User login
How PCPs are penalized for positive outcomes from lifestyle change
The Centers for Medicare & Medicaid Services 2022 National Quality Strategy is described as an “ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals.” It is a commendable goal for an overburdened U.S. health care system that spends more than other high-income counties yet experiences poorer outcomes. But whole-person, person-centered care cannot be achieved under current misaligned quality measures that fail to measure what we purport to value: the quintuple aim of improved health outcomes, cost savings, patient satisfaction, clinician well-being, and health equity.
Lifestyle first
Clinical practice guidelines for many chronic diseases recommend lifestyle intervention as the first and optimal treatment. A growing body of evidence supports lifestyle behavior interventions to treat and, when used intensively, even reverse common chronic conditions such as cardiovascular disease, obesity, and type 2 diabetes, while also providing effective prevention for those conditions. However, no current quality measures consider lifestyle interventions. In fact, some quality measures unintentionally penalize physicians for successfully treating or reversing disease through lifestyle behavior interventions while rewarding clinicians for meeting process measures – usually adherence to medication – regardless of whether health outcomes improved.
Rewarding medication adherence for the treatment of diseases in which lifestyle is a primary therapy (such as hypertension), combined with other health care constraints (lack of lifestyle education, time to spend with patients, and infrastructure support) incentivizes physicians to skip the conversation about lifestyle changes and go straight to medication prescription. Meanwhile, the clinician who takes the extra time to guide a patient toward lifestyle interventions that could treat their current disease and prevent future diseases – without side effects – is penalized.
Misaligned quality measures like these can stifle clinical judgment and risk reducing the practice of medicine to mindless box-checking. In many cases, patients are not even informed that lifestyle behavior change may be a treatment option (much less the first recommended option) for their conditions. This delivery of care is not person-centered and, in fact, may raise questions about the adequacy of informed treatment consent.
Reimbursement barriers
Lifestyle medicine is a growing medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions. Since certification began in 2017, almost 2500 US physicians and 1000 nonphysician health professionals have earned certification. Health systems, including the U.S. military, are increasingly integrating lifestyle medicine. There have been advancements since one survey found that more than half of lifestyle medicine clinicians reported receiving no reimbursement for lifestyle behavior interventions. However, barriers, especially in fee-for-service systems, still inhibit many patients from receiving insurance coverage for comprehensive, interdisciplinary, and whole-person treatments called intensive therapeutic lifestyle change (ITLC) programs.
Existing comprehensive lifestyle programs that patients are eligible for (ie, the Diabetes Prevention Program and intensive behavioral therapy) are often so poorly reimbursed that clinicians and health systems decline to offer them. An example of a well-reimbursed ITLC program is intensive cardiac rehabilitation (ICR), which remains underutilized and limited to a narrow segment of patients, despite ICR›s proven benefits for managing comorbid risk factors such as hemoglobin A1c and weight. Even when lifestyle intervention programs are available and patients are eligible to participate (often through shared medical appointments), patient copays for the frequent visits required to achieve and sustain behavior change – or the lack of reimbursement for interdisciplinary team members – discourage engagement.
Penalizing successful outcomes
Despite the fact that lifestyle behaviors are top contributors to health and, conversely, contribute to up to 80% of chronic diseases, few quality measures focus on screening for lifestyle factors or treating diseases with lifestyle interventions. An example of an existing quality measure is screening or treatment for harmful substance use.
Specific quality measures that penalize lifestyle medicine approaches include pharmacotherapy for type 2 diabetes, dyslipidemia, osteoporosis, and gout as well as approaches to rheumatoid arthritis.
Statins offer a useful example of the conundrum faced by clinicians who want to offer lifestyle interventions. A lifestyle medicine primary care physician had a patient covered by Medicare Advantage who was diagnosed with hyperlipidemia. The patient had total cholesterol of 226 and a triglycerides level of 132. Instead of prescribing the routine statin, the physician prescribed lifestyle behavior modifications. Within 3 weeks, the patient›s total cholesterol improved to 171 and triglycerides to 75. This was a great success for the delighted patient. However, the CMS 5-Star Rating System assigned the primary care physician a grade of C rather than A, which put the physician›s 5-star rating at risk. Why? Because the system bases its score largely on medication compliance. The physician was penalized despite achieving the optimal health outcome, and at a lower cost than with medication. This misalignment does not incentivize patient-centered care because it disregards patient preference, shared decision-making, and evidence-based practice.
Risk adjustment
Rather than automatically managing disease with ever-increasing quantities of costly medications and procedures, lifestyle medicine clinicians first pursue a goal of health restoration when appropriate. But Medicare risk adjustment incentivizes physicians to manage rather than reverse disease. How much Medicare pays health plans is determined in part by how sick the patients are; the sicker the patient, the more Medicare pays, because those patients› costs are expected to be higher. This ensures that health plans are not penalized for enrolling sicker patients. But a physician utilizing diet alone to achieve remission in a patient with type 2 diabetes is penalized financially because, when the risk is adjusted, diabetes is no longer listed among the patient›s conditions. So, Medicare pays the physician less money. That misalignment incentivizes clinicians to manage the symptoms of type 2 diabetes rather than achieve remission, despite remission being the ideal clinical outcome.
Realigning quality measures
Quality measures were developed to quantify health care processes and outcomes, and to ensure the delivery of safe care to all patients. However, over time the number of quality measures has swelled to 2500, evolving into a confusing, time-consuming, and even soul-crushing responsibility for the physician.
Instead of relying heavily on process measures, we must incentivize outcome measures that honor patient autonomy and allow clinicians to offer lifestyle intervention as the first line of treatment. Risk-score calculations should be adjusted so that we stop incentivizing disease management and penalizing disease reversal.
CMS’s proposed development of “a universal foundation” of quality measures is an opportunity to begin the realignment of quality measures and values. This foundation is intended to establish more consistent and meaningful measures, reduce clinician burnout by streamlining the reporting process, and advance health equity. For this change to be successful, it is vital that lifestyle behavior interventions – optimal nutrition, physical activity, restorative sleep, social connections, stress management, and avoidance of harmful substances – become the foundation of universal quality measures. This will ensure that every clinician is incentivized to discuss lifestyle behaviors with patients and pursue the first clinical step recommended by clinical practice guidelines for most chronic diseases. Only then can we truly deliver high-value, whole-person, person-centered care and achieve the quintuple aim.
