UPDATE

Focus on Practice

By Joan R. Rose

The ups and downs of jury verdicts

Median compensatory jury awards appear to be leveling off. After growing 40 percent—to $1 million—in 2000, data for 2001 show no change, according to the latest report from Horsham, PA-based Jury Verdict Research. However, the proportion of cases won by plaintiffs is rising, particularly among childbirth-related verdicts.

Even so, "the majority [of plaintiffs overall] lose their jury trials and never receive a dime," notes David Boxold, editor of the study.

New doctors shy away from primary care again

The number of family practice positions filled by US medical school seniors fell from 47 percent last year to 42 percent, while internal medicine matches slipped from 59 percent to 55 percent. Many of the remaining positions will be filled outside the match by international medical graduates and doctors of osteopathic medicine. Moreover, current trends suggest that fewer than 50 percent of seniors entering internal medicine will pursue careers in general internal medicine, says Patrick Alguire of the American College of Physicians. Instead, they will opt for subspecialty careers.

The only primary care specialty with much drawing power this year was pediatrics; more than two-thirds of its slots were filled by US seniors.

The highest number of couples in history, 575, participated in the 2003 match; 94 percent of them matched.

The bite that managed care took out of doctors' earning power

Physicians' real-dollar net incomes dropped 5 percent from 1995 through 1999, according to a study by the Center for Studying Health System Change (HSC). By comparison, other skilled professionals saw their average income increase 3.5 percent during the same period. Researchers say managed care's discounted fees and restrictions on care are likely to blame for doctors' predicament.

Primary care practitioners' income declined an average 6.4 percent, adjusted for inflation, compared with 4 percent for cardiologists, surgeons, and other specialists.

"The downward trend in physician income represents a dramatic shift from 1991 to 1995, when their income growth exceeded inflation," says study co-author Marie Reed, a health research analyst for HSC, a nonpartisan policy research organization funded by The Robert Wood Johnson Foundation.

Congress' Medicare "fix" just broke again

Even though Congress recently enacted legislation that authorizes CMS to alter the formula used by Medicare to calculate physician reimbursement, CMS is making noises about reducing payments again next year. The Feds recently noted that Medicare spending for physician services has been growing at an annual rate of 7 percent, despite the 5.4 percent pay cut physicians took last year. Consequently, CMS wants to slash doctors' reimbursement another 4.2 percent in October, when the next fiscal year begins.

Back to the future for the ACP

The American College of Physicians-American Society of Internal Medicine, which was created by the merger of two groups in 1998, has simplified its name to the American College of Physicians. Also, the National Association of Inpatient Physicians, which represents hospitalists, will now be known as the Society of Hospital Medicine.

The IOM wants to overhaul medical education

An outcome-based education system would better prepare clinicians to meet both the needs of patients and the requirements of a changing health system, according to a report from the Institutes of Medicine of the National Academies. The IOM recommends a core set of skills for health care professionals that includes delivering patient-centered care; working as a member of an interdisciplinary team; practicing evidence-based medicine; applying quality improvement; and using informatics.

The report calls for the leaders of the profession and "oversight organizations" to stress these skills in education, accreditation and credentialing, research, public reporting, and leadership.

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Medical Economics

May 9, 2003;80:18.