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The fate of the ACA now rests with the U.S. Supreme Court
The U.S. Supreme Court has agreed to hear Texas v. California, a closely watched case that could upend the Affordable Care Act.
The justices will hear oral arguments in the case in fall 2020, with a ruling likely in 2021.
The Texas case, consolidated with a similar challenge, stems from a lawsuit by 20 Republican state attorneys general and governors that was filed after Congress zeroed out the ACA’s individual mandate penalty in 2017. The plaintiffs contend the now-valueless mandate is no longer constitutional and thus, the entire ACA should be struck down. Since the Trump administration declined to defend the ACA, a coalition of Democratic attorneys general and governors intervened in the case as defendants.
In 2018, a Texas district court ruled in favor of the plaintiffs and declared the entire health care law invalid. The 5th U.S. Circuit Court of Appeals partially affirmed the district court’s decision, ruling that the mandate was unconstitutional, but sending the case back to the lower court for more analysis on severability. On March 2, the U.S. Supreme Court granted two petitions by the defendants requesting that the high court review the appeals court decision.
The review follows a previous look at the ACA’s mandate by the Supreme Court in 2012. In National Federation of Independent Business v. Sebelius, justices upheld the ACA’s insurance mandate as constitutional, ruling the requirement was authorized by Congress’ power to levy taxes. The vote was 5-4, with Chief Justice John G. Roberts Jr. in agreement with the court’s four more liberal members.
The U.S. Supreme Court has agreed to hear Texas v. California, a closely watched case that could upend the Affordable Care Act.
The justices will hear oral arguments in the case in fall 2020, with a ruling likely in 2021.
The Texas case, consolidated with a similar challenge, stems from a lawsuit by 20 Republican state attorneys general and governors that was filed after Congress zeroed out the ACA’s individual mandate penalty in 2017. The plaintiffs contend the now-valueless mandate is no longer constitutional and thus, the entire ACA should be struck down. Since the Trump administration declined to defend the ACA, a coalition of Democratic attorneys general and governors intervened in the case as defendants.
In 2018, a Texas district court ruled in favor of the plaintiffs and declared the entire health care law invalid. The 5th U.S. Circuit Court of Appeals partially affirmed the district court’s decision, ruling that the mandate was unconstitutional, but sending the case back to the lower court for more analysis on severability. On March 2, the U.S. Supreme Court granted two petitions by the defendants requesting that the high court review the appeals court decision.
The review follows a previous look at the ACA’s mandate by the Supreme Court in 2012. In National Federation of Independent Business v. Sebelius, justices upheld the ACA’s insurance mandate as constitutional, ruling the requirement was authorized by Congress’ power to levy taxes. The vote was 5-4, with Chief Justice John G. Roberts Jr. in agreement with the court’s four more liberal members.
The U.S. Supreme Court has agreed to hear Texas v. California, a closely watched case that could upend the Affordable Care Act.
The justices will hear oral arguments in the case in fall 2020, with a ruling likely in 2021.
The Texas case, consolidated with a similar challenge, stems from a lawsuit by 20 Republican state attorneys general and governors that was filed after Congress zeroed out the ACA’s individual mandate penalty in 2017. The plaintiffs contend the now-valueless mandate is no longer constitutional and thus, the entire ACA should be struck down. Since the Trump administration declined to defend the ACA, a coalition of Democratic attorneys general and governors intervened in the case as defendants.
In 2018, a Texas district court ruled in favor of the plaintiffs and declared the entire health care law invalid. The 5th U.S. Circuit Court of Appeals partially affirmed the district court’s decision, ruling that the mandate was unconstitutional, but sending the case back to the lower court for more analysis on severability. On March 2, the U.S. Supreme Court granted two petitions by the defendants requesting that the high court review the appeals court decision.
The review follows a previous look at the ACA’s mandate by the Supreme Court in 2012. In National Federation of Independent Business v. Sebelius, justices upheld the ACA’s insurance mandate as constitutional, ruling the requirement was authorized by Congress’ power to levy taxes. The vote was 5-4, with Chief Justice John G. Roberts Jr. in agreement with the court’s four more liberal members.
Gender imbalance seen in authorship of rheumatology guidelines
Less than one-third of first authors on rheumatology guidelines or recommendations are women, according to a research letter published in Annals of the Rheumatic Diseases.
Giovanni Adami, MD, from the department of medicine at the University of Verona (Italy), and coauthors examined 366 English-language guidelines and recommendations published between 2004 and 2019 around the world.
They found that only 32% featured a female first author. However, they did observe a significant trend toward increasing female first authorship over the study period, with parity first being achieved for guidelines and recommendations published in 2017.
Male-dominated first authorship was seen almost across the disease subject matter. For RA, only 18.8% of the 96 guidelines or recommendations examined had a female first author, and of the 12 documents on polymyalgia rheumatica and giant cell arteritis, none featured a female first author.
Among the 73 guidelines and recommendations relating to psoriatic arthritis and spondyloarthritis, only 23.3% featured a female first author. However, three of the six documents on polymyositis and dermatomyositis had a female lead author, the only area where parity was achieved.
The authors noted the recent establishment of the EULAR Task Force on Gender Equity in Academic Rheumatology, which they said was an important first step toward gender equity in rheumatology guidelines authorship.
“Indeed, in the last 15 years we have witnessed an increase in female representativeness,” they wrote. “Notwithstanding, efforts should be made to improve the representation of female authors nationally and internationally.”
Commenting on the findings, rheumatologist Jean Liew, MD, said an interesting thing is that, in the United States at least, rheumatology is not a male-dominated field.
“Even though the practicing clinicians in rheumatology, most of them are women ... at the top of things it’s not as equitable as what it should be,” said Dr. Liew, acting instructor and senior fellow in the division of rheumatology at the University of Washington, Seattle.
Dr. Liew, who coauthored another study showing a significant gender gap in speakers at American College of Rheumatology meetings, said there was evidence suggesting men were more likely to be promoted, get grants, and get positive reviews, which made it harder for women to advance to senior research and leadership positions.
She noted that the ACR has been making a concerted effort to improve gender balance in the choice of speakers for meetings, but said that the problem of gender inequity in rheumatology required more widespread initiatives to address.
“It really takes people being aware of the problem and being good sponsors and promoting women who are qualified,” she said in an interview. “There should be more mentorship and sponsorship for women, otherwise this will never change.”
She also commented that pursuing research careers in rheumatology was difficult enough without the additional pressures of family life. “It’s years and years of sacrifice, it’s hard to get funding, which already makes it harder, especially for women with families who feel like they have to also be there at home.”
The study had no outside funding, and the authors declared no competing interests.
SOURCE: Adami G et al. Ann Rheum Dis. 2020 Feb 26. doi: 10.1136/annrheumdis-2020-217119.
Less than one-third of first authors on rheumatology guidelines or recommendations are women, according to a research letter published in Annals of the Rheumatic Diseases.
Giovanni Adami, MD, from the department of medicine at the University of Verona (Italy), and coauthors examined 366 English-language guidelines and recommendations published between 2004 and 2019 around the world.
They found that only 32% featured a female first author. However, they did observe a significant trend toward increasing female first authorship over the study period, with parity first being achieved for guidelines and recommendations published in 2017.
Male-dominated first authorship was seen almost across the disease subject matter. For RA, only 18.8% of the 96 guidelines or recommendations examined had a female first author, and of the 12 documents on polymyalgia rheumatica and giant cell arteritis, none featured a female first author.
Among the 73 guidelines and recommendations relating to psoriatic arthritis and spondyloarthritis, only 23.3% featured a female first author. However, three of the six documents on polymyositis and dermatomyositis had a female lead author, the only area where parity was achieved.
The authors noted the recent establishment of the EULAR Task Force on Gender Equity in Academic Rheumatology, which they said was an important first step toward gender equity in rheumatology guidelines authorship.
“Indeed, in the last 15 years we have witnessed an increase in female representativeness,” they wrote. “Notwithstanding, efforts should be made to improve the representation of female authors nationally and internationally.”
Commenting on the findings, rheumatologist Jean Liew, MD, said an interesting thing is that, in the United States at least, rheumatology is not a male-dominated field.
“Even though the practicing clinicians in rheumatology, most of them are women ... at the top of things it’s not as equitable as what it should be,” said Dr. Liew, acting instructor and senior fellow in the division of rheumatology at the University of Washington, Seattle.
Dr. Liew, who coauthored another study showing a significant gender gap in speakers at American College of Rheumatology meetings, said there was evidence suggesting men were more likely to be promoted, get grants, and get positive reviews, which made it harder for women to advance to senior research and leadership positions.
She noted that the ACR has been making a concerted effort to improve gender balance in the choice of speakers for meetings, but said that the problem of gender inequity in rheumatology required more widespread initiatives to address.
“It really takes people being aware of the problem and being good sponsors and promoting women who are qualified,” she said in an interview. “There should be more mentorship and sponsorship for women, otherwise this will never change.”
She also commented that pursuing research careers in rheumatology was difficult enough without the additional pressures of family life. “It’s years and years of sacrifice, it’s hard to get funding, which already makes it harder, especially for women with families who feel like they have to also be there at home.”
The study had no outside funding, and the authors declared no competing interests.
SOURCE: Adami G et al. Ann Rheum Dis. 2020 Feb 26. doi: 10.1136/annrheumdis-2020-217119.
Less than one-third of first authors on rheumatology guidelines or recommendations are women, according to a research letter published in Annals of the Rheumatic Diseases.
Giovanni Adami, MD, from the department of medicine at the University of Verona (Italy), and coauthors examined 366 English-language guidelines and recommendations published between 2004 and 2019 around the world.
They found that only 32% featured a female first author. However, they did observe a significant trend toward increasing female first authorship over the study period, with parity first being achieved for guidelines and recommendations published in 2017.
Male-dominated first authorship was seen almost across the disease subject matter. For RA, only 18.8% of the 96 guidelines or recommendations examined had a female first author, and of the 12 documents on polymyalgia rheumatica and giant cell arteritis, none featured a female first author.
Among the 73 guidelines and recommendations relating to psoriatic arthritis and spondyloarthritis, only 23.3% featured a female first author. However, three of the six documents on polymyositis and dermatomyositis had a female lead author, the only area where parity was achieved.
The authors noted the recent establishment of the EULAR Task Force on Gender Equity in Academic Rheumatology, which they said was an important first step toward gender equity in rheumatology guidelines authorship.
“Indeed, in the last 15 years we have witnessed an increase in female representativeness,” they wrote. “Notwithstanding, efforts should be made to improve the representation of female authors nationally and internationally.”
Commenting on the findings, rheumatologist Jean Liew, MD, said an interesting thing is that, in the United States at least, rheumatology is not a male-dominated field.
“Even though the practicing clinicians in rheumatology, most of them are women ... at the top of things it’s not as equitable as what it should be,” said Dr. Liew, acting instructor and senior fellow in the division of rheumatology at the University of Washington, Seattle.
Dr. Liew, who coauthored another study showing a significant gender gap in speakers at American College of Rheumatology meetings, said there was evidence suggesting men were more likely to be promoted, get grants, and get positive reviews, which made it harder for women to advance to senior research and leadership positions.
She noted that the ACR has been making a concerted effort to improve gender balance in the choice of speakers for meetings, but said that the problem of gender inequity in rheumatology required more widespread initiatives to address.
“It really takes people being aware of the problem and being good sponsors and promoting women who are qualified,” she said in an interview. “There should be more mentorship and sponsorship for women, otherwise this will never change.”
She also commented that pursuing research careers in rheumatology was difficult enough without the additional pressures of family life. “It’s years and years of sacrifice, it’s hard to get funding, which already makes it harder, especially for women with families who feel like they have to also be there at home.”
The study had no outside funding, and the authors declared no competing interests.
SOURCE: Adami G et al. Ann Rheum Dis. 2020 Feb 26. doi: 10.1136/annrheumdis-2020-217119.
FROM ANNALS OF THE RHEUMATIC DISEASES
Among all physicians, internists near bottom for workplace happiness
Physicians in internal medicine struggle to find happiness both in and outside the workplace, according to Medscape’s 2020 Lifestyle, Happiness, and Burnout Report.
Only 22% of internists reported that they were very happy at work, with only neurologists reporting a worse at-work happiness rate, according to the Medscape report.
The news wasn’t much better when it came to happiness outside the office, as only 48% of internists reported they were very happy. Once again, neurologists had the lowest happiness rate outside the office, at 44%.
The rate of burnout among internists, at 43%, was similar to that of physicians overall at 41%; 14% of internists reported that they were both burned out and depressed. The most common contributing factors to burnout for internists were having too many bureaucratic tasks (62%), receiving a lack of respect from colleagues (34%), and spending too many hours at work (33%).
Internists dealt with burnout by isolating themselves from others (47%), talking with family/friends (45%), and exercising (41%). In addition, only 41% of internists took 3-4 weeks’ vacation, less than the 44% for physicians overall, and 43% took less than 3 weeks of vacation.
About 14% of internists said that they’d contemplated suicide, and 1% reported that they’d attempted it; 80% said they’d never thought about suicide. Only 16% said that they were seeking or planning to seek professional help for symptoms of burnout or depression, and 64% said they weren’t planning on seeking help and had never done so in the past.
The Medscape survey was conducted from June 25 to Sept. 19, 2019, and involved 15,181 physicians.