Dr. Patel is president-elect, American College of Lifestyle Medicine; Lifestyle Medicine Medical Director, Wellvana Health, Midland, Tex. She has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
The Centers for Medicare & Medicaid Services 2022 National Quality Strategy is described as an “ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals.” It is a commendable goal for an overburdened U.S. health care system that spends more than other high-income counties yet experiences poorer outcomes. But whole-person, person-centered care cannot be achieved under current misaligned quality measures that fail to measure what we purport to value: the quintuple aim of improved health outcomes, cost savings, patient satisfaction, clinician well-being, and health equity.
Lifestyle first
Clinical practice guidelines for many chronic diseases recommend lifestyle intervention as the first and optimal treatment. A growing body of evidence supports lifestyle behavior interventions to treat and, when used intensively, even reverse common chronic conditions such as cardiovascular disease, obesity, and type 2 diabetes, while also providing effective prevention for those conditions. However, no current quality measures consider lifestyle interventions. In fact, some quality measures unintentionally penalize physicians for successfully treating or reversing disease through lifestyle behavior interventions while rewarding clinicians for meeting process measures – usually adherence to medication – regardless of whether health outcomes improved.
Rewarding medication adherence for the treatment of diseases in which lifestyle is a primary therapy (such as hypertension), combined with other health care constraints (lack of lifestyle education, time to spend with patients, and infrastructure support) incentivizes physicians to skip the conversation about lifestyle changes and go straight to medication prescription. Meanwhile, the clinician who takes the extra time to guide a patient toward lifestyle interventions that could treat their current disease and prevent future diseases – without side effects – is penalized.
Misaligned quality measures like these can stifle clinical judgment and risk reducing the practice of medicine to mindless box-checking. In many cases, patients are not even informed that lifestyle behavior change may be a treatment option (much less the first recommended option) for their conditions. This delivery of care is not person-centered and, in fact, may raise questions about the adequacy of informed treatment consent.
Reimbursement barriers
Lifestyle medicine is a growing medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions. Since certification began in 2017, almost 2500 US physicians and 1000 nonphysician health professionals have earned certification. Health systems, including the U.S. military, are increasingly integrating lifestyle medicine. There have been advancements since one survey found that more than half of lifestyle medicine clinicians reported receiving no reimbursement for lifestyle behavior interventions. However, barriers, especially in fee-for-service systems, still inhibit many patients from receiving insurance coverage for comprehensive, interdisciplinary, and whole-person treatments called intensive therapeutic lifestyle change (ITLC) programs.
Existing comprehensive lifestyle programs that patients are eligible for (ie, the Diabetes Prevention Program and intensive behavioral therapy) are often so poorly reimbursed that clinicians and health systems decline to offer them. An example of a well-reimbursed ITLC program is intensive cardiac rehabilitation (ICR), which remains underutilized and limited to a narrow segment of patients, despite ICR›s proven benefits for managing comorbid risk factors such as hemoglobin A1c and weight. Even when lifestyle intervention programs are available and patients are eligible to participate (often through shared medical appointments), patient copays for the frequent visits required to achieve and sustain behavior change – or the lack of reimbursement for interdisciplinary team members – discourage engagement.
Penalizing successful outcomes
Despite the fact that lifestyle behaviors are top contributors to health and, conversely, contribute to up to 80% of chronic diseases, few quality measures focus on screening for lifestyle factors or treating diseases with lifestyle interventions. An example of an existing quality measure is screening or treatment for harmful substance use.
Specific quality measures that penalize lifestyle medicine approaches include pharmacotherapy for type 2 diabetes, dyslipidemia, osteoporosis, and gout as well as approaches to rheumatoid arthritis.
Statins offer a useful example of the conundrum faced by clinicians who want to offer lifestyle interventions. A lifestyle medicine primary care physician had a patient covered by Medicare Advantage who was diagnosed with hyperlipidemia. The patient had total cholesterol of 226 and a triglycerides level of 132. Instead of prescribing the routine statin, the physician prescribed lifestyle behavior modifications. Within 3 weeks, the patient›s total cholesterol improved to 171 and triglycerides to 75. This was a great success for the delighted patient. However, the CMS 5-Star Rating System assigned the primary care physician a grade of C rather than A, which put the physician›s 5-star rating at risk. Why? Because the system bases its score largely on medication compliance. The physician was penalized despite achieving the optimal health outcome, and at a lower cost than with medication. This misalignment does not incentivize patient-centered care because it disregards patient preference, shared decision-making, and evidence-based practice.
Risk adjustment
Rather than automatically managing disease with ever-increasing quantities of costly medications and procedures, lifestyle medicine clinicians first pursue a goal of health restoration when appropriate. But Medicare risk adjustment incentivizes physicians to manage rather than reverse disease. How much Medicare pays health plans is determined in part by how sick the patients are; the sicker the patient, the more Medicare pays, because those patients› costs are expected to be higher. This ensures that health plans are not penalized for enrolling sicker patients. But a physician utilizing diet alone to achieve remission in a patient with type 2 diabetes is penalized financially because, when the risk is adjusted, diabetes is no longer listed among the patient›s conditions. So, Medicare pays the physician less money. That misalignment incentivizes clinicians to manage the symptoms of type 2 diabetes rather than achieve remission, despite remission being the ideal clinical outcome.
Realigning quality measures
Quality measures were developed to quantify health care processes and outcomes, and to ensure the delivery of safe care to all patients. However, over time the number of quality measures has swelled to 2500, evolving into a confusing, time-consuming, and even soul-crushing responsibility for the physician.
Instead of relying heavily on process measures, we must incentivize outcome measures that honor patient autonomy and allow clinicians to offer lifestyle intervention as the first line of treatment. Risk-score calculations should be adjusted so that we stop incentivizing disease management and penalizing disease reversal.
CMS’s proposed development of “a universal foundation” of quality measures is an opportunity to begin the realignment of quality measures and values. This foundation is intended to establish more consistent and meaningful measures, reduce clinician burnout by streamlining the reporting process, and advance health equity. For this change to be successful, it is vital that lifestyle behavior interventions – optimal nutrition, physical activity, restorative sleep, social connections, stress management, and avoidance of harmful substances – become the foundation of universal quality measures. This will ensure that every clinician is incentivized to discuss lifestyle behaviors with patients and pursue the first clinical step recommended by clinical practice guidelines for most chronic diseases. Only then can we truly deliver high-value, whole-person, person-centered care and achieve the quintuple aim.
