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50 years of pediatric residency: What has changed?
When Eileen Ouellette, MD, graduated from Boston’s Harvard Medical School in 1962, she was one of seven women in her class of 141 students. She went on to become one of only three women in pediatric residency at Massachusetts General Hospital later that year.
Free room and board was included in the program, Dr. Ouellette recalled, but her cramped room was poorly insulated and so small that she had to kneel on the bed to open her chest of drawers. The young doctor also soon learned that the women residents made less money than their male counterparts.
Dr. Ouellette, 79, now can laugh at the memory of her tiny room and tinier paycheck. The pediatric residents of today are entering a vastly different environment, she said. For starters, the average pay for medical residents in 2017 is $54,107. Women pediatric residents today far outnumber male residents. And most residents enjoy standard-sized rooms or apartments when completing their residencies.
Technology, for instance, greatly aids pediatric residents in their education today, said Renee Jenkins, MD, a professor at Howard University in Washington and a past AAP president.
Fewer hours, more hand-offs
During Dr. Ouellette’s residency from 1962 to 1965, sleep became a luxury. Of 168 hours in a week, residents were sometimes off for only 26 of them, she said.
“That was absolutely brutal,” she said. “You could not think of anything other than sleep. That became the primary focus of your whole life.”
“It didn’t seem crazy at the time,” said Dr. Stanton, founding dean of Seton Hall University Hackensack Meridian School of Medicine, South Orange, N.J. ”You developed the kind of bond with these families that it wouldn’t occur to you to go home.”
In the 1960s, there were no explicit limits on duty hours, according to Susan White, director of external communications for the Accreditation Council of Graduate Medical Education (ACGME). A “Guide for Residency Programs in Pediatrics,” published in 1968, recommended that “time off should be taken only when the service needs of the patients are assured and that “night and weekend duty provides a valuable educational experience. ... Duty of this type every second or third night and weekend is desirable.”
The guide predates the existence of the ACGME – established in 1981 – but it originated from a committee approved by the American Academy of Pediatrics, the American Board of Pediatrics, and the Council on Medical Education of the American Medical Association, according to Ms. White. While some residency programs changed their work hours over the years, the first mandated requirements for duty hours came in 1990 when ACGME set an 80-hour work week for four specialties: internal medicine, dermatology, ophthalmology, and preventive medicine. The council also limited on-call to every third night that year. In 2003, ACGME put in place duty hour requirements for all specialties.
“The pediatric requirements currently in effect provide safeguards for the resident, guidelines for educational programs, specific competencies and medical knowledge, as well as communication skills, professionalism requirements, and standardized assessment,” Ms. White said.
Current limitations for duty hours are beneficial in terms of resident safety, but the restrictions can be a double-edged sword, Dr. Jenkins said.
A changing gender demographic
By the time Dr. Stanton graduated from Yale in 1976, about 15% of her class were women, a marked shift from just a few years earlier, she said.
“In my residency program, women made up a quarter of our group,” she recalled. “That was a big change.”
The number of women going into pediatric residency has steadily increased in the last 5 decades, now far surpassing the number of men. Of 8,933 pediatric residents from 2015 to 2016, 67% were female and 25% were male, (with 8% not reporting), according to ACGME data.
“
Pediatrics is a natural selection for women, especially for those who plan to raise families, said Antoinette Eaton, MD, a retired pediatrician who completed her residency in the late 1950s at what is now Nationwide Children’s Hospital in Columbus, Ohio. Pediatrics is a prime specialty for career and family balance, she said.
“I worked part time a lot during my career,” said Dr. Eaton, a past AAP president. “Always being responsible as a mother and to the house were very high priorities.”
Dr. Stanton agrees that pediatric practices are much more tolerant of part time work, allowing women to better juggle children and career. However, she notes that the decline of male pediatricians also can be negative for the field overall.
New focus, growing debt
The curriculum focus for pediatric residency, meanwhile, has changed significantly over the years, pediatricians say. Dr. Eaton recalls her residency being almost entirely focused on inpatient care. In fact, insurance companies often refused to pay for outpatient care in sharp contrast to today, she said.
“You had to admit the patient if you wanted insurance to pay for it,” she said. “For example, if you had a patient with cerebral palsy or special needs, I had to admit that patient for 3, 4, 5 days. It was really different than what you have today.”
As time has passed, pediatric requirements have changed to emphasize the need for balance between inpatient and outpatient care, with a focus on continuity of care in either setting, Ms. White said. Newer additions to the requirements include the competencies of professionalism, communication, and life-long learning.
“Over the years these setting have expanded to include inpatients in hospitals, clinics, emergency centers, intensive care units, and in the community, [including] schools and other settings,” she said. “The requirements have always emphasized the importance of having high-quality, board-certified faculty to provide bedside teaching and deliver lectures at conferences.”
Another marked change for pediatric residents is the accumulation of debt. After her medical education, Dr. Jenkins owed about $1,500, she recalls.
“Today, that’s a drop in the bucket,” she said. “For the most part, you stayed out of [debt] trouble. It was nothing compared to that kids have to pay now.”
In 2014, the average medical school student graduated with a median debt of $180,000, according to data from the Association of American Medical Colleges. The wide debt differences are attributed to more expensive medical education today, Dr. Jenkins said.
While debt has risen, clinical responsibilities for residents have dropped as physician extenders and advanced equipment have become commonplace.
When Dr. Ouellette was a resident in the 1960s, there were few technicians to assist and no CT scans or MRIs for imaging. Residents drew blood from and gave blood to patients themselves. They took x-rays and developed them, she said.
“We had to use our brains and figure out what was going on,” she said. “People don’t think so much now. They send x-rays or scans to someone else, rather than figuring out the answer. Medicine may not be as much fun now as it was back then.”
Dr. Eaton added that residents have more technical demands today, more regulations to follow, and more paperwork to complete than the residents of the past. However, she believes pediatrics remains a worthwhile medical path. Three of her four children became doctors, one of whom went into pediatrics.
“I’m very disturbed when people try to convince children not to go into medicine,” she said. “I think it’s still a wonderful and rewarding career.”
[email protected]
On Twitter @legal_med
*Clarification made on 4/21/17
When Eileen Ouellette, MD, graduated from Boston’s Harvard Medical School in 1962, she was one of seven women in her class of 141 students. She went on to become one of only three women in pediatric residency at Massachusetts General Hospital later that year.
Free room and board was included in the program, Dr. Ouellette recalled, but her cramped room was poorly insulated and so small that she had to kneel on the bed to open her chest of drawers. The young doctor also soon learned that the women residents made less money than their male counterparts.
Dr. Ouellette, 79, now can laugh at the memory of her tiny room and tinier paycheck. The pediatric residents of today are entering a vastly different environment, she said. For starters, the average pay for medical residents in 2017 is $54,107. Women pediatric residents today far outnumber male residents. And most residents enjoy standard-sized rooms or apartments when completing their residencies.
Technology, for instance, greatly aids pediatric residents in their education today, said Renee Jenkins, MD, a professor at Howard University in Washington and a past AAP president.
Fewer hours, more hand-offs
During Dr. Ouellette’s residency from 1962 to 1965, sleep became a luxury. Of 168 hours in a week, residents were sometimes off for only 26 of them, she said.
“That was absolutely brutal,” she said. “You could not think of anything other than sleep. That became the primary focus of your whole life.”
“It didn’t seem crazy at the time,” said Dr. Stanton, founding dean of Seton Hall University Hackensack Meridian School of Medicine, South Orange, N.J. ”You developed the kind of bond with these families that it wouldn’t occur to you to go home.”
In the 1960s, there were no explicit limits on duty hours, according to Susan White, director of external communications for the Accreditation Council of Graduate Medical Education (ACGME). A “Guide for Residency Programs in Pediatrics,” published in 1968, recommended that “time off should be taken only when the service needs of the patients are assured and that “night and weekend duty provides a valuable educational experience. ... Duty of this type every second or third night and weekend is desirable.”
The guide predates the existence of the ACGME – established in 1981 – but it originated from a committee approved by the American Academy of Pediatrics, the American Board of Pediatrics, and the Council on Medical Education of the American Medical Association, according to Ms. White. While some residency programs changed their work hours over the years, the first mandated requirements for duty hours came in 1990 when ACGME set an 80-hour work week for four specialties: internal medicine, dermatology, ophthalmology, and preventive medicine. The council also limited on-call to every third night that year. In 2003, ACGME put in place duty hour requirements for all specialties.
