(via AAMC: Physician specialist shortage to reach 63,000 by 2015)

Between now and 2015, the shortage of U.S. doctors across all specialties will quadruple to nearly 63,000, according to a report from the Association of American Medical Colleges (AAMC) Center for Workforce Studies.

While previous projections showed a baseline shortage of 39,600 doctors in 2015, AAMC estimated 62,900, with a worsening shortage of 130,600 by 2025. Partially driving the shortage, the U.S. Census Bureau projected a 36 percent growth in the number of Americans over age 65, and nearly one-third of all physicians are expected to retire in the next decade, the report found.

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There also will be a substantial shortage of non-primary care specialists, according to the report. In 2015, the U.S. will face a shortage of 33,100 physicians in specialties such as cardiology, oncology and emergency medicine. In 2025, AAMC estimated that number to rise to 64,800.

I do think this situation is not unique to the US. Other countries, including the Philippines, are feeling a shortage of doctors.

(via amednews: Wrong-patient, wrong-site procedures persist despite safety protocol – American Medical News.)

Patient safety experts said the problem is not with the safety protocol, but with failure to follow it every time. Sometimes physicians and other health professionals rush through the checks, and in some places, the surgeon may not even be in the operating room when the timeout discussion is done.

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Analyses of wrong-procedure cases find that failure to comply with protocols is the No. 1 reason they occur, with poor communication and lack of physician leadership also frequently contributing, said LaMar McGinnis, MD, immediate past president of the American College of Surgeons. He also serves as the colleges representative on the Joint Commission.

How common, do you think, is this here in RP? Although I’ve yet to hear of a sensational case about this, I’m sure this happens.

For-profit hospitals across the state are performing cesarean sections at higher rates than nonprofit hospitals, a California Watch analysis has found.

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In addition, some hospitals appear to be performing more C-sections for nonmedical reasons — including an individual doctor’s level of patience and the staffing schedules in maternity wards, according to interviews with health professionals.

via Cesareans more likely for women at for-profit hospitals, study finds – San Jose Mercury News.

The article says there’s at least 17% more C-sections in for-profit hospitals as compared to non-profit or public hospitals.

How high do you think is it here in the Philippines?

This would make a good study.

An article has an interesting idea: why not pay only for antibiotics that work?

Their big idea is to reward both hospitals and drug companies for what they do to keep antibiotics effective.

…

Radical? I think so. But it makes some sense. We would be paying for antibiotics to work and keep on working – not for more and more drugs that quickly become useless. I can imagine this being a nightmare to negotiate between the interested parties. But at least it’s a new idea. Like new antibiotics, we are short of those.

via A radical plan to save antibiotics | Society | guardian.co.uk.

What do you think?

Surgeons lack professionalism: Lancet medical journal – Telegraph.

A recent independent report found concerns over inadequately equipped operating theatres and a lack of anaesthetists and emergency care.

There was a statutory obligation to participate in the audit yet only half of centres actually did.

“That such revelations must come from outside the surgical community implies a lack of professionalism and leadership among the surgeons involved,” the editorial said.

It continued: “Surgeons, as patients’ advocates, should be active and united in drawing attention to inadequacies as part of an agenda of reform that promotes professionalism and leadership. But surgeons are largely absent from the debate.”

Read through the article to get a better handle of the topic.

Wachter suggests five ways to start addressing this system of neglect:

1. Improve board certification standards by requiring more frequent reviews and perhaps annual maintenance of certification documentation, with hospitals making that a requirement for staff privileges for certain specialties. Already, he says, efforts are underway to make this process more rigorous and remove some of the grandfather privileges that exempt doctors trained decades ago if they are still practicing.
2. Encourage research on diagnostic errors to better understand how and when they happen, and whether computerized decision support tools reduce them. The AHRQ has provided some seed funding for such research.
3. See what sorts of training are associated with improved diagnostic performance, and hospitals should be required to offer them or ensure that their medical staffs participate in them.
4. Use technology, perhaps some of the $20 billion in federal support from the stimulus bill, to find health information technology strategies that reduce diagnostic errors.
5. Improve medical teaching by having the Accreditation Council for Graduate Medical Education ensure that residencies and medical schools train students in diagnostic reasoning, including more creative use of simulations and model patients.

Do you have anything to add? What tips or advice can you give to fellow doctors to avoid diagnostic errors here in the Philippines?