Dr. Patel is president-elect, American College of Lifestyle Medicine; Lifestyle Medicine Medical Director, Wellvana Health, Midland, Tex. She has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
The Centers for Medicare & Medicaid Services 2022 National Quality Strategy is described as an “ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals.” It is a commendable goal for an overburdened U.S. health care system that spends more than other high-income counties yet experiences poorer outcomes. But whole-person, person-centered care cannot be achieved under current misaligned quality measures that fail to measure what we purport to value: the quintuple aim of improved health outcomes, cost savings, patient satisfaction, clinician well-being, and health equity.
Lifestyle first
Clinical practice guidelines for many chronic diseases recommend lifestyle intervention as the first and optimal treatment. A growing body of evidence supports lifestyle behavior interventions to treat and, when used intensively, even reverse common chronic conditions such as cardiovascular disease, obesity, and type 2 diabetes, while also providing effective prevention for those conditions. However, no current quality measures consider lifestyle interventions. In fact, some quality measures unintentionally penalize physicians for successfully treating or reversing disease through lifestyle behavior interventions while rewarding clinicians for meeting process measures – usually adherence to medication – regardless of whether health outcomes improved.
Rewarding medication adherence for the treatment of diseases in which lifestyle is a primary therapy (such as hypertension), combined with other health care constraints (lack of lifestyle education, time to spend with patients, and infrastructure support) incentivizes physicians to skip the conversation about lifestyle changes and go straight to medication prescription. Meanwhile, the clinician who takes the extra time to guide a patient toward lifestyle interventions that could treat their current disease and prevent future diseases – without side effects – is penalized.
Misaligned quality measures like these can stifle clinical judgment and risk reducing the practice of medicine to mindless box-checking. In many cases, patients are not even informed that lifestyle behavior change may be a treatment option (much less the first recommended option) for their conditions. This delivery of care is not person-centered and, in fact, may raise questions about the adequacy of informed treatment consent.
Reimbursement barriers
Lifestyle medicine is a growing medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions. Since certification began in 2017, almost 2500 US physicians and 1000 nonphysician health professionals have earned certification. Health systems, including the U.S. military, are increasingly integrating lifestyle medicine. There have been advancements since one survey found that more than half of lifestyle medicine clinicians reported receiving no reimbursement for lifestyle behavior interventions. However, barriers, especially in fee-for-service systems, still inhibit many patients from receiving insurance coverage for comprehensive, interdisciplinary, and whole-person treatments called intensive therapeutic lifestyle change (ITLC) programs.
Existing comprehensive lifestyle programs that patients are eligible for (ie, the Diabetes Prevention Program and intensive behavioral therapy) are often so poorly reimbursed that clinicians and health systems decline to offer them. An example of a well-reimbursed ITLC program is intensive cardiac rehabilitation (ICR), which remains underutilized and limited to a narrow segment of patients, despite ICR›s proven benefits for managing comorbid risk factors such as hemoglobin A1c and weight. Even when lifestyle intervention programs are available and patients are eligible to participate (often through shared medical appointments), patient copays for the frequent visits required to achieve and sustain behavior change – or the lack of reimbursement for interdisciplinary team members – discourage engagement.
Penalizing successful outcomes
Despite the fact that lifestyle behaviors are top contributors to health and, conversely, contribute to up to 80% of chronic diseases, few quality measures focus on screening for lifestyle factors or treating diseases with lifestyle interventions. An example of an existing quality measure is screening or treatment for harmful substance use.
Specific quality measures that penalize lifestyle medicine approaches include pharmacotherapy for type 2 diabetes, dyslipidemia, osteoporosis, and gout as well as approaches to rheumatoid arthritis.
Statins offer a useful example of the conundrum faced by clinicians who want to offer lifestyle interventions. A lifestyle medicine primary care physician had a patient covered by Medicare Advantage who was diagnosed with hyperlipidemia. The patient had total cholesterol of 226 and a triglycerides level of 132. Instead of prescribing the routine statin, the physician prescribed lifestyle behavior modifications. Within 3 weeks, the patient›s total cholesterol improved to 171 and triglycerides to 75. This was a great success for the delighted patient. However, the CMS 5-Star Rating System assigned the primary care physician a grade of C rather than A, which put the physician›s 5-star rating at risk. Why? Because the system bases its score largely on medication compliance. The physician was penalized despite achieving the optimal health outcome, and at a lower cost than with medication. This misalignment does not incentivize patient-centered care because it disregards patient preference, shared decision-making, and evidence-based practice.
Risk adjustment
Rather than automatically managing disease with ever-increasing quantities of costly medications and procedures, lifestyle medicine clinicians first pursue a goal of health restoration when appropriate. But Medicare risk adjustment incentivizes physicians to manage rather than reverse disease. How much Medicare pays health plans is determined in part by how sick the patients are; the sicker the patient, the more Medicare pays, because those patients› costs are expected to be higher. This ensures that health plans are not penalized for enrolling sicker patients. But a physician utilizing diet alone to achieve remission in a patient with type 2 diabetes is penalized financially because, when the risk is adjusted, diabetes is no longer listed among the patient›s conditions. So, Medicare pays the physician less money. That misalignment incentivizes clinicians to manage the symptoms of type 2 diabetes rather than achieve remission, despite remission being the ideal clinical outcome.
Realigning quality measures
Quality measures were developed to quantify health care processes and outcomes, and to ensure the delivery of safe care to all patients. However, over time the number of quality measures has swelled to 2500, evolving into a confusing, time-consuming, and even soul-crushing responsibility for the physician.
Instead of relying heavily on process measures, we must incentivize outcome measures that honor patient autonomy and allow clinicians to offer lifestyle intervention as the first line of treatment. Risk-score calculations should be adjusted so that we stop incentivizing disease management and penalizing disease reversal.
CMS’s proposed development of “a universal foundation” of quality measures is an opportunity to begin the realignment of quality measures and values. This foundation is intended to establish more consistent and meaningful measures, reduce clinician burnout by streamlining the reporting process, and advance health equity. For this change to be successful, it is vital that lifestyle behavior interventions – optimal nutrition, physical activity, restorative sleep, social connections, stress management, and avoidance of harmful substances – become the foundation of universal quality measures. This will ensure that every clinician is incentivized to discuss lifestyle behaviors with patients and pursue the first clinical step recommended by clinical practice guidelines for most chronic diseases. Only then can we truly deliver high-value, whole-person, person-centered care and achieve the quintuple aim.
