RVU Medicine, Technology, and Physician Loneliness Richard P. Wenzel, M.D. T he increasingly sharp focus in the United States on the business contours of medicine and the related use of a productivity lens for basing salaries on Medicare relative value units (RVUs) have left many health care providers disheartened. Young doctors, especially, fill the unforgiving minute with clinical efforts, keenly sensitive to substantial school debts, mortgage and car payments, day-care costs, and the modest increases made in the professional fee schedule over time. Furthermore, the administrative burdens of enhanced documentation (important for institutional billing and risk management) and various compliance-training sessions can add drudgery to a physician’s diurnal tasks. Clinicians speak of long days delivering care with less time to talk to patients and their relatives, to colleagues, and sometimes to their own family members. Many of us sense the erosion of time for reflection, for inhabiting that uplifting, quiet place where we know who we are, where we are going, and what we hold to be true. Socrates underscored the perils of an unexamined life. Yet for some physicians, a closely examined professional life would force a painful recognition of what’s missing. Robert Pirsig, whose philosophical writing focused on quality and values, crystallized the problem decades ago: “We’re
Alex John London, PhD Department of Philosophy, Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania. Jonathan Kimmelman, PhD Studies of Translation, Ethics, and Medicine, Biomedical Ethics Unit, McGill University, Montréal, Quebec, Canada. Clinical Trials in Medical Center Advertising Many well-established medical centers advertise the opportunity for clinical trial participation to suggest that they offer patients a therapeutic edge. A billboard for Georgia Cancer Center reads “Clinical Trials: Another Rea- son to See Us First” (https://jagwire.augusta.edu/archives /39855). A Johns Hopkins video encourages patients to participate in such trials, because “[they] open up new treatments that [patients] otherwise would not have available to them” (https://www.youtube.com/watch ?v=8ZKjQa4gFeQ&feature=c4-overview-vl&list =PL0A17443C77172961). Cancer Treatment Centers of America states that it “offers clinical trials as part of our commitment to bringing our patients new and innovative cancer treatment options…” (http://www.cancercenter .com/clinical-trials/). Such portrayals of trial participation involve a 2-way transfer of associations: the prestige of research is mar- shaled to elevate the reputation of the medical centers and the therapeutic mission of medical centers is in- voked to bolster participation in clinical trials.
Profile A Personalized, Holistic Approach to Cancer Care long-time oncologist and hematologist launches concierge practice; strives to be “country doctor” for patients By Jim Braibish, Kansas City Medicine
The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor. By REED ABELSON and JULIE CRESWELLAPRIL 7, 2018
Uncovering heritage,now called “Recreational genetics” ? Opening a Pandora’s box. “That DNA Test for Christmas?”
Dr.E.T.’s Concierge Care was awarded the 2017 Innovation award by the Kansas City Medical Society
Acute and chronic economic hardships are the little recognized but all too common effects of cancer therapy, new research shows. Mean annual medical expenditures are higher for male cancer survivors than for males without a history of cancer ($8091 vs $3094), according to a study published in the June 13 issue of the Morbidity and Mortality Weekly Report. For female cancer survivors, costs were even higher ($8412 vs $5119). In addition to out-of-pocket costs, men with a history of cancer lost an estimated $3700 in annual productivity, and women lost an estimated $4000, write Donatus U. Ekwueme, PhD, from the division of cancer prevention and control at the National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention (CDC), in Atlanta, and colleagues. These average annual productivity losses compared unfavorably with the $2260 for cancer-free males and the $2703 for cancer-free females. Employment disability accounted for about 75% of the productivity loss in male and female survivors. “The economic data presented in this report investigating the economic consequences of surviving cancer highlight the need to develop comprehensive intervention programs to improve the quality of the cancer survivorship experience and decrease the economic burden of cancer survivorship in the United States,” the authors write. One new and sligh