Physicians in internal medicine struggle to find happiness both in and outside the workplace, according to Medscape’s 2020 Lifestyle, Happiness, and Burnout Report.
Only 22% of internists reported that they were very happy at work, with only neurologists reporting a worse at-work happiness rate, according to the Medscape report.
The news wasn’t much better when it came to happiness outside the office, as only 48% of internists reported they were very happy. Once again, neurologists had the lowest happiness rate outside the office, at 44%.
The rate of burnout among internists, at 43%, was similar to that of physicians overall at 41%; 14% of internists reported that they were both burned out and depressed. The most common contributing factors to burnout for internists were having too many bureaucratic tasks (62%), receiving a lack of respect from colleagues (34%), and spending too many hours at work (33%).
Internists dealt with burnout by isolating themselves from others (47%), talking with family/friends (45%), and exercising (41%). In addition, only 41% of internists took 3-4 weeks’ vacation, less than the 44% for physicians overall, and 43% took less than 3 weeks of vacation.
About 14% of internists said that they’d contemplated suicide, and 1% reported that they’d attempted it; 80% said they’d never thought about suicide. Only 16% said that they were seeking or planning to seek professional help for symptoms of burnout or depression, and 64% said they weren’t planning on seeking help and had never done so in the past.
The Medscape survey was conducted from June 25 to Sept. 19, 2019, and involved 15,181 physicians.
Physicians in internal medicine struggle to find happiness both in and outside the workplace, according to Medscape’s 2020 Lifestyle, Happiness, and Burnout Report.
Only 22% of internists reported that they were very happy at work, with only neurologists reporting a worse at-work happiness rate, according to the Medscape report.
The news wasn’t much better when it came to happiness outside the office, as only 48% of internists reported they were very happy. Once again, neurologists had the lowest happiness rate outside the office, at 44%.
The rate of burnout among internists, at 43%, was similar to that of physicians overall at 41%; 14% of internists reported that they were both burned out and depressed. The most common contributing factors to burnout for internists were having too many bureaucratic tasks (62%), receiving a lack of respect from colleagues (34%), and spending too many hours at work (33%).
Internists dealt with burnout by isolating themselves from others (47%), talking with family/friends (45%), and exercising (41%). In addition, only 41% of internists took 3-4 weeks’ vacation, less than the 44% for physicians overall, and 43% took less than 3 weeks of vacation.
About 14% of internists said that they’d contemplated suicide, and 1% reported that they’d attempted it; 80% said they’d never thought about suicide. Only 16% said that they were seeking or planning to seek professional help for symptoms of burnout or depression, and 64% said they weren’t planning on seeking help and had never done so in the past.
The Medscape survey was conducted from June 25 to Sept. 19, 2019, and involved 15,181 physicians.
It is time to separate the O from the G
Two very different specialties, obstetrics (O) and gynecology (G), were fused into one in 1889. It is difficult to conceive that, with the expansion of both specialties in knowledge, procedures, and subspecialties, they still remain as one after 130 years. The American College of Obstetricians and Gynecologists was founded in 1952, and after 68 years no major changes have been made to accept or incorporate that there is a need to consider O and G as two different specialties.
Obstetrics and gynecology are the only specialties dedicated exclusively to women but with a very different purpose: the O is for reproduction, the G is for prevention and management of genital diseases. The specialties of O and G are so different the only thing in common is the patient.
It is time to separate the O from the G.
Are we training surgically competent residents?
No, we are not. There is an adequate volume for training and practice in O with close to 3.8 million births a year (the number cited by the Centers for Disease Control and Prevention in 2018). Not surprisingly, there is a need for trainees and also for practitioners in rural areas. As a result, the surgical training and practice in G is not optimal. If the number of hysterectomies was even near that of deliveries, there would be an adequate volume for everyone in training and in practice. But this is not the case.
The Accreditation Council for Graduate Medical Education (ACGME) mandates OG residents to graduate with a minimum of 70 minimally invasive hysterectomies (MIH), including laparoscopic (LH), vaginal (VH), and laparoscopic vaginally assisted (LAVH). In 2017, 51% of graduating residents fell below the minimum of 70 MIH.1 Because the learning curve of LH ranges from 30 to 80 cases,2 it is not surprising most residents feel surgically inadequate at graduation to function independently.
Increased procedures and technologies with reduced training hours
Let’s look at hysterectomies. From two techniques, vaginal and abdominal, they have expanded to LH, LAVH, robotic, single-site LH, single-site robotic, and recently single-port robotic. In addition, different and new technologies for hysteroscopy and myomectomy procedures have been developed.
All these operations are supposed to be part of any training program as ACGME demands “OG residents must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.”3 In addition, primary care has been added to OG residency training: “Primary health care management from adolescence through reproductive age to midlife and beyond is integral to any ob.gyn.’s practice” and “Obstetrician-gynecologists are viewed by some entities as being primary care physicians for women, especially as coordinators of care among most reproductive-aged women,” according to ACOG.4
All this with reduced training hours.
The number of training hours a week has been reduced to 80, while it used to be over 100 hours. If you do the math, 20 fewer hours a week for 4 years amounts to 4,240 hours, equivalent to 180 days, equal to 6 months.
Graduating residents must pass a written and an oral exam for certification and with this are approved to enter the operating room and operate on women without a surgical skills test.
A simple test shows that elimination of the O for 1 year improves laparoscopic performance
We compared the time to perform three basic laparoscopic skills by fourth-year OG residents with that of fellows at the end of their first year in a minimally invasive G fellowship.5 The mean time for the residents completing the three tasks within the allotted time was 16 minutes, compared with 3.5 minutes for fellows: a four times faster performance.
Are there enough patients to maintain surgical skills after residency?
No, there are not.
Consider the following reality after residency. Decreasing number of surgeries and increasing numbers of OGs results in what you have already guessed: a lower surgical volume per OG.
Since 1979, the number of G surgeries has decreased by almost half (46%) while the number of OGs has doubled (54%) resulting in an 81% decrease of number of surgeries per OG, from 132 in 1979 to 25 in 2007.6 For hysterectomies, there has been a continuous yearly decline per G from 28 in 1980 to 9.8 in 2007 and to 8.5 in 2010.7,8
Would any mother feel comfortable having an obstetrician for her pregnancy and delivery performing only 8.5 deliveries a year?
Where do we go from here?
Separate the training and practice of O and G, an initiative already started in some residency programs and in some institutions in the United States. The O and the G both include a medical and a surgical practice.
We need to start accepting there is a need for different practices: medical O, medical G, surgical O, and surgical G. It is not new, it is already happening, it is the case in our institution since inception, and it is expanding across the country because it is needed. Graduating residents recognize this need as noticed by the increasing number seeking subspecialty training, from 7% in 2000 to 19.5% in 2012.4
Will this require some patients to drive away from home to obtain the best possible care? Yes. It is not a new concept, and it already is occurring for patients traveling to specialized centers away from home for certain conditions. In some countries, the practice is restricted to only a few centers. In Sweden, for instance, patients diagnosed with gynecologic cancer must travel to one of only seven centers subspecialized in gynecologic malignancies.
Conclusion
We need to start someday. We already are late after 130 years. We need to provide optimal care for women. They are our mothers. They deserve it. Let the O deliver O care, let the G provide G care, and we will reap improved results.
Dr. Magrina is with the department of medical and surgical gynecology at the Mayo Clinic in Phoenix. The author has no conflict of interest or financial involvement with this manuscript.
References
1. Am J Obstet Gynecol. 2019 Nov 22. doi: 10.1016/j.ajog.2019.11.1258.
2. Clin Obstet Gynecol. 2011 Sep;54(3):376-81.
3. Accreditation Council for Graduate Medical Education. Program requirements for GME in Obstetrics and Gynecology 2017.
4. “The obstetrician-gynecologist workforce in the United States: Facts, figures, and implications, 2017” (Washington, D.C.: ACOG, 2017).
5. J Minim Invasive Gynecol. 2008 Jul-Aug;15(4):410-3.
6. J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):501-3.
7. National Health Statistics Report. Hysterectomy in the U.S. and oophorectomy 1979-2007. http://www.cdc.gov/nchs/products/nhsr.htm.
8. The Healthcare Cost and Utilization Project – Nationwide Inpatient Sample: Agency for Health Care Research Quality. 2013.
Two very different specialties, obstetrics (O) and gynecology (G), were fused into one in 1889. It is difficult to conceive that, with the expansion of both specialties in knowledge, procedures, and subspecialties, they still remain as one after 130 years. The American College of Obstetricians and Gynecologists was founded in 1952, and after 68 years no major changes have been made to accept or incorporate that there is a need to consider O and G as two different specialties.
Obstetrics and gynecology are the only specialties dedicated exclusively to women but with a very different purpose: the O is for reproduction, the G is for prevention and management of genital diseases. The specialties of O and G are so different the only thing in common is the patient.
It is time to separate the O from the G.
Are we training surgically competent residents?
No, we are not. There is an adequate volume for training and practice in O with close to 3.8 million births a year (the number cited by the Centers for Disease Control and Prevention in 2018). Not surprisingly, there is a need for trainees and also for practitioners in rural areas. As a result, the surgical training and practice in G is not optimal. If the number of hysterectomies was even near that of deliveries, there would be an adequate volume for everyone in training and in practice. But this is not the case.
The Accreditation Council for Graduate Medical Education (ACGME) mandates OG residents to graduate with a minimum of 70 minimally invasive hysterectomies (MIH), including laparoscopic (LH), vaginal (VH), and laparoscopic vaginally assisted (LAVH). In 2017, 51% of graduating residents fell below the minimum of 70 MIH.1 Because the learning curve of LH ranges from 30 to 80 cases,2 it is not surprising most residents feel surgically inadequate at graduation to function independently.
Increased procedures and technologies with reduced training hours
Let’s look at hysterectomies. From two techniques, vaginal and abdominal, they have expanded to LH, LAVH, robotic, single-site LH, single-site robotic, and recently single-port robotic. In addition, different and new technologies for hysteroscopy and myomectomy procedures have been developed.
All these operations are supposed to be part of any training program as ACGME demands “OG residents must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.”3 In addition, primary care has been added to OG residency training: “Primary health care management from adolescence through reproductive age to midlife and beyond is integral to any ob.gyn.’s practice” and “Obstetrician-gynecologists are viewed by some entities as being primary care physicians for women, especially as coordinators of care among most reproductive-aged women,” according to ACOG.4
All this with reduced training hours.
The number of training hours a week has been reduced to 80, while it used to be over 100 hours. If you do the math, 20 fewer hours a week for 4 years amounts to 4,240 hours, equivalent to 180 days, equal to 6 months.
Graduating residents must pass a written and an oral exam for certification and with this are approved to enter the operating room and operate on women without a surgical skills test.
A simple test shows that elimination of the O for 1 year improves laparoscopic performance
We compared the time to perform three basic laparoscopic skills by fourth-year OG residents with that of fellows at the end of their first year in a minimally invasive G fellowship.5 The mean time for the residents completing the three tasks within the allotted time was 16 minutes, compared with 3.5 minutes for fellows: a four times faster performance.
Are there enough patients to maintain surgical skills after residency?
No, there are not.
Consider the following reality after residency. Decreasing number of surgeries and increasing numbers of OGs results in what you have already guessed: a lower surgical volume per OG.
Since 1979, the number of G surgeries has decreased by almost half (46%) while the number of OGs has doubled (54%) resulting in an 81% decrease of number of surgeries per OG, from 132 in 1979 to 25 in 2007.6 For hysterectomies, there has been a continuous yearly decline per G from 28 in 1980 to 9.8 in 2007 and to 8.5 in 2010.7,8
Would any mother feel comfortable having an obstetrician for her pregnancy and delivery performing only 8.5 deliveries a year?
Where do we go from here?
Separate the training and practice of O and G, an initiative already started in some residency programs and in some institutions in the United States. The O and the G both include a medical and a surgical practice.
We need to start accepting there is a need for different practices: medical O, medical G, surgical O, and surgical G. It is not new, it is already happening, it is the case in our institution since inception, and it is expanding across the country because it is needed. Graduating residents recognize this need as noticed by the increasing number seeking subspecialty training, from 7% in 2000 to 19.5% in 2012.4
Will this require some patients to drive away from home to obtain the best possible care? Yes. It is not a new concept, and it already is occurring for patients traveling to specialized centers away from home for certain conditions. In some countries, the practice is restricted to only a few centers. In Sweden, for instance, patients diagnosed with gynecologic cancer must travel to one of only seven centers subspecialized in gynecologic malignancies.
Conclusion
We need to start someday. We already are late after 130 years. We need to provide optimal care for women. They are our mothers. They deserve it. Let the O deliver O care, let the G provide G care, and we will reap improved results.
Dr. Magrina is with the department of medical and surgical gynecology at the Mayo Clinic in Phoenix. The author has no conflict of interest or financial involvement with this manuscript.
References
1. Am J Obstet Gynecol. 2019 Nov 22. doi: 10.1016/j.ajog.2019.11.1258.
2. Clin Obstet Gynecol. 2011 Sep;54(3):376-81.
3. Accreditation Council for Graduate Medical Education. Program requirements for GME in Obstetrics and Gynecology 2017.
4. “The obstetrician-gynecologist workforce in the United States: Facts, figures, and implications, 2017” (Washington, D.C.: ACOG, 2017).