Dr. Patel is president-elect, American College of Lifestyle Medicine; Lifestyle Medicine Medical Director, Wellvana Health, Midland, Tex. She has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Repetitive primary care screenings may miss depression and anxiety
Routine screening for depression and anxiety at each primary care clinical encounter in order to meet performance metrics could compromise accuracy and clinical care, based on data from more than 380,000 individuals in primary care.
“Prioritizing repetition of intake screening questionnaires at primary care visits may have unintended consequences such as administrative burden, provision of low-value care, and reduced clinical capacity to deliver other, high-value services,” but the accuracy of workflow-based intake screening on subsequent diagnosis has not been explored, wrote Jodi Simon, DrPH, of AllianceChicago, Ill., and colleagues.
In a study published in the Annals of Family Medicine, the researchers reviewed data from screenings performed on 380,057 patients in primary care settings. They examined the accuracy and utility of the Patient Health Questionnaire (PHQ-2) for depression and the Generalized Anxiety Disorder 2 (GAD-2) for anxiety.
The data included 1,883,317 screenings with PHQ-2s and 1,573,107 with GAD-2s. Of these, 92.3% of PHQ-2 screenings and 91.4% of GAD-2 screenings indicated low likelihood of depression or anxiety (defined as cumulative scores of 0 or 1). Mean scores for the PHQ-2 and GAD-2 in the study population were 0.29 and 0.35, respectively.
In the current study, 11% of patients had positive PHQ-2 scores (defined as 2 or higher) vs. 47%-53% seen in previous studies and census data.
In an analysis of new diagnoses of depression and anxiety, the researchers found that 42.3% of patients with a new depression diagnosis were not identified on intake screening; they had scores of 0 or 1 on the PHQ-2 in the past 30 days. Similarly, 42.7% of patients with a new anxiety diagnosis had scores of 0 or 1 on the GAD-2 in the past 30 days.
In other words, “Screening only detected risk in 57.7% of patients subsequently diagnosed with depression and 57.3% of patients subsequently diagnosed with anxiety,” the researchers said. This low positivity rate in patients diagnosed within 30 days merits further research, they added.
More studies are needed, but preliminary interviews with patients, clinicians, and staff indicate that time constraints and variation in the administration of questionnaires are among the factors contributing to inaccurate screening, the researchers noted.
The current study results suggest that screenings for anxiety and depression may occur in a perfunctory or inconsistent manner that might compromise accuracy when they are part of the workflow for each clinical visit in order to meet performance metrics, they said. “Ineffective screening may unintentionally detract from clinical care because care teams and patients have less time and cognitive energy to focus on other priorities during busy clinical encounters,” they added.
Alternatively, , the researchers concluded.
The study was funded by the American Medical Association Transformation Initiative. The researchers had no financial conflicts to disclose.
Routine screening for depression and anxiety at each primary care clinical encounter in order to meet performance metrics could compromise accuracy and clinical care, based on data from more than 380,000 individuals in primary care.
“Prioritizing repetition of intake screening questionnaires at primary care visits may have unintended consequences such as administrative burden, provision of low-value care, and reduced clinical capacity to deliver other, high-value services,” but the accuracy of workflow-based intake screening on subsequent diagnosis has not been explored, wrote Jodi Simon, DrPH, of AllianceChicago, Ill., and colleagues.
In a study published in the Annals of Family Medicine, the researchers reviewed data from screenings performed on 380,057 patients in primary care settings. They examined the accuracy and utility of the Patient Health Questionnaire (PHQ-2) for depression and the Generalized Anxiety Disorder 2 (GAD-2) for anxiety.
The data included 1,883,317 screenings with PHQ-2s and 1,573,107 with GAD-2s. Of these, 92.3% of PHQ-2 screenings and 91.4% of GAD-2 screenings indicated low likelihood of depression or anxiety (defined as cumulative scores of 0 or 1). Mean scores for the PHQ-2 and GAD-2 in the study population were 0.29 and 0.35, respectively.
In the current study, 11% of patients had positive PHQ-2 scores (defined as 2 or higher) vs. 47%-53% seen in previous studies and census data.
In an analysis of new diagnoses of depression and anxiety, the researchers found that 42.3% of patients with a new depression diagnosis were not identified on intake screening; they had scores of 0 or 1 on the PHQ-2 in the past 30 days. Similarly, 42.7% of patients with a new anxiety diagnosis had scores of 0 or 1 on the GAD-2 in the past 30 days.
In other words, “Screening only detected risk in 57.7% of patients subsequently diagnosed with depression and 57.3% of patients subsequently diagnosed with anxiety,” the researchers said. This low positivity rate in patients diagnosed within 30 days merits further research, they added.
More studies are needed, but preliminary interviews with patients, clinicians, and staff indicate that time constraints and variation in the administration of questionnaires are among the factors contributing to inaccurate screening, the researchers noted.
The current study results suggest that screenings for anxiety and depression may occur in a perfunctory or inconsistent manner that might compromise accuracy when they are part of the workflow for each clinical visit in order to meet performance metrics, they said. “Ineffective screening may unintentionally detract from clinical care because care teams and patients have less time and cognitive energy to focus on other priorities during busy clinical encounters,” they added.
Alternatively, , the researchers concluded.
The study was funded by the American Medical Association Transformation Initiative. The researchers had no financial conflicts to disclose.
Routine screening for depression and anxiety at each primary care clinical encounter in order to meet performance metrics could compromise accuracy and clinical care, based on data from more than 380,000 individuals in primary care.
“Prioritizing repetition of intake screening questionnaires at primary care visits may have unintended consequences such as administrative burden, provision of low-value care, and reduced clinical capacity to deliver other, high-value services,” but the accuracy of workflow-based intake screening on subsequent diagnosis has not been explored, wrote Jodi Simon, DrPH, of AllianceChicago, Ill., and colleagues.
In a study published in the Annals of Family Medicine, the researchers reviewed data from screenings performed on 380,057 patients in primary care settings. They examined the accuracy and utility of the Patient Health Questionnaire (PHQ-2) for depression and the Generalized Anxiety Disorder 2 (GAD-2) for anxiety.