“The pediatric requirements currently in effect provide safeguards for the resident, guidelines for educational programs, specific competencies and medical knowledge, as well as communication skills, professionalism requirements, and standardized assessment,” Ms. White said.
Current limitations for duty hours are beneficial in terms of resident safety, but the restrictions can be a double-edged sword, Dr. Jenkins said.
A changing gender demographic
By the time Dr. Stanton graduated from Yale in 1976, about 15% of her class were women, a marked shift from just a few years earlier, she said.
“In my residency program, women made up a quarter of our group,” she recalled. “That was a big change.”
The number of women going into pediatric residency has steadily increased in the last 5 decades, now far surpassing the number of men. Of 8,933 pediatric residents from 2015 to 2016, 67% were female and 25% were male, (with 8% not reporting), according to ACGME data.
“
Pediatrics is a natural selection for women, especially for those who plan to raise families, said Antoinette Eaton, MD, a retired pediatrician who completed her residency in the late 1950s at what is now Nationwide Children’s Hospital in Columbus, Ohio. Pediatrics is a prime specialty for career and family balance, she said.
“I worked part time a lot during my career,” said Dr. Eaton, a past AAP president. “Always being responsible as a mother and to the house were very high priorities.”
Dr. Stanton agrees that pediatric practices are much more tolerant of part time work, allowing women to better juggle children and career. However, she notes that the decline of male pediatricians also can be negative for the field overall.
New focus, growing debt
The curriculum focus for pediatric residency, meanwhile, has changed significantly over the years, pediatricians say. Dr. Eaton recalls her residency being almost entirely focused on inpatient care. In fact, insurance companies often refused to pay for outpatient care in sharp contrast to today, she said.
“You had to admit the patient if you wanted insurance to pay for it,” she said. “For example, if you had a patient with cerebral palsy or special needs, I had to admit that patient for 3, 4, 5 days. It was really different than what you have today.”
As time has passed, pediatric requirements have changed to emphasize the need for balance between inpatient and outpatient care, with a focus on continuity of care in either setting, Ms. White said. Newer additions to the requirements include the competencies of professionalism, communication, and life-long learning.
“Over the years these setting have expanded to include inpatients in hospitals, clinics, emergency centers, intensive care units, and in the community, [including] schools and other settings,” she said. “The requirements have always emphasized the importance of having high-quality, board-certified faculty to provide bedside teaching and deliver lectures at conferences.”
Another marked change for pediatric residents is the accumulation of debt. After her medical education, Dr. Jenkins owed about $1,500, she recalls.
“Today, that’s a drop in the bucket,” she said. “For the most part, you stayed out of [debt] trouble. It was nothing compared to that kids have to pay now.”
In 2014, the average medical school student graduated with a median debt of $180,000, according to data from the Association of American Medical Colleges. The wide debt differences are attributed to more expensive medical education today, Dr. Jenkins said.
While debt has risen, clinical responsibilities for residents have dropped as physician extenders and advanced equipment have become commonplace.
When Dr. Ouellette was a resident in the 1960s, there were few technicians to assist and no CT scans or MRIs for imaging. Residents drew blood from and gave blood to patients themselves. They took x-rays and developed them, she said.
“We had to use our brains and figure out what was going on,” she said. “People don’t think so much now. They send x-rays or scans to someone else, rather than figuring out the answer. Medicine may not be as much fun now as it was back then.”
Dr. Eaton added that residents have more technical demands today, more regulations to follow, and more paperwork to complete than the residents of the past. However, she believes pediatrics remains a worthwhile medical path. Three of her four children became doctors, one of whom went into pediatrics.
“I’m very disturbed when people try to convince children not to go into medicine,” she said. “I think it’s still a wonderful and rewarding career.”
[email protected]
On Twitter @legal_med
*Clarification made on 4/21/17
When Eileen Ouellette, MD, graduated from Boston’s Harvard Medical School in 1962, she was one of seven women in her class of 141 students. She went on to become one of only three women in pediatric residency at Massachusetts General Hospital later that year.
Free room and board was included in the program, Dr. Ouellette recalled, but her cramped room was poorly insulated and so small that she had to kneel on the bed to open her chest of drawers. The young doctor also soon learned that the women residents made less money than their male counterparts.
Dr. Ouellette, 79, now can laugh at the memory of her tiny room and tinier paycheck. The pediatric residents of today are entering a vastly different environment, she said. For starters, the average pay for medical residents in 2017 is $54,107. Women pediatric residents today far outnumber male residents. And most residents enjoy standard-sized rooms or apartments when completing their residencies.
Technology, for instance, greatly aids pediatric residents in their education today, said Renee Jenkins, MD, a professor at Howard University in Washington and a past AAP president.
Fewer hours, more hand-offs
During Dr. Ouellette’s residency from 1962 to 1965, sleep became a luxury. Of 168 hours in a week, residents were sometimes off for only 26 of them, she said.
“That was absolutely brutal,” she said. “You could not think of anything other than sleep. That became the primary focus of your whole life.”
“It didn’t seem crazy at the time,” said Dr. Stanton, founding dean of Seton Hall University Hackensack Meridian School of Medicine, South Orange, N.J. ”You developed the kind of bond with these families that it wouldn’t occur to you to go home.”
In the 1960s, there were no explicit limits on duty hours, according to Susan White, director of external communications for the Accreditation Council of Graduate Medical Education (ACGME). A “Guide for Residency Programs in Pediatrics,” published in 1968, recommended that “time off should be taken only when the service needs of the patients are assured and that “night and weekend duty provides a valuable educational experience. ... Duty of this type every second or third night and weekend is desirable.”
The guide predates the existence of the ACGME – established in 1981 – but it originated from a committee approved by the American Academy of Pediatrics, the American Board of Pediatrics, and the Council on Medical Education of the American Medical Association, according to Ms. White. While some residency programs changed their work hours over the years, the first mandated requirements for duty hours came in 1990 when ACGME set an 80-hour work week for four specialties: internal medicine, dermatology, ophthalmology, and preventive medicine. The council also limited on-call to every third night that year. In 2003, ACGME put in place duty hour requirements for all specialties.
“The pediatric requirements currently in effect provide safeguards for the resident, guidelines for educational programs, specific competencies and medical knowledge, as well as communication skills, professionalism requirements, and standardized assessment,” Ms. White said.
Current limitations for duty hours are beneficial in terms of resident safety, but the restrictions can be a double-edged sword, Dr. Jenkins said.
A changing gender demographic
By the time Dr. Stanton graduated from Yale in 1976, about 15% of her class were women, a marked shift from just a few years earlier, she said.
“In my residency program, women made up a quarter of our group,” she recalled. “That was a big change.”
The number of women going into pediatric residency has steadily increased in the last 5 decades, now far surpassing the number of men. Of 8,933 pediatric residents from 2015 to 2016, 67% were female and 25% were male, (with 8% not reporting), according to ACGME data.
“
Pediatrics is a natural selection for women, especially for those who plan to raise families, said Antoinette Eaton, MD, a retired pediatrician who completed her residency in the late 1950s at what is now Nationwide Children’s Hospital in Columbus, Ohio. Pediatrics is a prime specialty for career and family balance, she said.
“I worked part time a lot during my career,” said Dr. Eaton, a past AAP president. “Always being responsible as a mother and to the house were very high priorities.”
Dr. Stanton agrees that pediatric practices are much more tolerant of part time work, allowing women to better juggle children and career. However, she notes that the decline of male pediatricians also can be negative for the field overall.
New focus, growing debt
The curriculum focus for pediatric residency, meanwhile, has changed significantly over the years, pediatricians say. Dr. Eaton recalls her residency being almost entirely focused on inpatient care. In fact, insurance companies often refused to pay for outpatient care in sharp contrast to today, she said.
“You had to admit the patient if you wanted insurance to pay for it,” she said. “For example, if you had a patient with cerebral palsy or special needs, I had to admit that patient for 3, 4, 5 days. It was really different than what you have today.”
