April 14, 2021
For older patients, online factors not so important for choosing a doc
How important is an online presence for older patients who are choosing a physician? A new study in Annals of Internal Medicine of patients between 50 and 80 years old found that 20% of respondents said that online ratings and reviews are very important, but more people—23%—said that word-of-mouth recommendations are just as important. But a HealthLeaders article says that the top three factors for older adults were acceptance of insurance (93%), time to get an appointment (61%), and convenience of office location (59%).
Working nights alters “circadian rhythmicity of genes”
We all know that working nights stinks, but new research yields data on how night work may increase your risk for cancer. An MDedge article says that researchers found a simulation of night work changed “the normal circadian rhythmicity of genes,” which can lead to hallmarks of cancer. The study, which appeared in the Journal of Pineal Research, concluded that night work reduces the ability of the body’s RNA to repair genes affected by working at night. During the simulation, some of the genes of participants lost their normal day-shift rhythmicity. The study also found that night work increases endogenous and exogenous DNA damage.
April 7, 2021
Which state has the most disciplinary actions against docs?
Your chance of getting in trouble with your licensing board may depend largely on what state you live in. Data released by the advocacy group Public Citizen found that between 2017 and 2019, Kentucky had the highest rate of “serious” disciplinary actions against physicians, with 2.29 cases per 1,000 physicians in the state. The lowest rate of disciplinary actions came from Washington D.C., which had only 0.29 actions per 1,000 physicians. That means that Kentucky had eight times as many disciplinary actions as the nation’s capital. Overall, 32 states had half as many disciplinary actions as Kentucky. California, which has the most physicians in the country, ranked 33rd on the list with 0.85 serious disciplinary actions per 1,000 doctors. Public Citizen would like to see more disciplinary actions against physicians, claiming that such actions protect the public from “dangerous doctors.” The data used to create the report come from the National Practitioner Data Bank.
“Open notes” is officially here: What does it mean for you?
Now that health care organizations are required to give patients access to notes (along with test results and lab reports), how will those notes be affected? As of April 5, the federal government began requiring health care organizations to provide “free, full and immediate electronic access” to notes and other documentation. A Medscape article says that physicians don’t necessarily have to change their style of documentation, but the reality is that some health systems are asking clinicians to do just that. Physicians quoted in the Medscape article suggest that clinicians write their notes using a similar style and tone they use when speaking to patients in person. Some physicians expect that patients with chronic health conditions will be most likely to read their notes, and other physicians have found that patients tend to actually enjoy reading their notes. The Medscape article also notes that it’s OK to keep certain information out of patients’ notes if there’s evidence that withholding information will “reduce the risk of harm” to patients or third parties.
March 31, 2021
Malpractice premiums on the rise after period of relative rate stability
The relative stability in medical malpractice insurance premiums that many physicians enjoyed in the 2010s seems to have come to a halt, with 2020 seeing a greater increase in premiums than any year other than 2005. According to research from the AMA, more than 30% of premiums increased from 2019 to 2020. That followed a similar jump in premiums from the year before, when 26.5% of premiums rose. (In 2018, by comparison, 14% of premiums rose.) The good news is that in some specialties in some states, premiums have dropped significantly in the last decade. The report shows that some Pennsylvania internists, for example, have seen their average premium drop from the high $30,000 range to the high $20,000 range. More detailed numbers about premium charges for three specialties (ob/gyn, internal medicine and general surgery) in a limited number of geographic areas are available in the report.
Busted! Health care workers bragging about fake vax cards
Health care workers hitting social media to brag about their ability to obtain fake proof of vaccination (yes, it’s a thing) are being called out over their efforts. There was the pharmacy tech who bragged on TikTok that she “grabbed a bunch of blank” vaccination cards for her and her husband. There was the nurse who asked the pharmacy tech if she could have some of the cards. And documenting it all were two other TikTok users (one of them a pharmacist) who have made it their mission to track down this type of activity by health care professionals. According to an article in the Daily Beast, the two have posted more than half a dozen videos on TikTok drawing attention to health care workers who are forging or trying to forge vaccine cards. The two are forwarding the evidence they find to local medical boards. Public health experts interviewed for the article say that health care workers talking about forging vaccination cards undermines the faith the public has in medical institutions and their ability to keep people safe. And the two TikTok users who are hunting down vax card forgers have themselves faced pushback, with one of them having to change her phone number after she began receiving harassing phone calls.
March 24, 2021
Almost half of all health care workers have not been vaccinated
While health care workers have been at the front of the line to receive vaccine, a new poll indicates that more than four out of 10 health care workers have not been vaccinated. The poll, which was put out by both the Kaiser Family Foundation and the Washington Post, finds that just a bare majority (52%) of health care workers across the country have received at least one dose of covid vaccine. While an additional 19% were either scheduled to be vaccinated or planned to be, 18% did not plan on being vaccinated while another 12% remained undecided. More than one in three surveyed health care workers reported not being confident that the vaccines were safe and effective. The survey, which was held mid-February to early-March, gathered responses from more than 1,300 health care workers. In related news, Kaiser Health News reports that new covid cases among nursing home staff members have plummeted by more than 80%. That’s despite the vaccine hesitancy felt by many staff members, with some nursing homes reporting that only half their staff have been vaccinated so far.
A drive-in Match?
It was once again a remote Match Day last Friday for more than 33,000 medical students and the more than 2,600 candidates around the world looking for residency slots. It was also an historic one that offered the most positions in Match history, with the number of slots up 3% from last year. MedPage Today reports that the need to hold a virtual Match Day led many medical schools to become creative, with at least one school holding a drive-in Match ceremony while another sent bottles of champagne or cookies to students’ homes. As for remote matching, students noted that not being able to travel to in-person interviews allowed them to apply to more programs. Internal medicine drew one-quarter of all applicants, with the number of internal medicine positions up 25% over five years ago. Over that same time frame, the number of family medicine positions increased 44%.