The data included 1,883,317 screenings with PHQ-2s and 1,573,107 with GAD-2s. Of these, 92.3% of PHQ-2 screenings and 91.4% of GAD-2 screenings indicated low likelihood of depression or anxiety (defined as cumulative scores of 0 or 1). Mean scores for the PHQ-2 and GAD-2 in the study population were 0.29 and 0.35, respectively.
In the current study, 11% of patients had positive PHQ-2 scores (defined as 2 or higher) vs. 47%-53% seen in previous studies and census data.
In an analysis of new diagnoses of depression and anxiety, the researchers found that 42.3% of patients with a new depression diagnosis were not identified on intake screening; they had scores of 0 or 1 on the PHQ-2 in the past 30 days. Similarly, 42.7% of patients with a new anxiety diagnosis had scores of 0 or 1 on the GAD-2 in the past 30 days.
In other words, “Screening only detected risk in 57.7% of patients subsequently diagnosed with depression and 57.3% of patients subsequently diagnosed with anxiety,” the researchers said. This low positivity rate in patients diagnosed within 30 days merits further research, they added.
More studies are needed, but preliminary interviews with patients, clinicians, and staff indicate that time constraints and variation in the administration of questionnaires are among the factors contributing to inaccurate screening, the researchers noted.
The current study results suggest that screenings for anxiety and depression may occur in a perfunctory or inconsistent manner that might compromise accuracy when they are part of the workflow for each clinical visit in order to meet performance metrics, they said. “Ineffective screening may unintentionally detract from clinical care because care teams and patients have less time and cognitive energy to focus on other priorities during busy clinical encounters,” they added.
Alternatively, , the researchers concluded.
The study was funded by the American Medical Association Transformation Initiative. The researchers had no financial conflicts to disclose.
FROM THE ANNALS OF FAMILY MEDICINE
Tool in development aims to steer telehealth visit appropriateness in rheumatology
Researchers have created a model to suggest which rheumatology visits can be effectively carried out via telehealth and which should remain in-person visits. The model not only could help to alleviate the decision burden on providers but also help to navigate how to incorporate telehealth into daily rheumatology practice as the COVID-19 pandemic subsides, experts say.
The beginning of the pandemic quickly drove rheumatology practices to adopt telehealth – which in the past has been studied only in selective groups of relatively stable patients. In Duke University’s department of rheumatology, nearly 90% of visits were conducted via telehealth for several weeks in April and May 2020, said David L. Leverenz, MD, an assistant professor of medicine at Duke University in Durham, N.C.
Since then, the practice has continued providing telehealth for a wider variety of patients: patients with high disease activity, those with low disease activity, people living 3 hours away or just 5 minutes from the medical center.
“Although the pandemic has really improved, and certainly we feel very safe providing in-person care, we’ve realized that it’s actually really possible to provide telehealth care to a lot of patients,” he said.
The model was then piloted with four Duke University rheumatologists for visits that took place from March through July 2022. A month prior to visits, researchers provided the rheumatologists a list of in-patient visits that the model suggested could be changed to telehealth visits. The list also included false changes, in which randomly selected visits were presented as being recommended for telehealth, although the model had not actually recommended the changes.
Dr. Leverenz and colleagues measured how frequently providers agreed with changes recommended by the model and the false changes. If a provider accepted a model-suggested change, the patient was contacted to either accept or reject the proposed switch. If a provider agreed with a false change, no additional action was taken.
Of the 201 patient encounters, there were 101 model-recommended changes and 100 artificial changes. Nearly all (99%) model-recommended changes suggested moving from in-person visits to telehealth visits. There was one recommendation to change a scheduled telehealth encounter to an in-person encounter. Of the false recommendations, 90 were for scheduled in-person visits, and 10 were for scheduled telehealth appointments.
Providers agreed with 71% of the model-recommended changes and with 21% of the false changes. Dr. Leverenz and colleagues reported “moderate agreement” between providers and model recommendations, reflected by a Cohen kappa coefficient of 0.45.
“This lined up pretty well with what providers thought was appropriate for the patient when presented with the information, and it also showed that, on top of current practice, that the model really does have the ability to expand appropriate telehealth care, which is really what we’re looking to do,” Dr. Leverenz said.
The article describing these results was published in Arthritis Care and Research.
Perhaps unsurprisingly, clinician preference for and experience with telemedicine were the biggest predictors of whether changes suggested by the model were accepted.
Focus model to specific diagnoses or many?
Currently, clinicians who are already juggling many other responsibilities throughout the day must use their own judgment to determine whether telemedicine may be appropriate. A model such as this could help alleviate that decision burden, said Kathleen Fear, PhD, the director of data and analytics at the University of Rochester Medical Center Health Lab, in New York.
“A model that can help with scheduling or prompt a provider or patient for when a visit is appropriate for telemedicine seems like a really effective way to make the most of telemedicine while reducing potential burden on providers,” she said.
Dr. Leverenz imagines that this model could be embedded into electronic health records as a “decision support tool” to aid discussions between patients and providers on whether telehealth might be appropriate for upcoming visits.
But developing a model that can generate predictions for the wide variety of conditions seen in daily rheumatology practice can be a challenge, said Christine Peoples, MD, a clinical associate professor of medicine and director of the tele-rheumatology program at the University of Pittsburgh.
“If you focus the model to certain diagnoses, at least in the beginning, that’s very helpful, because it’s too difficult to have one model for every single reason that folks see a rheumatologist,” she said.
Daniel A. Albert, MD, a professor of medicine and pediatrics at the Geisel School of Medicine at Dartmouth in Hanover, N,H., agreed. The model is “a good start,” he said, and highlights that tele-rheumatology continues to be underutilized in practice. But he argued that the moderate agreement found with the model was relatively low.
A more focused algorithm that targets a single or several more common conditions may be more accurate, he said. “You probably want to break it down,” Dr. Albert said.
But Dr. Leverenz argued that the novelty of this model is that it incorporates the many different conditions seen in daily rheumatology practice, whereas previous programs utilizing telehealth focused on specific conditions and patients with low disease activity.
In addition, the model is currently provider centric and does not take patient preference into account, Dr. Albert added. Dr. Leverenz said that that is the next step in further developing this model. He is currently conducting qualitative analyses with patients to better understand what patients think and how often their views on telehealth differ from that of their care providers.
