Monthly Archives: March 2013

Enough Is Enough: Time To Reevaluate Impact of Residency Training Rules

Shocking, simply shocking. A recent article highlighted unintended consequences of the most recent changes in resident work hour rules.

Why does the ACGME impose work hour restrictions without considering unintended consequences like increased medical errors due to increased patient hand offs?

I graduated residency in the “dark ages” (1999) but rarely worked more than 80 hours a week.  While rounding post call was never pleasant, it did prepare me for “real life.” Today, I worked 12 hours in the clinic then drove 3 hours to the state capitol so I could testify in support of expanded funding for family medicine residencies.  In my first 7 years of practice doing family medicine with Ob and hospital work, I took call for 1 week at a time while covering my own Ob patients 24-7.

The ACGME seems to extrapolate from existing data without studying the impact of its past actions. As a surgeon medical  school classmate of mine says, life has no work hour rules. A rural physician colleague who still does C sections and appendectomies told me last month he no longer hires third year family medicine residents from his own alma mater because they don’t have enough experience.  He only hires grads who complete the program’s 1 year rural medicine fellowship.  When I see graduates of the program where I am now faculty say they can’t do inpatient and outpatient medicine at the same time, our training model is gravely flawed and further fragments health care at a time when more well-trained generalists are needed.

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What Drew Me To Medicine Keeps Me Alive

This blog is from Tim Martindale, a friend and family physician in Waco, Texas. He is a former minister who went back to school to become a family doc.  For seven years, I drove past his office every day on the way to work.  This July, his son will start a family medicine residency.

” This is a paragraph I wrote on a physician website in response to the question of whether I am frustrated with medicine today, or at risk of burnout:

What drew me to medicine keeps me alive at 55.

Every decade there are new changes, paradigm shifts, governmental intrusions, insurance games… but none of them change the basic tenets of why I love medicine.

I get to make lives better, explore the endless universes that are people, be privy to the most challenging times of human experience.

I get to keep learning, keep changing and adapting, use and train my brain for ever-evolving understandings and circumstances.

I get an income through hard work that feeds and cares for my family, all while being given honor and respect and leadership in my community.

So are there hard times of change, shifting rules of success, moments of exasperation and exhaustion? Absolutely. But that’s everywhere in life, and we’re overcomers.”

-Tim Martindale, MD.

Waco, Texas

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We Do View Gun Control Differently Here: A Red State Perspective Part II

The Texas State Capitol has three lines at each entrance. One for legislators, one for the general public, and one for concealed carry permit holders. I understand legislators and state officials getting to use the express line, but only in Texas would we let people carrying a concealed weapon avoid the metal detectors. The metal detectors were placed after a Capitol visitor followed a female staffer, then fired his weapon into the air on the steps outside the main entrance.

When I stood in the long general visitor’s line this past January on the first day of the session watching permit holders breeze through the concealed carry line, I wondered: Do you have to have a weapon, or just a permit?

The answer, according to the New York Times: just a permit. So for $500 dollars you can buy a permit and gun, or for less than $200, you can buy just a permit and use the express line for a year.

http://www.nytimes.com/2013/03/09/us/guns-get-a-pass-at-texas-capitol.html?partner=rss&emc=rss&smid=tw-thecaucus&_r=1&

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The Good, The Bad, and The Ugly: Quality Improvement Part II

Recently I received my “gap” report from our employee insurance plan and my latest physician report card.  Now that I have worked through the 5 stages of grief, I’m ready to grapple with the numbers.

The Good
  • I finally hit the HEDIS 75th percentile for the number of diabetic patients with a Hemoglobin A1C less than 9%.   My percentage was parked in the 50’s for months.  I knew that my diabetics were better controlled than that, but maybe I was in denial.  Once I looked at the data and talked to our IT staff, we discovered that the list was incorrect.  Rewriting the data collection rules increased my percentage by 30%.  You have to make sure the data is correct.
The Bad
  • Although I have sent multiple letters for 6 months, I still cannot get several patients to come in for Pap smears and breast exams.  Do I need do call them repeatedly, drive to their homes, and beg them to come in?  Perhaps their insurer, our hospital system, could put some of the patient’s skin in the game.  Get all the preventive care you should and your premium goes down.  Don’t get the care you should and your insurance premium goes up.  Sounds fair to me.
The Ugly
  • My cervical cancer screening rate is now less than 20%?!  At least one outlier on my gap report doesn’t have a cervix.  Once I find out how to do a Pap smear on a nonexistent cervix, I’ll let y’all know.   We are being held responsible for errors in the insurers’ claims data.  Expertise in data collection and interpretation is essential for a modern physician.
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