Check out this interesting article in the Economist about how to reduce the level of greenhouse gas emissions caused by hospitals.
It cites a study published in the Journal of the American Medical Association that estimates that 8% of U.S. greenhouse gas emissions come from hospitals. Unfortunately, a solution is not as simple as building more efficient hospitals or reducing the amount energy expended to care for patients. That's because most of the carbon emissions are the result of pharmaceutical and medical equipment waste.
So what can hospitals do? The only truly effective remedy, as proposed in the article, is to simply keep patients out of hospitals...easier said than done, unfortunately. This would require more prevention, consultations over the phone/internet, and perhaps even doctor home-visits.
Much has already been discussed about the benefits of treating chronic diseases at the patients' home instead of in a hospital bed. These benefits would contribute to lower health care spending (an extremely relevant topic), greener practices, and improved safety and quality. In addition to the supposed better health of patients who have engaged in preventive measures, these patients would also eliminate the risk of serious infections that can occur in a hospital. The result: money saved and reduced greenhouse gas emissions.
Saturday, March 13, 2010
Thursday, March 4, 2010
Technology in med schools: iPods and 3D images
I came across these articles related to new technology's integration into medical education programs throughout the country:
Students at Ohio State College of Medicine are "freeing" up their time by listening to reduced lectures on their iPod's. Recorded versions of lectures can be edited to eliminate pauses and other non-essential elements. This allows students more time to view surgeries, shadow docs, and visit with patients. Other mobile functions include watching videos of procedures and reading up on current medical journals.
Meanwhile, students at the University of Aberdeen's med school are piloting a system of using Hollywood 3D technology to view detailed images of MRI's and CAT scans in class. The technology is similar to that used in the record-shattering blockbuster, Avatar. Unfortunately for me, I had a difficult time enjoying that film due to the side-splitting migraine it gave me. I knew medical school would be a headache, but this takes it to an entirely new (literal) level.
Students at Ohio State College of Medicine are "freeing" up their time by listening to reduced lectures on their iPod's. Recorded versions of lectures can be edited to eliminate pauses and other non-essential elements. This allows students more time to view surgeries, shadow docs, and visit with patients. Other mobile functions include watching videos of procedures and reading up on current medical journals.
Meanwhile, students at the University of Aberdeen's med school are piloting a system of using Hollywood 3D technology to view detailed images of MRI's and CAT scans in class. The technology is similar to that used in the record-shattering blockbuster, Avatar. Unfortunately for me, I had a difficult time enjoying that film due to the side-splitting migraine it gave me. I knew medical school would be a headache, but this takes it to an entirely new (literal) level.
Tuesday, March 2, 2010
My Op-Ed on Mass. health policy
So I had to write an Op-Ed for one my classes and, naturally, I chose to address health care. My somewhat long piece (sorry!) is in response to recent legislation proposed by Massachusetts' governor Deval Patrick. We had to assume the position of a leader in the state; therefore, I am the CEO of a community hospital...my dream job. Enjoy!
Community hospitals that treat most of the country’s lower-income and older citizens would be forced to compromise excellent patient care due to Patrick’s legislation. Unlike specialty hospitals and larger academic medical centers, community hospitals serve significantly more government-subsidized patients than those with private health insurance. These patients include low-income individuals who have state and federally funded Medicaid as well as those ages 65 and older with federally subsidized Medicare, in addition to other government-run programs. On average, a community hospital’s patient population includes about 55% to 65% of patients with government-subsidized health insurance; the remaining patients subscribe to private health insurance paid by their employers or out of pocket.
Because the government cannot afford to fully reimburse providers for the amount of costs associated with caring for Medicaid and Medicare patients, community hospitals must recoup losses by charging private insurers higher prices for care. Like any business, hospitals must adhere to basic principles of economics when designing pricing plans. In order to break-even, or generate enough revenue to at least cover costs, hospitals must charge private insurers for the deficit created by the government’s partial reimbursement system. On average, the government only pays community hospitals about 75% to 85% of the costs of caring for Medicaid and Medicare patients. Therefore, providers must impose a 15% to 25% premium on private insurers to simply maintain equilibrium between cost and revenue. This pricing strategy does not allow any room for the hospital to earn a margin, which would provide capital to invest in technology, expansion, and new employees. Further, many private insurance companies leverage their size to negotiate lower prices from providers; this deepens the financial strain on community hospitals.
Governor Patrick’s proposed cap on providers’ prices would force community hospitals to accept a deficit representing billions of dollars in revenue, patient services, and the quality and safety of the organization. Patrick’s bill allows the government to essentially squeeze providers from both ends. While continuing to offer only partial reimbursement for services, the governor’s legislation would prevent community hospitals from breaking-even. The consequences of which are dire for the entire health care industry.