March 17, 2021
Are employed physicians having second thoughts about their career choice?
While huge numbers of physicians have decided to work for large employers, new data show that a considerable number of those physicians may be questioning that decision in part because of the pandemic. A survey by Jackson Physician Search found that 69% of employed physicians said they are “actively disengaged” from their employers and that half are considering looking for a new employer. Slightly more than half (54%) said that the pandemic has changed their employment plans, 21% may retire early, and 15% are thinking about leaving the practice of medicine. The survey also found a startling disconnect between the views of physicians and administrators. While 69% of physicians say they’re disengaged, surveyed administrators estimated that only 35% of their physicians felt disengaged. Similarly, while 83% of surveyed physicians said their employers have no retention plan, only 30% of administrators said that they have no retention program. A Medscape article notes that when it comes to retention, 63% of physicians said the most important factor was increased pay, while 12% identified additional time off, 8% pointed to reduced call, and 4% identified paid sabbaticals.
Independent physicians see some relief, but feel left out of vaccination effort
While employed physicians may be having second thoughts about their decision to work for someone else, many of their colleagues in independent practices are finally coming up for air after struggling for their financial survival during the pandemic. An article in Healthcare Dive says that the good news is that for many of the practices that survived the pandemic, many have shored up their finances and are no longer facing an imminent threat of going out of business. The article says that interviews with practices found that patient volumes have returned to some semblance of normal, but that expenses—particularly for PPE—remain high. But one sore spot that remains, particularly for primary care physicians, is the fact many have been shut out of the vaccine efforts. Physicians interviewed for the article say that excluding independent practices from the vaccine effort makes no sense, particularly because those practices administer about half of all vaccines during normal years.
March 10, 2021
ABIM extends deadline for MOC requirements until end of 2022
If you can’t complete your recertification MOC requirements this year, the ABIM will give you a break. For the second time since the pandemic began, the ABIM has extended its deadline for completing the MOC. The ABIM says that physicians will not lose their board certification if they aren’t able to complete MOC requirements, and that physicians who had an assessment, points or an attestation requirement due in 2020 or 2021 now have until the end of 2022 to complete those items. More information is available online.
Will virtual primary care compete with the nation’s PCPs?
As U.S. insurance companies launch virtual medicine services, some physicians are worried that technology will end up separating patients from their local primary care physicians. An article in MDedge raises the possibility that mega-insurers could take advantage of loosened telemedicine regulations to encourage patients to get more care from virtual panels of physicians, in part to cut their costs. (Some data show that fewer prescriptions and tests are ordered in telehealth visits.) Physicians say that while telemedicine is appropriate for one-off visits for acute care, primary care visits benefit from in-person visits, particularly when it comes to patients with chronic conditions. Local PCPs not only develop long-term relationships when seeing patients in person, the thinking goes, but they also know the specialists in their area and help patients choose the best one. Data published by HealthLeaders show that telehealth grew from 0.22% of commercial insurance medical claims in December of 2019 to 6.51% of all medical claims in December of 2020. In a sign that telehealth continues to grow, commercial insurance medical claims also grew 8.3% from November to December of 2020.
March 3, 2021
Physicians affiliated with health systems take home more pay
Physicians who are affiliated with hospitals and health systems tend to earn considerably more than physicians working for independent groups. A MedPage Today article says that researchers found that physicians affiliated with a health system earned an average of $114,000 more than non-affiliated physicians. Researchers found that primary care physicians on average can make $63,000 more if they’re integrated into a hospital or health system, while specialists can earn an average of $178,000 more. Surgeons integrated with a health system can earn on average $150,000 more. Differences in pay by specialty ranged from $363,000 more for urologists to $15,000 for psychiatrists. The study also found that the higher pay rates were associated with a “modest” probability that physicians would integrate with health systems, and that PCPs and specialists were more likely to integrate with health systems because of pay than surgeons. The Medscape article says the pay differences stem from Medicare’s outpatient payment policies. The data were published by the journal Health Services Research.
One quarter of physicians personally attacked on social media
A pre-pandemic survey found that nearly one-quarter of respondents felt they had been personally attacked on social media. While there were no substantial differences in the number of attacks by gender, women were much more likely to report online sexual harassment (16.4%) than men (1.5%). Respondents said that themes like advocacy on topics like vaccines, abortion and smoking were associated with attacks, but even topics like patient care and personal information were associated with attacks. The data, which appeared in JAMA Internal Medicine, was based on a small survey of less than 500 people, which led researchers to call for a larger study. In a separate article, one of the study’s authors predicted that if the survey were conducted again today, many more physicians would report personal attacks because of the politicization of health care information during the pandemic.
February 25, 2021
Is state-based physician licensure due for a post-pandemic change?
Will the boom in telemedicine during the pandemic make the recent flexibility physicians have seen in state licensure permanent? A perspective piece in the New England Journal of Medicine says that while changes like states and Medicare recognizing out-of-state licenses is a positive development, health care needs to do more to make physician licensure more flexible. The authors say that legislation encouraging states to participate in the Interstate Medical Licensure Compact could help lead to licensing reciprocity. (A MedPage Today article says that less than 1% of U.S. physicians have made use of that compact.) The authors of the NEJM piece also note that they support a state-based system of licensure, in part because disciplinary actions can be best administered locally.