As time has passed, pediatric requirements have changed to emphasize the need for balance between inpatient and outpatient care, with a focus on continuity of care in either setting, Ms. White said. Newer additions to the requirements include the competencies of professionalism, communication, and life-long learning.
“Over the years these setting have expanded to include inpatients in hospitals, clinics, emergency centers, intensive care units, and in the community, [including] schools and other settings,” she said. “The requirements have always emphasized the importance of having high-quality, board-certified faculty to provide bedside teaching and deliver lectures at conferences.”
Another marked change for pediatric residents is the accumulation of debt. After her medical education, Dr. Jenkins owed about $1,500, she recalls.
“Today, that’s a drop in the bucket,” she said. “For the most part, you stayed out of [debt] trouble. It was nothing compared to that kids have to pay now.”
In 2014, the average medical school student graduated with a median debt of $180,000, according to data from the Association of American Medical Colleges. The wide debt differences are attributed to more expensive medical education today, Dr. Jenkins said.
While debt has risen, clinical responsibilities for residents have dropped as physician extenders and advanced equipment have become commonplace.
When Dr. Ouellette was a resident in the 1960s, there were few technicians to assist and no CT scans or MRIs for imaging. Residents drew blood from and gave blood to patients themselves. They took x-rays and developed them, she said.
“We had to use our brains and figure out what was going on,” she said. “People don’t think so much now. They send x-rays or scans to someone else, rather than figuring out the answer. Medicine may not be as much fun now as it was back then.”
Dr. Eaton added that residents have more technical demands today, more regulations to follow, and more paperwork to complete than the residents of the past. However, she believes pediatrics remains a worthwhile medical path. Three of her four children became doctors, one of whom went into pediatrics.
“I’m very disturbed when people try to convince children not to go into medicine,” she said. “I think it’s still a wonderful and rewarding career.”
[email protected]
On Twitter @legal_med
*Clarification made on 4/21/17
Apply By May 1 for International Scholarships for Surgical Education
Two international scholarships focused on surgical education and sponsored by the American College of Surgeons (ACS) Division of Education and the International Relations Committee will offer faculty members from countries outside the U.S. and Canada the opportunity to participate in a variety of faculty development activities. All application materials and supporting documents are due May 1.
The scholars will participate in the Surgical Education: Principles and Practice Course at the Clinical Congress 2017, October 22–26 in San Diego, CA. In addition, the scholars will attend plenary sessions and courses that address surgical education and training across the continuum of professional development. The scholars, in turn, will use the knowledge and skills they acquire to improve surgical education and training in their home institutions and countries. The scholarships include a stipend of $10,000 to cover travel, per diem expenses, and the cost of Clinical Congress courses. The registration cost for Clinical Congress and fees for the surgical education courses will be provided free to the scholars.
View the scholarship requirements and access the application on the ACS website at facs.org/member-services/scholarships/international/issurged. Direct questions to the ACS International Liaison at [email protected].
Two international scholarships focused on surgical education and sponsored by the American College of Surgeons (ACS) Division of Education and the International Relations Committee will offer faculty members from countries outside the U.S. and Canada the opportunity to participate in a variety of faculty development activities. All application materials and supporting documents are due May 1.
The scholars will participate in the Surgical Education: Principles and Practice Course at the Clinical Congress 2017, October 22–26 in San Diego, CA. In addition, the scholars will attend plenary sessions and courses that address surgical education and training across the continuum of professional development. The scholars, in turn, will use the knowledge and skills they acquire to improve surgical education and training in their home institutions and countries. The scholarships include a stipend of $10,000 to cover travel, per diem expenses, and the cost of Clinical Congress courses. The registration cost for Clinical Congress and fees for the surgical education courses will be provided free to the scholars.
View the scholarship requirements and access the application on the ACS website at facs.org/member-services/scholarships/international/issurged. Direct questions to the ACS International Liaison at [email protected].
Two international scholarships focused on surgical education and sponsored by the American College of Surgeons (ACS) Division of Education and the International Relations Committee will offer faculty members from countries outside the U.S. and Canada the opportunity to participate in a variety of faculty development activities. All application materials and supporting documents are due May 1.
The scholars will participate in the Surgical Education: Principles and Practice Course at the Clinical Congress 2017, October 22–26 in San Diego, CA. In addition, the scholars will attend plenary sessions and courses that address surgical education and training across the continuum of professional development. The scholars, in turn, will use the knowledge and skills they acquire to improve surgical education and training in their home institutions and countries. The scholarships include a stipend of $10,000 to cover travel, per diem expenses, and the cost of Clinical Congress courses. The registration cost for Clinical Congress and fees for the surgical education courses will be provided free to the scholars.
View the scholarship requirements and access the application on the ACS website at facs.org/member-services/scholarships/international/issurged. Direct questions to the ACS International Liaison at [email protected].
From the Washington Office: Advocacy in Action
Fellows frequently ask how they can get more involved in the advocacy efforts of the ACS. Whether you are new to the arena of policy and advocacy or an experienced veteran of innumerable efforts directed at ensuring access to quality surgical care, I can think of no better way to learn new skills and exercise old ones than by attending the ACS’ annual Leadership and Advocacy Summit.
The 2017 Leadership and Advocacy Summit will take place May 6–9 at the Renaissance Washington, DC Downtown Hotel. More than 300 individuals have already registered and you can join them by registering via the link found here: https://www.facs.org/advocacy/participate/summit-2017/register
The Advocacy Summit portion of the meeting will kick-off on the evening of May 7 with a reception and dinner featuring bestselling author, MSNBC political analyst, and former Communications Chief for President George W. Bush, Nicolle Wallace as the Keynote Speaker.
A robust agenda is planned for Monday, May 8. The morning will lead off with a panel entitled, Perspectives on 2017 Health Care Reform, featuring health policy experts from the Georgetown University Law Center, the George Washington University Milken Institute School of Public Health, the American Enterprise Institute, and the Heritage Foundation. The Monday agenda will also feature a panel of senior staffers from Capitol Hill discussing issues of particular interest to Fellows, a Medicare physician payment panel, and an address from a leading authority on effective communications strategies designed to make your interaction with legislators and their staff more effective.
The luncheon speaker for Monday will be Fox News contributor and Washington Examiner columnist, Lisa Boothe. The afternoon agenda will conclude with a series of issue briefings from ACS staff (in preparation for the Hill visits to legislator’s offices scheduled for Tuesday, May 9) and remarks from several United States Senators. ACSPA-SurgeonsPAC will host a reception on Monday evening, May 8 for all 2017 PAC contributors and a guest.
On Tuesday morning, May 9, attendees will be transported to Capitol Hill to visit the offices of their individual Member of Congress, Senators and staff with visits concluding in time to make flights out of Washington that afternoon.
I encourage all Fellows who are able to set aside time for the event to do so as I believe all will find the program educational and the experience rewarding.
For information about the Leadership Summit, contact Connie Bura at [email protected], or 312-919-5290. For information about the Advocacy Summit, contact Michael Carmody at [email protected], or 202-672-1511.
Until next month ….
Dr. Bailey is a pediatric surgeon, and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Fellows frequently ask how they can get more involved in the advocacy efforts of the ACS. Whether you are new to the arena of policy and advocacy or an experienced veteran of innumerable efforts directed at ensuring access to quality surgical care, I can think of no better way to learn new skills and exercise old ones than by attending the ACS’ annual Leadership and Advocacy Summit.
The 2017 Leadership and Advocacy Summit will take place May 6–9 at the Renaissance Washington, DC Downtown Hotel. More than 300 individuals have already registered and you can join them by registering via the link found here: https://www.facs.org/advocacy/participate/summit-2017/register
The Advocacy Summit portion of the meeting will kick-off on the evening of May 7 with a reception and dinner featuring bestselling author, MSNBC political analyst, and former Communications Chief for President George W. Bush, Nicolle Wallace as the Keynote Speaker.
A robust agenda is planned for Monday, May 8. The morning will lead off with a panel entitled, Perspectives on 2017 Health Care Reform, featuring health policy experts from the Georgetown University Law Center, the George Washington University Milken Institute School of Public Health, the American Enterprise Institute, and the Heritage Foundation. The Monday agenda will also feature a panel of senior staffers from Capitol Hill discussing issues of particular interest to Fellows, a Medicare physician payment panel, and an address from a leading authority on effective communications strategies designed to make your interaction with legislators and their staff more effective.