If Patrick’s bill passes, community hospitals will have three basic choices. First, and depending on the financial health of the organization, community hospitals could redesign pricing strategies, eliminate patient services, and continue struggling to generate enough revenue to survive. This is a poor option for consumers, as patients would have to go elsewhere for important services like obstetrics, cardiac surgery, and radiation oncology. These services, among others, would most likely be eliminated first as they represent enormous costs for the organization due to required technology, specialist salaries, and insurance against risky procedures. Unless the financial performances of the organizations dramatically improve, community hospitals could continue cutting services until they exist solely as emergency clinics. The second choice is even bleaker. Community hospitals could decide that they cannot generate enough operational revenue to repay bondholders; this would force the closure of the organizations. Shutting down a community hospital, however, is a major ethical dilemma. Patients within the community would be forced to travel greater distances for care and would face longer wait times for appointments at larger specialty hospitals or academic medical centers.
The third and most likely option involves mergers and acquisitions among community hospitals and larger hospital networks. Massachusetts has already seen a vast number of partnerships develop in the past few years. Currently, most community hospitals in the state no longer exist as freestanding organizations but are affiliated with larger medical centers in Boston. The larger and more advanced centers treat severe cases while referring patients to community clinics for routine procedures. Patrick’s legislation, though, would alter the depth and breadth of hospitals’ affiliation. No longer would the partnership exist to provide patients with better care; rather, the organizations would become financially dependent on the network. Administration would most likely be streamlined to save costs, eventually resulting in only one or a few management teams controlling all the state’s hospitals.
The economic incentive for hospitals to join monopolistic networks would virtually eliminate consumer choice and contribute to decreased patient safety and quality. The basic theory driving hospitals to merge is known as economies of scale. Not unlike major U.S. corporations McDonald's and Wal-Mart, hospital networks would seek to generate revenue by keeping prices low and treating as many patients as possible. While consumers may benefit to some degree by this strategy in the restaurant and retail industries, health care is far too risky to put in the hands of just a few individuals. Further, while McDonald's and Wal-Mart certainly dominate their markets in terms of pricing, consumers still have many choices when searching for quality products. Health care, however, presents a challenge in terms of a patient’s ability to choose. Unlike fast food restaurants and retail stores, it takes a tremendous amount of capital to run a hospital; this means far fewer hospitals can exist than other business outlets. Patients, then, would have to travel extreme distances to reach a hospital run by a different network, not to mention that choice becomes virtually impossible while having a heart attack in the back of an ambulance.
Because the consumer’s choice is limited, there is significantly less incentive for health care managers to continually improve the safety and quality of patient care, particularly when such tasks involve financial investment. The tradeoff for the “dollar menu” at McDonald's and the steep discounts at Wal-Mart is the occasional dirty store, incompetent employee, and poor quality product. Is this something that residents of Massachusetts are ready to compromise for cheaper health care? If so, the true costs of health care may no longer be measured in a dollar amount but in patient dissatisfaction, medical errors, and lives lost.
Rather than proposing legislation that makes providers look like the enemy, the government should focus on managing their own expenses so that they can reimburse community hospitals for the full costs of treating Medicaid and Medicare patients. If that means raising taxes, than Massachusetts’ residents should elect a leader that has the fiscal responsibility and courage to do the right thing and fix health care in this state.
Measuring the True Costs of Health Care
Recently, Governor Deval Patrick proposed a bill that would allow the state insurance commissioner to cap the price of care charged by providers in Massachusetts. The motivation for this bill comes from years of debate as to how the government can curb health spending and relieve employers and individuals from paying increasingly high premiums for private health insurance. However, the governor’s proposals are purely political and would not effectively manage the cost of health care. Rather, providers, particularly community hospitals, would suffer greatly from the impact of such a bill. Further, Patrick’s legislation would contribute to a decline in patient safety and quality for the entire health care industry.Community hospitals that treat most of the country’s lower-income and older citizens would be forced to compromise excellent patient care due to Patrick’s legislation. Unlike specialty hospitals and larger academic medical centers, community hospitals serve significantly more government-subsidized patients than those with private health insurance. These patients include low-income individuals who have state and federally funded Medicaid as well as those ages 65 and older with federally subsidized Medicare, in addition to other government-run programs. On average, a community hospital’s patient population includes about 55% to 65% of patients with government-subsidized health insurance; the remaining patients subscribe to private health insurance paid by their employers or out of pocket.
Because the government cannot afford to fully reimburse providers for the amount of costs associated with caring for Medicaid and Medicare patients, community hospitals must recoup losses by charging private insurers higher prices for care. Like any business, hospitals must adhere to basic principles of economics when designing pricing plans. In order to break-even, or generate enough revenue to at least cover costs, hospitals must charge private insurers for the deficit created by the government’s partial reimbursement system. On average, the government only pays community hospitals about 75% to 85% of the costs of caring for Medicaid and Medicare patients. Therefore, providers must impose a 15% to 25% premium on private insurers to simply maintain equilibrium between cost and revenue. This pricing strategy does not allow any room for the hospital to earn a margin, which would provide capital to invest in technology, expansion, and new employees. Further, many private insurance companies leverage their size to negotiate lower prices from providers; this deepens the financial strain on community hospitals.