Physician moms at high risk of burnout in the pandemic
Physicians who are also mothers are facing extreme levels of anxiety during the pandemic. In a survey of more than 1,800 physicians conducted in April by the Physician Moms Group, 41% of respondents had scores that indicated moderate to severe anxiety, and 18% indicated that they suffer from severe anxiety. Anxiety was higher for physician moms who were frontline workers (46%) than for respondents who weren’t frontline workers (37%). The data were published in a letter in the American Journal of Psychiatry. The authors noted that in the past year, about 19% of American adults experienced any type of anxiety disorder. Researchers noted that data from China found that female health care workers experienced a disproportionate amount of anxiety during the pandemic.
February 17, 2021
Report: How PCPs have survived the pandemic
Despite dramatic reductions in patient volume due to the pandemic, the nation’s primary care practices are finding ways to survive. That’s according to a new report from the Robert Wood Johnson Foundation, which is based on a review of published data and interviews with 16 PCPs. The report found that the PCPs researchers interviewed were able to survive by embracing shifts in business models (think telemedicine) and by taking advantage of government assistance (PPP loans) when available. The physicians who participated in the report said that those two developments were critical to the survival of their practices. A HealthLeaders article says that moving forward, many primary care practices may be more willing to explore consolidation and acquisition, and others may be more willing to consider capitated agreements.
IMs, FPs show changing views on medical ethics
New data show that internists and family physicians may be showing signs of changing their thinking on some major ethical issues. A Medscape report found that a growing number of internists and family physicians think it’s OK for a physician to have a romantic or sexual relationship with a patient once the patient has no longer been receiving care for six months. Nearly one-third (31%) of internists think it’s OK (up from 22% in 2018), while 33% of family physicians agreed (up from 28% in 2018). Another example: While upcoding was supported by 17% of physicians 10 years ago, that number has dropped to just 8% today. Internists were a little more flexible on the topic, with 15% responding “it depends.” (One internist said upcoding could be justified if it would help patients obtain necessary services.) The data come from a series of surveys conducted by Medscape.
February 10, 2021
Which specialties did, and didn’t, embrace telehealth in 2020?
Researchers looking at how telehealth exploded in 2020 have compiled a list of the specialties that were the most—and least—likely to use the technology during the early months of the pandemic. A Health Affairs study found that nearly one-third of patient visits in late 2020 spring/summer took place via telehealth, which constituted a 23-fold increase in the use of the technology. Specialists that used telehealth the most (defined as using the technology at least once) included endocrinologists (67.7%), gastroenterologists (57.0%), neurologists (56.3%), pain management physicians (50.6%), psychiatrists (50.2%) and cardiologists (50.0%). Specialists that used telehealth the least included orthopedic surgeons (20.7%), ophthalmologists (9.3%), physical therapists (6.6%) and optometrists (3.3%). During the pandemic, six specialties conducted about half of all visits via telehealth: psychiatry, gastroenterology, endocrinology, social work, psychology and neurology. Researchers also found that despite the rise in patients using telehealth, overall patient volumes during the first six months of last year fell 35%, although specialties that embraced telehealth saw smaller drops in volume. A Fierce Healthcare report on the study says that nearly 80% of patients who used telehealth were commercially insured and nearly 90% lived in an urban area. The study found that patients in areas with higher poverty rates were less likely to use telemedicine; in those areas, 28% of patients did not use telehealth.
New data show how the gender-based pay gap is tied to specialty
When trying to explain why female physicians are paid less than men, analysts have often noted that women tend to work in lower-paying specialties (think pediatrics). New research has been able to quantify just how much less physicians make in specialties dominated by women—and how that wage difference applies to both male and female physicians. A study published in JAMA Pediatrics looked at the salaries of 120,000 academic physicians in U.S. medical schools. Researchers found that for every 10% of women who work in a specialty, there was an $8,255 decrease in mean salary for all physicians (both men and women). When researchers drilled down deeper, they found that the wage gap hit women twice as hard as men. While men in specialties with a large percentage of women earned $7,465 less than the mean compensation, women earned $15,003 less than the mean. The data led the researchers to conclude that “The days of devaluing women’s work should be long behind us; yet, in the medical profession, the work has hardly begun.”
February 3, 2021
Report names most hazardous technology in health care
An annual list of the top 10 hazards in health care that result from technology run amok puts a special focus on the unintended consequences of workarounds created to deal with the covid pandemic. ECRI, a national patient safety organization, said that the FDA’s move to temporarily authorize hundreds of devices during the pandemic was the No. 1 threat to patient safety, because the temporary approval process uses a lower standard when an emergency use authorization is granted. According to a Medscape article, another pandemic-related technology threat includes the rapid adoption of telehealth, which ECRI says could compromise not only patient care, but the confidentiality of patient information. The report says other hazards include inadequate PPE imported from other countries, consumer-grade products like pulse oximeters, and the hasty deployment of disinfection technology.
Physician compensation down 4.5% from 2019-20
New data show that compensation for physicians dropped nearly 5% in 2020 because of the pandemic. The report, which was issued by the consulting firm KaufmanHall and contains data from practices employing 68,000 physicians, says that after seeing patient volumes crash during the early months of the pandemic, many practices saw those volumes rebound in the summer and fall. The good news was that physician compensation jumped 1.5% between July and October, but those gains weren’t enough to offset losses earlier in the year. As a result, compensation per work RVU was still down 4.5% for the year. The report notes that many practices have reported a lull in patient visits and a slowdown in hospital diagnostic services and procedures over the last few months, a trend that KaufmanHall predicts will continue throughout the first half of 2021.
In related news, a report issued jointly by the Medical Group Management Association and Humana found that by April of last year, 97% of physician practices had reported a drop in care volume. The report found that 87% of patients said they skipped appointments due to concerns about safety. Another 9% blamed a loss of jobs and/or insurance. A Fierce Healthcare article looks at the ways that telehealth was used to fill in those gaps in patient visits.