The luncheon speaker for Monday will be Fox News contributor and Washington Examiner columnist, Lisa Boothe. The afternoon agenda will conclude with a series of issue briefings from ACS staff (in preparation for the Hill visits to legislator’s offices scheduled for Tuesday, May 9) and remarks from several United States Senators. ACSPA-SurgeonsPAC will host a reception on Monday evening, May 8 for all 2017 PAC contributors and a guest.
On Tuesday morning, May 9, attendees will be transported to Capitol Hill to visit the offices of their individual Member of Congress, Senators and staff with visits concluding in time to make flights out of Washington that afternoon.
I encourage all Fellows who are able to set aside time for the event to do so as I believe all will find the program educational and the experience rewarding.
For information about the Leadership Summit, contact Connie Bura at [email protected], or 312-919-5290. For information about the Advocacy Summit, contact Michael Carmody at [email protected], or 202-672-1511.
Until next month ….
Dr. Bailey is a pediatric surgeon, and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Fellows frequently ask how they can get more involved in the advocacy efforts of the ACS. Whether you are new to the arena of policy and advocacy or an experienced veteran of innumerable efforts directed at ensuring access to quality surgical care, I can think of no better way to learn new skills and exercise old ones than by attending the ACS’ annual Leadership and Advocacy Summit.
The 2017 Leadership and Advocacy Summit will take place May 6–9 at the Renaissance Washington, DC Downtown Hotel. More than 300 individuals have already registered and you can join them by registering via the link found here: https://www.facs.org/advocacy/participate/summit-2017/register
The Advocacy Summit portion of the meeting will kick-off on the evening of May 7 with a reception and dinner featuring bestselling author, MSNBC political analyst, and former Communications Chief for President George W. Bush, Nicolle Wallace as the Keynote Speaker.
A robust agenda is planned for Monday, May 8. The morning will lead off with a panel entitled, Perspectives on 2017 Health Care Reform, featuring health policy experts from the Georgetown University Law Center, the George Washington University Milken Institute School of Public Health, the American Enterprise Institute, and the Heritage Foundation. The Monday agenda will also feature a panel of senior staffers from Capitol Hill discussing issues of particular interest to Fellows, a Medicare physician payment panel, and an address from a leading authority on effective communications strategies designed to make your interaction with legislators and their staff more effective.
The luncheon speaker for Monday will be Fox News contributor and Washington Examiner columnist, Lisa Boothe. The afternoon agenda will conclude with a series of issue briefings from ACS staff (in preparation for the Hill visits to legislator’s offices scheduled for Tuesday, May 9) and remarks from several United States Senators. ACSPA-SurgeonsPAC will host a reception on Monday evening, May 8 for all 2017 PAC contributors and a guest.
On Tuesday morning, May 9, attendees will be transported to Capitol Hill to visit the offices of their individual Member of Congress, Senators and staff with visits concluding in time to make flights out of Washington that afternoon.
I encourage all Fellows who are able to set aside time for the event to do so as I believe all will find the program educational and the experience rewarding.
For information about the Leadership Summit, contact Connie Bura at [email protected], or 312-919-5290. For information about the Advocacy Summit, contact Michael Carmody at [email protected], or 202-672-1511.
Until next month ….
Dr. Bailey is a pediatric surgeon, and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
2017 Claude H. Organ, Jr., MD, FACS Traveling Fellowship Applications due June 1
The family and friends of the late Dr. Claude H. Organ, Jr., established an endowment through the American College of Surgeons (ACS) Foundation to provide funding for an annual fellowship to be awarded to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association.
The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow under age 45 who is a member of one of the above societies to attend an educational meeting or make an extended visit to an institution of his or her choice, tailored to his or her research interests.
Past awardees have used their fellowships to develop their careers in creative ways. The 2016 fellow, Stephanie Bonne, MD, is researching a successful hospital-based violence program in San Francisco in order to develop one at her home institution.
View the full requirements for the Claude H. Organ Traveling Fellowship at facs.org/member-services/scholarships/special/organ. The deadline for receipt of all application materials is June 1, with decisions to be made by August 2017. Questions and application materials should be submitted to the attention of the ACS Scholarships Administrator at [email protected].
The family and friends of the late Dr. Claude H. Organ, Jr., established an endowment through the American College of Surgeons (ACS) Foundation to provide funding for an annual fellowship to be awarded to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association.
The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow under age 45 who is a member of one of the above societies to attend an educational meeting or make an extended visit to an institution of his or her choice, tailored to his or her research interests.
Past awardees have used their fellowships to develop their careers in creative ways. The 2016 fellow, Stephanie Bonne, MD, is researching a successful hospital-based violence program in San Francisco in order to develop one at her home institution.
View the full requirements for the Claude H. Organ Traveling Fellowship at facs.org/member-services/scholarships/special/organ. The deadline for receipt of all application materials is June 1, with decisions to be made by August 2017. Questions and application materials should be submitted to the attention of the ACS Scholarships Administrator at [email protected].
The family and friends of the late Dr. Claude H. Organ, Jr., established an endowment through the American College of Surgeons (ACS) Foundation to provide funding for an annual fellowship to be awarded to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association.
The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow under age 45 who is a member of one of the above societies to attend an educational meeting or make an extended visit to an institution of his or her choice, tailored to his or her research interests.
Past awardees have used their fellowships to develop their careers in creative ways. The 2016 fellow, Stephanie Bonne, MD, is researching a successful hospital-based violence program in San Francisco in order to develop one at her home institution.
View the full requirements for the Claude H. Organ Traveling Fellowship at facs.org/member-services/scholarships/special/organ. The deadline for receipt of all application materials is June 1, with decisions to be made by August 2017. Questions and application materials should be submitted to the attention of the ACS Scholarships Administrator at [email protected].
Access new surgeon and resident well-being resources
Personal and professional well-being are vital to the success of members of the American College of Surgeons (ACS) and your patients. Many health care professionals experience periods of distress, yet few physicians seek help. In an effort to provide relief to interested surgeons, the ACS has compiled several resources to support surgeons and residents as they confront the challenges associated with surgical care.
Visit the ACS Surgeon Well-Being page at facs.org/burnout to learn more about the tool and how to access it, as well as to review other helpful resources.
Personal and professional well-being are vital to the success of members of the American College of Surgeons (ACS) and your patients. Many health care professionals experience periods of distress, yet few physicians seek help. In an effort to provide relief to interested surgeons, the ACS has compiled several resources to support surgeons and residents as they confront the challenges associated with surgical care.
Visit the ACS Surgeon Well-Being page at facs.org/burnout to learn more about the tool and how to access it, as well as to review other helpful resources.
Personal and professional well-being are vital to the success of members of the American College of Surgeons (ACS) and your patients. Many health care professionals experience periods of distress, yet few physicians seek help. In an effort to provide relief to interested surgeons, the ACS has compiled several resources to support surgeons and residents as they confront the challenges associated with surgical care.
Visit the ACS Surgeon Well-Being page at facs.org/burnout to learn more about the tool and how to access it, as well as to review other helpful resources.
Three days in the life of a surgeon
By sheer happenstance, I was visiting a surgery program on the day after “the Match.” As all of you know, four days before the official release of the placement of every new surgical trainee, both the medical students involved and the programs affected are informed as to whether they have been matched. Students don’t know where they are going, just that the last rung of training is now in place. They have a job and a relatively secure future. Those who have not been matched and those programs that did not fill all their slots now enter into a scramble (officially called SOAP) to find students for the remaining slots. This year, the scramble occurred on a Wednesday and was orchestrated by a set of rules I’d never been privy to before.
On Tuesday night, all the programs in need of students for their open slots, whether categorical or preliminary, looked over the list of candidates remaining and made their choices. So did the students now hoping to find a place. At 10 a.m., the offers went out to students in the first round. Next, in precisely timed order, the programs found out who had accepted the offers. And, if slots were left over, the programs had a short time to put up another set of offers – and so on throughout the day until all the slots were gone. Like a game of musical chairs, the music finally stopped and the Match was over for the entering class of residents for 2017.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and coeditor of ACS Surgery News.
