Biology Reference
In-Depth Information
programs are under threat based on recommendations of Med Pac. The debt loads continue
increase for medical students (the average for medical students is $158,000 according to the
AAMC; it is $28,000 for a bachelor's degree) and residents but the cost of expansion of
programs are huge. On average a primary care doctor also spend 21,700 hours of education
training over 11 years (see earlier comment about Outliers). In a survey, 79.2% of physicians
said there is too much regulation/paperwork, two thirds said there was a loss of clinical
autonomy, and over half said there has been an erosion of the physician-patient relationship.]
While most physicians who are in private practice and fee for service practice a very high
standard of care, there is always the temptation to over investigate or over treat for the sake of
reimbursement or defensive medicine, estimated by some studies to reach $200 billion
annually. The increasing trend of doctors being employed by hospitals may not entirely take
this temptation away since many hospital employ doctors with a prescribed bonus system for
extra pay based on for example procedures performed. This is measured by what is called
Relative Value Units (RVUs), a system setup by the US government (CMS) for valuing
physician services. The downside of not having an incentive bonus system is the danger that
physicians will underperform or under treat, a problem that has developed in some socialist
healthcare systems in Europe. The alternative to the carrot is a stick (defined period renewable
contracts). Physicians respond to positive encouragement, boosting pride, and some vanity
related achievement. The same passion is also what drives quality research and patient
protection as long as there are not adverse financial incentives. The investigator who wants to
see a new treatment succeed is going be more passionate about perfect outcomes and patient
safety. I have often said that if you want to check on whether a physician is a true expert in an
area, look on PubMed for his publications. If he or she is passionate about a disease process
or treatment, he will have published peer-reviewed articles on the subject.
Quality: While this gives some insight into a physician's outcomes, gauging a hospitals
outcomes and patient safety is more difficult to define, although better than it used to be
because of reports such as US News and World Report and University Health Consortium
administrative data. From a practical point of view, the quality outcomes metrics and this
process improvement measures at a hospital are what ensure high quality care and perceived
value. The way I like to do this is ensure that one's has high quality data sources from multiple
databases to cross check. It is also important to examine safety metrics, known as Patient
Safety Indicators or PSI. The number keeps increasing based on CMS directives, but includes
things like antibiotic use, medications, prevention of pressure sores or deep vein thrombosis or
IV related infections (CLABSI) or deep wound infections rates or for cardiac surgery, blood
sugar levels the day after surgery. The next step is to ensure that patient's perception of care is
both of high quality and value. Gallup polls have looked at what customers perceive as good
value and this can be applied to hospitals and doctors. It starts with a patient's confidence in
the institution, a physician's reputation and results, and that the patient is treated with integrity,
compassion, and empathy at successive levels of involvement. If this is achieved, then patients
will speak with great pride of their care and become the most important advocates of an
institution or physician.
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