How Being a Doctor Became the Most Miserable Profession
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?
By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.
Simply put, being a doctor has become amiserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.
Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.
It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize withphysicians—that’s a tall order in our noxious and decidedly un-empathetic times.
After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.
In Poorest States, Political Stigma Is Depressing Participation in Health Law
HUNTINGTON, W.Va. — Inside the sleek hillside headquarters of Valley Health Systems, built with a grant from the health care law, two employees played an advertisement they had helped produce to promote the law’s insurance coverage for young, working-class West Virginians.
The ads ran just over 100 times during the recent six-month enrollment period. But three conservative groups ran 12 times as many, to oppose the law and the local Democratic congressman who voted for it.
This is a disparity with consequences. Health professionals, state officials, social workers, insurance agents and others trying to make the law work for uninsured Americans say the partisan divisions and attack ads have depressed participation in some places. They say the law has been stigmatized for many who could benefit from it, especially in conservative states like West Virginia that have the poorest, most medically underserved populations but where President Obama and his signature initiative are hugely unpopular.
Healthcare options for undocumented immigrants
Undocumented immigrants have limited access to health insurance, a fact the Affordable Care Act does little to change. But there are some options.
By Lisa Zamosky
5:00 AM PDT, April 27, 2014
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Arlette Lozano came to this country 18 years ago from Mexico at age 8 when her mother sent her and her 3-year-old brother across the border with the help of a coyote — someone paid to smuggle people across the border.
There wasn't enough money for their mother to travel with them, so the children came alone to meet an aunt living in East Los Angeles. "It was very scary," Lozano recalls. "I remember my mom telling me not to fall asleep because they can kidnap us."
Lozano, now a 26-year-old student at UCLA with a double major in global studies and anthropology, grew up in Fullerton with her brother and mother, who eventually made her way to the U.S.
Despite distant memories of the dangerous trek she and her brother took years ago, she says she knows no other life than the one she's lived here in America.
Yet, without legal immigration status, her family has been shut out of many benefits available to U.S. citizens, including access to health insurance. "It's always been a concern," Lozano says of living without coverage.
Undocumented immigrants have limited access to health insurance and medical care, a fact the Affordable Care Act does little to change. Though it increases access to Medicaid and private health insurance, the law bars millions of undocumented immigrants, including an estimated 1 million Californians, from these programs.
"Undocumented immigrants continue to be outside the coverage expansions under the Affordable Care Act," says Steve Zuckerman, with the Urban Institute, a Washington think tank.
Even when aware of the programs and services that are available to them, people can be apprehensive about trying to take advantage of them.
Many undocumented immigrants "say fear of deportation for themselves or family members is a barrier in terms of signing up for coverage and accessing healthcare services," says Laurel Lucia, policy analyst at the UC Berkeley Center for Labor Research and Education.
Lucia points out that U.S. Immigration and Customs Enforcement has established that any information submitted by immigrants — both documented and undocumented — for Medicaid or private insurance will not be used to enforce immigration law against those applying or their family members.
Despite the barriers, there are options for immigrants in Lozano's position to find health insurance and medical treatment. Here are some suggestions.
Student health plans. Many colleges and universities require students to either buy their school's health insurance policy or show proof of other coverage. Immigration status is generally not questioned when students apply, and the plans are affordable.
UCLA enforces such a requirement, and so for the first time in her life Lozano has health insurance. But she worries that once she completes her education she'll no longer have access to coverage.
"I'm very, very concerned about when I graduate school," she says.
http://www.latimes.com/business/la-fi-healthcare-watch-20140420,0,6282397,print.story
Obamacare gives voters a clash of candidates
The issue highlights big differences among Maine’s three gubernatorial candidates and hands the parties something to ‘fire up the base.’
By Randy Billings rbillings@pressherald.com
Staff Writer
Staff Writer
During a mid-April campaign swing through Lincoln County, U.S. Rep. Mike Michaud, the Democratic candidate for governor, sat down in the Boothbay Town Office with senior citizens who were fired up about last year’s closing of St. Andrews Hospital and Healthcare Center.
The town manager was trying to squeeze an additional $400,000 out of the local budget to fund the increased cost of ambulance services, and the seniors were concerned about being hit with a double-whammy – a reduction in service and an increase in property taxes.