Conclusions: Whereas patients admitted to an ICU over the weekend appear to be at an increased risk of death, nighttime admissions were not associated with an increased mortality. The lower level of staffing and intensity of care provided by many hospitals over the weekend may account for this finding. The heterogeneity noted between studies evaluating nighttime admissions likely reflects the diverse organizational structure of the hospitals and ICUs where these studies were carried out.

(Bold emphasis mine.)

You will need to login to read the whole article.

From WebMD: Action Video Games Help Decision-Making.

In the new study of 18- to 25-year-old non-gamers, one group played 50 hours of action-packed video games, while the other played a slow-moving strategy game for the same amount of time. Participants were then asked to perform two specific decision-making tasks in the lab. The first task involved determining whether a bunch of moving white dots were going right or left. The second task measured their ability to tell if a single pitched tone was heard in their right or left ear while wearing a pair of headphones that emitted white noise.

“Action video games help you make faster decisions across the board because you are learning to translate what you are seeing or hearing into correct probability,” Green says.

“Action gamers are not trigger happy or impulsive,” he says. “They press the button faster, and are just as accurate,” he says.

This quality is beneficial for people in the military or police officers who must think quickly on their feet with little margin for error, he says.

This gives us more reasons to spend on game consoles.

Exposure to thimerosal-containing vaccines in infancy or in the womb is not associated with an increased risk for developing autism, according to a new study from the CDC.

Children in the study who developed autism spectrum disorder (ASD) actually had less exposure to vaccines with the mercury-containing preservative than children who developed normally.

The study is the latest of almost 20 studies to find no link between childhood vaccinations and autism.

It’s on slideshare.net:

Philippine CPG on Diagnosis & Screening for Gestational Diabetes

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Do you have CPG’s you’d like to share? Send us the link and we’ll post them here.

Let’s wave goodbye to “transplant tourism” — Turner 336 7657: 1377 — bmj.com.

There’s even a series of connected replies about “The Filipino Connection”.

Here’s an excerpt of the above link:

“Transplant tourism” is a phrase to which we should say goodbye. True, the term has an alliterative ring. And yes, travel is involved when someone journeys to Pakistan or the Philippines to receive a transplant. Nevertheless, “transplant” and “tourism” are two words that do not belong together.

The phrase is used not only by newspapers, magazines, films, and television programmes but also by prestigious academic journals and scholarly conferences. Several major transplant associations have policies on transplant tourism.

BTW, you cannot access the full text of the article. Only the abstract. If someone has full-text article, I’d appreciate a copy.

IMGs, U.S. medical graduates provide same level of care – American Medical News.

Here’s an excerpt:

The quality of care provided by international medical graduates is the same as U.S. medical school graduates, according to a new study.

Researchers analyzed patient outcomes of 6,113 practicing Pennsylvania physicians who graduated from foreign and U.S. medicals school after 1958. They found no difference in mortality among patients hospitalized for congestive heart failure or acute myocardial infarction from 2003 to 2006, according to the study in the August issue of Health Affairs.

What about the quality of care in their homelands?

Related articles by Zemanta

• International medical graduates and their patient outcomes (kevinmd.com)
• Decline in international medical graduates exacerbates shortage of general surgeons (eurekalert.org)

MANILA, Philippines—World Suicide Prevention Day will be marked on Sept. 10 with the theme “Many Faces, Many Places: Suicide Prevention Across the World” to underscore the importance of an international effort to prevent suicides.

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According to the World Health Organization (WHO), nearly 3,000 people commit suicide around the globe daily, or one every 40 seconds. For every suicide, 20 or more may have attempted to end their lives, it said.

In the Philippines, the DoH has reported that about five people take their own lives each day, with the 20-24 age group having the highest suicide rate.

Do we really need one?

Written and Submitted By Dr. Alex U. Pisig

I am a "moonlighter." In medical circles, the word largely refers to a Filipino doctor practicing as a general physician (GP), one who works outside one’s specialization or without one. Some doctors choose "moonlighting" as a lifetime career; others go into it while they are still undecided on what "path" to take or while in the process of formulating their so-called "plan of life."

In the United States, "moonlighters" would refer to doctors who take on night-duties (and, therefore, metaphorically work under the moon’s light) to sub for another physician for some extra earnings. Such a moonlighter would be a "lokun" if he were in Singapore.

Well, moonlighting in the Philippines is just one of several "paths" for doctors. A doctor could go into a field of specialization; or he could review for the United States Medical Licensure Exam (USMLE) or for the US Nursing boards. Yes, nursing!

So what’s the big deal if one is a GP, a moonlighter?