January 27, 2021
How much of a pay cut would you take to be happier?
How much of your salary would you sacrifice to be happier outside of work? According to a new Medscape survey, nearly half of physicians said they would take a cut in exchange for being happier. About one-third of physicians said they would take a cut of $10,000-$20,000, and another third would take a cut of between $20,000 and $50,000. Not surprisingly, there’s evidence that those numbers are being driven by the stress of the pandemic. According to a Medscape article, the survey found that the number of physicians who said they’re very happy outside of work dropped dramatically in the last year, from 43% before the pandemic to only 20% post-pandemic. The survey looked at many other issues, from physicians’ happiness in marriage to how much vacation they take.
The challenges medical practices faced in 2020
A series of surveys focused on medical practice leaders sheds some light on the biggest challenges groups faced in 2020 because of the covid pandemic. Over the course of 2020, MGMA polled the leaders of medical practices about the challenges facing their organizations. Here’s a summary of the results of those surveys published by MDedge.
- Provider income. In May, 82% of practice leaders said that some or all of their providers’ incomes had been affected by the pandemic. About 62% said that all of their providers’ incomes had been affected.
- Staffing shortages. In March, 40% of practices said they were experiencing staff shortages. As a result, the following month, 53% of practice leaders said they were trying to address the mental health of providers and all staff.
- Billing & coding. The top billing and documentation challenges for practices came in the form of billing for telehealth and telephone visits during the pandemic. Respondents said the top three billing issues were inconsistent rules from payers, the accuracy of payment, and the documentation of virtual visits.
- Vaccines. While delays in the covid vaccine are on everyone’s minds, a September poll found that medical practices were having trouble getting their hands on the flu vaccine. That survey found that one-third of practices were experiencing delays in getting the flu vaccine.
January 20, 2021
Video can be effective follow-up tool for low-risk surgeries
Telehealth has been particularly popular in specialties like mental health, but new data show that it might be a growth area for surgeons. A study in JAMA Surgery found that surgeons had similar levels of success conducting follow-up for patients who have had low-risk surgeries via video as with traditional in-hospital visits. One encouraging sign was that while the video visits were shorter (20 minutes for video vs. almost 50 minutes for in-person), patients still got the same amount of time with their surgeons (about eight minutes.) A MedPage Today article says one barrier to the video calls was working with non-English speakers. Interpreters were available for the calls, but the video platform itself was still in English, which created some obstacles.
A colleague is being disruptive during a meeting. What do you do?
How can you handle a colleague who insists on being disruptive during committee meetings? It may be easier to try to acquiesce to the behavior to make it go away, but you risk encouraging the behavior by rewarding it. A HealthLeaders article offers strategies that physicians in a group can use to help the offending physician understand what’s wrong with the behavior. The article suggests one strategy is to ask the physician if she or he believes everyone on the committee should go along with his or her thoughts even if they disagree with them. If the answer is yes, they need to ask the physician if he or she would find that acceptable if the tables were turned. Other strategies focus on ways to find common ground or to show the disruptive physician how much other members of the group disagree with his or her position. Finally, the article states, if the physician’s behavior is really offensive, a last resort is filing a formal complaint.
January 14, 2021
Health care job market takes hit, but still popular
While the job market in health care suffered a body blow in 2020, careers in health care are still considered desirable by the public. First, the bad news. Bureau of Labor statistics show as a whole health care shed just over a half a million jobs in 2020. Since February, hospitals lost 70,000 jobs, ambulatory services lost 173,000 jobs and residential care homes lost 264,000 jobs. Things may be turning around; in December, hospitals added back 32,000 jobs and ambulatory services brought back 21,000 jobs.
Despite that trend, health care jobs occupied 42 of the top 100 slots on the U.S. News & World Report’s 2021 “100 Best Jobs” list. The No. 1 job on the list was physician assistant. Nurse practitioner came in at No. 3 and physician came in at No. 5. It’s probably no coincidence that health care jobs were also well-represented on the publication’s list of the highest-paying jobs. The top job on that list was anesthesiologist, which reported a median salary of $208,000.
And rather than being deterred from a career in medicine by the pandemic, there are signs that more are interested in working as a physician. Data from 2020 found that applications for allopathic medical schools were up 14% and applications for osteopathic medical schools were up nearly 18%. A Medscape report quotes industry analysts as saying that the pandemic was likely causing an increase in interest in working as a physician from people who wanted to help. They may have been spurred to act by the recent attention given to physicians treating covid patients.
Programs try to help medical workers cope with covid stress
The stress on clinicians from caring for covid patients has led several health systems to create programs to try to help. Researchers at The Ohio State University Wexner Medical Center found that a mindfulness program helped reduce burnout by 27%. Participants in the eight-week program spend an hour a week doing reflective writing exercises, watching videos on interventions, talking about their responses, and meditating around a weekly theme. A HealthLeaders article says that staff might write about a moment they had experienced with a patient or co-worker where they felt “totally present.” Researchers also found a significant increase in clinicians’ resilience and in their work engagement.
At Mount Sinai Medical Center in New York City, the Center for Stress, Resilience and Personal Growth was launched in June to help staff members counter the stress of working during the pandemic. A Medscape report says that during the weekly workshops, staff have talked about their trouble being hailed as heroes during the early days of the pandemic because they felt like they weren’t effectively treating covid patients. The program screens participants to identify people who are at the highest risk of PTSD and has trained moderators give staff tools to build resilience and process their experiences. Mt. Sinai officials believe that up to 40% of health care workers will suffer from post-traumatic stress because of the pandemic.