5. J Minim Invasive Gynecol. 2008 Jul-Aug;15(4):410-3.
6. J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):501-3.
7. National Health Statistics Report. Hysterectomy in the U.S. and oophorectomy 1979-2007. http://www.cdc.gov/nchs/products/nhsr.htm.
8. The Healthcare Cost and Utilization Project – Nationwide Inpatient Sample: Agency for Health Care Research Quality. 2013.
Two very different specialties, obstetrics (O) and gynecology (G), were fused into one in 1889. It is difficult to conceive that, with the expansion of both specialties in knowledge, procedures, and subspecialties, they still remain as one after 130 years. The American College of Obstetricians and Gynecologists was founded in 1952, and after 68 years no major changes have been made to accept or incorporate that there is a need to consider O and G as two different specialties.
Obstetrics and gynecology are the only specialties dedicated exclusively to women but with a very different purpose: the O is for reproduction, the G is for prevention and management of genital diseases. The specialties of O and G are so different the only thing in common is the patient.
It is time to separate the O from the G.
Are we training surgically competent residents?
No, we are not. There is an adequate volume for training and practice in O with close to 3.8 million births a year (the number cited by the Centers for Disease Control and Prevention in 2018). Not surprisingly, there is a need for trainees and also for practitioners in rural areas. As a result, the surgical training and practice in G is not optimal. If the number of hysterectomies was even near that of deliveries, there would be an adequate volume for everyone in training and in practice. But this is not the case.
The Accreditation Council for Graduate Medical Education (ACGME) mandates OG residents to graduate with a minimum of 70 minimally invasive hysterectomies (MIH), including laparoscopic (LH), vaginal (VH), and laparoscopic vaginally assisted (LAVH). In 2017, 51% of graduating residents fell below the minimum of 70 MIH.1 Because the learning curve of LH ranges from 30 to 80 cases,2 it is not surprising most residents feel surgically inadequate at graduation to function independently.
Increased procedures and technologies with reduced training hours
Let’s look at hysterectomies. From two techniques, vaginal and abdominal, they have expanded to LH, LAVH, robotic, single-site LH, single-site robotic, and recently single-port robotic. In addition, different and new technologies for hysteroscopy and myomectomy procedures have been developed.
All these operations are supposed to be part of any training program as ACGME demands “OG residents must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.”3 In addition, primary care has been added to OG residency training: “Primary health care management from adolescence through reproductive age to midlife and beyond is integral to any ob.gyn.’s practice” and “Obstetrician-gynecologists are viewed by some entities as being primary care physicians for women, especially as coordinators of care among most reproductive-aged women,” according to ACOG.4
All this with reduced training hours.
The number of training hours a week has been reduced to 80, while it used to be over 100 hours. If you do the math, 20 fewer hours a week for 4 years amounts to 4,240 hours, equivalent to 180 days, equal to 6 months.
Graduating residents must pass a written and an oral exam for certification and with this are approved to enter the operating room and operate on women without a surgical skills test.
A simple test shows that elimination of the O for 1 year improves laparoscopic performance
We compared the time to perform three basic laparoscopic skills by fourth-year OG residents with that of fellows at the end of their first year in a minimally invasive G fellowship.5 The mean time for the residents completing the three tasks within the allotted time was 16 minutes, compared with 3.5 minutes for fellows: a four times faster performance.
Are there enough patients to maintain surgical skills after residency?
No, there are not.
Consider the following reality after residency. Decreasing number of surgeries and increasing numbers of OGs results in what you have already guessed: a lower surgical volume per OG.
Since 1979, the number of G surgeries has decreased by almost half (46%) while the number of OGs has doubled (54%) resulting in an 81% decrease of number of surgeries per OG, from 132 in 1979 to 25 in 2007.6 For hysterectomies, there has been a continuous yearly decline per G from 28 in 1980 to 9.8 in 2007 and to 8.5 in 2010.7,8
Would any mother feel comfortable having an obstetrician for her pregnancy and delivery performing only 8.5 deliveries a year?
Where do we go from here?
Separate the training and practice of O and G, an initiative already started in some residency programs and in some institutions in the United States. The O and the G both include a medical and a surgical practice.
We need to start accepting there is a need for different practices: medical O, medical G, surgical O, and surgical G. It is not new, it is already happening, it is the case in our institution since inception, and it is expanding across the country because it is needed. Graduating residents recognize this need as noticed by the increasing number seeking subspecialty training, from 7% in 2000 to 19.5% in 2012.4
Will this require some patients to drive away from home to obtain the best possible care? Yes. It is not a new concept, and it already is occurring for patients traveling to specialized centers away from home for certain conditions. In some countries, the practice is restricted to only a few centers. In Sweden, for instance, patients diagnosed with gynecologic cancer must travel to one of only seven centers subspecialized in gynecologic malignancies.
Conclusion
We need to start someday. We already are late after 130 years. We need to provide optimal care for women. They are our mothers. They deserve it. Let the O deliver O care, let the G provide G care, and we will reap improved results.
Dr. Magrina is with the department of medical and surgical gynecology at the Mayo Clinic in Phoenix. The author has no conflict of interest or financial involvement with this manuscript.
References
1. Am J Obstet Gynecol. 2019 Nov 22. doi: 10.1016/j.ajog.2019.11.1258.
2. Clin Obstet Gynecol. 2011 Sep;54(3):376-81.
3. Accreditation Council for Graduate Medical Education. Program requirements for GME in Obstetrics and Gynecology 2017.
4. “The obstetrician-gynecologist workforce in the United States: Facts, figures, and implications, 2017” (Washington, D.C.: ACOG, 2017).
5. J Minim Invasive Gynecol. 2008 Jul-Aug;15(4):410-3.
6. J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):501-3.
7. National Health Statistics Report. Hysterectomy in the U.S. and oophorectomy 1979-2007. http://www.cdc.gov/nchs/products/nhsr.htm.
8. The Healthcare Cost and Utilization Project – Nationwide Inpatient Sample: Agency for Health Care Research Quality. 2013.
Research protocol overkill
This is a lot of paper.
It’s not a chart. Or mortgage forms. Or Family and Medical Leave Act paperwork.
It’s a research protocol for a study I’m involved in.
Now, I understand that research needs detailed protocols. It’s serious business, and when it’s happening at multiple sites they all need to know exactly what the plan is, what steps should be followed, who qualifies and who doesn’t, and so on.
But here’s what irritates me: That huge pile showed up at my office about an hour after all of the same documents were delivered to me by email, as PDFs.
Not only that, but someone had paid a messenger service to get them to me promptly. When I asked why I was told “because it’s the protocol that each site have both paper and digital copies.”
I don’t understand this at all. To me, the whole thing seems pretty wasteful on multiple levels. I’m told there are 28 sites for this study, so there’s a minimum stack of 28 times that one involved. Of course, each site probably has three to five copies (at least). Then, if the protocol is amended in a few months ... you get the idea.
To me this seems ridiculously wasteful. That’s a lot of paper and ink and shipping charges. If the whole thing can be sent digitally for a lot less money, why are they requiring both? If they need a signed signature sheet saying I read it, why not just print up that sheet? It’s one page instead of a huge pile. If I can digitally sign a document to refinance my house, why can’t I do it to acknowledge reading the protocol? I’m more likely to read study data on my iPad, anyway.
Not only that, now I have to store that stack in my office for several years, in spite of also having it on my hard drive.
Obviously, this is just a fraction of research costs, but it’s still money wasted.
The environmental issues of trees, water to make paper, the ink cartridges, and fuel to transport documents are all there, too. I could certainly go on.
I guess the overlying problem is that we’re still between two worlds (paper and digital) and, in spite of the marked shift to the latter, many are still insisting we try to live in both. At some point it gets silly. And costly.
I’m sure we won’t become completely paperless in my career, but there are plenty of ways we can eliminate its often-unnecessary overhead. Money is just the most obvious one.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This is a lot of paper.
It’s not a chart. Or mortgage forms. Or Family and Medical Leave Act paperwork.
It’s a research protocol for a study I’m involved in.
Now, I understand that research needs detailed protocols. It’s serious business, and when it’s happening at multiple sites they all need to know exactly what the plan is, what steps should be followed, who qualifies and who doesn’t, and so on.
But here’s what irritates me: That huge pile showed up at my office about an hour after all of the same documents were delivered to me by email, as PDFs.
Not only that, but someone had paid a messenger service to get them to me promptly. When I asked why I was told “because it’s the protocol that each site have both paper and digital copies.”
I don’t understand this at all. To me, the whole thing seems pretty wasteful on multiple levels. I’m told there are 28 sites for this study, so there’s a minimum stack of 28 times that one involved. Of course, each site probably has three to five copies (at least). Then, if the protocol is amended in a few months ... you get the idea.
To me this seems ridiculously wasteful. That’s a lot of paper and ink and shipping charges. If the whole thing can be sent digitally for a lot less money, why are they requiring both? If they need a signed signature sheet saying I read it, why not just print up that sheet? It’s one page instead of a huge pile. If I can digitally sign a document to refinance my house, why can’t I do it to acknowledge reading the protocol? I’m more likely to read study data on my iPad, anyway.
Not only that, now I have to store that stack in my office for several years, in spite of also having it on my hard drive.
Obviously, this is just a fraction of research costs, but it’s still money wasted.
The environmental issues of trees, water to make paper, the ink cartridges, and fuel to transport documents are all there, too. I could certainly go on.
I guess the overlying problem is that we’re still between two worlds (paper and digital) and, in spite of the marked shift to the latter, many are still insisting we try to live in both. At some point it gets silly. And costly.
I’m sure we won’t become completely paperless in my career, but there are plenty of ways we can eliminate its often-unnecessary overhead. Money is just the most obvious one.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This is a lot of paper.
It’s not a chart. Or mortgage forms. Or Family and Medical Leave Act paperwork.
It’s a research protocol for a study I’m involved in.
Now, I understand that research needs detailed protocols. It’s serious business, and when it’s happening at multiple sites they all need to know exactly what the plan is, what steps should be followed, who qualifies and who doesn’t, and so on.
But here’s what irritates me: That huge pile showed up at my office about an hour after all of the same documents were delivered to me by email, as PDFs.
Not only that, but someone had paid a messenger service to get them to me promptly. When I asked why I was told “because it’s the protocol that each site have both paper and digital copies.”
I don’t understand this at all. To me, the whole thing seems pretty wasteful on multiple levels. I’m told there are 28 sites for this study, so there’s a minimum stack of 28 times that one involved. Of course, each site probably has three to five copies (at least). Then, if the protocol is amended in a few months ... you get the idea.
To me this seems ridiculously wasteful. That’s a lot of paper and ink and shipping charges. If the whole thing can be sent digitally for a lot less money, why are they requiring both? If they need a signed signature sheet saying I read it, why not just print up that sheet? It’s one page instead of a huge pile. If I can digitally sign a document to refinance my house, why can’t I do it to acknowledge reading the protocol? I’m more likely to read study data on my iPad, anyway.
Not only that, now I have to store that stack in my office for several years, in spite of also having it on my hard drive.
Obviously, this is just a fraction of research costs, but it’s still money wasted.
The environmental issues of trees, water to make paper, the ink cartridges, and fuel to transport documents are all there, too. I could certainly go on.
I guess the overlying problem is that we’re still between two worlds (paper and digital) and, in spite of the marked shift to the latter, many are still insisting we try to live in both. At some point it gets silly. And costly.
I’m sure we won’t become completely paperless in my career, but there are plenty of ways we can eliminate its often-unnecessary overhead. Money is just the most obvious one.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Are patient portals living up to the hype? Ask your mother-in-law!
While preparing to write this technology column, I received a great deal of insight from the unlikeliest of sources: my mother-in-law.
Now don’t get me wrong – she’s a truly lovely, intelligent, and capable woman. I have sought her advice often on many things and have always been impressed by her wisdom and pragmatism, but I’ve just never thought of asking her for her opinion on medicine or technology, as I considered her knowledge of both subjects to be limited.
This occasion changed my opinion. In fact, I believe that, as health care IT becomes more complex, people like my mother-in-law may be exactly who we should be looking to for answers.
A few weeks ago, my mother-in-law and I were discussing her recent trip to the doctor. When she mentioned some lab tests, I suggested that we log in to her patient portal to view the results. This elicited several questions and a declaration of frustration.
“Which portal?” she asked. “I have so many and can’t keep all of the websites and passwords straight! Why can’t all of my doctors use the same portal, and why do they all have different password requirements?”
As she spoke these words, I was immediately struck with an unfortunate reality of EHRs: We have done a brilliant job creating state-of-the-art digital castles and have filled them with the data needed to revolutionize care and improve population health – but we haven’t given our patients the keys to get inside.
We must ask ourselves if, in trying to construct fortresses of information around our patients, we have lost sight of the individuals in the center. I believe that we can answer this question and improve the benefits of patient portals, but we all must agree to a few simple steps to streamline the experience for everyone.
Make it easy
A study recently published in the Journal of General Internal Medicine surveyed several hospitals on their usage of patient portals. After determining whether or not the institutions had such portals, the authors then investigated to find out what, if any, guidance was provided to patients about how to use them.
Their findings are frustrating, though not surprising. While 89% of hospitals had some form of patient portal, only 65% of those “had links that were easily found, defined as links accessible within two clicks from the home page.”
