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The number of graduating seniors in the United States choosing family medicine has declined nearly 50% since 1997, with less than 10% of the U.S. medical graduates in 2004 choosing family medicine. The reasons for such appear to be multi-factorial including lifestyle issues, compensation and a growing focus on specialty therapeutics.
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The annual benefit and enrollment season brings millions of workers and company-sponsored health plans to a point of facing another cycle of changes in premiums, co-payments and deductibles. The following lists some trends in employee benefits that are being offered in enrollment packages this year.
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In the United States, 36% of adults use some sort of Complimentary and Alternative Medicine (CAM) not counting prayer, according to a recent survey by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Of these, 55% believe in combining CAM with conventional or allopathic medicine. Throughout the country we see the borders between CAM and conventional medicine blurring. Since 1998 this National Center for Complimentary and Alternative Medicine, a branch of the National Institutes of Health, has been studying the efficacy of naturopathy, guided imagery, St. John’s Wort, acupuncture and other treatments.
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In two decades, medical imaging technology has made a major impact on the practice of medicine. Doctors consider Magnetic Imaging (MRI) and computer tomography (CT) the greatest medical innovations in a generation. As researchers develop new uses for the scans and engineers improve the clarity, the machines have proliferated making these imaging technologies standard tools for diagnosis and treatment. The following survey results indicate where leading internists place the significance of imaging capabilities.
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Most Americans rate the profession of “physician” as having “very great” prestige, putting it at the top of a survey of which professions are most respected.
Despite the fact that medicine and science are considered the most prestigious, doctors fell in consumers’ eyes by 9 points from 1998-2004. Participants in a nationwide sample of 1,012 adults were asked to rate 22 different professions as having very great prestige, considerable prestige, some prestige or hardly any prestige at all. 
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A roster of national consensus measures for evaluating and reporting heart surgery quality in hospitals endorsed by the National Quality Forum (NQF) set the stage for consumers to be told about death rates in six categories of cardiac procedures and about rates for several types of major complications. The twenty-one measures add to the compendium of measures that the Washington-based consensus building organization has turned out in the past two years. While these endorsements have no mandate in the healthcare industry, quality oversight and government healthcare regulatory organizations have adopted NQF measures in their reporting initiatives. The cardiac surgery measures include death rates for coronary artery bypass surgery – a standard that has been provided for many years – but for the first time it’s joined by risk-adjusted measures of mortality for two types of heart valve replacements as well as separate measures for when those procedures are combined with coronary artery bypass surgery. The Society of Thoracic Surgeons, which operates a database with three million cases, developed a risk-adjustment model for those procedures during the past several years.
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A growing number of disease management programs offer to monitor patients with chronic conditions. By most estimates people with chronic diseases account for more than two-thirds of the national $1.6 trillion medical bill, a figure that is expected to grow as baby boomers age. The purported aim of disease management, whether through the family doctor or a health plan service, is to educate patients about their disease and help them manage its symptoms, such as controlling blood sugar in diabetics to stave off blindness, kidney failure and amputations. The percentage of employer-sponsored health plans offering disease management programs grew to 58% last year from 41% the year before, according to Mercer Human Resources Consulting. A number of health plans outsource such work to more than 100 companies that have crowded into the market. Disease management programs are now expanding to include depression, cancer, kidney disease, obesity and lower back pain. While there is support for these programs, others express skepticism about outsourced disease management programs which sometimes use automated response systems to check on patients. Critics claim that hands-on efforts should not be confused with more expensive and more visible activities of some of the disease management vendors where evidence of their success has been somewhat variable. Medicare is about to launch an ambitious pilot program to test disease management programs. That plan is expected to include about 10-12 different sites around the country, covering 20,000 or more patients each. The outcome will have significant impact on how we approach disease-management efforts.
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Health policy experts have often been confronted with regional variation in the application of therapies. This graph shows a regional comparison of primary cardiac intervention and coronary artery bypass grafting for unstable angina.
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The following question was posted on the Riner Group Website:
“Some people feel human conditions previously thought of as normal, now warrant treatment. Medical guidelines are being expanded and genetic tests are becoming readily available. Previous typical issues such as menopause, shyness, shortness of stature and symptoms of old age are potentially now being deemed worthy of medical intervention. Do you think we run the risk of all being labeled as sick? Are we emphasizing medicalization of the society too much?” The answer to this question is highly debated. Some people feel “medicalization” is a threat to health, turning the United States into a nation of over treated, worried well who are unable to cope with life’s normal travails. Dr. Clifton Mador addressed this issue in a paper in the New England Journal of Medicine in 1994 entitled “The Last Well Person.” Some feel that we really need some basic research to see whether these designations do have beneficial outcome other than driving up the cost of healthcare. On the other side of the debate, some would say that the growth of medicalization and the ever expanding definition of who is in need of treatment empowers patients. Some physicians say their patients take action rather than taking to their beds as a consequence of being labeled with a potential risk factor, etc. This month’s Quick Poll question is: Do you feel there is an under supply of physicians as we look to the future?. To cast your vote, see how your colleagues respond and learn more about this question, please visit our home page. 
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With over twenty-five years of clinical and business experience, we have worked with physician practices, hospitals, health systems, academic medical centers and healthcare businesses in 48 states with focus on strategy, new business development and performance improvement. We specialize in integrating the business and clinical aspects of healthcare. Some of our current projects include:
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Naples, FL 34108 |
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Copyright - The Riner Group, 2010 |
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