“Hopefully, we can expand appropriate telehealth visits by teaching providers not just to do what they think is right for the patient but also meet the patient’s expectations and needs, based on what we learn,” he said.
The study was funded by a grant from Pfizer. Dr. Leverenz has received grants from Pfizer and has served as a consultant for Sanofi. None of the study’s other authors report relevant financial relationships. Dr. Peoples is an educational consultant on telehealth for Pfizer. Dr. Alberts has previously received grant funding from Pfizer. Dr. Fear has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Researchers have created a model to suggest which rheumatology visits can be effectively carried out via telehealth and which should remain in-person visits. The model not only could help to alleviate the decision burden on providers but also help to navigate how to incorporate telehealth into daily rheumatology practice as the COVID-19 pandemic subsides, experts say.
The beginning of the pandemic quickly drove rheumatology practices to adopt telehealth – which in the past has been studied only in selective groups of relatively stable patients. In Duke University’s department of rheumatology, nearly 90% of visits were conducted via telehealth for several weeks in April and May 2020, said David L. Leverenz, MD, an assistant professor of medicine at Duke University in Durham, N.C.
Since then, the practice has continued providing telehealth for a wider variety of patients: patients with high disease activity, those with low disease activity, people living 3 hours away or just 5 minutes from the medical center.
“Although the pandemic has really improved, and certainly we feel very safe providing in-person care, we’ve realized that it’s actually really possible to provide telehealth care to a lot of patients,” he said.
The model was then piloted with four Duke University rheumatologists for visits that took place from March through July 2022. A month prior to visits, researchers provided the rheumatologists a list of in-patient visits that the model suggested could be changed to telehealth visits. The list also included false changes, in which randomly selected visits were presented as being recommended for telehealth, although the model had not actually recommended the changes.
Dr. Leverenz and colleagues measured how frequently providers agreed with changes recommended by the model and the false changes. If a provider accepted a model-suggested change, the patient was contacted to either accept or reject the proposed switch. If a provider agreed with a false change, no additional action was taken.
Of the 201 patient encounters, there were 101 model-recommended changes and 100 artificial changes. Nearly all (99%) model-recommended changes suggested moving from in-person visits to telehealth visits. There was one recommendation to change a scheduled telehealth encounter to an in-person encounter. Of the false recommendations, 90 were for scheduled in-person visits, and 10 were for scheduled telehealth appointments.
Providers agreed with 71% of the model-recommended changes and with 21% of the false changes. Dr. Leverenz and colleagues reported “moderate agreement” between providers and model recommendations, reflected by a Cohen kappa coefficient of 0.45.
“This lined up pretty well with what providers thought was appropriate for the patient when presented with the information, and it also showed that, on top of current practice, that the model really does have the ability to expand appropriate telehealth care, which is really what we’re looking to do,” Dr. Leverenz said.
The article describing these results was published in Arthritis Care and Research.
Perhaps unsurprisingly, clinician preference for and experience with telemedicine were the biggest predictors of whether changes suggested by the model were accepted.
Focus model to specific diagnoses or many?
Currently, clinicians who are already juggling many other responsibilities throughout the day must use their own judgment to determine whether telemedicine may be appropriate. A model such as this could help alleviate that decision burden, said Kathleen Fear, PhD, the director of data and analytics at the University of Rochester Medical Center Health Lab, in New York.
“A model that can help with scheduling or prompt a provider or patient for when a visit is appropriate for telemedicine seems like a really effective way to make the most of telemedicine while reducing potential burden on providers,” she said.
Dr. Leverenz imagines that this model could be embedded into electronic health records as a “decision support tool” to aid discussions between patients and providers on whether telehealth might be appropriate for upcoming visits.
But developing a model that can generate predictions for the wide variety of conditions seen in daily rheumatology practice can be a challenge, said Christine Peoples, MD, a clinical associate professor of medicine and director of the tele-rheumatology program at the University of Pittsburgh.
“If you focus the model to certain diagnoses, at least in the beginning, that’s very helpful, because it’s too difficult to have one model for every single reason that folks see a rheumatologist,” she said.
Daniel A. Albert, MD, a professor of medicine and pediatrics at the Geisel School of Medicine at Dartmouth in Hanover, N,H., agreed. The model is “a good start,” he said, and highlights that tele-rheumatology continues to be underutilized in practice. But he argued that the moderate agreement found with the model was relatively low.
A more focused algorithm that targets a single or several more common conditions may be more accurate, he said. “You probably want to break it down,” Dr. Albert said.
But Dr. Leverenz argued that the novelty of this model is that it incorporates the many different conditions seen in daily rheumatology practice, whereas previous programs utilizing telehealth focused on specific conditions and patients with low disease activity.
In addition, the model is currently provider centric and does not take patient preference into account, Dr. Albert added. Dr. Leverenz said that that is the next step in further developing this model. He is currently conducting qualitative analyses with patients to better understand what patients think and how often their views on telehealth differ from that of their care providers.
“Hopefully, we can expand appropriate telehealth visits by teaching providers not just to do what they think is right for the patient but also meet the patient’s expectations and needs, based on what we learn,” he said.
The study was funded by a grant from Pfizer. Dr. Leverenz has received grants from Pfizer and has served as a consultant for Sanofi. None of the study’s other authors report relevant financial relationships. Dr. Peoples is an educational consultant on telehealth for Pfizer. Dr. Alberts has previously received grant funding from Pfizer. Dr. Fear has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Researchers have created a model to suggest which rheumatology visits can be effectively carried out via telehealth and which should remain in-person visits. The model not only could help to alleviate the decision burden on providers but also help to navigate how to incorporate telehealth into daily rheumatology practice as the COVID-19 pandemic subsides, experts say.
The beginning of the pandemic quickly drove rheumatology practices to adopt telehealth – which in the past has been studied only in selective groups of relatively stable patients. In Duke University’s department of rheumatology, nearly 90% of visits were conducted via telehealth for several weeks in April and May 2020, said David L. Leverenz, MD, an assistant professor of medicine at Duke University in Durham, N.C.
Since then, the practice has continued providing telehealth for a wider variety of patients: patients with high disease activity, those with low disease activity, people living 3 hours away or just 5 minutes from the medical center.
“Although the pandemic has really improved, and certainly we feel very safe providing in-person care, we’ve realized that it’s actually really possible to provide telehealth care to a lot of patients,” he said.