Furthermore, even in cases where portals were easily found, good instructions on how to use them were missing. Those instructions that did exist centered on rules and restrictions and laying out “terms and conditions” and informing patients on “what not to do,” rather than explaining how to make the most of the experience.
According to the authors, “this focus on curtailing behavior, and the hurdles placed on finding and understanding guidance, suggest that some hospitals may be prioritizing reducing liability over improving the patient experience with portals.”
If we want our patients to use them, portals must be easy to access and intuitive to use. They also must provide value.
Make it meaningful
Patient portals have proliferated exponentially over the last 10 years, thanks to government incentive programs. One such program, known as “meaningful use,” is primarily responsible for this, as it made implementation of a patient portal one of its core requirements.
Sadly, in spite of its oft-reviled name, the meaningful use program never defined patient-friendly standards of usability for patient portals. As a result, current portals just aren’t very good. Patients like my mother-in-law find them to be too numerous, too unfriendly to use, and too limited, so they are not being used to their full potential.
In fact, many institutions may choose not to enable all of the available features in order to limit technical issues and reduce the burden on providers. In the study referenced above, only 63% of portals offered the ability for patients to communicate directly with their physicians, and only 43% offered the ability to refill prescriptions.
When enabled, these functions improve patient engagement and efficiency. Without them, patients are less likely to log on, and physicians are forced to rely on less-efficient telephone calls or traditional letters to communicate results to their patients.
Put the patient, not the portal, at the center
History has all but forgotten the attempts by tech giants such as Google and Microsoft to create personal health records. While these initially seemed like a wonderful concept, they sadly proved to be a total flop. Some patients embraced the idea, but security concerns and the lack of buy-in from EHR vendors significantly limited their uptake.
They may simply have been ahead of their time.
A decade later, wearable technology and telemedicine are ushering in a new era of patient-centric care. Individuals have been embracing a greater share of the responsibility for their own personal health information, yet most EHRs lack the ability to easily incorporate data acquired outside physicians’ offices.
It’s time for EHR vendors to go all in and change that. Instead of enslaving patients to the tyranny of fragmented health records, they should prioritize the creation of a robust, standardized, and portable health record that travels with the patient, not the other way around.
Have any other ideas on how to improve patient engagement? We’d love to hear about them and share them in a future column.
If you want to contribute but don’t have any ideas, we have a suggestion: Ask your mother-in-law. You may be surprised at what you learn!
Dr. Notte is a family physician and associate chief medical information officer for Abington (Pa.) Hospital–Jefferson Health. Follow him on twitter (@doctornotte). Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Philadelphia, and associate director of the family medicine residency program at Abington Hospital–Jefferson Health.
Reference
Lee JL et al. J Gen Intern Med. 2019 Nov 12. doi: 10.1007/s11606-019-05528-z.
While preparing to write this technology column, I received a great deal of insight from the unlikeliest of sources: my mother-in-law.
Now don’t get me wrong – she’s a truly lovely, intelligent, and capable woman. I have sought her advice often on many things and have always been impressed by her wisdom and pragmatism, but I’ve just never thought of asking her for her opinion on medicine or technology, as I considered her knowledge of both subjects to be limited.
This occasion changed my opinion. In fact, I believe that, as health care IT becomes more complex, people like my mother-in-law may be exactly who we should be looking to for answers.
A few weeks ago, my mother-in-law and I were discussing her recent trip to the doctor. When she mentioned some lab tests, I suggested that we log in to her patient portal to view the results. This elicited several questions and a declaration of frustration.
“Which portal?” she asked. “I have so many and can’t keep all of the websites and passwords straight! Why can’t all of my doctors use the same portal, and why do they all have different password requirements?”
As she spoke these words, I was immediately struck with an unfortunate reality of EHRs: We have done a brilliant job creating state-of-the-art digital castles and have filled them with the data needed to revolutionize care and improve population health – but we haven’t given our patients the keys to get inside.
We must ask ourselves if, in trying to construct fortresses of information around our patients, we have lost sight of the individuals in the center. I believe that we can answer this question and improve the benefits of patient portals, but we all must agree to a few simple steps to streamline the experience for everyone.
Make it easy
A study recently published in the Journal of General Internal Medicine surveyed several hospitals on their usage of patient portals. After determining whether or not the institutions had such portals, the authors then investigated to find out what, if any, guidance was provided to patients about how to use them.
Their findings are frustrating, though not surprising. While 89% of hospitals had some form of patient portal, only 65% of those “had links that were easily found, defined as links accessible within two clicks from the home page.”
Furthermore, even in cases where portals were easily found, good instructions on how to use them were missing. Those instructions that did exist centered on rules and restrictions and laying out “terms and conditions” and informing patients on “what not to do,” rather than explaining how to make the most of the experience.
According to the authors, “this focus on curtailing behavior, and the hurdles placed on finding and understanding guidance, suggest that some hospitals may be prioritizing reducing liability over improving the patient experience with portals.”
If we want our patients to use them, portals must be easy to access and intuitive to use. They also must provide value.
Make it meaningful
Patient portals have proliferated exponentially over the last 10 years, thanks to government incentive programs. One such program, known as “meaningful use,” is primarily responsible for this, as it made implementation of a patient portal one of its core requirements.
Sadly, in spite of its oft-reviled name, the meaningful use program never defined patient-friendly standards of usability for patient portals. As a result, current portals just aren’t very good. Patients like my mother-in-law find them to be too numerous, too unfriendly to use, and too limited, so they are not being used to their full potential.
In fact, many institutions may choose not to enable all of the available features in order to limit technical issues and reduce the burden on providers. In the study referenced above, only 63% of portals offered the ability for patients to communicate directly with their physicians, and only 43% offered the ability to refill prescriptions.
When enabled, these functions improve patient engagement and efficiency. Without them, patients are less likely to log on, and physicians are forced to rely on less-efficient telephone calls or traditional letters to communicate results to their patients.
Put the patient, not the portal, at the center
History has all but forgotten the attempts by tech giants such as Google and Microsoft to create personal health records. While these initially seemed like a wonderful concept, they sadly proved to be a total flop. Some patients embraced the idea, but security concerns and the lack of buy-in from EHR vendors significantly limited their uptake.
They may simply have been ahead of their time.
A decade later, wearable technology and telemedicine are ushering in a new era of patient-centric care. Individuals have been embracing a greater share of the responsibility for their own personal health information, yet most EHRs lack the ability to easily incorporate data acquired outside physicians’ offices.
It’s time for EHR vendors to go all in and change that. Instead of enslaving patients to the tyranny of fragmented health records, they should prioritize the creation of a robust, standardized, and portable health record that travels with the patient, not the other way around.
Have any other ideas on how to improve patient engagement? We’d love to hear about them and share them in a future column.
If you want to contribute but don’t have any ideas, we have a suggestion: Ask your mother-in-law. You may be surprised at what you learn!
Dr. Notte is a family physician and associate chief medical information officer for Abington (Pa.) Hospital–Jefferson Health. Follow him on twitter (@doctornotte). Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Philadelphia, and associate director of the family medicine residency program at Abington Hospital–Jefferson Health.
Reference
Lee JL et al. J Gen Intern Med. 2019 Nov 12. doi: 10.1007/s11606-019-05528-z.
While preparing to write this technology column, I received a great deal of insight from the unlikeliest of sources: my mother-in-law.
Now don’t get me wrong – she’s a truly lovely, intelligent, and capable woman. I have sought her advice often on many things and have always been impressed by her wisdom and pragmatism, but I’ve just never thought of asking her for her opinion on medicine or technology, as I considered her knowledge of both subjects to be limited.
This occasion changed my opinion. In fact, I believe that, as health care IT becomes more complex, people like my mother-in-law may be exactly who we should be looking to for answers.
A few weeks ago, my mother-in-law and I were discussing her recent trip to the doctor. When she mentioned some lab tests, I suggested that we log in to her patient portal to view the results. This elicited several questions and a declaration of frustration.
“Which portal?” she asked. “I have so many and can’t keep all of the websites and passwords straight! Why can’t all of my doctors use the same portal, and why do they all have different password requirements?”
As she spoke these words, I was immediately struck with an unfortunate reality of EHRs: We have done a brilliant job creating state-of-the-art digital castles and have filled them with the data needed to revolutionize care and improve population health – but we haven’t given our patients the keys to get inside.
We must ask ourselves if, in trying to construct fortresses of information around our patients, we have lost sight of the individuals in the center. I believe that we can answer this question and improve the benefits of patient portals, but we all must agree to a few simple steps to streamline the experience for everyone.
Make it easy
A study recently published in the Journal of General Internal Medicine surveyed several hospitals on their usage of patient portals. After determining whether or not the institutions had such portals, the authors then investigated to find out what, if any, guidance was provided to patients about how to use them.
Their findings are frustrating, though not surprising. While 89% of hospitals had some form of patient portal, only 65% of those “had links that were easily found, defined as links accessible within two clicks from the home page.”
Furthermore, even in cases where portals were easily found, good instructions on how to use them were missing. Those instructions that did exist centered on rules and restrictions and laying out “terms and conditions” and informing patients on “what not to do,” rather than explaining how to make the most of the experience.
According to the authors, “this focus on curtailing behavior, and the hurdles placed on finding and understanding guidance, suggest that some hospitals may be prioritizing reducing liability over improving the patient experience with portals.”
If we want our patients to use them, portals must be easy to access and intuitive to use. They also must provide value.
Make it meaningful
Patient portals have proliferated exponentially over the last 10 years, thanks to government incentive programs. One such program, known as “meaningful use,” is primarily responsible for this, as it made implementation of a patient portal one of its core requirements.
Sadly, in spite of its oft-reviled name, the meaningful use program never defined patient-friendly standards of usability for patient portals. As a result, current portals just aren’t very good. Patients like my mother-in-law find them to be too numerous, too unfriendly to use, and too limited, so they are not being used to their full potential.
In fact, many institutions may choose not to enable all of the available features in order to limit technical issues and reduce the burden on providers. In the study referenced above, only 63% of portals offered the ability for patients to communicate directly with their physicians, and only 43% offered the ability to refill prescriptions.
When enabled, these functions improve patient engagement and efficiency. Without them, patients are less likely to log on, and physicians are forced to rely on less-efficient telephone calls or traditional letters to communicate results to their patients.
Put the patient, not the portal, at the center
History has all but forgotten the attempts by tech giants such as Google and Microsoft to create personal health records. While these initially seemed like a wonderful concept, they sadly proved to be a total flop. Some patients embraced the idea, but security concerns and the lack of buy-in from EHR vendors significantly limited their uptake.
They may simply have been ahead of their time.
A decade later, wearable technology and telemedicine are ushering in a new era of patient-centric care. Individuals have been embracing a greater share of the responsibility for their own personal health information, yet most EHRs lack the ability to easily incorporate data acquired outside physicians’ offices.
It’s time for EHR vendors to go all in and change that. Instead of enslaving patients to the tyranny of fragmented health records, they should prioritize the creation of a robust, standardized, and portable health record that travels with the patient, not the other way around.
Have any other ideas on how to improve patient engagement? We’d love to hear about them and share them in a future column.
If you want to contribute but don’t have any ideas, we have a suggestion: Ask your mother-in-law. You may be surprised at what you learn!
Dr. Notte is a family physician and associate chief medical information officer for Abington (Pa.) Hospital–Jefferson Health. Follow him on twitter (@doctornotte). Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Philadelphia, and associate director of the family medicine residency program at Abington Hospital–Jefferson Health.
Reference
Lee JL et al. J Gen Intern Med. 2019 Nov 12. doi: 10.1007/s11606-019-05528-z.
Supreme Court roundup: Latest health care decisions
The Trump administration can move forward with expanding a rule that makes it more difficult for immigrants to remain in the United States if they receive health care assistance, the U.S. Supreme Court ruled in a 5-4 vote.
The Feb. 21 order allows the administration to broaden the so-called “public charge rule” while legal challenges against the expanded regulation continue in the lower courts. The Supreme Court’s decision, which lifts a preliminary injunction against the expansion, applies to enforcement only in Illinois, where a district court blocked the revised rule from moving forward in October 2019. The Supreme Court’s measure follows another 5-4 order in January, in which justices lifted a nationwide injunction against the revised rule.
Under the long-standing public charge rule, immigration officials can refuse to admit immigrants into the United States or can deny them permanent legal status if they are deemed likely to become a public charge. Previously, immigration officers considered cash aid, such as Temporary Assistance for Needy Families or long-term institutionalized care, as potential public charge reasons for denial.
The revised regulation allows officials to consider previously excluded programs in their determination, including nonemergency Medicaid, the Supplemental Nutrition Assistance Program, and several housing programs. Use of these programs for more than 12 months in the aggregate during a 36-month period may result in a “public charge” designation and lead to green card denial.
Eight legal challenges were immediately filed against the rule changes, including a complaint issued by 14 states. At least five trial courts have since blocked the measure, while appeals courts have lifted some of the injunctions and upheld enforcement.
In its Jan. 27 order lifting the nationwide injunction, Associate Justice Neil M. Gorsuch wrote that nationwide injunctions are being overused by trial courts with negative consequences.