Governor Patrick’s proposed cap on providers’ prices would force community hospitals to accept a deficit representing billions of dollars in revenue, patient services, and the quality and safety of the organization. Patrick’s bill allows the government to essentially squeeze providers from both ends. While continuing to offer only partial reimbursement for services, the governor’s legislation would prevent community hospitals from breaking-even. The consequences of which are dire for the entire health care industry.
If Patrick’s bill passes, community hospitals will have three basic choices. First, and depending on the financial health of the organization, community hospitals could redesign pricing strategies, eliminate patient services, and continue struggling to generate enough revenue to survive. This is a poor option for consumers, as patients would have to go elsewhere for important services like obstetrics, cardiac surgery, and radiation oncology. These services, among others, would most likely be eliminated first as they represent enormous costs for the organization due to required technology, specialist salaries, and insurance against risky procedures. Unless the financial performances of the organizations dramatically improve, community hospitals could continue cutting services until they exist solely as emergency clinics. The second choice is even bleaker. Community hospitals could decide that they cannot generate enough operational revenue to repay bondholders; this would force the closure of the organizations. Shutting down a community hospital, however, is a major ethical dilemma. Patients within the community would be forced to travel greater distances for care and would face longer wait times for appointments at larger specialty hospitals or academic medical centers.
The third and most likely option involves mergers and acquisitions among community hospitals and larger hospital networks. Massachusetts has already seen a vast number of partnerships develop in the past few years. Currently, most community hospitals in the state no longer exist as freestanding organizations but are affiliated with larger medical centers in Boston. The larger and more advanced centers treat severe cases while referring patients to community clinics for routine procedures. Patrick’s legislation, though, would alter the depth and breadth of hospitals’ affiliation. No longer would the partnership exist to provide patients with better care; rather, the organizations would become financially dependent on the network. Administration would most likely be streamlined to save costs, eventually resulting in only one or a few management teams controlling all the state’s hospitals.
The economic incentive for hospitals to join monopolistic networks would virtually eliminate consumer choice and contribute to decreased patient safety and quality. The basic theory driving hospitals to merge is known as economies of scale. Not unlike major U.S. corporations McDonald's and Wal-Mart, hospital networks would seek to generate revenue by keeping prices low and treating as many patients as possible. While consumers may benefit to some degree by this strategy in the restaurant and retail industries, health care is far too risky to put in the hands of just a few individuals. Further, while McDonald's and Wal-Mart certainly dominate their markets in terms of pricing, consumers still have many choices when searching for quality products. Health care, however, presents a challenge in terms of a patient’s ability to choose. Unlike fast food restaurants and retail stores, it takes a tremendous amount of capital to run a hospital; this means far fewer hospitals can exist than other business outlets. Patients, then, would have to travel extreme distances to reach a hospital run by a different network, not to mention that choice becomes virtually impossible while having a heart attack in the back of an ambulance.
Because the consumer’s choice is limited, there is significantly less incentive for health care managers to continually improve the safety and quality of patient care, particularly when such tasks involve financial investment. The tradeoff for the “dollar menu” at McDonald's and the steep discounts at Wal-Mart is the occasional dirty store, incompetent employee, and poor quality product. Is this something that residents of Massachusetts are ready to compromise for cheaper health care? If so, the true costs of health care may no longer be measured in a dollar amount but in patient dissatisfaction, medical errors, and lives lost.
Rather than proposing legislation that makes providers look like the enemy, the government should focus on managing their own expenses so that they can reimburse community hospitals for the full costs of treating Medicaid and Medicare patients. If that means raising taxes, than Massachusetts’ residents should elect a leader that has the fiscal responsibility and courage to do the right thing and fix health care in this state.
Monday, March 1, 2010
Starbucks v. NESCAFE, an employee's taste test
This morning, a team of guerrilla marketers pulled up to my school outside the cafe where I was eating breakfast. This is not an uncommon phenomenon as many companies seek the young, easily persuaded market of poor college students who will take samples of just about anything as long as its free.
This time, it was a team from NESCAFE, a company that produces instant coffee. They were handing out free samples of their product and challenging people to compare the taste to that of "expensive coffee stores", eh'em...Starbucks.
The picture on their bags even showed one of these expensive coffees (a white cup with a suspiciously familiar green logo) next to the NESCAFE product. However, if you look closely at this picture I snapped, you can see the team leader sipping not an instant coffee drink, but a Starbucks product...whoops!
I guess he is just confirming his own conviction that Starbucks is highly inferior to the product he is getting paid to represent, right??
This time, it was a team from NESCAFE, a company that produces instant coffee. They were handing out free samples of their product and challenging people to compare the taste to that of "expensive coffee stores", eh'em...Starbucks.
The picture on their bags even showed one of these expensive coffees (a white cup with a suspiciously familiar green logo) next to the NESCAFE product. However, if you look closely at this picture I snapped, you can see the team leader sipping not an instant coffee drink, but a Starbucks product...whoops!
I guess he is just confirming his own conviction that Starbucks is highly inferior to the product he is getting paid to represent, right??
Sunday, February 28, 2010
Modeling leadership in health care
Check out this great interview published yesterday by the NY Times. Found in the weekly "Corner Office" section, the article features Tachi Yamada, M.D., current president of the Bill and Melinda Gates Foundation's Global Health Program. Dr. Yamada discusses his experience managing a variety of organizations including a small lab, a large department of medicine, an even larger R&D firm, and his current team at the Gates Foundation.