By sheer happenstance, I was visiting a surgery program on the day after “the Match.” As all of you know, four days before the official release of the placement of every new surgical trainee, both the medical students involved and the programs affected are informed as to whether they have been matched. Students don’t know where they are going, just that the last rung of training is now in place. They have a job and a relatively secure future. Those who have not been matched and those programs that did not fill all their slots now enter into a scramble (officially called SOAP) to find students for the remaining slots. This year, the scramble occurred on a Wednesday and was orchestrated by a set of rules I’d never been privy to before.
On Tuesday night, all the programs in need of students for their open slots, whether categorical or preliminary, looked over the list of candidates remaining and made their choices. So did the students now hoping to find a place. At 10 a.m., the offers went out to students in the first round. Next, in precisely timed order, the programs found out who had accepted the offers. And, if slots were left over, the programs had a short time to put up another set of offers – and so on throughout the day until all the slots were gone. Like a game of musical chairs, the music finally stopped and the Match was over for the entering class of residents for 2017.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and coeditor of ACS Surgery News.
By sheer happenstance, I was visiting a surgery program on the day after “the Match.” As all of you know, four days before the official release of the placement of every new surgical trainee, both the medical students involved and the programs affected are informed as to whether they have been matched. Students don’t know where they are going, just that the last rung of training is now in place. They have a job and a relatively secure future. Those who have not been matched and those programs that did not fill all their slots now enter into a scramble (officially called SOAP) to find students for the remaining slots. This year, the scramble occurred on a Wednesday and was orchestrated by a set of rules I’d never been privy to before.
On Tuesday night, all the programs in need of students for their open slots, whether categorical or preliminary, looked over the list of candidates remaining and made their choices. So did the students now hoping to find a place. At 10 a.m., the offers went out to students in the first round. Next, in precisely timed order, the programs found out who had accepted the offers. And, if slots were left over, the programs had a short time to put up another set of offers – and so on throughout the day until all the slots were gone. Like a game of musical chairs, the music finally stopped and the Match was over for the entering class of residents for 2017.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and coeditor of ACS Surgery News.
Legends Come to Lunch
A highlight of the Postgraduate Symposia at the AATS Centennial will be the Legends Luncheons. This year, renowned cardiothoracic surgeons, William I. Norwood, MD, Valerie W. Rusch, MD, and Magdi H. Yacoub, MD, will share their experiences at the interactive luncheons on Sunday at each of the Postgraduate Symposia. You must be registered for a Sunday Postgraduate Symposia to attend the Legend Luncheons, but you may select any luncheon to attend.
William I. Norwood, MD (Congenital Heart Surgery)
Dr. Norwood trained in cardiac surgery at the University of Minnesota as well as at Brigham and Women’s Hospital. He took a staff position at Boston Children’s Hospital in 1976. In 1981, he and his colleageues first reported the hypoplastic left heart syndrome (HLHS) procedure that bears his name. 
HLHS is congenital heart defect in which one or more of the left-sided cardiac structures are underdeveloped and unable to support the systemic circulation. Dr. Norwood’s operation, improved over the years with subsequent stages and refinements, alleviated the universally fatal condition, allowing survivors to live functional lives, even if restricted to varying degreess.
Dr. Norwood became chief of cardiac surgery at Children’s Hospital of Philadelphia, after which, he and Aldo Castaneda, MD, established a private clinic in Geneva, Switzerland in 1994. Dr. Norwood later moved to Nemours/Alfred I. duPont Hospital for Children, from which he retired from clinical practice in 2003.
Valerie W. Rusch, MD (General Thoraic Surgery)
Dr. Rusch is the Vice Chair for Clinical Research, Department of Surgery, and Miner Family Chair in Intrathoracic Cancers at Memorial Sloan Kettering Cancer Center. Dr. Rusch was a pioneer among women in cardiothoracic surgery, and was among the first women in the country to be board certified. In 2015, Dr. Rusch was elected Chair of the Board of Regents of the American College of Surgeons, one of the most prestigious positions a surgeon can attain.
Dr. Rusch specializes in the diagnosis and treatment of patients with a variety of thoracic cancers, including lung, esophageal, mediastinaal, chest wall, and pleural.
She is a national leader in clinical trials for thoracic malignancies, and has received the Thoracic Surgery Foundation for Research and Education Socrates Award. Dr. Rusch is co-author on more than 260 papers and numerous book chapters and invited texts and has received numerous teaching and patient-care excellence awards.
Magdi H. Yacoub, MD (Adult Cardiac Surgery and Transplantation)
Dr. Yacoub is Professor of Cardiothoracic Surgery at the National Heart and Lung Institute, Imperial College London, and Founder and Director of Research at the Magdi Yacoub Institute, Harefield Heart Science Centre, which focuses on tissue engineering, myocardial regeneration, stem cell biology, end stage heart failure, and transplant immunology. He is also Founder and Director of Magdi Yacoub Research Network which has created the Qatar Cardiovascular Research Center in collaboration with Qatar Foundation and Hamad Medical Corporation.
Dr. Yacoub was born in Egypt and held an assistant professorship at the University of Chicago. He was a British Heart Foundation Professor of Cardiothoracic Surgery for over 20 years, and a consultant cardiothoracic surgeon at Harefield Hospital from 1969-2001 and Royal Brompton Hospital from 1986-2001. 
Dr. Yacoub established the largest heart and lung transplantation program in the world (in the United Kingdom) where more than 2,500 transplant operations have been performed. Among his many other accomplishments, he pioneered a live-saving surgical technique for treating infants born with transposition of the great arteries.
Dr. Yacoub was knighted for his services to medicine and surgery in 1991, awarded Fellowship of the Academy of Medical Sciences in 1998 and became a Fellow of The Royal Society in 1999.
Dr. Yacoub is author or co-author on more than 1,000 articles
A highlight of the Postgraduate Symposia at the AATS Centennial will be the Legends Luncheons. This year, renowned cardiothoracic surgeons, William I. Norwood, MD, Valerie W. Rusch, MD, and Magdi H. Yacoub, MD, will share their experiences at the interactive luncheons on Sunday at each of the Postgraduate Symposia. You must be registered for a Sunday Postgraduate Symposia to attend the Legend Luncheons, but you may select any luncheon to attend.
William I. Norwood, MD (Congenital Heart Surgery)
Dr. Norwood trained in cardiac surgery at the University of Minnesota as well as at Brigham and Women’s Hospital. He took a staff position at Boston Children’s Hospital in 1976. In 1981, he and his colleageues first reported the hypoplastic left heart syndrome (HLHS) procedure that bears his name.
HLHS is congenital heart defect in which one or more of the left-sided cardiac structures are underdeveloped and unable to support the systemic circulation. Dr. Norwood’s operation, improved over the years with subsequent stages and refinements, alleviated the universally fatal condition, allowing survivors to live functional lives, even if restricted to varying degreess.
Dr. Norwood became chief of cardiac surgery at Children’s Hospital of Philadelphia, after which, he and Aldo Castaneda, MD, established a private clinic in Geneva, Switzerland in 1994. Dr. Norwood later moved to Nemours/Alfred I. duPont Hospital for Children, from which he retired from clinical practice in 2003.
Valerie W. Rusch, MD (General Thoraic Surgery)
Dr. Rusch is the Vice Chair for Clinical Research, Department of Surgery, and Miner Family Chair in Intrathoracic Cancers at Memorial Sloan Kettering Cancer Center. Dr. Rusch was a pioneer among women in cardiothoracic surgery, and was among the first women in the country to be board certified. In 2015, Dr. Rusch was elected Chair of the Board of Regents of the American College of Surgeons, one of the most prestigious positions a surgeon can attain.
Dr. Rusch specializes in the diagnosis and treatment of patients with a variety of thoracic cancers, including lung, esophageal, mediastinaal, chest wall, and pleural.
She is a national leader in clinical trials for thoracic malignancies, and has received the Thoracic Surgery Foundation for Research and Education Socrates Award. Dr. Rusch is co-author on more than 260 papers and numerous book chapters and invited texts and has received numerous teaching and patient-care excellence awards.
Magdi H. Yacoub, MD (Adult Cardiac Surgery and Transplantation)
Dr. Yacoub is Professor of Cardiothoracic Surgery at the National Heart and Lung Institute, Imperial College London, and Founder and Director of Research at the Magdi Yacoub Institute, Harefield Heart Science Centre, which focuses on tissue engineering, myocardial regeneration, stem cell biology, end stage heart failure, and transplant immunology. He is also Founder and Director of Magdi Yacoub Research Network which has created the Qatar Cardiovascular Research Center in collaboration with Qatar Foundation and Hamad Medical Corporation.