First, let’s take a look at the "ideal career trajectory" of a doctor. After earning a health- or science-related college degree, the wannabe doctor has to go through four grueling years of medical study. After which, he is academically entitled to be called a doctor. Then he must serve for a year as a medical intern in a hospital of choice—a requirement for taking the board examination.

Passing the exam would seem like the happiest point in his life. But the happiness doesn’t really last long. After a few days or weeks of partying, the "ideal" path beckons to specialization which would entail three to six more years of training, depending on the chosen field. After this, the doctor becomes a consultant, and has to pay millions of pesos for shares of stocks so that he will, at least, have a right to practice in a decent tertiary hospital. The "super ideal" scenario is to train for a subspecialty, which will require another two to three years. And we haven’t counted in the months or years of irregular semesters the medical student might have gone through before.

Finally, the subspecialist has to attend continuing education seminars to update himself on the latest in the field of medicine. This he has to do until he won’t be able to read, or hear or walk as he used to; or until he has used up all the ideas on how to spend the millions of pesos he earned from his successful medical practice.

So being a GP deviates from the ideal path?

I passed the medical board exams in August 2008 but I chose not to apply for any residency (specialization) program just yet. Since then, I have been in a number of moonlighting stints.

The doctors I’ve met in these stints come from different batches: new graduates; fiftyish—but moonlighters all, each with a unique story to tell. Stories that made them decide not to shun specialized medicine, which includes hospital work that lasts 12 hours, or even 36 hours, non-stop or alternately; with hundreds of patients per day attended to—for stipends that range from P10,000 to P15,000 a month. All this in a hospital culture of seniority, money and politics.

I know of some doctors who earn a little more than P50 an hour from moonlighting. Imagine, this, after paying approximately a hundred thousand pesos per semester. Decent? Well, others settle for this income because they can’t find better options. Better to be "productive" while waiting for "good luck" (read: opportunity) in other countries.

Why don’t the moonlighters get better opportunities, or the residents-in-training better stipends? Perhaps, because doctors don’t stand to protest the reality (or the abuse?) they are made to suffer, opting instead "to protect the dignity and nobility of their profession."

I confess I am guilty of wanting to work as a doctor in another country. But since medicine is a "protected field," some countries do not recognize the Philippine licensure. To go to these countries—Australia, New Zealand, Canada and the United States, to name a few—Filipino doctors will have to pass the medical licensure exams there. But years will also be used up to qualify for these examinations. Eventually, those wanting to go to other countries end up, where else, but moonlighting.

After a few months of moonlighting, I have learned many things not taught in thick medical books. And I have seen the real face of the medical profession in the country. Yes, you may recognize a doctor earning millions of pesos, the big-timers, when you see one! But they are few and far between. Most doctors in the country can’t even compare their salaries with those of call center agents! For this reason, I’m not really surprised why doctors (and other health professionals) would want to work abroad. They feel that all the years of difficulties, sacrifices they went through to become doctors are not worth the "prize." In fact, around half of my school batch is now reviewing for a medical licensure exam of another country. They seem to have no more plans to practice medicine in the Philippines. And the brain drain—"brain hemorrhage" would be the more appropriate phrase—won’t stop until the government (oh my, our government) would institute measures that would stanch the bleeding.

But another face of the medical profession tells me that it’s not all about money. When I participate in medical missions in the provinces, I meet doctors who live simple lives. They say that it’s really one’s expectations in life that define true happiness. It won’t matter if one’s a GP or a specialist. The Filipino doctor on a ship or an oil-rig physician is a GP earning a decent wage though, being away from his family, he has to endure loneliness.

The GPs in the barrios are the true heroes. They live a life close in style to the life of the people they serve, and enjoy a most rewarding feeling in healing and saving the lives of their less fortunate countrymen.

Many young Filipinos wanting to become doctors have asked me if the medical profession would be a good choice as a career. I always tell them that if it is sincerely in their hearts to help the sick and save lives, then they should pursue their dream. And I always tell them that if money is all they want, then they should forget about Medicine. Rich doctors get rich because of hard work and because they engage in other businesses, not necessarily because they are doctors. In our country, the life of a doctor is a life of sacrifice, a life of service, a life for others. For a dedicated doctor, the monetary reward comes just as a bonus; the real reward comes from heaven.

When I was a child, people would ask me what I would want to be when I grow up. My typical response was, "Paglaki ko po, gusto kong maging doctor!"

—
Dr. Alex U. Pisig is a graduate of the UST Faculty of Medicine and Surgery, Batch 2007.

This piece was originally published in the Youngblood section of the Philippine Daily Inquirer on May 23, 2009.