A few notable topics include: the importance of delegation, staying in touch with the organization, mentors, giving employees undivided attention, working with "what you have" and bringing out the best in people, the ability to endure change, humor, emotional intelligence, and giving feedback.
He is a true model and a rare example of successful health care leadership.
A few notable topics include: the importance of delegation, staying in touch with the organization, mentors, giving employees undivided attention, working with "what you have" and bringing out the best in people, the ability to endure change, humor, emotional intelligence, and giving feedback.
He is a true model and a rare example of successful health care leadership.
Have six and a half hours to spare?
President Obama's bipartisan Health Summit took place last week. Despite many political talking points clearly directed at the cameras in the room, there were some candid discussions that actually made the group of elected officials appear concerned about the health care debacle in this country.
While it seems that little progress was made in terms of major compromise, there were some promising steps towards inclusion of certain Republican concerns about the health bill. If nothing else, the six and a half hour summit acts as a good summation of the major debates regarding health care that occurred in Washington over this past year.
While it seems that little progress was made in terms of major compromise, there were some promising steps towards inclusion of certain Republican concerns about the health bill. If nothing else, the six and a half hour summit acts as a good summation of the major debates regarding health care that occurred in Washington over this past year.
My dream seminar
The newest "Short White Coat" entry, an interesting blog written by a fourth-year med student at Harvard University through the Boston Globe's website, discusses an extremely important idea: teaching doctors about competition and quality in health care delivery.
Ishani Ganguli, the blog's author, details a seminar she recently attended through Harvard's B-school. Taught by renown business scholar Michael Porter and Elisabeth Teisberg (who co-authored Redefining Health Care: Creating Value Based Competition on Results, an intimidating 430-page book that has sat unopened on my shelf for a year), the seminar brought together health care executives, physicians, and students.
Ganguli gets it right when she says this topic is "critical for all doctors to understand." Further, this was pretty much my dream seminar. I wonder how I can get invited to the next one..?
Ishani Ganguli, the blog's author, details a seminar she recently attended through Harvard's B-school. Taught by renown business scholar Michael Porter and Elisabeth Teisberg (who co-authored Redefining Health Care: Creating Value Based Competition on Results, an intimidating 430-page book that has sat unopened on my shelf for a year), the seminar brought together health care executives, physicians, and students.
Ganguli gets it right when she says this topic is "critical for all doctors to understand." Further, this was pretty much my dream seminar. I wonder how I can get invited to the next one..?
Thursday, February 18, 2010
More U.S. med schools, fewer opportunities?
My brother-in-law, Tom, brought this article from the NY Times to my attention. It discusses the expected surge in new U.S. medical schools. Some takeaway points:
During the 1980s and ’90s only one new medical school was established...If all the schools being proposed [today] actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country...And beyond the new schools, many existing schools are expanding enrollment, sometimes through branch campuses...
The proliferation of new schools is...a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system...
Many of the developing medical schools...are billing themselves as different from traditional medical schools, more focused on serving primary care needs in immigrant and disadvantaged communities. Administrators say that they expect that approach to be buttressed by a shift in state and federal reimbursements from specialists to primary care doctors....
Whether the demand for new medical schools exists among patients, it clearly exists among prospective doctors...The Association of American Medical Colleges, a trade group, has called for a 30 percent increase in enrollment, or about 5,000 more doctors a year. The association’s Center for Workforce Studies estimates that 3,500 more M.D.s will enter graduate training over the next 10 years...
Although the article points out that new schools in the U.S. will supply physicians for residency programs that would otherwise have to recruit international students, both Tom and I are weary that there will be enough residency spots for the higher demand. Either way, this is certainly a positive sign for anyone hoping to get into med school in the next few years.
During the 1980s and ’90s only one new medical school was established...If all the schools being proposed [today] actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country...And beyond the new schools, many existing schools are expanding enrollment, sometimes through branch campuses...
The proliferation of new schools is...a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system...
Many of the developing medical schools...are billing themselves as different from traditional medical schools, more focused on serving primary care needs in immigrant and disadvantaged communities. Administrators say that they expect that approach to be buttressed by a shift in state and federal reimbursements from specialists to primary care doctors....
Whether the demand for new medical schools exists among patients, it clearly exists among prospective doctors...The Association of American Medical Colleges, a trade group, has called for a 30 percent increase in enrollment, or about 5,000 more doctors a year. The association’s Center for Workforce Studies estimates that 3,500 more M.D.s will enter graduate training over the next 10 years...
Although the article points out that new schools in the U.S. will supply physicians for residency programs that would otherwise have to recruit international students, both Tom and I are weary that there will be enough residency spots for the higher demand. Either way, this is certainly a positive sign for anyone hoping to get into med school in the next few years.
Monday, February 15, 2010
Less autonomy than you might think
Physicians base their medical decisions on the clinical training they have received in school, practice of that knowledge during residency, and the vast experiences they have confronted during their career...right?? Well, not exactly.