“The real problem here is the increasingly common practice of trial courts ordering relief that transcends the cases before them. Whether framed as injunctions of ‘nationwide,’ ‘universal,’ or ‘cosmic’ scope, these orders share the same basic flaw – they direct how the defendant must act toward persons who are not parties to the case,” he wrote. “It has become increasingly apparent that this court must, at some point, confront these important objections to this increasingly widespread practice. As the brief and furious history of the regulation before us illustrates, the routine issuance of universal injunctions is patently unworkable, sowing chaos for litigants, the government, courts, and all those affected by these conflicting decisions.”
In the court’s Feb. 21 order lifting the injunction in Illinois, justices gave no explanation for overturning the lower court’s injunction. However, Associate Justice Sonia Sotomayor issued a sharply-worded dissent, criticizing her fellow justices for allowing the rule to proceed.
“In sum, the government’s only claimed hardship is that it must enforce an existing interpretation of an immigration rule in one state – just as it has done for the past 20 years – while an updated version of the rule takes effect in the remaining 49,” she wrote. “The government has not quantified or explained any burdens that would arise from this state of the world.”
ACA cases still in limbo
Meanwhile, the Supreme Court still has not decided whether it will hear Texas v. United States, a case that could effectively dismantle the Affordable Care Act.
The high court was expected to announce whether it would take the high-profile case at a private Feb. 21 conference, but the justices have released no update. The case was relisted for consideration at the court’s Feb. 28 conference.
Texas v. United States stems from a lawsuit by 20 Republican state attorneys general and governors that was filed after Congress zeroed out the ACA’s individual mandate penalty in 2017. The plaintiffs contend the now-valueless mandate is no longer constitutional and thus, the entire ACA should be struck down. Because the Trump administration declined to defend the law, a coalition of Democratic attorneys general and governors intervened in the case as defendants.
In 2018, a Texas district court ruled in favor of the plaintiffs and declared the entire health care law invalid. The 5th U.S. Circuit Court of Appeals partially affirmed the district court’s decision, ruling that the mandate was unconstitutional, but sending the case back to the lower court for more analysis on severability. The Democratic attorneys general and governors appealed the decision to the U.S. Supreme Court.
If the Supreme Court agrees to hear the challenge, the court could fast-track the case and schedule arguments for the current term or wait until its next term, which starts in October 2020. If justices decline to hear the case, the challenge will remain with the district court for more analysis about the law’s severability.
Another ACA-related case – Maine Community Health Options v. U.S. – also remains in limbo. Justices heard the case, which was consolidated with two similar challenges, on Dec. 10, 2019, but still have not issued a decision.
The consolidated challenges center on whether the federal government owes insurers billions based on an Affordable Care Act provision intended to help health plans mitigate risk under the law. The ACA’s risk corridor program required the U.S. Department of Health & Human Services to collect funds from profitable insurers that offered qualified health plans under the exchanges and distribute the funds to insurers with excessive losses. Collections from profitable insurers under the program fell short in 2014, 2015, and 2016, while losses steadily grew, resulting in the HHS paying about 12 cents on the dollar in payments to insurers. More than 150 insurers now allege they were shortchanged and they want the Supreme Court to force the government to reimburse them to the tune of $12 billion.
The Department of Justice counters that the government is not required to pay the insurers because of appropriations measures passed by Congress in 2014 and in later years that limited the funding available to compensate insurers for their losses.
The federal government and insurers have each experienced wins and losses at the lower court level. Most recently, the U.S. Court of Appeals for the Federal Circuit decided in favor of the government, ruling that while the ACA required the government to compensate the insurers for their losses, the appropriations measures repealed or suspended that requirement.
A Supreme Court decision in the case could come as soon as Feb. 26.
Court to hear women’s health cases
Two closely watched reproductive health cases will go before the court this spring.
On March 4, justices will hear oral arguments in June Medical Services v. Russo, regarding the constitutionality of a Louisiana law that requires physicians performing abortions to have admitting privileges at a nearby hospital. Doctors who perform abortions without admitting privileges at a hospital within 30 miles face fines and imprisonment, according to the state law, originally passed in 2014. Clinics that employ such doctors can also have their licenses revoked.
June Medical Services LLC, a women’s health clinic, sued over the law. A district court ruled in favor of the plaintiff, but the 5th U.S. Circuit Court of Appeals reversed and upheld Louisiana’s law. The clinic appealed to the U.S. Supreme Court. Louisiana officials argue the challenge should be dismissed, and the law allowed to proceed, because the plaintiffs lack standing.
The Supreme Court in 2016 heard a similar case – Whole Woman’s Health v. Hellerstedt – concerning a comparable law in Texas. In that case, justices struck down the measure as unconstitutional.
And on April 29, justices will hear arguments in Little Sisters of the Poor v. Pennsylvania, a consolidated case about whether the Trump administration acted properly when it expanded exemptions under the Affordable Care Act’s contraceptive mandate. Entities that object to providing contraception on the basis of religious beliefs can opt out of complying with the mandate, according to the 2018 regulations. Additionally, nonprofit organizations and small businesses that have nonreligious moral convictions against the mandate can skip compliance. A number of states and entities sued over the new rules.
A federal appeals court temporarily barred the regulations from moving forward, ruling the plaintiffs were likely to succeed in proving the Trump administration did not follow appropriate procedures when it promulgated the new rules and that the regulations were not authorized under the ACA.
Justices will decide whether the parties have standing in the case, whether the Trump administration followed correct rule-making procedures, and if the regulations can stand.
The Trump administration can move forward with expanding a rule that makes it more difficult for immigrants to remain in the United States if they receive health care assistance, the U.S. Supreme Court ruled in a 5-4 vote.
The Feb. 21 order allows the administration to broaden the so-called “public charge rule” while legal challenges against the expanded regulation continue in the lower courts. The Supreme Court’s decision, which lifts a preliminary injunction against the expansion, applies to enforcement only in Illinois, where a district court blocked the revised rule from moving forward in October 2019. The Supreme Court’s measure follows another 5-4 order in January, in which justices lifted a nationwide injunction against the revised rule.
Under the long-standing public charge rule, immigration officials can refuse to admit immigrants into the United States or can deny them permanent legal status if they are deemed likely to become a public charge. Previously, immigration officers considered cash aid, such as Temporary Assistance for Needy Families or long-term institutionalized care, as potential public charge reasons for denial.
The revised regulation allows officials to consider previously excluded programs in their determination, including nonemergency Medicaid, the Supplemental Nutrition Assistance Program, and several housing programs. Use of these programs for more than 12 months in the aggregate during a 36-month period may result in a “public charge” designation and lead to green card denial.
Eight legal challenges were immediately filed against the rule changes, including a complaint issued by 14 states. At least five trial courts have since blocked the measure, while appeals courts have lifted some of the injunctions and upheld enforcement.
In its Jan. 27 order lifting the nationwide injunction, Associate Justice Neil M. Gorsuch wrote that nationwide injunctions are being overused by trial courts with negative consequences.
“The real problem here is the increasingly common practice of trial courts ordering relief that transcends the cases before them. Whether framed as injunctions of ‘nationwide,’ ‘universal,’ or ‘cosmic’ scope, these orders share the same basic flaw – they direct how the defendant must act toward persons who are not parties to the case,” he wrote. “It has become increasingly apparent that this court must, at some point, confront these important objections to this increasingly widespread practice. As the brief and furious history of the regulation before us illustrates, the routine issuance of universal injunctions is patently unworkable, sowing chaos for litigants, the government, courts, and all those affected by these conflicting decisions.”
In the court’s Feb. 21 order lifting the injunction in Illinois, justices gave no explanation for overturning the lower court’s injunction. However, Associate Justice Sonia Sotomayor issued a sharply-worded dissent, criticizing her fellow justices for allowing the rule to proceed.
“In sum, the government’s only claimed hardship is that it must enforce an existing interpretation of an immigration rule in one state – just as it has done for the past 20 years – while an updated version of the rule takes effect in the remaining 49,” she wrote. “The government has not quantified or explained any burdens that would arise from this state of the world.”
ACA cases still in limbo
Meanwhile, the Supreme Court still has not decided whether it will hear Texas v. United States, a case that could effectively dismantle the Affordable Care Act.
The high court was expected to announce whether it would take the high-profile case at a private Feb. 21 conference, but the justices have released no update. The case was relisted for consideration at the court’s Feb. 28 conference.
Texas v. United States stems from a lawsuit by 20 Republican state attorneys general and governors that was filed after Congress zeroed out the ACA’s individual mandate penalty in 2017. The plaintiffs contend the now-valueless mandate is no longer constitutional and thus, the entire ACA should be struck down. Because the Trump administration declined to defend the law, a coalition of Democratic attorneys general and governors intervened in the case as defendants.
In 2018, a Texas district court ruled in favor of the plaintiffs and declared the entire health care law invalid. The 5th U.S. Circuit Court of Appeals partially affirmed the district court’s decision, ruling that the mandate was unconstitutional, but sending the case back to the lower court for more analysis on severability. The Democratic attorneys general and governors appealed the decision to the U.S. Supreme Court.
If the Supreme Court agrees to hear the challenge, the court could fast-track the case and schedule arguments for the current term or wait until its next term, which starts in October 2020. If justices decline to hear the case, the challenge will remain with the district court for more analysis about the law’s severability.
Another ACA-related case – Maine Community Health Options v. U.S. – also remains in limbo. Justices heard the case, which was consolidated with two similar challenges, on Dec. 10, 2019, but still have not issued a decision.
The consolidated challenges center on whether the federal government owes insurers billions based on an Affordable Care Act provision intended to help health plans mitigate risk under the law. The ACA’s risk corridor program required the U.S. Department of Health & Human Services to collect funds from profitable insurers that offered qualified health plans under the exchanges and distribute the funds to insurers with excessive losses. Collections from profitable insurers under the program fell short in 2014, 2015, and 2016, while losses steadily grew, resulting in the HHS paying about 12 cents on the dollar in payments to insurers. More than 150 insurers now allege they were shortchanged and they want the Supreme Court to force the government to reimburse them to the tune of $12 billion.
The Department of Justice counters that the government is not required to pay the insurers because of appropriations measures passed by Congress in 2014 and in later years that limited the funding available to compensate insurers for their losses.
The federal government and insurers have each experienced wins and losses at the lower court level. Most recently, the U.S. Court of Appeals for the Federal Circuit decided in favor of the government, ruling that while the ACA required the government to compensate the insurers for their losses, the appropriations measures repealed or suspended that requirement.
A Supreme Court decision in the case could come as soon as Feb. 26.
Court to hear women’s health cases
Two closely watched reproductive health cases will go before the court this spring.
On March 4, justices will hear oral arguments in June Medical Services v. Russo, regarding the constitutionality of a Louisiana law that requires physicians performing abortions to have admitting privileges at a nearby hospital. Doctors who perform abortions without admitting privileges at a hospital within 30 miles face fines and imprisonment, according to the state law, originally passed in 2014. Clinics that employ such doctors can also have their licenses revoked.
June Medical Services LLC, a women’s health clinic, sued over the law. A district court ruled in favor of the plaintiff, but the 5th U.S. Circuit Court of Appeals reversed and upheld Louisiana’s law. The clinic appealed to the U.S. Supreme Court. Louisiana officials argue the challenge should be dismissed, and the law allowed to proceed, because the plaintiffs lack standing.
The Supreme Court in 2016 heard a similar case – Whole Woman’s Health v. Hellerstedt – concerning a comparable law in Texas. In that case, justices struck down the measure as unconstitutional.
And on April 29, justices will hear arguments in Little Sisters of the Poor v. Pennsylvania, a consolidated case about whether the Trump administration acted properly when it expanded exemptions under the Affordable Care Act’s contraceptive mandate. Entities that object to providing contraception on the basis of religious beliefs can opt out of complying with the mandate, according to the 2018 regulations. Additionally, nonprofit organizations and small businesses that have nonreligious moral convictions against the mandate can skip compliance. A number of states and entities sued over the new rules.
A federal appeals court temporarily barred the regulations from moving forward, ruling the plaintiffs were likely to succeed in proving the Trump administration did not follow appropriate procedures when it promulgated the new rules and that the regulations were not authorized under the ACA.
Justices will decide whether the parties have standing in the case, whether the Trump administration followed correct rule-making procedures, and if the regulations can stand.
The Trump administration can move forward with expanding a rule that makes it more difficult for immigrants to remain in the United States if they receive health care assistance, the U.S. Supreme Court ruled in a 5-4 vote.
The Feb. 21 order allows the administration to broaden the so-called “public charge rule” while legal challenges against the expanded regulation continue in the lower courts. The Supreme Court’s decision, which lifts a preliminary injunction against the expansion, applies to enforcement only in Illinois, where a district court blocked the revised rule from moving forward in October 2019. The Supreme Court’s measure follows another 5-4 order in January, in which justices lifted a nationwide injunction against the revised rule.
Under the long-standing public charge rule, immigration officials can refuse to admit immigrants into the United States or can deny them permanent legal status if they are deemed likely to become a public charge. Previously, immigration officers considered cash aid, such as Temporary Assistance for Needy Families or long-term institutionalized care, as potential public charge reasons for denial.
The revised regulation allows officials to consider previously excluded programs in their determination, including nonemergency Medicaid, the Supplemental Nutrition Assistance Program, and several housing programs. Use of these programs for more than 12 months in the aggregate during a 36-month period may result in a “public charge” designation and lead to green card denial.