Michaud used the opening to slam Republican Gov. Paul LePage for not expanding MaineCare – the state’s Medicaid program – under the Affordable Care Act.
He told the group of nearly two dozen seniors that expanding MaineCare would cover an additional 70,000 people, including 3,000 veterans. If more residents were insured, Michaud said, the town would not need to shoulder as much of the ambulance costs.
“On Day One, I will submit legislation to cover those 70,000 people,” Michaud said, referring to his plans if he beats LePage and independent Eliot Cutler. Michaud said he was also working on a plan to create a statewide health insurance exchange by looking at best practices nationwide.
Michaud’s support for Medicaid expansion stands in sharp contrast to LePage’s fierce opposition, offering a clear example of how the Affordable Care Act is emerging as a central issue in Maine’s gubernatorial race, which is attracting national attention.
The Republican Governors Association has already targeted Michaud in news releases for his support of the act, reflecting a party strategy that aims to capitalize on the relative national unpopularity of the law, also known as Obamacare.
http://www.pressherald.com/politics/Obamacare_gives_voters_a_clash_of_candidates_.htmlhttp://www.pressherald.com/politics/Obamacare_gives_voters_a_clash_of_candidates_.html?pagenum=full
One Therapist, $4 Million in 2012 Medicare Billing
By JULIE CRESWELL and ROBERT GEBELOFF
A few miles from the Coney Island boardwalk in Brooklyn stands an outpost of what, on paper, is a giant of American medicine.
Nothing about the place hints at the money that is said to flow there. But in 2012, according to federal data, $4.1 million from Medicare coursed through the office in a modest white house on Ocean Avenue.
In all, the practice treated around 1,950 Medicare patients that year. On average, it was paid by Medicare for 94 separate procedures for each one. That works out to about 183,000 treatments a year, 500 a day, 21 an hour.
What makes those figures more remarkable, and raises eyebrows among medical experts, is that judging by Medicare billing records, one person did it all. His name is Wael Bakry, and he is not some A-list cardiologist, oncologist or internist. He is a physical therapist.
But physical therapy, it turns out, is a big recipient of national Medicare dollars — and physical therapy in Brooklyn is among the biggest of all. Of the 10 physical therapists nationwide who were paid the most by Medicare in 2012, half listed Brooklyn addresses, according to an analysis of Medicare billing data by The New York Times. Two others listed addresses on Long Island, one in Queens, and one each in California and Texas.
Mr. Bakry, 42, did not dispute the $4.1 million figure. But he said that the Medicare data, released to much fanfare this month, could be “deceiving.” One person, he said, could not provide all of that care alone.
“I’m not Superman,” Mr. Bakry said.
One thing is certain: Physical therapy has become a Medicare gold mine. Medicare paid physical therapists working in offices $1.8 billion in 2012 alone, the 10th-highest field among 74 specialties, according to the Times analysis. In Brooklyn, physical therapy was second only to internal medicine.
Why Brooklyn? Federal authorities say the borough is a national hot spot for Medicare fraud, particularly fraud involving physical therapy. Unscrupulous practitioners bill Medicare for unnecessary treatments or procedures they never perform — something that is often easier to do in physical therapy than in fields like oncology or cardiology.
While some experts have expressed skepticism about Mr. Bakry’s numbers, he said Medicare had never questioned his billing practices nor denied payments to his practice. Mr. Bakry does not appear in a database of providers who are currently excluded from the Medicare program.
Health Law’s Pay Policy Is Skewed, Panel Finds
By ROBERT PEAR
WASHINGTON — Federal policies to reward high-quality health care are unfairly penalizing doctors and hospitals that treat large numbers of poor people, according to a new report commissioned by the Obama administration that recommends sweeping changes in payment policy.
Medicare and private insurers are increasingly paying health care providers according to their performance as measured by the quality of the care they provide. But, the draft report by an expert panel says, the measures of quality are fundamentally flawed because they do not recognize that it is often harder to achieve success when treating people who do not have much income or education.
Low-income people may be unable to afford needed medications or transportation to doctor’s offices and clinics, the panel said. If they have low levels of formal education or literacy, they may have difficulty understanding or following written instructions for home care and the use of medications. In addition, the clinics and hospitals they use may lack the resources and high tech equipment needed to diagnose and treat illnesses.