A 2010 survey conducted by Health Leaders Media examined the external forces that affect physicians' decision-making. The study came in response to discussions about health reform in which proponents cite unnecessary tests prescribed by doctors (due to external pressures) as a major cause for rising health care costs. From the article:
While most doctors make clinically-sound decisions for nearly all patients, there are external pressures that can influence and increase the tests and procedures doctors order at the margins. An occasional unnecessary test times thousands of physicians and millions of patient encounters can quickly equal billions in unnecessary healthcare spending.
The survey measured four major factors: patients, fear of malpractice lawsuits, reimbursements/revenue considerations, and pressure from administrators and other third parties. There were some interesting results.
27.5% of physicians surveyed said that patients were a major influence, while 54.6% said they had a minor influence on medical decisions. This category measured how patients' requests determined medications, treatments plans, or tests. I have a feeling this number will continue to increase as pharmaceutical companies invest more money into marketing efforts aimed at getting patients to ask for certain drugs, tests, etc. Case in point: this article about patients requesting robot-assisted prostatectomies regardless of their doctors' recommendations largely due to the marketing efforts of specialists with the technology.
33.1% of respondents believe that fear of lawsuits has a major influence on decisions; 48.1% said malpractice has a minor impact. We have heard a lot of dialogue about malpractice or "tort" reform in the past several months. Perhaps these results will help push legislation through that limits the amount of a physician's influence (and cost) expended on fear of lawsuits.
30.2% indicated that reimbursement/revenue considerations had a major influence; 38.1% felt a minor influence on decision-making. I feel that this is a significant finding, especially as our health care system ponders whether or not to reform the way primary care physicians are paid. Clearly, reimbursement plays a role in the quality and nature of medical decisions.
11.2% of physicians said that pressures from administrators and other third parties had a major impact; 34.0% cited a minor impact. The article indicates that this is perhaps the most surprising finding and I agree. It is comforting to know that physicians can make medical decisions without overwhelming pressure from hospitals and health care groups to focus on the bottom line.
The point here is if you plan to go into medicine, be prepared to balance the many factors that affect a physician's decision. As if diagnosing a problem and prescribing a treatment plan weren't hard enough...
Wednesday, February 10, 2010
Its not me, its you
Check out this article from the Wall Street Journal about physicians "firing" patients for unruly behavior, continued drug abuse, etc. As you can imagine, there are strict rules for this process. Interesting read about something you might not otherwise consider.
Snow day
Classes cancelled tonight despite only getting a dusting. Too bad I had to submit a paper via email; I guess that's the downside of technology.
Who is walking barefoot through the icy sidewalks??
Who is walking barefoot through the icy sidewalks??
Tuesday, February 9, 2010
120 hours/week, 13 days straight
A new article in the American Medical Association's Graduate Medical Education e-newsletter addresses the highly debated topic of a hospital resident's working hours. Some surgical residencies require up to 120 hours per week, 13 days straight. Does this make the resident more prone to mistakes or contribute to his/her training??
Personally, I believe in the recommendations of medical professors over those of the state or federal government (who set the often ignored standards). However, I now know where they derive the term resident as this leaves the physician less than 50 hours per week at "home."
There are other nice features of the newsletter, like a link to this NBC Dateline special on the job of the first-year resident.
Personally, I believe in the recommendations of medical professors over those of the state or federal government (who set the often ignored standards). However, I now know where they derive the term resident as this leaves the physician less than 50 hours per week at "home."
There are other nice features of the newsletter, like a link to this NBC Dateline special on the job of the first-year resident.
Monday, February 8, 2010
A new prerequisite for med school, experienced speed-dater!?
Check out this article from the American Medical Association on one hospital's use of a patient-physician matchmaking event based on the speed-dating model. Patients have a chance to screen physicians for a period of 5 minutes before deciding if they want to make an appointment with the doc. This has apparently supplemented the hospital's marketing efforts and appears to be a successful program. Could a new question to the medical school application ask: what experience have you had with speed-dating? More importantly, were you successful??
Sunday, February 7, 2010
Saints, buffalo chicken, ETrade
The Saints pulled through! That made the delicious Super Bowl feast taste even better. MVP goes to my girlfriend's homemade buffalo chicken fingers...
It was a close game with some gutsy play calling by Saints coach Sean Payton.
After all that investment from Doritos and Bud Light, my favorite commercials belong to ETrade doing what they do best: toddlers and financial-speak.
It was a close game with some gutsy play calling by Saints coach Sean Payton.
After all that investment from Doritos and Bud Light, my favorite commercials belong to ETrade doing what they do best: toddlers and financial-speak.
Super bowl XLIV and undercover boss
I don't know which to be more excited about. If you haven't seen the preview for the new CBS reality show, Undercover Boss, check out a sneak peek below.
While I am not a reality TV fan, I am intrigued by the premise of this show. I only hope that it is not merely staged melodrama, but that it reveals something about the importance of upper management being attuned to an organization's employees. Further, the concept of a corporate boss on the front lines could work well in a health care setting (e.g., the CEO as a patient transporter, food service worker, etc.). We will have to see.