Eight legal challenges were immediately filed against the rule changes, including a complaint issued by 14 states. At least five trial courts have since blocked the measure, while appeals courts have lifted some of the injunctions and upheld enforcement.
In its Jan. 27 order lifting the nationwide injunction, Associate Justice Neil M. Gorsuch wrote that nationwide injunctions are being overused by trial courts with negative consequences.
“The real problem here is the increasingly common practice of trial courts ordering relief that transcends the cases before them. Whether framed as injunctions of ‘nationwide,’ ‘universal,’ or ‘cosmic’ scope, these orders share the same basic flaw – they direct how the defendant must act toward persons who are not parties to the case,” he wrote. “It has become increasingly apparent that this court must, at some point, confront these important objections to this increasingly widespread practice. As the brief and furious history of the regulation before us illustrates, the routine issuance of universal injunctions is patently unworkable, sowing chaos for litigants, the government, courts, and all those affected by these conflicting decisions.”
In the court’s Feb. 21 order lifting the injunction in Illinois, justices gave no explanation for overturning the lower court’s injunction. However, Associate Justice Sonia Sotomayor issued a sharply-worded dissent, criticizing her fellow justices for allowing the rule to proceed.
“In sum, the government’s only claimed hardship is that it must enforce an existing interpretation of an immigration rule in one state – just as it has done for the past 20 years – while an updated version of the rule takes effect in the remaining 49,” she wrote. “The government has not quantified or explained any burdens that would arise from this state of the world.”
ACA cases still in limbo
Meanwhile, the Supreme Court still has not decided whether it will hear Texas v. United States, a case that could effectively dismantle the Affordable Care Act.
The high court was expected to announce whether it would take the high-profile case at a private Feb. 21 conference, but the justices have released no update. The case was relisted for consideration at the court’s Feb. 28 conference.
Texas v. United States stems from a lawsuit by 20 Republican state attorneys general and governors that was filed after Congress zeroed out the ACA’s individual mandate penalty in 2017. The plaintiffs contend the now-valueless mandate is no longer constitutional and thus, the entire ACA should be struck down. Because the Trump administration declined to defend the law, a coalition of Democratic attorneys general and governors intervened in the case as defendants.
In 2018, a Texas district court ruled in favor of the plaintiffs and declared the entire health care law invalid. The 5th U.S. Circuit Court of Appeals partially affirmed the district court’s decision, ruling that the mandate was unconstitutional, but sending the case back to the lower court for more analysis on severability. The Democratic attorneys general and governors appealed the decision to the U.S. Supreme Court.
If the Supreme Court agrees to hear the challenge, the court could fast-track the case and schedule arguments for the current term or wait until its next term, which starts in October 2020. If justices decline to hear the case, the challenge will remain with the district court for more analysis about the law’s severability.
Another ACA-related case – Maine Community Health Options v. U.S. – also remains in limbo. Justices heard the case, which was consolidated with two similar challenges, on Dec. 10, 2019, but still have not issued a decision.
The consolidated challenges center on whether the federal government owes insurers billions based on an Affordable Care Act provision intended to help health plans mitigate risk under the law. The ACA’s risk corridor program required the U.S. Department of Health & Human Services to collect funds from profitable insurers that offered qualified health plans under the exchanges and distribute the funds to insurers with excessive losses. Collections from profitable insurers under the program fell short in 2014, 2015, and 2016, while losses steadily grew, resulting in the HHS paying about 12 cents on the dollar in payments to insurers. More than 150 insurers now allege they were shortchanged and they want the Supreme Court to force the government to reimburse them to the tune of $12 billion.
The Department of Justice counters that the government is not required to pay the insurers because of appropriations measures passed by Congress in 2014 and in later years that limited the funding available to compensate insurers for their losses.
The federal government and insurers have each experienced wins and losses at the lower court level. Most recently, the U.S. Court of Appeals for the Federal Circuit decided in favor of the government, ruling that while the ACA required the government to compensate the insurers for their losses, the appropriations measures repealed or suspended that requirement.
A Supreme Court decision in the case could come as soon as Feb. 26.
Court to hear women’s health cases
Two closely watched reproductive health cases will go before the court this spring.
On March 4, justices will hear oral arguments in June Medical Services v. Russo, regarding the constitutionality of a Louisiana law that requires physicians performing abortions to have admitting privileges at a nearby hospital. Doctors who perform abortions without admitting privileges at a hospital within 30 miles face fines and imprisonment, according to the state law, originally passed in 2014. Clinics that employ such doctors can also have their licenses revoked.
June Medical Services LLC, a women’s health clinic, sued over the law. A district court ruled in favor of the plaintiff, but the 5th U.S. Circuit Court of Appeals reversed and upheld Louisiana’s law. The clinic appealed to the U.S. Supreme Court. Louisiana officials argue the challenge should be dismissed, and the law allowed to proceed, because the plaintiffs lack standing.
The Supreme Court in 2016 heard a similar case – Whole Woman’s Health v. Hellerstedt – concerning a comparable law in Texas. In that case, justices struck down the measure as unconstitutional.
And on April 29, justices will hear arguments in Little Sisters of the Poor v. Pennsylvania, a consolidated case about whether the Trump administration acted properly when it expanded exemptions under the Affordable Care Act’s contraceptive mandate. Entities that object to providing contraception on the basis of religious beliefs can opt out of complying with the mandate, according to the 2018 regulations. Additionally, nonprofit organizations and small businesses that have nonreligious moral convictions against the mandate can skip compliance. A number of states and entities sued over the new rules.
A federal appeals court temporarily barred the regulations from moving forward, ruling the plaintiffs were likely to succeed in proving the Trump administration did not follow appropriate procedures when it promulgated the new rules and that the regulations were not authorized under the ACA.
Justices will decide whether the parties have standing in the case, whether the Trump administration followed correct rule-making procedures, and if the regulations can stand.
Neurologists report low job satisfaction
The report found that only 18% of neurologists were very happy at work, and 41% overall identified themselves as burned out. Among reasons for burnout, 61% reported mounting bureaucratic tasks as their top reason, with 40% listing spending too many hours at work.
Coping strategies varied, with isolation from others topping the list at 46%, followed by talking with close friends and family and exercise tied at 40%.
Less than half (46%) claimed there was no impact on patients, but most (65%) don’t intend to seek professional help for depression and/or burnout and haven’t done so in the past. Similarly, 48% reported it’s unlikely they’d participate in a workplace program – in fact, only 33% said they would.
A slideshow laying out the findings in the report is available on Medscape.
A closer look at the numbers
Over 15,000 physicians across 29 specialties completed the 10-minute survey in the summer of 2019; 62% were men and most of the group were Baby Boomers (ages 55-73), then Generation X (ages 40-54), and lastly Millennials (ages 25-39). Of the specialties surveyed, neurologists scored lowest in the happiness-at-work category, with only 18% saying they were happy. Neurologists also scored lowest in happiness outside of work (44%). Half the neurologists surveyed said they were burned out, which was slightly more than the surveyed group of physicians in general. The biggest contributors to burnout were bureaucratic tasks, too many hours at work, and lack of control. Most coped by isolating themselves, talking with family members or friends, exercising and sleep. About 65% did not seek help for burnout or depression. The main reasons were being too busy, preferring to deal with it themselves, or feeling that the problem was not significant enough to warrant intervention.
A majority of the neurologists surveyed (70%-80%) are married and 85% say they have a good marriage. Almost half of neurologists take 3-4 weeks of vacation and a third take 1-2 weeks. Neurologists surveyed drive mostly Hondas and Toyotas; 4% drive Teslas and 3% drive Porsches. One third of neurologists exercise two to three times per week and 10% exercise daily. Only 20% have a drink more than four times per week.
Looking for solutions
“It is a bit distressing to see how many neurologists are unhappy at work and unhappy even outside of work,” said Alan M. Rapoport, MD, clinical professor of neurology at the University of California, Los Angeles. Many neurologists claim to be burned out and a small percent report depression. Most do not seek help, do not take care of themselves well enough, and do not vacation or exercise enough, added Dr. Rapoport, who also is a past president of the International Headache Society and is editor in chief of Neurology Reviews.
Dr. Rapoport believes that some studies about this situation should be done by the American Academy of Neurology and other subspecialty organizations (for example, the American Headache Society), and results should be published in the neurology and subspecialty journals. Further work in this area should include suggestions for rectifying the situation and encouraging neurologists to seek help and improve their lifestyle. “I think that one of the ways that headache specialists have avoided burnout and depression is by focusing on one subspecialty area and engaging in different types of activities, such as seeing patients in the office and hospital, giving lectures, traveling to meetings, writing papers, and balancing their professional and personal lives. It appears that we need help as a profession, and we had better help ourselves to get it.”
The report found that only 18% of neurologists were very happy at work, and 41% overall identified themselves as burned out. Among reasons for burnout, 61% reported mounting bureaucratic tasks as their top reason, with 40% listing spending too many hours at work.
Coping strategies varied, with isolation from others topping the list at 46%, followed by talking with close friends and family and exercise tied at 40%.
Less than half (46%) claimed there was no impact on patients, but most (65%) don’t intend to seek professional help for depression and/or burnout and haven’t done so in the past. Similarly, 48% reported it’s unlikely they’d participate in a workplace program – in fact, only 33% said they would.
A slideshow laying out the findings in the report is available on Medscape.
A closer look at the numbers
Over 15,000 physicians across 29 specialties completed the 10-minute survey in the summer of 2019; 62% were men and most of the group were Baby Boomers (ages 55-73), then Generation X (ages 40-54), and lastly Millennials (ages 25-39). Of the specialties surveyed, neurologists scored lowest in the happiness-at-work category, with only 18% saying they were happy. Neurologists also scored lowest in happiness outside of work (44%). Half the neurologists surveyed said they were burned out, which was slightly more than the surveyed group of physicians in general. The biggest contributors to burnout were bureaucratic tasks, too many hours at work, and lack of control. Most coped by isolating themselves, talking with family members or friends, exercising and sleep. About 65% did not seek help for burnout or depression. The main reasons were being too busy, preferring to deal with it themselves, or feeling that the problem was not significant enough to warrant intervention.
A majority of the neurologists surveyed (70%-80%) are married and 85% say they have a good marriage. Almost half of neurologists take 3-4 weeks of vacation and a third take 1-2 weeks. Neurologists surveyed drive mostly Hondas and Toyotas; 4% drive Teslas and 3% drive Porsches. One third of neurologists exercise two to three times per week and 10% exercise daily. Only 20% have a drink more than four times per week.
Looking for solutions
“It is a bit distressing to see how many neurologists are unhappy at work and unhappy even outside of work,” said Alan M. Rapoport, MD, clinical professor of neurology at the University of California, Los Angeles. Many neurologists claim to be burned out and a small percent report depression. Most do not seek help, do not take care of themselves well enough, and do not vacation or exercise enough, added Dr. Rapoport, who also is a past president of the International Headache Society and is editor in chief of Neurology Reviews.
Dr. Rapoport believes that some studies about this situation should be done by the American Academy of Neurology and other subspecialty organizations (for example, the American Headache Society), and results should be published in the neurology and subspecialty journals. Further work in this area should include suggestions for rectifying the situation and encouraging neurologists to seek help and improve their lifestyle. “I think that one of the ways that headache specialists have avoided burnout and depression is by focusing on one subspecialty area and engaging in different types of activities, such as seeing patients in the office and hospital, giving lectures, traveling to meetings, writing papers, and balancing their professional and personal lives. It appears that we need help as a profession, and we had better help ourselves to get it.”
The report found that only 18% of neurologists were very happy at work, and 41% overall identified themselves as burned out. Among reasons for burnout, 61% reported mounting bureaucratic tasks as their top reason, with 40% listing spending too many hours at work.
Coping strategies varied, with isolation from others topping the list at 46%, followed by talking with close friends and family and exercise tied at 40%.
Less than half (46%) claimed there was no impact on patients, but most (65%) don’t intend to seek professional help for depression and/or burnout and haven’t done so in the past. Similarly, 48% reported it’s unlikely they’d participate in a workplace program – in fact, only 33% said they would.
A slideshow laying out the findings in the report is available on Medscape.
A closer look at the numbers
Over 15,000 physicians across 29 specialties completed the 10-minute survey in the summer of 2019; 62% were men and most of the group were Baby Boomers (ages 55-73), then Generation X (ages 40-54), and lastly Millennials (ages 25-39). Of the specialties surveyed, neurologists scored lowest in the happiness-at-work category, with only 18% saying they were happy. Neurologists also scored lowest in happiness outside of work (44%). Half the neurologists surveyed said they were burned out, which was slightly more than the surveyed group of physicians in general. The biggest contributors to burnout were bureaucratic tasks, too many hours at work, and lack of control. Most coped by isolating themselves, talking with family members or friends, exercising and sleep. About 65% did not seek help for burnout or depression. The main reasons were being too busy, preferring to deal with it themselves, or feeling that the problem was not significant enough to warrant intervention.
A majority of the neurologists surveyed (70%-80%) are married and 85% say they have a good marriage. Almost half of neurologists take 3-4 weeks of vacation and a third take 1-2 weeks. Neurologists surveyed drive mostly Hondas and Toyotas; 4% drive Teslas and 3% drive Porsches. One third of neurologists exercise two to three times per week and 10% exercise daily. Only 20% have a drink more than four times per week.