The model was then piloted with four Duke University rheumatologists for visits that took place from March through July 2022. A month prior to visits, researchers provided the rheumatologists a list of in-patient visits that the model suggested could be changed to telehealth visits. The list also included false changes, in which randomly selected visits were presented as being recommended for telehealth, although the model had not actually recommended the changes.
Dr. Leverenz and colleagues measured how frequently providers agreed with changes recommended by the model and the false changes. If a provider accepted a model-suggested change, the patient was contacted to either accept or reject the proposed switch. If a provider agreed with a false change, no additional action was taken.
Of the 201 patient encounters, there were 101 model-recommended changes and 100 artificial changes. Nearly all (99%) model-recommended changes suggested moving from in-person visits to telehealth visits. There was one recommendation to change a scheduled telehealth encounter to an in-person encounter. Of the false recommendations, 90 were for scheduled in-person visits, and 10 were for scheduled telehealth appointments.
Providers agreed with 71% of the model-recommended changes and with 21% of the false changes. Dr. Leverenz and colleagues reported “moderate agreement” between providers and model recommendations, reflected by a Cohen kappa coefficient of 0.45.
“This lined up pretty well with what providers thought was appropriate for the patient when presented with the information, and it also showed that, on top of current practice, that the model really does have the ability to expand appropriate telehealth care, which is really what we’re looking to do,” Dr. Leverenz said.
The article describing these results was published in Arthritis Care and Research.
Perhaps unsurprisingly, clinician preference for and experience with telemedicine were the biggest predictors of whether changes suggested by the model were accepted.
Focus model to specific diagnoses or many?
Currently, clinicians who are already juggling many other responsibilities throughout the day must use their own judgment to determine whether telemedicine may be appropriate. A model such as this could help alleviate that decision burden, said Kathleen Fear, PhD, the director of data and analytics at the University of Rochester Medical Center Health Lab, in New York.
“A model that can help with scheduling or prompt a provider or patient for when a visit is appropriate for telemedicine seems like a really effective way to make the most of telemedicine while reducing potential burden on providers,” she said.
Dr. Leverenz imagines that this model could be embedded into electronic health records as a “decision support tool” to aid discussions between patients and providers on whether telehealth might be appropriate for upcoming visits.
But developing a model that can generate predictions for the wide variety of conditions seen in daily rheumatology practice can be a challenge, said Christine Peoples, MD, a clinical associate professor of medicine and director of the tele-rheumatology program at the University of Pittsburgh.
“If you focus the model to certain diagnoses, at least in the beginning, that’s very helpful, because it’s too difficult to have one model for every single reason that folks see a rheumatologist,” she said.
Daniel A. Albert, MD, a professor of medicine and pediatrics at the Geisel School of Medicine at Dartmouth in Hanover, N,H., agreed. The model is “a good start,” he said, and highlights that tele-rheumatology continues to be underutilized in practice. But he argued that the moderate agreement found with the model was relatively low.
A more focused algorithm that targets a single or several more common conditions may be more accurate, he said. “You probably want to break it down,” Dr. Albert said.
But Dr. Leverenz argued that the novelty of this model is that it incorporates the many different conditions seen in daily rheumatology practice, whereas previous programs utilizing telehealth focused on specific conditions and patients with low disease activity.
In addition, the model is currently provider centric and does not take patient preference into account, Dr. Albert added. Dr. Leverenz said that that is the next step in further developing this model. He is currently conducting qualitative analyses with patients to better understand what patients think and how often their views on telehealth differ from that of their care providers.
“Hopefully, we can expand appropriate telehealth visits by teaching providers not just to do what they think is right for the patient but also meet the patient’s expectations and needs, based on what we learn,” he said.
The study was funded by a grant from Pfizer. Dr. Leverenz has received grants from Pfizer and has served as a consultant for Sanofi. None of the study’s other authors report relevant financial relationships. Dr. Peoples is an educational consultant on telehealth for Pfizer. Dr. Alberts has previously received grant funding from Pfizer. Dr. Fear has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
FROM ARTHRITIS CARE AND RESEARCH
Analysis spotlights economic burden of vitiligo in the U.S.
TOPLINE:
METHODOLOGY:
- No published studies have quantified the medical costs and health care resource utilization (HCRU) among patients with vitiligo in the United States, compared with the general population.
- Drawing from the Merative MarketScan Commercial Claims and Encounters database, researchers reviewed the records of 49,512 patients diagnosed with vitiligo between Jan. 1, 2008, and Dec. 31, 2020, and those of 99,024 matched control persons who did not have vitiligo.
- Costs were in 2021 dollars during a 1-year postindex period. The student t test and chi square analysis were used to determine P values.
TAKEAWAY:
- In both cohorts, the median age of patients was 43 years, 79.2% were female, and most (39%) were from the southern region of the United States.
- All-cause total health care costs for patients with vitiligo were significantly higher than those of matched controls ($15,551 vs. $7,735; P < .0001).
- Similarly, medical costs for patients with vitiligo were significantly higher than those of control persons ($11,953 vs. $5,722), as were pharmacy costs ($3,598 vs. $2,014; P < .001 for both associations).
- A significantly greater proportion of patients with vitiligo had higher all-cause HCRU, compared with matched control persons. That included at least one ED visit (17.5% vs 13.4%), at least one inpatient visit (12.9% vs 6.8%), and at least one outpatient visit (99.8% vs. 88.3%; P < .0001 for all associations).
IN PRACTICE:
“These findings reveal an unmet need for cost-effective treatments and highlight the importance of fully identifying the drivers of economic burden for patients with vitiligo,” the authors concluded.
SOURCE:
Khaled Ezzedine, MD, PhD, of the department of dermatology at the Henri Mondor University Hospital, Créteil, France, led the study, which was published in the Journal of Investigative Dermatology.
LIMITATIONS:
The investigators did not evaluate indirect medical costs of vitiligo, such as work productivity, early retirement, and lost opportunities. Also, the results may not be generalizable to populations outside of the United States.
DISCLOSURES:
Dr. Ezzedine has received honoraria as a consultant for AbbVie, Incyte, La Roche–Posay, Pfizer, Pierre Fabre, Sanofi, and Viela Bio. One author is an investigator for Incyte and is a consultant for several pharmaceutical companies. Three authors are AbbVie employees.
A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- No published studies have quantified the medical costs and health care resource utilization (HCRU) among patients with vitiligo in the United States, compared with the general population.