As for the Super Bowl, go Saints!!
Air travel and a better education
I recently saw this interesting parody of the health care industry in the form of a viral video titled "If Air Travel Worked Like Health Care." It was inspired by an article in the National Journal by Jonathan Rauch, which posed the question: what would the airline industry look like if it were run like the health care industry? The video is a good, comprehensive presentation of the administrative failures that are plaguing health care and driving up costs. Check it out.
Related, I found this great post on the NYTimes "Well Blog" discussing the implications of only educating med students on clinical topics while failing to address the social/economic aspects of health care.
An interesting piece of evidence--as cited by the article--was this study conducted by the journal of Academic Medicine that revealed that "the vast majority of students felt they had received adequate clinical training during their four years of schooling. But fewer than half felt they had had adequate exposure to health care systems and practice, an area of study that extends to subjects like medical economics, managed care, practice management and medical record-keeping."
Related, I found this great post on the NYTimes "Well Blog" discussing the implications of only educating med students on clinical topics while failing to address the social/economic aspects of health care.
An interesting piece of evidence--as cited by the article--was this study conducted by the journal of Academic Medicine that revealed that "the vast majority of students felt they had received adequate clinical training during their four years of schooling. But fewer than half felt they had had adequate exposure to health care systems and practice, an area of study that extends to subjects like medical economics, managed care, practice management and medical record-keeping."
The students that did receive the non-clinical training felt more satisfied with their education and did not believe that the extra courses took away from their clinical preparation. Further, medical education programs that have offered courses in these areas reported that it did not take long to teach students about such concepts (only about 16-17 lectures).
Dr. Pauline Chen, who authored the post, wrote about her education, "It was possible to learn about the economic and social aspects of health care while immersed in the details of biology, physiology and pharmacology...it was impossible to become a good clinician without doing so."
I am curious to see whether or not my future training will include such areas of study. Hopefully by then, programs around the country will have adopted a system of educating future physicians on the social/economic issues involved in medicine. Perhaps then will the health care industry begin to look not so frighteningly similar to the video above.
Tuesday, January 19, 2010
Why do I want to be a doctor?
While this may be fairly obvious, before you make the substantial investment into medical school (of time, money, and energy), it is important to make sure that you actually want to be a doctor. It is not uncommon for students to become attracted to the perceived financial rewards, social status, and humanitarian nature of a medical profession without fully considering the equal amount of disadvantages associated with such a career.
Med school is a long, long process. For me, I will have to complete a two year post baccalaureate, pre-medical education program in order to catch up on all the science requirements that I didn't take in college; a four year medical education (assuming I do not take a year off somewhere, which is not uncommon); a two to five year residency; and possibly a one to two year fellowship...all in hopes that I will pass my boards and can begin practicing soon after graduation. In all, this is roughly a decade of education with which comes a decade's worth of cost. Not only do tuition, books, and miscellaneous fees leave a large hole one's pocket, but the costs of living for 10 years with little to no income only worsen the financial outlook (check aamc's website for some financial advice). So why bother?
I believe that my skill set, career goals, and the current challenges/opportunities of health care make medicine the correct path for me.
Specifically, I believe that I am a good decision maker. I like combining my educational and work experiences as well as carefully considering the opinions of those around me to make important decisions. Even more challenging and exciting is having to make quick decisions while under stress. I also believe that I am a level-headed, mature individual who can engage in all kinds of conversations from a discussion of sports to a highly personal health-related issue. Further, I am interested in and feel that I will succeed at managing teams, which is an increasingly important skill for physicians, particularly in the hospital environment.
In terms of my career goals, medicine is in line with my desire to do something I can get excited about every day of my life. While every profession has its place and is important to our society and economy, I feel that medicine will particularly drive me to excel at my job and will, well, get me out of bed in the morning! Moreover, I enjoy working hard and keeping busy and am not opposed to being rewarded at the end of the day.
The reason I ultimately decided to pursue medicine was because of my interest in the current state of health care. Each day, this industry changes due to new regulations, discoveries, cost concerns, etc. Such an environment creates both challenges and opportunities. While all health providers are forced to respond and react to changing policies or practices, there lies the potential for leaders to emerge and discover new ways to provide the best care to patients will decreasing costs and inefficiency; this is something I want to be a part of.
There you have it. Do you think these are good reasons? I would be interested in hearing others' rationals for a career in medicine (or anything else for that matter). Feel free to email me if you would like to share.
Med school is a long, long process. For me, I will have to complete a two year post baccalaureate, pre-medical education program in order to catch up on all the science requirements that I didn't take in college; a four year medical education (assuming I do not take a year off somewhere, which is not uncommon); a two to five year residency; and possibly a one to two year fellowship...all in hopes that I will pass my boards and can begin practicing soon after graduation. In all, this is roughly a decade of education with which comes a decade's worth of cost. Not only do tuition, books, and miscellaneous fees leave a large hole one's pocket, but the costs of living for 10 years with little to no income only worsen the financial outlook (check aamc's website for some financial advice). So why bother?
