments | by

Is the Cleveland Clinic Replicable?

Great institutional cultures can accomplish great things. But in some ways, that’s a problem for the rest of us. It’s natural to want to emulate the achievements of Cleveland Clinic in our policies. But you can’t make a culture out of rules. Culture is an organic outgrowth of an organization’s history, it’s people, its successes and failures. It cannot be ordered from the top, or nurtured by simply altering the financial incentives. Cosgrove speaks of maintaining the institution’s culture in much the way that he talks of maintaining their electronic health records system: a constant process of checking in, re-evaluating, and upgrading.

We can salary doctors and order them to care as much as the Cleveland Clinic doctors and administrators do about continual improvement. We can mandate checklists and appointment follow ups and staffing levels. But we can’t make them be the Cleveland Clinic.

More from Megan McArdle on Cleveland Clinic’s salaried physicians.

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Mar 04, 2013 | 12 comments | by

Why ACOs Won’t Work

Doctors: ACOs aren’t designed or equipped to transform physician behaviors on the scale that will be needed.

Patients: There is no preferential pricing, discounting or other way for ACOs to steer patients to the most effective providers.

ACO Management: Even the most optimistic assumptions come up with relatively small reductions to annual health-care spending nationally.

Clayton Christensen, et al in the WSJ.

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Feb 21, 2013 | 6 comments | by

The 15,000 Doctor Gap

Source: Association of American Medical Colleges.

Sarah Kliff discusses causes and solutions.

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Feb 18, 2013 | 5 comments | by

Doctors On Tap

HealthTap:

[T]heir mobile app connect[s] you with doctors who [can] answer your health questions at any time, right on your smartphone. Now, HealthTap has improved its service to give you personal and private medical consultations, a directory of local doctors, all ranked by quality, and the ability to schedule in-person appointments right through the app.

HT: Jason Shafrin.

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Feb 15, 2013 | 6 comments | by
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