Dr. Yacoub was born in Egypt and held an assistant professorship at the University of Chicago. He was a British Heart Foundation Professor of Cardiothoracic Surgery for over 20 years, and a consultant cardiothoracic surgeon at Harefield Hospital from 1969-2001 and Royal Brompton Hospital from 1986-2001.
Dr. Yacoub established the largest heart and lung transplantation program in the world (in the United Kingdom) where more than 2,500 transplant operations have been performed. Among his many other accomplishments, he pioneered a live-saving surgical technique for treating infants born with transposition of the great arteries.
Dr. Yacoub was knighted for his services to medicine and surgery in 1991, awarded Fellowship of the Academy of Medical Sciences in 1998 and became a Fellow of The Royal Society in 1999.
Dr. Yacoub is author or co-author on more than 1,000 articles
A highlight of the Postgraduate Symposia at the AATS Centennial will be the Legends Luncheons. This year, renowned cardiothoracic surgeons, William I. Norwood, MD, Valerie W. Rusch, MD, and Magdi H. Yacoub, MD, will share their experiences at the interactive luncheons on Sunday at each of the Postgraduate Symposia. You must be registered for a Sunday Postgraduate Symposia to attend the Legend Luncheons, but you may select any luncheon to attend.
William I. Norwood, MD (Congenital Heart Surgery)
Dr. Norwood trained in cardiac surgery at the University of Minnesota as well as at Brigham and Women’s Hospital. He took a staff position at Boston Children’s Hospital in 1976. In 1981, he and his colleageues first reported the hypoplastic left heart syndrome (HLHS) procedure that bears his name.
HLHS is congenital heart defect in which one or more of the left-sided cardiac structures are underdeveloped and unable to support the systemic circulation. Dr. Norwood’s operation, improved over the years with subsequent stages and refinements, alleviated the universally fatal condition, allowing survivors to live functional lives, even if restricted to varying degreess.
Dr. Norwood became chief of cardiac surgery at Children’s Hospital of Philadelphia, after which, he and Aldo Castaneda, MD, established a private clinic in Geneva, Switzerland in 1994. Dr. Norwood later moved to Nemours/Alfred I. duPont Hospital for Children, from which he retired from clinical practice in 2003.
Valerie W. Rusch, MD (General Thoraic Surgery)
Dr. Rusch is the Vice Chair for Clinical Research, Department of Surgery, and Miner Family Chair in Intrathoracic Cancers at Memorial Sloan Kettering Cancer Center. Dr. Rusch was a pioneer among women in cardiothoracic surgery, and was among the first women in the country to be board certified. In 2015, Dr. Rusch was elected Chair of the Board of Regents of the American College of Surgeons, one of the most prestigious positions a surgeon can attain.
Dr. Rusch specializes in the diagnosis and treatment of patients with a variety of thoracic cancers, including lung, esophageal, mediastinaal, chest wall, and pleural.
She is a national leader in clinical trials for thoracic malignancies, and has received the Thoracic Surgery Foundation for Research and Education Socrates Award. Dr. Rusch is co-author on more than 260 papers and numerous book chapters and invited texts and has received numerous teaching and patient-care excellence awards.
Magdi H. Yacoub, MD (Adult Cardiac Surgery and Transplantation)
Dr. Yacoub is Professor of Cardiothoracic Surgery at the National Heart and Lung Institute, Imperial College London, and Founder and Director of Research at the Magdi Yacoub Institute, Harefield Heart Science Centre, which focuses on tissue engineering, myocardial regeneration, stem cell biology, end stage heart failure, and transplant immunology. He is also Founder and Director of Magdi Yacoub Research Network which has created the Qatar Cardiovascular Research Center in collaboration with Qatar Foundation and Hamad Medical Corporation.
Dr. Yacoub was born in Egypt and held an assistant professorship at the University of Chicago. He was a British Heart Foundation Professor of Cardiothoracic Surgery for over 20 years, and a consultant cardiothoracic surgeon at Harefield Hospital from 1969-2001 and Royal Brompton Hospital from 1986-2001.
Dr. Yacoub established the largest heart and lung transplantation program in the world (in the United Kingdom) where more than 2,500 transplant operations have been performed. Among his many other accomplishments, he pioneered a live-saving surgical technique for treating infants born with transposition of the great arteries.
Dr. Yacoub was knighted for his services to medicine and surgery in 1991, awarded Fellowship of the Academy of Medical Sciences in 1998 and became a Fellow of The Royal Society in 1999.
Dr. Yacoub is author or co-author on more than 1,000 articles
Teens’ marijuana use higher during pregnancy
The prevalence of marijuana use among pregnant teenagers is more than double that among teens who are not pregnant, according to a study involving 410,000 females aged 12-44 years.
For pregnant teens aged 12-17 years, the past-month prevalence of marijuana use was 14% between 2002 and 2015, compared with 6.5% for their nonpregnant peers, Nora D. Volkow, MD, director of the National Institute on Drug Abuse in Bethesda, Md., and her associates reported in a letter on April 17 (Ann Intern Med. 2017 Apr 17. doi: 10.7326/L17-0067).
The pattern of use in the youngest age group “may reflect underlying risky behavior common to both teen pregnancy and early substance use and suggests the importance of intervention for teenagers,” the researchers wrote. “Because of consistent overlap between use of marijuana and other substances, identification of marijuana use during pregnancy warrants evaluation for comorbid substance abuse.”
The overall annual average prevalence of marijuana use was 3.8% among the 14,400 pregnant women and 7.5% for the 395,600 nonpregnant women who responded to the survey from 2002 to 2015. The investigators also found that marijuana use was higher in the first trimester (6.4%) than in the second (3.3%) or third (1.8%) trimesters and that use was higher in pregnant black women (6.5%) than in white (3.8%) or Hispanic women(2.9%) or women of other races/ethnicities (1.4%).
Although evidence on the effects of marijuana on prenatal development is limited, “pregnant females and those considering becoming pregnant should be advised not to use marijuana or other cannabinoids recreationally or to treat nausea,” Dr. Volkow and her associates wrote.
The study was sponsored by the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration. Dr. Volkow reported having no financial disclosures. One coauthor reported stock ownership of Pfizer, and another reported stock ownership of Sanofi and Eli Lilly.
The prevalence of marijuana use among pregnant teenagers is more than double that among teens who are not pregnant, according to a study involving 410,000 females aged 12-44 years.
For pregnant teens aged 12-17 years, the past-month prevalence of marijuana use was 14% between 2002 and 2015, compared with 6.5% for their nonpregnant peers, Nora D. Volkow, MD, director of the National Institute on Drug Abuse in Bethesda, Md., and her associates reported in a letter on April 17 (Ann Intern Med. 2017 Apr 17. doi: 10.7326/L17-0067).
The pattern of use in the youngest age group “may reflect underlying risky behavior common to both teen pregnancy and early substance use and suggests the importance of intervention for teenagers,” the researchers wrote. “Because of consistent overlap between use of marijuana and other substances, identification of marijuana use during pregnancy warrants evaluation for comorbid substance abuse.”
The overall annual average prevalence of marijuana use was 3.8% among the 14,400 pregnant women and 7.5% for the 395,600 nonpregnant women who responded to the survey from 2002 to 2015. The investigators also found that marijuana use was higher in the first trimester (6.4%) than in the second (3.3%) or third (1.8%) trimesters and that use was higher in pregnant black women (6.5%) than in white (3.8%) or Hispanic women(2.9%) or women of other races/ethnicities (1.4%).
Although evidence on the effects of marijuana on prenatal development is limited, “pregnant females and those considering becoming pregnant should be advised not to use marijuana or other cannabinoids recreationally or to treat nausea,” Dr. Volkow and her associates wrote.
The study was sponsored by the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration. Dr. Volkow reported having no financial disclosures. One coauthor reported stock ownership of Pfizer, and another reported stock ownership of Sanofi and Eli Lilly.
The prevalence of marijuana use among pregnant teenagers is more than double that among teens who are not pregnant, according to a study involving 410,000 females aged 12-44 years.
