Surgery News - September 2007 - (Page 3) SEPTEMBER 2007 • SURGERY NEWS NEWS More Medical Schools, Residencies Needed to Ease Physician Shortage The AAMC is now recommend- But the survey also found that parting to Congress a 30% increase in time work opportunities and less U.S. medical school capacity. A 17% bureaucracy would keep physicians C O L O R A D O S P R I N G S — Amer- increase in capacity by 2012 is pos- over age 50 in the workforce. Less than two-thirds of residency ica’s physician shortage—still bare- sible simply by maximizing existing ly noticeable in much of the coun- capacity, according to the latest slots are now filled by graduates of try—is here to stay and will grow AAMC survey of the 125 medical U.S. medical schools. Most of the much worse, panelists agreed at the school deans. An additional strategy rest are filled by non-U.S.-citizen annual meeting of the American is to create regional or branch cam- international medical graduates. puses of existing med- Adding more U.S. medical schools Surgical Association. ical schools, as many os- would increase the proportion of “We’ll have to invent teopathic schools are U.S. graduates in the postgraduate ways to deal with it, bedoing, said Dr. Kirch, a pipeline and keep more internacause none of us has psychiatrist. “The Lake tional graduates where they were ever experienced within Erie College of Osteo- trained, noted Dr. George F. Shelour lifetimes in medipathic Medicine in Erie, don, an ACS Fellow and professor cine a shortage of the Pa., has established its of surgery at the University of sort we’re building into regional campus in Jack- North Carolina at Chapel Hill. the future,” warned Dr. Dr. L.D. Britt got a big hand sonville, Fla.,” he noted. Richard A. Cooper, proHe also sees a need from the audience when he told the fessor of medicine and a There are now for more flexibility in the panelists the time has come to senior fellow at the Uni5%-8% too few premedical curriculum. “give up the ruse and declare what versity of Pennsylvania’s physicians, and “We still have that em- we already know—that the most Leonard Davis Institute the shortfall will of Health Economics, grow to about 20% phasis on the core of cal- wasted year in all medical educaculus, physics, general tion is the fourth year of medical Philadelphia. within 20 years. school.” Eliminating it and organic On the basis of ecoDR. COOPER would make medical chemistr y. nomic and population school more attractive projections, he estimated the na- How many of you in and substantially cut the tion will need 10,000 additional the OR have stepped crushing student debt first-year residency slots and 60 back from a case and burden, argued Dr. new medical or osteopathic schools said, ‘If I only knew Britt, professor and more calculus I could by 2020 to control the crisis. chairman of the deBy Dr. Cooper’s estimate, there manage this case’? partment of surgery at are now 5%-8% too few physicians Maybe there can be Eastern Virginia Mednationally, and the shortfall will more flexibility that grow to about 20% within 20 years. would allow us to at- A 17% increase in ical School, Norfolk, and an ACS Fellow. Physician assistants and nurse prac- tract people who have medical school And way too many titioners aren’t being trained in suf- great intellects but aren’t capacity by 2012 ficient numbers to be the solution. quite so oriented toward is possible simply obstacles are placed in the way of physicians Dr. Darell G. Kirch, president the physical sciences,” by maximizing interested in making a and chief executive officer of the he said. existing capacity. midcareer change in The physician shortAmerican Association of Medical DR. KIRCH specialty, he said. Colleges, Washington, D.C., age is compounded by All papers presented at the 127th praised Dr. Cooper for conducting workforce exit issues. A national surthe pioneering research that is vey done last year showed 1 in 3 annual meeting of the ASA are subawakening health policy planners physicians over age 50 would retire sequently submitted to the Annals to the looming physician shortage. now if they could afford to, he said. of Surgery for consideration. ■ BY BRUCE JANCIN Preventable Events Errors • from page 1 Else vier Global Medical Ne ws patients. However, hospitals