Finally, a report from The Daily Beast details the pharmacologic lengths that some health care workers are taking to get a good night’s sleep to combat stress. There’s a story of one ED doc who at one point tried taking seven Benadryl tablets to get a good night’s sleep (it didn’t work) and tales of physicians trying drugs like trazodone, CBD, CBD with THC, antidepressants and “obsessive knitting while watching Star Wars.” The story details the stress that’s preventing these physicians from sleeping at night and how they’re coping with a chronic lack of sleep.
January 6, 2021
Job market: ED residents have trouble finding jobs
While there’s a shortage of physicians in the United States, many ED residents are facing an exceptionally tough job market. A Washington Post article describes one resident who can’t find a full-time job in his hometown of Houston and talks to experts about problems facing other young ED physicians. One of the problems is that staffing companies, which run about 60% of U.S. emergency rooms, are losing contracts with financially stressed health systems and therefore cutting back on hiring physicians. Experts quoted in the Post article estimate that at least one-quarter of third-year ED residents are having trouble finding work. Many have had their contracts changed or had job offers rescinded altogether.
Patients want to handle billing with text messaging
If you’re looking for new ways to make patients happy, you might consider looking into text messaging for billing. A new study says that skyrocketing numbers of patients are not only embracing text messaging for health care billing but are willing to leave physician practices that don’t allow them to handle billing via text messages. The use of billing-related text messaging has grown more than 200% in the last year, but nearly one-third of patients don’t think their current providers have done enough to improve billing and payment.
December 23, 2020
You spend a lot more time with your EHR than non-U.S. docs
According to a new study in JAMA Internal Medicine, U.S. physicians spend an average of 90 minutes a day working with an EHR compared to 59 minutes for physicians in other parts of the world. The study also found that U.S. physicians spend significantly more time on four activities: notes, orders, messages, and clinical review. That probably explains why U.S. physicians composed more automated notes than their non-U.S. colleagues; 77.5% of text by U.S. physicians is automated, compared to 60.8% of text by non-U.S. physicians. U.S. physicians also received more messages per day than their non-U.S. counterparts (33.8 vs. 12.8).
One more thing to worry about when it comes to surgery
A new study gives some evidence that patients over 65 may want to avoid having surgery on their surgeon’s birthday. Research in the BMJ found that patients over 65 who underwent one of 17 emergency surgical procedures had a higher 30-day mortality rate when it was the surgeon’s birthday (6.9% vs. 5.6%). Researchers said the evidence behind the trend wasn’t clear but speculated that one explanation may be that the surgeons were distracted by their birthday. The researchers also said they were not recommending that patients avoid surgeries on the surgeon’s birthday, which would be difficult to do with emergency surgery. They said further research is needed to establish a meaningful relationship between surgeons’ birthdays and mortality rates.
December 16, 2020
Can hospitals require workers to take the covid vaccine?
Health care workers are slated to be among the first Americans to receive the covid vaccine, but what happens for workers who don’t want the vaccine—and refuse? According to a health care attorney writing in MDedge, the closest analogy is the laws surrounding influenza vaccines. Based on that body of the law, hospitals likely have the right to force workers to get the covid vaccination. Short of exceptions based on religion or disabilities, the courts have been fairly consistent in allowing health care employers to require vaccinations. And people who receive an exemption are generally required to take other measures to protect patients. The author did say that workers who refuse the vaccine probably won’t be fired immediately, as long as they take other measures like masking to mitigate the spread of the virus.
Terrible patients: Can private practice physicians fire terrible patients?
Can private practice physicians fire an “extremely unpleasant” patient? A MedPage Today article by a physician/lawyer points out that while institutions like hospitals are required to care for all comers, no such law exists for physicians. The only catch, the author says, is that if physicians “fire” patients and those people have no other care options, the courts may rule against the physician. The article offers examples of physicians who fired difficult patients and had to face legal challenges.
December 9, 2020
Are women leaving medicine faster than men during the pandemic?
The stress of working as a physician during a pandemic especially hard for female physicians? A Medscape article points to evidence that the pandemic is causing women to leave medicine in disproportionately high numbers. Experts interviewed say that longstanding complaints like inequitable pay and a difficult path for promotions are insurmountable when combined with the challenges of working in a pandemic. A survey of physician mothers in April found that just under half of respondents scored above the threshold for moderate or severe anxiety. The article points out that caregiving duties during the pandemic are also putting significant stress on many female physicians.
How speaking out during the pandemic went wrong for two clinicians
Two stories from this week’s news illustrate the perils of speaking up during the pandemic. The first story involved an Oregon family physician who bragged during a Trump rally that he and the people who work in his office refuse to wear masks. The Web site of the state’s medical board says it issued an emergency suspension of the license of the physician due to “concern for the safety and welfare of current and future patients.” Oregon state law requires health care providers to wear face masks in health care settings. At the rally, the physician urged attendees to remove “the mask of shame,” adding that the purpose of masks is to “shut down the American people.”
At the other end of the political spectrum is a nurse who was fired after raising concerns about the safety of the scrubs that nurses wore at a hospital in St. Paul, Minn. When the hospital instructed nurses to wear and launder their own scrubs, the nurse, Cliff Willmeng, RN, instead wore hospital-issued (and laundered) scrubs and issued a complaint with OSHA, alleging that the policy was unsafe for providers and patients alike. A MedPage Today story says that when Mr. Willmeng was fired in the spring for violating the hospital’s dress code, he sued the hospital for whistleblower retaliation and wrongful termination. Now the state’s licensing board for nurses is investigating Mr. Willmeng’s conduct, putting his license at stake. According to the MedPage Today story, a union steward at the hospital says that nurses are still required to wear and clean their own scrubs.