The panel found that existing payment policies unintentionally worsen disparities between rich and poor by shifting money away from doctors and hospitals that care for “disadvantaged patients.”
Measures of health care quality and performance — widely used by Medicare and private insurers in calculating financial rewards and penalties — should be adjusted for various “sociodemographic factors,” the expert panel said. The panel was created by the National Quality Forum, an influential nonprofit, nonpartisan organization that endorses health care standards.
“Factors far outside the control of a doctor or hospital — patients’ income, housing, education, even race — can significantly affect patient health, health care and providers’ performance scores,” said Dr. Christine K. Cassel, the president of the organization.
The Obama administration commissioned the study, but is not entirely comfortable with the recommendations, officials acknowledged. The existing policies of the National Quality Forum and the government say performance scores should generally not be adjusted or corrected to reflect differences in the income, race or socioeconomic status of patients.
Steven H. Lipstein, the president of BJC HealthCare in St. Louis and a member of the panel, said: “The administration’s current policy on adjustments for socioeconomic status are quite inadvertently exacerbating disparities in access to medical care for poor people who live in isolated neighborhoods. I’m sure that’s not what President Obama intended with the Affordable Care Act.”
The 26-member panel said policy makers who devise or use performance measures should “assess the potential impact on disadvantaged patient populations and the providers serving them,” to avoid hurting “safety net providers.”
Many provisions of the 2010 health law seek to improve care by tying Medicare payments to the performance of doctors, hospitals, nursing homes and health plans. Medicare, for example, is reducing payments to hospitals where an above-average share of patients return within a month of being treated and discharged.
When Maine looks in the mirror, it sees an aging face.
One in five residents is now 65 or older, and as their numbers rapidly grow, seniors are having a profound impact on the state. Housing, health care, transportation and caregivers are already in short supply for older Mainers, and the demands for more of these critical services will escalate quickly.
T
hrough the eyes and voices of Maine seniors, the Portland Press Herald/Maine Sunday Telegram is publishing an extended series that explores the aging of Maine, what it means for the state's economy and identity, and how it will shape the lives of so many of its people.
The project includes stories, videos and a comprehensive resource website to help families and caregivers find the assistance they need. Additional installments will be published throughout the year.
Watch the introductory video
http://specialprojects.pressherald.com/aging/#item19
We Kill Germs at Our Peril
‘Missing Microbes’: How Antibiotics Can Do Harm
You never get something for nothing, especially not in health care. Every test, every incision, every little pill brings benefits and risks.
Nowhere is that balance tilting more ominously in the wrong direction than in the once halcyon realm of infectious diseases, that big success story of the 20th century. We have hadantibiotics since the mid-1940s — just about as long as we have had the atomic bomb, as Dr. Martin J. Blaser points out — and our big mistake was failing long ago to appreciate the parallels between the two.
Antibiotics have cowed many of our old bacterial enemies into submission: We aimed to blast them off the planet, and we dosed accordingly. Now we are beginning to reap the consequences. It turns out that not all germs are bad — and even some bad germs are not all bad. In “Missing Microbes,” Dr. Blaser, a professor of medicine and infectious diseases at New York University, presents the daunting array of reasons we have to rethink the enthusiastic destruction of years past.
Second, as always, it is the hapless bystanders who have suffered the most — not human beings, mind you, but the gazillions of benevolent, hardworking bacteria colonizing our skin and the inner linings of our gastrointestinal tracts. We need these good little creatures to survive, but even a short course of antibiotics can destroy their universe, with incalculable casualties and a devastated landscape. Sometimes neither the citizenry nor the habitat ever recovers.
And finally, there is the accumulation of disheartening evidence that the war against the old plagues is simply leading to worse wars against a whole series of new ones.
Parts of Dr. Blaser’s argument are familiar, such as the story of Clostridium difficilecolitis, an increasingly common cause ofdiarrhea. This condition arises most often when a course of antibiotics skews the normal microbial population of the gut to favor a single toxin-producing organism. Sometimes yet more antibiotics will restore normal intestinal function. But sometimes no treatment works — nothing but infusing feces full of normal bacteria into the ailing intestines, a last-ditch strategy that has proved stunningly successful. Without it, otherwise perfectly healthy people can die.
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