Looking for solutions
“It is a bit distressing to see how many neurologists are unhappy at work and unhappy even outside of work,” said Alan M. Rapoport, MD, clinical professor of neurology at the University of California, Los Angeles. Many neurologists claim to be burned out and a small percent report depression. Most do not seek help, do not take care of themselves well enough, and do not vacation or exercise enough, added Dr. Rapoport, who also is a past president of the International Headache Society and is editor in chief of Neurology Reviews.
Dr. Rapoport believes that some studies about this situation should be done by the American Academy of Neurology and other subspecialty organizations (for example, the American Headache Society), and results should be published in the neurology and subspecialty journals. Further work in this area should include suggestions for rectifying the situation and encouraging neurologists to seek help and improve their lifestyle. “I think that one of the ways that headache specialists have avoided burnout and depression is by focusing on one subspecialty area and engaging in different types of activities, such as seeing patients in the office and hospital, giving lectures, traveling to meetings, writing papers, and balancing their professional and personal lives. It appears that we need help as a profession, and we had better help ourselves to get it.”
Pondering jumping into teledermatology?
LAHAINA, HAWAII – Teledermatology and dermoscopy were made for each other, Trilokraj Tejasvi, MBBS, MD, declared at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.
“If somebody is The dermatoscope manufacturers make teledermoscopy systems with attachments for iPhones, iPads, and Android devices,” said Dr. Tejasvi, who is director of teledermatology services and also director of the cutaneous lymphoma program at the University of Michigan, Ann Arbor.
To make his point, he presented slides of six standard unenhanced teledermatologic photos of ambiguous pigmented skin lesions. When he asked the large audience which ones they’d want to biopsy and which they were confident were benign, there was absolutely no consensus. But when he followed up with teledermoscopic photos of the same lesions, the dermoscopists in the audience quickly voiced agreement that four of the lesions were benign and two were obvious melanoma. Based on that information, instead of having to bring in all six patients for biopsy of their indeterminant suspicious lesions, only two of the patients would need to come in promptly for treatment of their malignancy.
“Dermoscopy changes the whole triage system and the teledermoscopy concept model, because dermoscopy remains the same: it’s going to stay [two-dimensional] whether you’re going to see the images in the clinic or in teledermatology. So using teledermoscopy images actually makes it far better for your teledermatology services,” explained Dr. Tejasvi, who is also chief of the dermatology service at the Ann Arbor Veterans Affairs Hospital.
Why get into teledermatology?
The benefits of teledermatology include earlier diagnosis and treatment of skin cancers as documented in a Spanish study of 43,677 patients. The Spanish dermatologists reported that teledermatologically detected melanomas had a thinner Breslow depth and lower tumor stage because they were diagnosed earlier. Teledermatology also brought a twofold increase in the basal cell carcinoma detection rate and – most importantly – a reduction in time to biopsy for what turned out to be skin cancers (JAMA Dermatol. 2015 Dec 1;151[12]:1289-90).
In addition, teledermatology is an effective triage tool for busy clinicians whose appointment calendars are booked weeks or months in advance.
“Let’s say you are the only dermatologist in the surrounding five counties. You can use teledermatology to see which patients actually need to come to your clinic,” Dr. Tejasvri said. Just make sure the referring primary care providers know to send photos taken with the dermatoscope attachment.
Internet-based teledermatology also provides a way to follow patients with chronic conditions, including psoriasis, atopic dermatitis, and venous ulcers, he noted.
Before getting started
Dr. Tejasvri emphasized the importance of visiting the American Academy of Dermatology Teledermatology Task Force website as well as the American Telemedicine Association’s Teledermatology Special Interest Group, which he chairs. These resources, he stressed, are invaluable.
The AAD site, open to all academy members, includes a tool kit for getting started in teledermatology. It’s individually tailored for the dermatologist in solo, small group, academic, or multispecialty practice. This highly practical tool kit includes a checklist that aids in determining whether a dermatologist’s practice is suited for teledermatology, as well as the suggested optimal teledermatology practice model for that individual, the nuts and bolts of equipment, relevant state laws, and how to navigate legal concerns, among the most critical of which is to get in writing the malpractice insurer’s verbal reassurance that the policy covers telemedicine.
The American Telemedicine Association Teledermatology Special Interest Group provides best-practice guidelines (Telemed J E Health. 2016 Dec;22[12]:981-90)
Teledermatology practice model options
The most common teledermatology model is called “store-and-forward.” It relies upon transmission of still images of skin lesions. Its advantages are that it’s not dependent upon internet speed and it accommodates physicians working in different time zones. Most commonly, this is a consult model in which a remote primary care provider takes the photos and transmits them to the dermatologist specialist. The referring provider retains responsibility for patient care.
The other model entails creation of a virtual clinic with real-time videoconference-based communication using a HIPAA-compliant high-speed broadband internet connection. The advantages are that reimbursement is good – indeed, the same as for a face-to-face office visit – and it’s possible to ask questions of the patient and referring physician, although that’s generally not necessary for the straightforward evaluation of suspicious pigmented or nonpigmented skin lesions. However, the video image quality isn’t as good as with still photos, the virtual clinic requires dedicated scheduling, and the quality of the experience is highly dependent upon internet speed.
“If you have a bad internet speed the whole process becomes choppy. When you ask a question, the answer you get is the one to your previous question,” Dr. Tejasvi said.
Reimbursement
Currently 38 states and Washington, D.C., have laws governing private payer telehealth reimbursement policy.
Under the 2019 Medicare physician fee schedule, code number 99446 – interprofessional telephone/internet consult lasting 5-10 minutes – pays $18.36. A 99447, lasting 11-20 minutes, pays $36.36, and a 99448, representing a 21-30 minute interprofessional consult, pays $54.72.
“Reimbursement is poor. It’s not a lot at all. If you spend 5-10 minutes on a consult you get paid about 20 bucks. But it’s better than nothing, and it used to be that patients had to pay out of pocket,” the dermatologist commented.
And of course, the improved timely and efficient patient access to dermatologist evaluation of potential skin cancer that’s afforded via teledermatology helps out with the profession’s workforce shortage and responds to the common criticism that dermatologists are geographically maldistributed and treatment delayed is treatment denied.
How accurate is teledermatology?
Numerous studies have reported diagnostic concordance rates between teledermatology and face-to-face clinical diagnosis of 72.5%-90% for melanoma, dropping off markedly to 31.2%-62% for lentigines. However, teledermoscopic images greatly improved the diagnostic accuracy.
In one recent study involving teledermatology versus face-to-face evaluation of 293 index lesions, the face-to-face dermatologist examination turned up 131 incidental skin lesions, including 6 incidental melanomas not suspected or photographed by the consulting primary care providers. That worked out to a 2.6% risk of incidental melanoma per consult, which Dr. Tejasvi called “kind of scary.”
“All six of the incidental melanomas were located on the back, chest, or abdomen, so a good teaching point is that, if you’re doing a teledermatology consult, ask the primary care provider who’s sending you this consult to do a careful waist-up exam to look for other lesions,” he advised.
He added that more and larger studies are needed in order to determine the diagnostic concordance rate for nonpigmented lesions.
Dr. Tejasvi reported having no financial conflicts regarding his presentation.
SDEF/Global Academy for Medical Education and this news organization are owned by the same parent company.
LAHAINA, HAWAII – Teledermatology and dermoscopy were made for each other, Trilokraj Tejasvi, MBBS, MD, declared at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.
“If somebody is The dermatoscope manufacturers make teledermoscopy systems with attachments for iPhones, iPads, and Android devices,” said Dr. Tejasvi, who is director of teledermatology services and also director of the cutaneous lymphoma program at the University of Michigan, Ann Arbor.
To make his point, he presented slides of six standard unenhanced teledermatologic photos of ambiguous pigmented skin lesions. When he asked the large audience which ones they’d want to biopsy and which they were confident were benign, there was absolutely no consensus. But when he followed up with teledermoscopic photos of the same lesions, the dermoscopists in the audience quickly voiced agreement that four of the lesions were benign and two were obvious melanoma. Based on that information, instead of having to bring in all six patients for biopsy of their indeterminant suspicious lesions, only two of the patients would need to come in promptly for treatment of their malignancy.
“Dermoscopy changes the whole triage system and the teledermoscopy concept model, because dermoscopy remains the same: it’s going to stay [two-dimensional] whether you’re going to see the images in the clinic or in teledermatology. So using teledermoscopy images actually makes it far better for your teledermatology services,” explained Dr. Tejasvi, who is also chief of the dermatology service at the Ann Arbor Veterans Affairs Hospital.
Why get into teledermatology?
The benefits of teledermatology include earlier diagnosis and treatment of skin cancers as documented in a Spanish study of 43,677 patients. The Spanish dermatologists reported that teledermatologically detected melanomas had a thinner Breslow depth and lower tumor stage because they were diagnosed earlier. Teledermatology also brought a twofold increase in the basal cell carcinoma detection rate and – most importantly – a reduction in time to biopsy for what turned out to be skin cancers (JAMA Dermatol. 2015 Dec 1;151[12]:1289-90).
In addition, teledermatology is an effective triage tool for busy clinicians whose appointment calendars are booked weeks or months in advance.
“Let’s say you are the only dermatologist in the surrounding five counties. You can use teledermatology to see which patients actually need to come to your clinic,” Dr. Tejasvri said. Just make sure the referring primary care providers know to send photos taken with the dermatoscope attachment.
Internet-based teledermatology also provides a way to follow patients with chronic conditions, including psoriasis, atopic dermatitis, and venous ulcers, he noted.
Before getting started
Dr. Tejasvri emphasized the importance of visiting the American Academy of Dermatology Teledermatology Task Force website as well as the American Telemedicine Association’s Teledermatology Special Interest Group, which he chairs. These resources, he stressed, are invaluable.
The AAD site, open to all academy members, includes a tool kit for getting started in teledermatology. It’s individually tailored for the dermatologist in solo, small group, academic, or multispecialty practice. This highly practical tool kit includes a checklist that aids in determining whether a dermatologist’s practice is suited for teledermatology, as well as the suggested optimal teledermatology practice model for that individual, the nuts and bolts of equipment, relevant state laws, and how to navigate legal concerns, among the most critical of which is to get in writing the malpractice insurer’s verbal reassurance that the policy covers telemedicine.
The American Telemedicine Association Teledermatology Special Interest Group provides best-practice guidelines (Telemed J E Health. 2016 Dec;22[12]:981-90)
Teledermatology practice model options
The most common teledermatology model is called “store-and-forward.” It relies upon transmission of still images of skin lesions. Its advantages are that it’s not dependent upon internet speed and it accommodates physicians working in different time zones. Most commonly, this is a consult model in which a remote primary care provider takes the photos and transmits them to the dermatologist specialist. The referring provider retains responsibility for patient care.
The other model entails creation of a virtual clinic with real-time videoconference-based communication using a HIPAA-compliant high-speed broadband internet connection. The advantages are that reimbursement is good – indeed, the same as for a face-to-face office visit – and it’s possible to ask questions of the patient and referring physician, although that’s generally not necessary for the straightforward evaluation of suspicious pigmented or nonpigmented skin lesions. However, the video image quality isn’t as good as with still photos, the virtual clinic requires dedicated scheduling, and the quality of the experience is highly dependent upon internet speed.
“If you have a bad internet speed the whole process becomes choppy. When you ask a question, the answer you get is the one to your previous question,” Dr. Tejasvi said.
Reimbursement
Currently 38 states and Washington, D.C., have laws governing private payer telehealth reimbursement policy.
Under the 2019 Medicare physician fee schedule, code number 99446 – interprofessional telephone/internet consult lasting 5-10 minutes – pays $18.36. A 99447, lasting 11-20 minutes, pays $36.36, and a 99448, representing a 21-30 minute interprofessional consult, pays $54.72.
“Reimbursement is poor. It’s not a lot at all. If you spend 5-10 minutes on a consult you get paid about 20 bucks. But it’s better than nothing, and it used to be that patients had to pay out of pocket,” the dermatologist commented.
And of course, the improved timely and efficient patient access to dermatologist evaluation of potential skin cancer that’s afforded via teledermatology helps out with the profession’s workforce shortage and responds to the common criticism that dermatologists are geographically maldistributed and treatment delayed is treatment denied.
How accurate is teledermatology?
Numerous studies have reported diagnostic concordance rates between teledermatology and face-to-face clinical diagnosis of 72.5%-90% for melanoma, dropping off markedly to 31.2%-62% for lentigines. However, teledermoscopic images greatly improved the diagnostic accuracy.
In one recent study involving teledermatology versus face-to-face evaluation of 293 index lesions, the face-to-face dermatologist examination turned up 131 incidental skin lesions, including 6 incidental melanomas not suspected or photographed by the consulting primary care providers. That worked out to a 2.6% risk of incidental melanoma per consult, which Dr. Tejasvi called “kind of scary.”
“All six of the incidental melanomas were located on the back, chest, or abdomen, so a good teaching point is that, if you’re doing a teledermatology consult, ask the primary care provider who’s sending you this consult to do a careful waist-up exam to look for other lesions,” he advised.
He added that more and larger studies are needed in order to determine the diagnostic concordance rate for nonpigmented lesions.
Dr. Tejasvi reported having no financial conflicts regarding his presentation.
SDEF/Global Academy for Medical Education and this news organization are owned by the same parent company.