December 2, 2020
Hospital nurses are part of “a national bidding war”
It’s a staffing problem that hospitals are struggling with: an exodus of nurses being lured away to other facilities or to traveling-nurse agencies by lucrative incentives. An article from Kaiser Health News describes what its authors call a national bidding war as nurses—especially those who feel they’re not adequately protected against covid in their hospitals—easily find higher-paying opportunities elsewhere. The article quotes one nurse who quit a full-time job in a suburban Denver hospital where PPE was reused until it fell apart; as a traveling nurse, she saw her salary jump from $800 a week to $5,200, with a contract that guaranteed adequate PPE. Job postings, particularly for slots in Plains and Rocky Mountain states looking for ICU nurses, are offering up to $10,000 a week. Rural and urban safety-net hospitals can’t begin to afford such salaries and have the most to lose.
How one medical group uses Uber Eats to combat burnout
Would restaurant deliveries to your house, along with laundry and dry-cleaning services, help alleviate some of the burnout you’re probably feeling during these dark days of the pandemic? A group with more than 2,000 clinicians outside of Boston found that offering those perks, along with other services like a personal concierge, help with childcare and free access to Peloton workouts, was able to reduce clinician burnout by 20%. A FierceHealthcare article says the physician group also made workplace-based changes, such as reducing the number of clicks needed to navigate EHR software. The effort to reduce burnout began before the pandemic, but the group quickly changed direction once the pandemic began affecting physicians and other clinicians.
November 25, 2020
Big changes are coming to CPT in 2021
Are you ready for changes to the physician fee schedule that take effect in just over a month? According to an article in HealthLeaders, major changes in 2021 include the elimination of CPT code 99201, and a system of choosing CPT codes based on either time or medical decision-making (instead of elements of the history and physical exam). The article also explains that the Medicare conversion factor, which plays a major role in physician reimbursement, is scheduled to drop by about 11%, which will hurt physician fees across the fee schedule.
Update: How are PCP offices faring during the pandemic?
As the country enters the latest surge of coronavirus, primary care physicians report that their situations have improved somewhat since the spring, but most say they are still struggling. A new survey found that only 33% of PCPs said they had enough cash to function for four weeks, and 60% said they were seeing a rise in covid in their communities. The good news is that the financial troubles faced by PCPs have eased, with only 6% of practices saying that they are unable to pay some bills. But 35% of practices reported trouble hiring staff, 27% said they had permanently lost members of their practices (in part because of illness and early retirement), and 23% said that they feel unsafe because they are being forced to reuse PPE.
November 18, 2020
How is your mental health during the pandemic?
Several articles in this week’s press paint a dismal picture of not only the country’s surging number of coronavirus cases, but the mental health state of physicians and clinicians caring for patients.
Closing practices and retiring physicians
An article in the New York Times looks at outpatient physicians who are being forced to close or sell their practices because of financial pressure generated by the pandemic. Plummeting patient revenue and difficulties finding protective gear are making it impossible for some smaller practices to survive. The article quotes one study that found about 8% of physicians had closed their offices earlier this year and another 4% planned to close in the next year. Another study found that 20% of PCPs said someone in their practice had already retired early or was planning to retire early because of covid.
Staff shortages and stress
An article in The Atlantic, “No one is listening to us,” paints a grim picture of hospital staff trying to care for patients as the pandemic rages out of control. Hospitals are trying to keep up by adding beds and covid units, but staff shortages are pushing physicians and nurses to the breaking point. One Iowa nurse facing an ED with 25 covid patients—but not enough nursing staff to care for them—said that while managing the pandemic was “doable” in the summer, the recent surge in coronavirus patients is leaving clinicians feeling overwhelmed and burned out.
Nurses and PPE shortages
Finally, a Medscape article says that 11 months into the pandemic, many U.S. hospitals are still struggling to get their hands on adequate supplies of PPE. In a survey of nurses around the country, more than 80% say they are still re-using single-use PPE; 20% report that their employers have recently limited the use of N95 masks because of shortages. Just under half of the nurses (42%) said that staffing shortages have gotten worse, leading to feelings of stress among 80% of nurses, anxiety among 75% and feelings of sadness and depression among 62%. Registration is required to read the full article on Medscape.
November 11, 2020
What kind of lawsuits should you worry about?
When it comes to malpractice lawsuits, do you know the types of claims that are commonly filed? An article from MD Edge says that in frivolous claims, patients lack any evidence of injury or damage. In nonmeritorious lawsuits, injury or damages are suffered, but not because of negligence. And in fake claims, patients are making things up to shake you down for a few dollars. The good news is that of about 18,000 liability claims filed between 2016 and 2018, 65% were dropped. The MD Edge article looks at the difference between different types of liability lawsuits and offers a quick primer on malpractice law for physicians.
Fewer docs receive industry payments, but dollar amount remains the same
While a system that reports on industry payments to physicians seems to have slowed the number of physicians taking those payments, the total value of those payments has stayed relatively the same. Researchers found that in 2018, 45% of physicians received at least one payment from industry. In 2014, by contrast, that number was 52%. A HealthLeaders article says that from 2014 to 2018, physicians received nearly 50 million payments from industry totaling $9.3 billion. Most physicians–90%–received less than $10,000. Between 2014 and 2018, the total value of industry payments remained the same in all specialties except for primary care, which saw a dip in total payments.
November 4, 2020
More clues about the wage gap between male and female doctors
It’s been a busy week or so when it comes to data on the gender gap in wages for male and female physicians. Three reports offer more data on the wage gap—and an interesting explanation about its origins.
- A new survey from Doximity found that the wage gap between male and female physicians grew to 28% in 2020. The report found that female physicians make $115,000 less than male physicians.
- Last week, another report found a slightly smaller, but still significant, gender gap in physician wages. The drug discount company SingleCare found that female specialists earn $89,000 less than their male colleagues ($375,000 for men vs. $212,000 for women). Among primary care physicians, the gap was $52,000 ($264,000 for men vs. $212,000).