For pregnant teens aged 12-17 years, the past-month prevalence of marijuana use was 14% between 2002 and 2015, compared with 6.5% for their nonpregnant peers, Nora D. Volkow, MD, director of the National Institute on Drug Abuse in Bethesda, Md., and her associates reported in a letter on April 17 (Ann Intern Med. 2017 Apr 17. doi: 10.7326/L17-0067).
The pattern of use in the youngest age group “may reflect underlying risky behavior common to both teen pregnancy and early substance use and suggests the importance of intervention for teenagers,” the researchers wrote. “Because of consistent overlap between use of marijuana and other substances, identification of marijuana use during pregnancy warrants evaluation for comorbid substance abuse.”
The overall annual average prevalence of marijuana use was 3.8% among the 14,400 pregnant women and 7.5% for the 395,600 nonpregnant women who responded to the survey from 2002 to 2015. The investigators also found that marijuana use was higher in the first trimester (6.4%) than in the second (3.3%) or third (1.8%) trimesters and that use was higher in pregnant black women (6.5%) than in white (3.8%) or Hispanic women(2.9%) or women of other races/ethnicities (1.4%).
Although evidence on the effects of marijuana on prenatal development is limited, “pregnant females and those considering becoming pregnant should be advised not to use marijuana or other cannabinoids recreationally or to treat nausea,” Dr. Volkow and her associates wrote.
The study was sponsored by the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration. Dr. Volkow reported having no financial disclosures. One coauthor reported stock ownership of Pfizer, and another reported stock ownership of Sanofi and Eli Lilly.
FROM ANNALS OF INTERNAL MEDICINE
Proceed cautiously with liver cancer resection in elderly patients
MIAMI BEACH – A decision to proceed with major hepatectomy in patients 75 and older with perihilar cholangiocarcinoma should be made on a case-by-case basis following strict selection, Thuy Tran, MD, said, based on a study of 210 patients.
“As the U.S. population ages, an increasing number of elderly patients are being evaluated for resection of GI malignancies,” Dr. Tran said at the annual meeting of the Americas Hepato-Pancreato-Biliary Association.
“Advanced age has been regarded as contraindication to resection for complex hepatobiliary malignancies,” she explained, with concerns that “it may be too risky, and the survival benefit is limited in elderly populations. However, the oncologic benefit of aggressive surgical strategies in perihilar cholangiocarcinoma remains a subject of debate.”
Dr. Tran and her colleagues identified patients who underwent curative resection for perihilar cholangiocarcinoma (CCA) in the U.S. Extrahepatic Biliary Malignancy Consortium database. They compared outcomes of those younger than 75 years versus patients 75 years and older. A total of 59% of the cohort were men, 20% were 75 years and older, and the median age was 66 years.
CCA is a rare and aggressive malignancy, often presenting with obstructive jaundice, said Dr. Tran, a postdoctoral research fellow in general surgery at Stanford (Calif.) University.
Preoperative characteristics were similar in the groups, except that cardiac morbidity was higher in the older cohort. In addition, pathology characteristics did not differ significantly between age groups, including tumor stage, nodal status, grade, size, and margin status.
The in-hospital mortality was double for the older patients, 15% versus 8%, despite the similarities, Dr. Tran said. “This supports the notion that it is more difficult to salvage older patients when they run into a complication,” she added.
Postoperative morbidity was also higher in older patients, 78% versus 68%, but did not reach statistical significance (P = .34).
The 90-day mortality rate was 22% in patients 75 years and older, compared with 10% in younger patients, a nonsignificant difference (P = .09).
Five-year survival was 15% in the older cohort and 22% for the younger patients (P = .003). There was a “more significant drop in the survival curves in the older age group, but then they get closer,” Dr. Tran said. The disease-specific survival did not differ significantly at 46 months versus 37 months, respectively.
Advanced-stage cancer and elevated CA 19-9 tumor marker levels were independent predictors of survival in a multivariate analysis, but age was not. Higher body mass index was associated with a higher perioperative mortality in older patients, but sex, cardiac morbidity, and ASA status were not. Dr. Tran said, “Lower BMI may be a useful tool to select elderly patients,” she noted.
“Elderly patients have double the mortality following major hepatectomy for perihilar cholangiocarcinoma,” Dr. Tran said. “However, the long-term, cancer-specific outcome appears similar to that of younger patients.” Physiologically robust older patients may be better candidates for surgery, she suggested.
Of the six patients who died in the 75 and older group, two patients died from liver failure, one from sepsis, one intraoperatively, one from unknown causes, and one died who required reoperation for postop bleeding, Dr. Tran said. “We did not find patients dying from MI or pneumonia, probably due to the small number of patients.”
Dr. Tran said that 2.5% of the older group and 5% of the younger group received neoadjuvant chemotherapy, which was not a statistically significant difference.
A meeting attendee asked if left versus right hepatectomy made a difference, and why the researchers chose 75 years as the cutoff age between younger and older groups.
“Left vs. right laterality does not seem to make an impact in terms of survival,” Dr. Tran said. “The median age was 66 years, and we used the upper limit of standard deviation, which was 75.”
Dr. Tran had no relevant financial disclosures.
MIAMI BEACH – A decision to proceed with major hepatectomy in patients 75 and older with perihilar cholangiocarcinoma should be made on a case-by-case basis following strict selection, Thuy Tran, MD, said, based on a study of 210 patients.
“As the U.S. population ages, an increasing number of elderly patients are being evaluated for resection of GI malignancies,” Dr. Tran said at the annual meeting of the Americas Hepato-Pancreato-Biliary Association.
“Advanced age has been regarded as contraindication to resection for complex hepatobiliary malignancies,” she explained, with concerns that “it may be too risky, and the survival benefit is limited in elderly populations. However, the oncologic benefit of aggressive surgical strategies in perihilar cholangiocarcinoma remains a subject of debate.”
Dr. Tran and her colleagues identified patients who underwent curative resection for perihilar cholangiocarcinoma (CCA) in the U.S. Extrahepatic Biliary Malignancy Consortium database. They compared outcomes of those younger than 75 years versus patients 75 years and older. A total of 59% of the cohort were men, 20% were 75 years and older, and the median age was 66 years.
CCA is a rare and aggressive malignancy, often presenting with obstructive jaundice, said Dr. Tran, a postdoctoral research fellow in general surgery at Stanford (Calif.) University.
Preoperative characteristics were similar in the groups, except that cardiac morbidity was higher in the older cohort. In addition, pathology characteristics did not differ significantly between age groups, including tumor stage, nodal status, grade, size, and margin status.
The in-hospital mortality was double for the older patients, 15% versus 8%, despite the similarities, Dr. Tran said. “This supports the notion that it is more difficult to salvage older patients when they run into a complication,” she added.
Postoperative morbidity was also higher in older patients, 78% versus 68%, but did not reach statistical significance (P = .34).
The 90-day mortality rate was 22% in patients 75 years and older, compared with 10% in younger patients, a nonsignificant difference (P = .09).
Five-year survival was 15% in the older cohort and 22% for the younger patients (P = .003). There was a “more significant drop in the survival curves in the older age group, but then they get closer,” Dr. Tran said. The disease-specific survival did not differ significantly at 46 months versus 37 months, respectively.
Advanced-stage cancer and elevated CA 19-9 tumor marker levels were independent predictors of survival in a multivariate analysis, but age was not. Higher body mass index was associated with a higher perioperative mortality in older patients, but sex, cardiac morbidity, and ASA status were not. Dr. Tran said, “Lower BMI may be a useful tool to select elderly patients,” she noted.
“Elderly patients have double the mortality following major hepatectomy for perihilar cholangiocarcinoma,” Dr. Tran said. “However, the long-term, cancer-specific outcome appears similar to that of younger patients.” Physiologically robust older patients may be better candidates for surgery, she suggested.
Of the six patients who died in the 75 and older group, two patients died from liver failure, one from sepsis, one intraoperatively, one from unknown causes, and one died who required reoperation for postop bleeding, Dr. Tran said. “We did not find patients dying from MI or pneumonia, probably due to the small number of patients.”
Dr. Tran said that 2.5% of the older group and 5% of the younger group received neoadjuvant chemotherapy, which was not a statistically significant difference.
