DCMedical News: Tuesday, May 10, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, May 10, 2022
Congress Returns
Both houses of Congress are in session today, the first of eight such working days in May.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors Trained Abroad Want to See You Now
Stateline reports (here) that "Increasingly, states are eying immigrants . . . foreign-trained health professionals, as part of a solution to two problems that have deepened during the COVID-19 pandemic: the growing shortage of health care workers as the overall population in the country ages, and the worse health outcomes experienced by minority and immigrant communities."
The report notes, "As many as 270,000 underemployed immigrant health care professionals are now living in the U.S., according to a report released last month by the Migration Policy Institute, a nonpartisan research organization that analyzes immigration. Many have taken low-paying jobs as Uber drivers or cashiers just to stay above water."
They add, "A handful of states are easing certain licensing requirements, creating programs for foreign-trained doctors to work alongside U.S.-trained ones, reserving residency spots for immigrant health workers and providing help, sometimes including financial aid, for those working to get a U.S. license. States hope the efforts can not only get medical providers to more places where they are needed—particularly underserved rural and urban areas—but also lead to more professionals who speak the same language as and are culturally attuned to those they treat in an ever more diverse America."
Job Security in Medicine? It Depends on the Specialty
The blog Med School Insiders reports (here) on threats to physician job security. "The AAMC estimates that by the year 2034, we will experience a shortage of between 38,000 and 124,000 physicians; however, these shortages are not uniform across all specialties . . . With issues like oversaturation, mid-level encroachment, and advancements in artificial intelligence, the livelihoods of some specialties are not as secure as you might think."
On the supply side, "Since 2002, there has been an increase in allopathic medical school first-year enrollment, from approximately 16,000 positions to over 22,000 positions -- an increase of nearly 30%."
The result has some specialties at risk: radiation oncology, with the number of new entrants higher than the demand; plastic surgery, especially aesthetic, and, surprisingly, emergency medicine. "Although emergency medicine physicians have been integral during the pandemic, many new EM doctors are reporting difficulty finding jobs. The number of accredited emergency medicine programs has nearly doubled over the last 15 years, going from 133 in 2005 to 265 in 2019 . . . the demand . . . is not increasing fast enough to keep up with the amount of new doctors entering the field."
"Surprisingly, the coronavirus pandemic has only added to this issue. In many areas of the country, emergency departments experienced significant decreases in patient volumes during the pandemic. Many people were avoiding hospitals for fear of contracting COVID-19. The transition to remote learning and working from home also meant that fewer people were leaving the house, leading to fewer accidents. Many emergency departments were even forced to close their doors due to a lack of inpatient beds on overrun hospital floors."
"Patient volume matters a lot more in emergency medicine than it does in other specialties. There aren't as many high-cost procedures in emergency medicine, so EM physicians rely on seeing a high volume of patients as opposed to seeing just a few complicated ones."
Choosing Politically
Dr. Elizabeth Rourke takes off on the "Choosing Wisely" campaign against low value medical services, in the pages of The New England Journal of Medicine, here. She writes, "Ten years later, however, it’s clear that making lists and publicizing them are not sufficient to reduce low value care. Medical services that do not improve patients’ health continue to account for an estimated 10 to 20% of health care provided in the United States"; that "the political compromises that have allowed Choosing Wisely to flourish have also rendered it toothless"; that "only a small number of recommendations are based on data from randomized, controlled trials"; and that "specialty societies rarely select income-generating treatments provided by their members for inclusion on the lists."
The root cause of this whiff of hypocrisy, complicated by sanctimony, is evident, she says: "Health care is the tent pole of the American postindustrial service economy, and any significant reduction in the amount of care provided would result in financial and job losses."
Some Doctors and States Decry Race in a "Merit-Based" (MIPS) System
A feature in the 2021 physician fee schedule rule for Medicare's Merit Based Incentive Payment System (MIPS) "created a financial incentive within the Medicare reimbursement system for doctors to implement an anti-racism plan," according to a suit (Bloomberg report here, Complaint here) filed by two doctors and eight mostly Southern states.
"But the practical effect of the rule is to divert doctors’ time and energy from their main task, taking care of their patients, in the service of faddish theories . . . The rule also creates an unfair reimbursement penalty for doctors who refuse to submit anti-racism plans to the CMS because they object to the injection of race-based decision-making into medical care and would rather spend their time on patient care."
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Telemedicine a Particular Advantage for the Disadvantaged
Makary and colleagues (in Health Affairs, here) note that the pandemic-era policy of full payment for telemedicine physician office "visits" was a particular advantage to those who have difficulty making such visits in person. "Before the waiver, 0.42 percent of patients had at least one outpatient telemedicine visit, with no significant differences between people residing in the most versus the least disadvantaged neighborhoods. With the waiver, 9.97 percent of patients had at least one outpatient telemedicine visit, with the highest odds of utilization seen for people residing in the most disadvantaged neighborhoods."
Healthcare Workforce, Rural Hospitals
The Assistant Secretary for Planning and Evaluation (HHS) reports on the healthcare workforce here. The Bipartisan Policy Center reports on COVID-19 and Rural Health, here. The New York Times reports on stress in hospitals serving the disadvantage, secondary to loss of pandemic aid for those hospitals, here.
DRUGS & DEVICES
340B
A report on the program from consultants retained by pharmaceutical manufacturers, here.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here. The JAMA Patient Page explains the current status of oral anti-viral medications for COVID-19, here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
May 11, 12, 13, 16, 17, 18, 19
June 7, 8, 9, 10, 13, 14, 15, 16, 21, 22, 23, 24
July 12, 13, 14, 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no issues
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org