Practice Beat

Joan R. Rose

Physician Supply: For new doctors, general surgery doesn't cut it

If current trends continue, you're likely to see fewer general surgeons in the not-too-distant future, according to a study published in the Archives of Surgery.

Throughout the 1980s, the number of graduating US medical students seeking a career in general surgery exceeded the number of residency positions available. Last year, for the first time, the number of students interested in general surgery was fewer than the number of positions offered. This year, although the number of general surgery positions remained largely unchanged, the number of US medical school seniors filling those positions declined again.

As the US population grows, researchers note, the need for general surgeons will inevitably increase, but about half of all surgery residents now select fellowships in a surgical subspecialty. By 2005, less than 5 percent of US graduates—down from a high of 12.1 percent in 1981—are expected to head into general surgery.

Malpractice: A double whammy for doctors in the courtroom

Plaintiffs in medical malpractice cases are not only winning more often but they're reaping bigger jury awards as well, according to a new report from Jury Verdict Research. The Horsham, PA-based publisher of statistical trends in personal-injury cases reports that the median jury award for malpractice cases jumped to $1 million in 2000—a 43-percent increase from 1999's $700,000. On the other hand, the median amount agreed to in settlements fell for the first time in five years.

How patients fare in court

2000

Percent of jury verdicts favoring plaintiffs

2000

Medical Education: The high cost of becoming a doctor

Only about one in five allopathic medical school students graduated debt-free last year, according to the Association of American Medical Colleges. The rest left school carrying an average debt load of $99,089—4 percent higher than 2000's graduates. The increase in osteopathic medical students' debt was even higher (6 percent), and their average indebtedness grew to $128,700, according to the American Association of Colleges of Osteopathic Medicine.

Tort Reform: Pennsylvania sprinkles a measure of relief on doctors' liability woes

Pennsylvania Gov. Mark Schweiker has signed legislation reforming the state's medical malpractice insurance system. The new law provides immediate relief by giving physicians a discount on the surcharge they'll pay this year to underwrite the state's Medical Professional Liability Catastrophic Loss Fund. High-risk physicians will get a 7 to 8 percent discount; all others, including primary care doctors, will receive a 2.5 percent discount. Last year, the typical primary care physician's surcharge ranged from $3,795 in Harrisburg to $7,762 in Philadelphia. This fund will eventually be phased out and replaced by a new patient compensation fund to be subsidized by an anticipated infusion of $40 million annually (beginning in 2004) from the state's Auto Catastrophic Loss Fund.

Once all the reforms are in place, the governor claims, doctors can expect to save up to 20 percent annually on their insurance premiums. But it will be years before the full impact on premium and surcharge levels is realized.

The new law also:
• Requires periodic payment (rather than one lump sum) for awards of future medical costs.
• Allows the court to reduce monetary awards if the amount would affect access to care.
• Prohibits plaintiffs from recovering damages for losses covered by a collateral source.
• Permits plaintiffs to retain just 75 percent of punitive damages awarded; the rest will be transferred to the compensation fund.
• Requires claims (except those involving minors or foreign objects left in a body) to be filed within seven years of when the alleged injury occurred.
• Imposes higher standards on expert witnesses, requiring them to be in the same or similar specialty as the defendant.

Inpatient Care: The hospital of the future: Safer—and all digital?

HealthSouth says it is building the world's first all digital, completely automated hospital. The Alabama acute care facility is designed to enable physicians to monitor a patient's condition anytime, anywhere. Every patient will wear a wireless "wellness monitor" that alerts clinicians when problems develop and also identifies the patient's location. In addition, each hospital bed will be connected to the Internet, enabling video conferencing with physicians or family members.

Doctors will be able to electronically access comprehensive patient information (such as vital signs, images, and test results), update information, and enter orders. The system is also expected to generate alerts on drug interactions and dosing at the time doctors enter the orders.

Burnout: Stress takes a toll on resident physicians—and their patients

Two recent studies published in the Annals of Internal Medicine suggest that resident physicians commonly suffer from emotional exhaustion, depersonalization, and a sense of low accomplishment. The first study found that 76 percent of 115 residents in one internal medicine residency program suffered from "burnout" and reported providing suboptimal patient care at least once a month.

In the second study—a survey of residents in all 415 US internal medicine residency programs—35 percent of the 4,128 respondents reported at least four symptoms of depression, and three-fifths said they'd grown more cynical as they progressed through residency. The large financial debt they carry contributes heavily to their condition, researchers suggest. Despite an 80-hour workweek, 33 percent of residents in their second through fifth year said they moonlighted.

Nevertheless, the Association of American Medical Colleges opposes a federal attempt to regulate residents' hours. A bill sponsored by Rep. John Conyers Jr. (D-MI) and signed by 50 House members would not only reduce hours, it would allow residents to file anonymous complaints regarding violations and impose financial penalties for institutions that did not comply.

In a letter to Conyers, the AAMC argued against a need for such federal oversight of graduate medical education, citing its own recently approved policies. Those policies hold faculty responsible for determining "when a resident physician is unable to function at the level required to provide safe, high quality care" and also gives faculty "the authority to adjust duty hours as necessary."

Nonphysician Salaries: CRNAs get higher pay than some primary care physicians

Because of a shortage of anesthesiologists in many places, Certified Registered Nurse Anesthetists are being offered salaries of up to $180,000 a year—more than many primary care physicians earn, according to a survey by Allied Consulting, a Dallas-based health care staffing firm. For some hospitals and medical groups who need anesthesiology services, hiring CRNAs makes sense because they still earn less than anesthesiologists.

Salaries of pharmacists are also beginning to approach six figures, at least at the high end, although the demand for pharmacists has recently slackened somewhat.

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The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2002;9:18.