LAHAINA, HAWAII – Teledermatology and dermoscopy were made for each other, Trilokraj Tejasvi, MBBS, MD, declared at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.
“If somebody is The dermatoscope manufacturers make teledermoscopy systems with attachments for iPhones, iPads, and Android devices,” said Dr. Tejasvi, who is director of teledermatology services and also director of the cutaneous lymphoma program at the University of Michigan, Ann Arbor.
To make his point, he presented slides of six standard unenhanced teledermatologic photos of ambiguous pigmented skin lesions. When he asked the large audience which ones they’d want to biopsy and which they were confident were benign, there was absolutely no consensus. But when he followed up with teledermoscopic photos of the same lesions, the dermoscopists in the audience quickly voiced agreement that four of the lesions were benign and two were obvious melanoma. Based on that information, instead of having to bring in all six patients for biopsy of their indeterminant suspicious lesions, only two of the patients would need to come in promptly for treatment of their malignancy.
“Dermoscopy changes the whole triage system and the teledermoscopy concept model, because dermoscopy remains the same: it’s going to stay [two-dimensional] whether you’re going to see the images in the clinic or in teledermatology. So using teledermoscopy images actually makes it far better for your teledermatology services,” explained Dr. Tejasvi, who is also chief of the dermatology service at the Ann Arbor Veterans Affairs Hospital.
Why get into teledermatology?
The benefits of teledermatology include earlier diagnosis and treatment of skin cancers as documented in a Spanish study of 43,677 patients. The Spanish dermatologists reported that teledermatologically detected melanomas had a thinner Breslow depth and lower tumor stage because they were diagnosed earlier. Teledermatology also brought a twofold increase in the basal cell carcinoma detection rate and – most importantly – a reduction in time to biopsy for what turned out to be skin cancers (JAMA Dermatol. 2015 Dec 1;151[12]:1289-90).
In addition, teledermatology is an effective triage tool for busy clinicians whose appointment calendars are booked weeks or months in advance.
“Let’s say you are the only dermatologist in the surrounding five counties. You can use teledermatology to see which patients actually need to come to your clinic,” Dr. Tejasvri said. Just make sure the referring primary care providers know to send photos taken with the dermatoscope attachment.
Internet-based teledermatology also provides a way to follow patients with chronic conditions, including psoriasis, atopic dermatitis, and venous ulcers, he noted.
Before getting started
Dr. Tejasvri emphasized the importance of visiting the American Academy of Dermatology Teledermatology Task Force website as well as the American Telemedicine Association’s Teledermatology Special Interest Group, which he chairs. These resources, he stressed, are invaluable.
The AAD site, open to all academy members, includes a tool kit for getting started in teledermatology. It’s individually tailored for the dermatologist in solo, small group, academic, or multispecialty practice. This highly practical tool kit includes a checklist that aids in determining whether a dermatologist’s practice is suited for teledermatology, as well as the suggested optimal teledermatology practice model for that individual, the nuts and bolts of equipment, relevant state laws, and how to navigate legal concerns, among the most critical of which is to get in writing the malpractice insurer’s verbal reassurance that the policy covers telemedicine.
The American Telemedicine Association Teledermatology Special Interest Group provides best-practice guidelines (Telemed J E Health. 2016 Dec;22[12]:981-90)
Teledermatology practice model options
The most common teledermatology model is called “store-and-forward.” It relies upon transmission of still images of skin lesions. Its advantages are that it’s not dependent upon internet speed and it accommodates physicians working in different time zones. Most commonly, this is a consult model in which a remote primary care provider takes the photos and transmits them to the dermatologist specialist. The referring provider retains responsibility for patient care.
The other model entails creation of a virtual clinic with real-time videoconference-based communication using a HIPAA-compliant high-speed broadband internet connection. The advantages are that reimbursement is good – indeed, the same as for a face-to-face office visit – and it’s possible to ask questions of the patient and referring physician, although that’s generally not necessary for the straightforward evaluation of suspicious pigmented or nonpigmented skin lesions. However, the video image quality isn’t as good as with still photos, the virtual clinic requires dedicated scheduling, and the quality of the experience is highly dependent upon internet speed.
“If you have a bad internet speed the whole process becomes choppy. When you ask a question, the answer you get is the one to your previous question,” Dr. Tejasvi said.
Reimbursement
Currently 38 states and Washington, D.C., have laws governing private payer telehealth reimbursement policy.
Under the 2019 Medicare physician fee schedule, code number 99446 – interprofessional telephone/internet consult lasting 5-10 minutes – pays $18.36. A 99447, lasting 11-20 minutes, pays $36.36, and a 99448, representing a 21-30 minute interprofessional consult, pays $54.72.
“Reimbursement is poor. It’s not a lot at all. If you spend 5-10 minutes on a consult you get paid about 20 bucks. But it’s better than nothing, and it used to be that patients had to pay out of pocket,” the dermatologist commented.
And of course, the improved timely and efficient patient access to dermatologist evaluation of potential skin cancer that’s afforded via teledermatology helps out with the profession’s workforce shortage and responds to the common criticism that dermatologists are geographically maldistributed and treatment delayed is treatment denied.
How accurate is teledermatology?
Numerous studies have reported diagnostic concordance rates between teledermatology and face-to-face clinical diagnosis of 72.5%-90% for melanoma, dropping off markedly to 31.2%-62% for lentigines. However, teledermoscopic images greatly improved the diagnostic accuracy.
In one recent study involving teledermatology versus face-to-face evaluation of 293 index lesions, the face-to-face dermatologist examination turned up 131 incidental skin lesions, including 6 incidental melanomas not suspected or photographed by the consulting primary care providers. That worked out to a 2.6% risk of incidental melanoma per consult, which Dr. Tejasvi called “kind of scary.”
“All six of the incidental melanomas were located on the back, chest, or abdomen, so a good teaching point is that, if you’re doing a teledermatology consult, ask the primary care provider who’s sending you this consult to do a careful waist-up exam to look for other lesions,” he advised.
He added that more and larger studies are needed in order to determine the diagnostic concordance rate for nonpigmented lesions.
Dr. Tejasvi reported having no financial conflicts regarding his presentation.
SDEF/Global Academy for Medical Education and this news organization are owned by the same parent company.
EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SEMINAR
New leaders at SKCC, Mount Sinai, NHF
The Sidney Kimmel Cancer Center–Jefferson Health (SKCC) has a new director of bone marrow transplant and cell-based therapy, Mount Sinai has a new head of clinical cancer research, and the National Hemophilia Foundation (NHF) has a new president and CEO.
Usama Gergis, MD, has joined SKCC in Philadelphia as director of the bone marrow transplant and immune cellular therapy program and as a professor in the department of medical oncology, division of hematological malignancies.
Dr. Gergis came to SKCC from Weill Cornell Medicine in New York, where he helped expand the use of umbilical cord blood transplant and established an immune cellular therapy program. He also established and led one of the largest oncology international medicine programs in the United States.
Dr. Gergis earned his medical degree from Cairo (Egypt) University. He completed an internal medicine residency and a hematology/oncology fellowship at the Brooklyn Hospital of Weill Cornell. He also completed a bone marrow transplant fellowship at the Moffitt Cancer Center in Tampa.
Karyn Aalami Goodman, MD, has been hired to lead clinical cancer research at Mount Sinai, New York. She is now the associate director for clinical research at the Tisch Cancer Institute and a professor and vice-chair for research and quality in the department of radiation oncology. In these roles, she will develop the infrastructure and resources to support clinical trials of cancer patients.
Dr. Goodman’s own research is focused on improving outcomes for patients with gastrointestinal malignancies. She has helped develop protocols combining radiation, chemotherapy, targeted agents, and immunotherapy.
Dr. Goodman earned her medical degree from Stanford (Calif.) University. She completed an internship in internal medicine at Stanford and residency training in radiation oncology at Memorial Sloan-Kettering Cancer Center in New York. She was previously associate director of clinical research at the University of Colorado Cancer Center in Aurora.
Leonard A. Valentino, MD, has assumed the role of president and CEO of the National Hemophilia Foundation in New York. In this role, Dr. Valentino will “work to advance the foundation’s mission of education, advocacy, and research,” according to the NHF.
Dr. Valentino previously held leadership roles at Spark Therapeutics, Shire, Baxalta, and Baxter Healthcare Corporation. Prior to that, he founded and led the Hemophilia and Thrombophilia Center at Rush University Medical Center in Chicago.
Dr. Valentino earned his undergraduate and medical degrees from Creighton University in Omaha, Neb. He completed his residency at the University of Illinois at Chicago and a fellowship in pediatric hematology-oncology at the University of California, Los Angeles .
The Sidney Kimmel Cancer Center–Jefferson Health (SKCC) has a new director of bone marrow transplant and cell-based therapy, Mount Sinai has a new head of clinical cancer research, and the National Hemophilia Foundation (NHF) has a new president and CEO.
Usama Gergis, MD, has joined SKCC in Philadelphia as director of the bone marrow transplant and immune cellular therapy program and as a professor in the department of medical oncology, division of hematological malignancies.
Dr. Gergis came to SKCC from Weill Cornell Medicine in New York, where he helped expand the use of umbilical cord blood transplant and established an immune cellular therapy program. He also established and led one of the largest oncology international medicine programs in the United States.
Dr. Gergis earned his medical degree from Cairo (Egypt) University. He completed an internal medicine residency and a hematology/oncology fellowship at the Brooklyn Hospital of Weill Cornell. He also completed a bone marrow transplant fellowship at the Moffitt Cancer Center in Tampa.
Karyn Aalami Goodman, MD, has been hired to lead clinical cancer research at Mount Sinai, New York. She is now the associate director for clinical research at the Tisch Cancer Institute and a professor and vice-chair for research and quality in the department of radiation oncology. In these roles, she will develop the infrastructure and resources to support clinical trials of cancer patients.
Dr. Goodman’s own research is focused on improving outcomes for patients with gastrointestinal malignancies. She has helped develop protocols combining radiation, chemotherapy, targeted agents, and immunotherapy.
Dr. Goodman earned her medical degree from Stanford (Calif.) University. She completed an internship in internal medicine at Stanford and residency training in radiation oncology at Memorial Sloan-Kettering Cancer Center in New York. She was previously associate director of clinical research at the University of Colorado Cancer Center in Aurora.
Leonard A. Valentino, MD, has assumed the role of president and CEO of the National Hemophilia Foundation in New York. In this role, Dr. Valentino will “work to advance the foundation’s mission of education, advocacy, and research,” according to the NHF.
Dr. Valentino previously held leadership roles at Spark Therapeutics, Shire, Baxalta, and Baxter Healthcare Corporation. Prior to that, he founded and led the Hemophilia and Thrombophilia Center at Rush University Medical Center in Chicago.
Dr. Valentino earned his undergraduate and medical degrees from Creighton University in Omaha, Neb. He completed his residency at the University of Illinois at Chicago and a fellowship in pediatric hematology-oncology at the University of California, Los Angeles .
The Sidney Kimmel Cancer Center–Jefferson Health (SKCC) has a new director of bone marrow transplant and cell-based therapy, Mount Sinai has a new head of clinical cancer research, and the National Hemophilia Foundation (NHF) has a new president and CEO.
Usama Gergis, MD, has joined SKCC in Philadelphia as director of the bone marrow transplant and immune cellular therapy program and as a professor in the department of medical oncology, division of hematological malignancies.
Dr. Gergis came to SKCC from Weill Cornell Medicine in New York, where he helped expand the use of umbilical cord blood transplant and established an immune cellular therapy program. He also established and led one of the largest oncology international medicine programs in the United States.
Dr. Gergis earned his medical degree from Cairo (Egypt) University. He completed an internal medicine residency and a hematology/oncology fellowship at the Brooklyn Hospital of Weill Cornell. He also completed a bone marrow transplant fellowship at the Moffitt Cancer Center in Tampa.
Karyn Aalami Goodman, MD, has been hired to lead clinical cancer research at Mount Sinai, New York. She is now the associate director for clinical research at the Tisch Cancer Institute and a professor and vice-chair for research and quality in the department of radiation oncology. In these roles, she will develop the infrastructure and resources to support clinical trials of cancer patients.
Dr. Goodman’s own research is focused on improving outcomes for patients with gastrointestinal malignancies. She has helped develop protocols combining radiation, chemotherapy, targeted agents, and immunotherapy.
Dr. Goodman earned her medical degree from Stanford (Calif.) University. She completed an internship in internal medicine at Stanford and residency training in radiation oncology at Memorial Sloan-Kettering Cancer Center in New York. She was previously associate director of clinical research at the University of Colorado Cancer Center in Aurora.
Leonard A. Valentino, MD, has assumed the role of president and CEO of the National Hemophilia Foundation in New York. In this role, Dr. Valentino will “work to advance the foundation’s mission of education, advocacy, and research,” according to the NHF.
Dr. Valentino previously held leadership roles at Spark Therapeutics, Shire, Baxalta, and Baxter Healthcare Corporation. Prior to that, he founded and led the Hemophilia and Thrombophilia Center at Rush University Medical Center in Chicago.
Dr. Valentino earned his undergraduate and medical degrees from Creighton University in Omaha, Neb. He completed his residency at the University of Illinois at Chicago and a fellowship in pediatric hematology-oncology at the University of California, Los Angeles .