I believe that my skill set, career goals, and the current challenges/opportunities of health care make medicine the correct path for me.
Specifically, I believe that I am a good decision maker. I like combining my educational and work experiences as well as carefully considering the opinions of those around me to make important decisions. Even more challenging and exciting is having to make quick decisions while under stress. I also believe that I am a level-headed, mature individual who can engage in all kinds of conversations from a discussion of sports to a highly personal health-related issue. Further, I am interested in and feel that I will succeed at managing teams, which is an increasingly important skill for physicians, particularly in the hospital environment.
In terms of my career goals, medicine is in line with my desire to do something I can get excited about every day of my life. While every profession has its place and is important to our society and economy, I feel that medicine will particularly drive me to excel at my job and will, well, get me out of bed in the morning! Moreover, I enjoy working hard and keeping busy and am not opposed to being rewarded at the end of the day.
The reason I ultimately decided to pursue medicine was because of my interest in the current state of health care. Each day, this industry changes due to new regulations, discoveries, cost concerns, etc. Such an environment creates both challenges and opportunities. While all health providers are forced to respond and react to changing policies or practices, there lies the potential for leaders to emerge and discover new ways to provide the best care to patients will decreasing costs and inefficiency; this is something I want to be a part of.
There you have it. Do you think these are good reasons? I would be interested in hearing others' rationals for a career in medicine (or anything else for that matter). Feel free to email me if you would like to share.
Sunday, January 17, 2010
Physical
I have not posted in a few days as I am in the somewhat stressful process of transitioning back to school after the winter break for my second-to-last semester as an undergraduate.
Like many college students, I utilized the break to schedule all those appointments that I procrastinate throughout the year. One of these was a routine physical with a family practice physician whom I had never gone to before. Since it is relevant to the current state of health care and certainly of note to future physicians (who are hopefully reading this blog!), I think my experience is worth sharing...
I will look over the unprofessional, even insulting comments and demeanor of the physician for now and focus on my biggest problem with this appointment. Currently, our country is in the midst of a major push towards a more preventive approach to medicine; this could promote a healthier nation and (in theory) reduce the soaring costs of health insurance.
Therefore, I expected that my proactive check-up as a college student who has not been to the doctor in about three years would be met with enthusiasm. Further, I assumed that my questions for the physician would be commended since it would show that I am an active participant in my own health. Rather, my doctor could not seem to fathom why I had come in to the office. He kept asking "so wait, nothing is wrong? You're just here for a physical??" My question regarding whether he opted for my cholesterol to be checked as part of my blood work was met with a highly sarcastic "uh, yes...anything else I missed?"
Perhaps the doctor was having an off day (something that as a future physician I would like to be sympathetic to) or maybe he had not seen this recent commercial from the Agency for Healthcare Research and Quality (AHRQ):
My concern is that not only are many patients unprepared to become fully active members of their own health care, but that many physicians are unwilling to let them. My decision to seek a routine physical exam brings money into the physician's practice and could potentially reduce insurance costs if a problem is detected in its early stages. Not to mention that I will be healthier. That should be a good thing.
Like many college students, I utilized the break to schedule all those appointments that I procrastinate throughout the year. One of these was a routine physical with a family practice physician whom I had never gone to before. Since it is relevant to the current state of health care and certainly of note to future physicians (who are hopefully reading this blog!), I think my experience is worth sharing...
I will look over the unprofessional, even insulting comments and demeanor of the physician for now and focus on my biggest problem with this appointment. Currently, our country is in the midst of a major push towards a more preventive approach to medicine; this could promote a healthier nation and (in theory) reduce the soaring costs of health insurance.
Therefore, I expected that my proactive check-up as a college student who has not been to the doctor in about three years would be met with enthusiasm. Further, I assumed that my questions for the physician would be commended since it would show that I am an active participant in my own health. Rather, my doctor could not seem to fathom why I had come in to the office. He kept asking "so wait, nothing is wrong? You're just here for a physical??" My question regarding whether he opted for my cholesterol to be checked as part of my blood work was met with a highly sarcastic "uh, yes...anything else I missed?"
Perhaps the doctor was having an off day (something that as a future physician I would like to be sympathetic to) or maybe he had not seen this recent commercial from the Agency for Healthcare Research and Quality (AHRQ):
My concern is that not only are many patients unprepared to become fully active members of their own health care, but that many physicians are unwilling to let them. My decision to seek a routine physical exam brings money into the physician's practice and could potentially reduce insurance costs if a problem is detected in its early stages. Not to mention that I will be healthier. That should be a good thing.
Wednesday, January 13, 2010
A note on anonymity
Please note: While I am a proponent of transparency, I feel quite uneasy about the idea of med school admissions officers (whom I will presumably be working with in the future...fingers crossed) Google-ing my name and gaining access to this front-row journey of my entire applications process. And believe me, they do check. CNN ran an article about the Journal of the American Medical Association's study of med school policies regarding students' online behavior. It is certainly no stretch to assume that such policies will also have ramifications on the admissions process.