A meeting attendee asked if left versus right hepatectomy made a difference, and why the researchers chose 75 years as the cutoff age between younger and older groups.
“Left vs. right laterality does not seem to make an impact in terms of survival,” Dr. Tran said. “The median age was 66 years, and we used the upper limit of standard deviation, which was 75.”
Dr. Tran had no relevant financial disclosures.
MIAMI BEACH – A decision to proceed with major hepatectomy in patients 75 and older with perihilar cholangiocarcinoma should be made on a case-by-case basis following strict selection, Thuy Tran, MD, said, based on a study of 210 patients.
“As the U.S. population ages, an increasing number of elderly patients are being evaluated for resection of GI malignancies,” Dr. Tran said at the annual meeting of the Americas Hepato-Pancreato-Biliary Association.
“Advanced age has been regarded as contraindication to resection for complex hepatobiliary malignancies,” she explained, with concerns that “it may be too risky, and the survival benefit is limited in elderly populations. However, the oncologic benefit of aggressive surgical strategies in perihilar cholangiocarcinoma remains a subject of debate.”
Dr. Tran and her colleagues identified patients who underwent curative resection for perihilar cholangiocarcinoma (CCA) in the U.S. Extrahepatic Biliary Malignancy Consortium database. They compared outcomes of those younger than 75 years versus patients 75 years and older. A total of 59% of the cohort were men, 20% were 75 years and older, and the median age was 66 years.
CCA is a rare and aggressive malignancy, often presenting with obstructive jaundice, said Dr. Tran, a postdoctoral research fellow in general surgery at Stanford (Calif.) University.
Preoperative characteristics were similar in the groups, except that cardiac morbidity was higher in the older cohort. In addition, pathology characteristics did not differ significantly between age groups, including tumor stage, nodal status, grade, size, and margin status.
The in-hospital mortality was double for the older patients, 15% versus 8%, despite the similarities, Dr. Tran said. “This supports the notion that it is more difficult to salvage older patients when they run into a complication,” she added.
Postoperative morbidity was also higher in older patients, 78% versus 68%, but did not reach statistical significance (P = .34).
The 90-day mortality rate was 22% in patients 75 years and older, compared with 10% in younger patients, a nonsignificant difference (P = .09).
Five-year survival was 15% in the older cohort and 22% for the younger patients (P = .003). There was a “more significant drop in the survival curves in the older age group, but then they get closer,” Dr. Tran said. The disease-specific survival did not differ significantly at 46 months versus 37 months, respectively.
Advanced-stage cancer and elevated CA 19-9 tumor marker levels were independent predictors of survival in a multivariate analysis, but age was not. Higher body mass index was associated with a higher perioperative mortality in older patients, but sex, cardiac morbidity, and ASA status were not. Dr. Tran said, “Lower BMI may be a useful tool to select elderly patients,” she noted.
“Elderly patients have double the mortality following major hepatectomy for perihilar cholangiocarcinoma,” Dr. Tran said. “However, the long-term, cancer-specific outcome appears similar to that of younger patients.” Physiologically robust older patients may be better candidates for surgery, she suggested.
Of the six patients who died in the 75 and older group, two patients died from liver failure, one from sepsis, one intraoperatively, one from unknown causes, and one died who required reoperation for postop bleeding, Dr. Tran said. “We did not find patients dying from MI or pneumonia, probably due to the small number of patients.”
Dr. Tran said that 2.5% of the older group and 5% of the younger group received neoadjuvant chemotherapy, which was not a statistically significant difference.
A meeting attendee asked if left versus right hepatectomy made a difference, and why the researchers chose 75 years as the cutoff age between younger and older groups.
“Left vs. right laterality does not seem to make an impact in terms of survival,” Dr. Tran said. “The median age was 66 years, and we used the upper limit of standard deviation, which was 75.”
Dr. Tran had no relevant financial disclosures.
Key clinical point: Patients 75 years and older undergoing hepatectomy for perihilar cholangiocarcinoma trended toward higher mortality but experienced cancer-specific outcomes similar to younger patients.
Major finding: 90-day mortality was 22% in patients 75 years and older versus 10% in younger patients (nonsignificant, P = .09).
Data source: Retrospective database study of 210 people who had curative intent resection for perihilar cholangiocarcinoma.
Disclosures: Dr. Tran had no relevant financial disclosures.
FDA: REMS no longer necessary for epoetin, darbepoetin
The Food and Drug Administration no longer requires certification of doctors and hospitals to prescribe epoetin alfa (Procrit, Epogen) or darbepoetin alfa (Aranesp) for chemotherapy anemia.
A Risk Evaluation and Mitigation Strategy (REMS) program was put in place in 2011 to make sure that the benefits of erythropoiesis-stimulating agents (ESAs) outweighed the risks when prescribed. Under the program, providers were required to become certified in the ESA REMS and to demonstrate that each patient had received counseling on the benefits and risks of the therapies prior to use.
Amgen’s prescriber surveys demonstrated “acceptable knowledge” of the need to counsel patients about the risks. Utilization data indicated “appropriate prescribing” as an alternative to transfusion.
In addition, in an evaluation of the impact of multiple regulatory actions, the FDA determined that full implementation of the ESA REMS in 2011 had minimal impact on trends in ESA utilization metrics, the FDA wrote.
The FDA concluded that regulatory actions and label changes – and the cut in payments for nonrenal indications from the Center for Medicare & Medicaid Services – were enough to reduce overuse in chemotherapy.
However, while the REMS is no longer necessary, the FDA says serious risks of shortened overall survival and/or increased risk of tumor progression or recurrence associated with these drugs remain and health care providers should continue to discuss the risks and benefits of using ESAs with each patient before initiating use.
The Food and Drug Administration no longer requires certification of doctors and hospitals to prescribe epoetin alfa (Procrit, Epogen) or darbepoetin alfa (Aranesp) for chemotherapy anemia.
A Risk Evaluation and Mitigation Strategy (REMS) program was put in place in 2011 to make sure that the benefits of erythropoiesis-stimulating agents (ESAs) outweighed the risks when prescribed. Under the program, providers were required to become certified in the ESA REMS and to demonstrate that each patient had received counseling on the benefits and risks of the therapies prior to use.
Amgen’s prescriber surveys demonstrated “acceptable knowledge” of the need to counsel patients about the risks. Utilization data indicated “appropriate prescribing” as an alternative to transfusion.
In addition, in an evaluation of the impact of multiple regulatory actions, the FDA determined that full implementation of the ESA REMS in 2011 had minimal impact on trends in ESA utilization metrics, the FDA wrote.
The FDA concluded that regulatory actions and label changes – and the cut in payments for nonrenal indications from the Center for Medicare & Medicaid Services – were enough to reduce overuse in chemotherapy.
However, while the REMS is no longer necessary, the FDA says serious risks of shortened overall survival and/or increased risk of tumor progression or recurrence associated with these drugs remain and health care providers should continue to discuss the risks and benefits of using ESAs with each patient before initiating use.
The Food and Drug Administration no longer requires certification of doctors and hospitals to prescribe epoetin alfa (Procrit, Epogen) or darbepoetin alfa (Aranesp) for chemotherapy anemia.
A Risk Evaluation and Mitigation Strategy (REMS) program was put in place in 2011 to make sure that the benefits of erythropoiesis-stimulating agents (ESAs) outweighed the risks when prescribed. Under the program, providers were required to become certified in the ESA REMS and to demonstrate that each patient had received counseling on the benefits and risks of the therapies prior to use.
Amgen’s prescriber surveys demonstrated “acceptable knowledge” of the need to counsel patients about the risks. Utilization data indicated “appropriate prescribing” as an alternative to transfusion.
In addition, in an evaluation of the impact of multiple regulatory actions, the FDA determined that full implementation of the ESA REMS in 2011 had minimal impact on trends in ESA utilization metrics, the FDA wrote.
The FDA concluded that regulatory actions and label changes – and the cut in payments for nonrenal indications from the Center for Medicare & Medicaid Services – were enough to reduce overuse in chemotherapy.
However, while the REMS is no longer necessary, the FDA says serious risks of shortened overall survival and/or increased risk of tumor progression or recurrence associated with these drugs remain and health care providers should continue to discuss the risks and benefits of using ESAs with each patient before initiating use.