- Finally, a study says that female physicians may be paid less because they spend more time with patients during visits. The research article in the New England Journal of Medicine, which looked at nearly 25 million primary care office visits, found that female physicians spent 16% more time with patients than their male colleagues and that they generated 11% less revenue per year. HealthLeaders reports that researchers concluded that female physicians’ lower wages were driven “entirely” by differences in volume, and that the lower volume was not explained by female physicians working fewer days.
Are your patients too distracted—or drunk—to do telehealth right?
While upwards of 50% of Americans have used telehealth this year, not all of them are paying close attention to what you discuss. A survey from the health care tech company Dr. First found that patients are routinely distracted during telehealth visits by Web surfing, checking e-mail and texting (24.5%), watching TV or movies (24%), checking on social media (21%) and eating (21%). If that’s not bad enough, consider that just under 10% of patients admitted to having a cocktail (a “quarantine”) or some other type of alcoholic drink during televisits. The survey found that telehealth was most widely used for annual checkups (38% of respondents said they had used a televisit for this purpose), mental health therapy (25%) and specialist visits (21%).
October 30, 2020
Are you voting?
Given this year’s record turnout in early voting, a new research letter delivers this surprising news: Physicians are less likely to vote than the general population. The authors looked at voter registration and turnout among physicians in California, New York and Texas, the three states with the highest number of doctors. They found that only 37% of eligible physicians between 2006-18 voted vs. 51% of the general public. Further, half of all physicians aren’t even registered to vote. Why? “(L) ow participation,” the authors write, “may be because of the fear of seeming political while practicing medicine, in addition to other administrative and psychological barriers.” The same authors also published results of a single-site survey they did of close to 200 residents. The majority of residents cited their long work hours as a barrier to voting, while close to one in four believed their individual vote didn’t have much impact.
October 28, 2020
Physicians fight claims that they’re overcounting covid cases for money
Medical groups this week struck back against President Trump’s claims that physicians are overreporting fatalities from covid to increase their reimbursement. According to a Medscape article, groups like the AMA and ACP lashed out against those claims. In a statement, ACP said the president’s comments are “a reprehensible attack on physicians’ ethics and professionalism.” The Society of Hospital Medicine said that hospitalists are “selflessly placing their lives at risk” during the pandemic. The Medscape article notes that a growing body of research shows that fatalities from covid are likely being undercounted, not overcounted.
Covid has physicians working more for less money
A new survey shows that a variety of specialties are working harder and longer during the covid pandemic, with 31% of specialists saying they’re working more hours for little to no extra compensation. Seventy percent of ED physicians reported that they have suffered a “negative economic impact” from covid, and 63% of anesthesiologists say they’re suffering because covid patients have squeezed out elective surgery patients. About 36% of respondents said they’ve taken on new tasks during the pandemic; 49% have taken on an advisory role, and 29% have worked as an investigator in covid studies.
October 21, 2020
Telehealth services: CMS expands what it will pay for
The CMS this month announced that it is adding close to a dozen telehealth service lines that it will pay for during the pandemic. On that list of 11 new services: cardiac rehab and intensive cardiac rehab, with and without exercise, and pulmonary rehab with exercise. Other services that will now be covered include in-person ventricular assist device interrogation and several types of electronic analysis of implanted neurostimulator pulse. With the new additions, the CMS has since March OKed payment for more than 130 telehealth services for Medicare beneficiaries, including initial inpatient visits and ED visits. The CMS also announced that it plans to boost support to state Medicaid and CHIP programs to expand access to telehealth. In other virtual care news, a Seattle-based start-up that relies on a text-based primary care platform is attracting big investors. The on-demand service, called 98point6, just received $118 million in funding for a total of $247 million. Boeing and Sam’s Club are among the startup’s partners.
Why the hate for DOs?
The high profile given Sean Conley, DO, the president’s physician, had this unintended and ill-informed consequence: It produced a lot of disparaging remarks about doctors who train in osteopathic medicine. Apparently, many members of the media and the public mistakenly assume that DOs aren’t fully qualified, licensed physicians. In response, the American Osteopathic Association pushed back, targeting media figures and social media as well as connecting reporters to prominent DOs. And in a commentary published on KevinMD, two prominent hospitalists—both of whom are DOs—likewise rallied support for their colleagues. “(W)hen someone challenges the validity of a legitimate medical degree,” they write, “the entire house of medicine is under attack.”
October 7, 2020
Women increase their numbers in specialties, but pay gap persists
While more women are practicing medicine in specialties like rheumatology and dermatology, they are earning less than their male colleagues. A compensation report from Medscape focusing on female physicians found that since 2015, three specialties have seen dramatic increases in the number of women in their ranks. Rheumatology saw its number of female physicians skyrocket from 29% to 54%. Dermatology saw its number of women physicians increase from 32% to 49%, and family medicine saw a jump from 35% to 43%. That report noted that those gains, however, have not leveled the playing field when it comes to compensation. In primary care, men still make 25% more than women ($264,000 vs. $212,000). And in specialties, men make 31% more than women ($375,000 vs. $286,000). The report offers a detailed look at how much women earn compared to men by specialty, practice setting, percent of income from incentive bonus, number of work hours, and more.