Rather, I believe that remaining publicly anonymous will allow me to write more honestly and openly about this process. However, feel free to email me (destinationmedschool@gmail.com) if you are just dying to know something about my personal life that I have not published. Otherwise, I will be known as Chris (my real first name).
Rather, I believe that remaining publicly anonymous will allow me to write more honestly and openly about this process. However, feel free to email me (destinationmedschool@gmail.com) if you are just dying to know something about my personal life that I have not published. Otherwise, I will be known as Chris (my real first name).
Brief background
Only four hours after my first post and I just can't stay away..!
While I have no intention of bombarding readers with my autobiography, it is pertinent to include a very brief overview of who I am so that you may fully understand where this journey begins.
I would describe my educational background as an ever-winding path. While I attended good schools and did pretty well, I never applied myself 100% and my interests were, well, diverse. In college I declared several majors ranging from the arts, to politics, to business, and finally settling on communication studies.
Unlike my older siblings, I did not attend a high ranking university. I looked over my high school guidance counselor's list of recommended schools and applied to only one: a small, slightly obscure college in New England. Throughout my parade of different majors there, I have received decent grades (currently have a 3.6 GPA, may have a 3.7 by graduation, could have had a 3.8 if not for a few classes that I failed to regularly attend during my freshman year...it happens). However, since the majority of med school admissions departments will most likely never have heard of my school, even the best grades will not raise me above any of the very qualified candidates that I will soon compete with for acceptance.
I do have some advantages. My family seems to be ingrained in heath care (my mother is a nurse, sister a physician, and two brother-in-laws are also doctors). I have already had a great experience working in an excellent health care organization. Oh yeah, and I'm motivated as hell.
I will get into the specific reasons for wanting to go into medicine in a later post; the point here is that, like many people, it took me a while to mature as a student and to really figure out where I want to go in life. Maybe this relates to you or maybe not. But I say we can make it happen.
While I have no intention of bombarding readers with my autobiography, it is pertinent to include a very brief overview of who I am so that you may fully understand where this journey begins.
I would describe my educational background as an ever-winding path. While I attended good schools and did pretty well, I never applied myself 100% and my interests were, well, diverse. In college I declared several majors ranging from the arts, to politics, to business, and finally settling on communication studies.
Unlike my older siblings, I did not attend a high ranking university. I looked over my high school guidance counselor's list of recommended schools and applied to only one: a small, slightly obscure college in New England. Throughout my parade of different majors there, I have received decent grades (currently have a 3.6 GPA, may have a 3.7 by graduation, could have had a 3.8 if not for a few classes that I failed to regularly attend during my freshman year...it happens). However, since the majority of med school admissions departments will most likely never have heard of my school, even the best grades will not raise me above any of the very qualified candidates that I will soon compete with for acceptance.
I do have some advantages. My family seems to be ingrained in heath care (my mother is a nurse, sister a physician, and two brother-in-laws are also doctors). I have already had a great experience working in an excellent health care organization. Oh yeah, and I'm motivated as hell.
I will get into the specific reasons for wanting to go into medicine in a later post; the point here is that, like many people, it took me a while to mature as a student and to really figure out where I want to go in life. Maybe this relates to you or maybe not. But I say we can make it happen.
Destination: Med School
Welcome to my blog. I created my blogger account 15 minutes ago and am already moving right along to my inaugural post...how efficient this site is!
A wise professor once told me that to be pithy and engaging always begin a project with a thesis and justification. Well...
Thesis: The purpose of my blog is threefold: (1) to track my journey from the realization that I wanted to be a doctor to acceptance into med school; (2) to elicit your help, encouragement, and advice along the way; and (3) to start conversations with other med school prospects, current students, physicians, professors, health professionals, and patients as to the application process, health care, and anything else.
Justification: I am writing this blog because acceptance into med school is an overwhelming daunting task. I, especially, face great challenges in that I am nearly finished with my non-scientific undergraduate education from a "second-tier" college and have a less than impressive resume of health-related experience. In other words...if I can get in, so can you. And hopefully I'll be able to show you how.
Ultimately, I hope that this blog might reveal something noteworthy about the current system of medical education or health care in general. Further, I feel that publishing this blog will keep me motivated towards my formidable goal of med school acceptance; your comments and emails could help as well!
A wise professor once told me that to be pithy and engaging always begin a project with a thesis and justification. Well...
Thesis: The purpose of my blog is threefold: (1) to track my journey from the realization that I wanted to be a doctor to acceptance into med school; (2) to elicit your help, encouragement, and advice along the way; and (3) to start conversations with other med school prospects, current students, physicians, professors, health professionals, and patients as to the application process, health care, and anything else.
Justification: I am writing this blog because acceptance into med school is an overwhelming daunting task. I, especially, face great challenges in that I am nearly finished with my non-scientific undergraduate education from a "second-tier" college and have a less than impressive resume of health-related experience. In other words...if I can get in, so can you. And hopefully I'll be able to show you how.
Ultimately, I hope that this blog might reveal something noteworthy about the current system of medical education or health care in general. Further, I feel that publishing this blog will keep me motivated towards my formidable goal of med school acceptance; your comments and emails could help as well!
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