will not bear the total financial risk of these cases because the payment policy will not affect Medicare’s high-cost outlier policy. CMS will continue to use the hospital’s total charges for all inpatient services provided during a patient’s stay when determining whether the case qualifies for an outlier payment. The policy was issued as part of the Medicare acute care hospital inpatient prospective payment system final rule, which was published in the Federal Register on Aug. 22. In a June 12 letter to CMS, the American Medical Association voiced concerns that the policy could have “significant unintended consequences for patients.” “The concept of not paying for complications that are often a biological inevitability regardless of safe practice is discriminatory and could be punitive to those patients at the greatest risk,” wrote Dr. Michael D. Maves, executive vice president and CEO of the AMA. In comments submitted on June 12 in response to a proposed rule issued by CMS, the American College of Surgeons agreed that “objects left behind during surgery, air embolism, and blood incompatibility are appropriate conditions to include.” However, the College also said that it “did not believe the other three conditions are ready for implementation because they describe conditions that may not be preventable under certain conditions.” Although the CMS focus on quality and patient safety is laudable, agency officials are overreaching with their list of conditions, said Dr. Junaid Khan, a cardiothoracic surgeon in Oakland, Calif., and an ACS Fellow. For example, surgical site infections are a significant problem, but it’s unlikely that they can be eliminated even if guidelines are followed. The devil is likely to be in the details, said Dr. Jeffrey Milliken, a cardiothoracic surgeon at the University of California, Irvine, and an ACS Fellow. The nature of the underlying disease and whether clinical guidelines were followed must be considered in order for the policy to be fair and effective. The American Hospital Association supports the inclusion of only three of the conditions outlined by CMS (an object left in during surgery, air embolism, and blood incompatibility). However, there are concerns about whether the other conditions are always or even usually preventable, even with excellent care, said David Allen, an AHA spokesman. But Susan Pisano, a spokesperson for America’s Health Insurance Plans, said the new policy provides an incentive for hospitals to develop processes to avoid these conditions. And Rachel Weissburg, a program associate at the Leapfrog Group, said the CMS policy sends a “loud and clear signal” to hospitals that they must pay attention to these preventable events. ■ SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Mark S. Allen, M.D., FACS, Cardiothoracic Surgery, Minnesota John H. Armstrong, M.D., FACS, Trauma and Mass Casualties, Florida Hunt Batjer, M.D., FACS, Neurological Surgery, Illinois Mark R. Belsky, M.D., FACS, Orthopedic Surgery, Massachusetts David G. Burris, M.D., FACS, Trauma and Uniformed Services, Maryland Gregory S. Cherr, M.D., ACS Resident/Associate Society, New York Fred A. Crawford, Jr., M.D., FACS, Cardiothoracic Surgery, South Carolina William J. Hoskins, M.D., FACS, Obstetrics and Gynecology, Georgia Natalie C. Kerr, M.D., FACS, Ophthalmology, Tennessee William M. Kuzon, Jr., M.D., Ph.D., FACS, Plastic Surgery, Michigan Robert Madoff, M.D., FACS, Colorectal Surgery, Minnesota James Markmann, M.D., FACS, Transplantation, Pennsylvania Jack W. McAninch, M.D., FACS, Urology, California Robert Morell, M.D., Anesthesiology, Florida James P. Neifeld, M.D., Surgical Oncology, Virginia Richard A. Prinz, M.D., FACS, Endocrine Surgery, Illinois David W. Rattner, M.D., FACS, Minimally Invasive Surgery, Massachusetts Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgery, Rhode Island Kevin K. Tremper, M.D., Ph.D., Anesthesiology, Michigan Patricia L. Turner, M.D., FACS, Information Technology, Maryland Thomas Wakefield, M.D., FACS, Vascular Surgery, Michigan Mark Weissler, M.D., FACS, Otolaryngology, North Carolina Steven E. Wolf, M.D., FACS, Trauma (Burns and Mass Casualties), Texas SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. 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