These payers are changing telehealth reimbursement
Oct. 1 marked a significant change in coverage for telehealth—which became ultra-popular during the pandemic—when several private insurers began to no longer fully pay for virtual visits under certain circumstances. UnitedHealthcare terminated a benefit that fully covered patients’ virtual visits with their in-network clinician for any non-Covid-19 issue. Anthem stopped waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to Covid-19. Many patients have become reliant on virtual visits during the pandemic, especially older individuals and those with disabilities that made traveling to and from appointments difficult. “For many patients, it’s their lifeline right now — it’s the only way that they’re feeling comfortable or safe receiving care,” one expert tells STAT’s Rebecca Robbins and Erin Brodwin. One recent report estimates that during the pandemic, the number of people who had at least a single telehealth visit grew by 57%. That report, from Doximity, also predicted that 20% of all medical visits in 2020 will be conducted via telehealth.
September 23, 2020
One-quarter of physicians know a doc who has committed suicide
A new report says that 22% physicians know another physician who has committed suicide and that 26% know a colleague who has considered suicide. The report, which was released by The Physicians Foundation, says that 8% of physicians have had thoughts of self-harm as they cope with the effects of covid on their practices and that a stunning 58% of physicians say they’ve shown signs of burnout. Half of physicians say they’ve been angry, cried or been anxious because of the pandemic’s effects on their practices. To cope, 18% of physicians said they have increased their use of medications, alcohol or illegal drugs. The report was released last Thursday to coincide with National Physician Suicide Awareness Day.
Avoid these malpractice risks when seeing patients via video
While the increased use of telehealth is often viewed as one of the positive changes made to medicine as a result of the covid pandemic, telemedicine visits can pose risks to physicians. A Medscape article looking at the risks of video visits points out that physicians’ inability to actually see or touch patients can put them at a disadvantage that can lead to legal problems. The article describes the case of a man with swelling of the leg that turned out to be a fatal DVT. His family sued the ED physician who saw the man via video, claiming that the DVT could have been detected and treated if the physician had seen the patient in person. One insurer found that 66% of malpractice claims involving telemedicine were related to diagnoses. The article also looks at issues with documentation and consent when it comes to video visits.
September 16, 2020
What’s the future of medical meetings?
Are you looking forward to the day when meetings for physicians are once again in-person, and not virtual? In a Medscape article, one physician looks at the upsides and downsides of virtual meetings—and concludes that he, for five distinct reasons, prefers virtual meetings. The physician argues that because virtual meetings provide greater access to physicians and let them digest content more efficiently, the medical profession shouldn’t necessarily rush back to in-person meetings once the covid pandemic subsides. Comments on the article offer their own perspectives on the merits of virtual vs. in-person meetings.
September 11, 2020
Will primary care survive the financial impact of covid?
A new survey found that 20% of primary care physicians were considering leaving primary care because of the financial fallout of covid, and 13% were unsure of their futures in medicine. The survey, which was conducted by the Larry A. Green Center and Primary Care Collaborative, also found that in August, 2% of primary care practices have closed and another 2% were considering bankruptcy. According to coverage from FierceHealthcare, 21% of the physicians surveyed have had layoffs of furloughs, 28% have seen a revenue drop of 30%-50%, and 24% have shut down quality initiatives that started before the pandemic.
Survey data finds physician pay rose 4% in 2019
New survey data found that physician pay grew by just under 4% in 2019, up from the 2.92% increase in pay recorded the year before. According to HealthLeaders coverage, survey data from the American Medical Group Association found that primary care specialties saw an increase of 4.46% and medical specialties saw an increase of 3.52%. Coverage in Becker’s Healthcare reports that internal medicine saw a 5.65% increase, family medicine saw a 3.75% increase, and pediatrics saw a 5.06% increase. The data also show that despite a rise in compensation, physician productivity remained relatively flat, rising just 0.56% over the previous year. Analysts worry that raises in compensation without similar gains in productivity may point to an unsustainable trend in physician pay. Data are not available for pay trends since the beginning of the covid pandemic.
AMA proposes changes to simplify outpatient E/M codes
Changes to outpatient evaluation and management (E/M) codes announced last week by the AMA are being lauded by primary care groups as a step in reversing what they see as the undervaluation of E/M services and in streamlining documentation requirements. The revisions eliminate the history and physical exam as the basis for selecting codes. The changes also permit code levels to be based on either medical decision-making or total time. The AMA said that the changes, which represent the first time E/M codes have been changed in 25 years, were designed to make coding for office visits more flexible. The AMA is proposing that Medicare implement the changes, which include 206 new codes, 54 deletions and 69 revisions, on Jan. 1, 2021.
Physicians experience EHR-induced fatigue in as little as one minute
In a finding that will shock few physicians, research released this spring found that 80% of physicians experienced fatigue after working with EHR systems for as little as 22 minutes.
A study in JAMA Network Open looked at data from a study of 25 physicians who reviewed simulated cases of four ICU patients using EHR software. All physicians in the study were fatigued at some point during the simulation, with 36% experiencing fatigue in the first minute and 64% experiencing fatigue at least in the first 20 minutes. By 22 minutes, 80% of the subjects had experienced some fatigue. Researchers also found that once physicians had experienced fatigue, the next case they reviewed took more time, more clicks of the mouse and more screen visits.
Physicians struggle to adapt to less telehealth
With physician offices around the country opening up, telehealth has lost some of its popularity with patients and physicians alike. That’s leaving many medical offices struggling to adjust to a new normal where patients are being seen by a combination of virtual and in-person visits.
According to an article from STAT, telemedicine visits shrank from 69% of all patient encounters in April to 21% by the middle of July. Practices that switched all visits to virtual back in the spring are now struggling to move some—or most—of their visits back to in-person encounters, but it has not always been an easy switch. Administrators have to determine in advance which patients should be in-person vs. via teleconferencing, for example, and they need to decide how to most efficiently split the time of physicians between the two visits. The STAT article notes that telehealth visits for mental health services is still growing, and that while the number of telemedicine visits has shrunk since the spring, there has still been a drastic increase in the number of patients receiving care via telehealth.