- Drawing from the Merative MarketScan Commercial Claims and Encounters database, researchers reviewed the records of 49,512 patients diagnosed with vitiligo between Jan. 1, 2008, and Dec. 31, 2020, and those of 99,024 matched control persons who did not have vitiligo.
- Costs were in 2021 dollars during a 1-year postindex period. The student t test and chi square analysis were used to determine P values.
TAKEAWAY:
- In both cohorts, the median age of patients was 43 years, 79.2% were female, and most (39%) were from the southern region of the United States.
- All-cause total health care costs for patients with vitiligo were significantly higher than those of matched controls ($15,551 vs. $7,735; P < .0001).
- Similarly, medical costs for patients with vitiligo were significantly higher than those of control persons ($11,953 vs. $5,722), as were pharmacy costs ($3,598 vs. $2,014; P < .001 for both associations).
- A significantly greater proportion of patients with vitiligo had higher all-cause HCRU, compared with matched control persons. That included at least one ED visit (17.5% vs 13.4%), at least one inpatient visit (12.9% vs 6.8%), and at least one outpatient visit (99.8% vs. 88.3%; P < .0001 for all associations).
IN PRACTICE:
“These findings reveal an unmet need for cost-effective treatments and highlight the importance of fully identifying the drivers of economic burden for patients with vitiligo,” the authors concluded.
SOURCE:
Khaled Ezzedine, MD, PhD, of the department of dermatology at the Henri Mondor University Hospital, Créteil, France, led the study, which was published in the Journal of Investigative Dermatology.
LIMITATIONS:
The investigators did not evaluate indirect medical costs of vitiligo, such as work productivity, early retirement, and lost opportunities. Also, the results may not be generalizable to populations outside of the United States.
DISCLOSURES:
Dr. Ezzedine has received honoraria as a consultant for AbbVie, Incyte, La Roche–Posay, Pfizer, Pierre Fabre, Sanofi, and Viela Bio. One author is an investigator for Incyte and is a consultant for several pharmaceutical companies. Three authors are AbbVie employees.
A version of this article first appeared on Medscape.com.
TOPLINE:
METHODOLOGY:
- No published studies have quantified the medical costs and health care resource utilization (HCRU) among patients with vitiligo in the United States, compared with the general population.
- Drawing from the Merative MarketScan Commercial Claims and Encounters database, researchers reviewed the records of 49,512 patients diagnosed with vitiligo between Jan. 1, 2008, and Dec. 31, 2020, and those of 99,024 matched control persons who did not have vitiligo.
- Costs were in 2021 dollars during a 1-year postindex period. The student t test and chi square analysis were used to determine P values.
TAKEAWAY:
- In both cohorts, the median age of patients was 43 years, 79.2% were female, and most (39%) were from the southern region of the United States.
- All-cause total health care costs for patients with vitiligo were significantly higher than those of matched controls ($15,551 vs. $7,735; P < .0001).
- Similarly, medical costs for patients with vitiligo were significantly higher than those of control persons ($11,953 vs. $5,722), as were pharmacy costs ($3,598 vs. $2,014; P < .001 for both associations).
- A significantly greater proportion of patients with vitiligo had higher all-cause HCRU, compared with matched control persons. That included at least one ED visit (17.5% vs 13.4%), at least one inpatient visit (12.9% vs 6.8%), and at least one outpatient visit (99.8% vs. 88.3%; P < .0001 for all associations).
IN PRACTICE:
“These findings reveal an unmet need for cost-effective treatments and highlight the importance of fully identifying the drivers of economic burden for patients with vitiligo,” the authors concluded.
SOURCE:
Khaled Ezzedine, MD, PhD, of the department of dermatology at the Henri Mondor University Hospital, Créteil, France, led the study, which was published in the Journal of Investigative Dermatology.
LIMITATIONS:
The investigators did not evaluate indirect medical costs of vitiligo, such as work productivity, early retirement, and lost opportunities. Also, the results may not be generalizable to populations outside of the United States.
DISCLOSURES:
Dr. Ezzedine has received honoraria as a consultant for AbbVie, Incyte, La Roche–Posay, Pfizer, Pierre Fabre, Sanofi, and Viela Bio. One author is an investigator for Incyte and is a consultant for several pharmaceutical companies. Three authors are AbbVie employees.
A version of this article first appeared on Medscape.com.
RVUs: A fair measure of your productivity?
This transcript has been edited for clarity.
The other day, I received a flowery, elaborate email from none other than a physician recruiter: “Beautiful parks, hiking, great schools, blah blah blah, worked RVU production bonus on top of base pay.”
That last part – RVUs. I’m lost. I hear mixed reviews from physicians who work in RVU-based systems. The entire thing seems overly complex and confusing, so let’s clear it up. I did my research, and I’m going to explain RVUs.
Types of RVUs
RVUs, or relative value units, are a standard set by Medicare, used to measure physician productivity and ultimately determine compensation. There are three types:
- Work RVUs (basically everything that happens during a patient encounter).
- Practice expense RVUs.
- Professional liability insurance RVUs.
Now, envision this equation. All three of those RVUs are each multiplied by a geographic practice cost index to come up with a total number, and then that is multiplied by the Medicare conversion factor, which right now is around $33 to $34, to come up with a total dollar amount.
Work RVUs make up the bulk of total RVUs and they get their value from CPT codes. That value is determined by CMS. The AMA’s Relative Value Scale Update Committee, or RUC, which is made up of 32 people from various medical and surgical subspecialties, regularly meets and makes recommendations on the value of various CPT codes.
Is specialty representation fair and balanced?
CMS historically has accepted a high percentage of RUC’s recommendations, so this is a very influential committee. This is also why RUC has led to some controversy, with some stating that there is a lack of primary care representation, and perhaps this is why CPT codes related to procedures tend to reimburse higher.
How does one weigh the value of an hour-long palliative conversation against the quick removal of a benign skin lesion? That’s a loaded question.
This is especially important if your salary, or at least part of it, is determined by total RVUs. You want to have a sense of the pros and cons of working in an RVU system and how this relates to your specialty, your practice, and your schedule.
An RVU-based system provides an objective measure on complex patient encounters, volume, and procedures, and it’s a somewhat unified measure. The cons are pretty clear because these models favor you seeing many patients and billing a lot, and often this favors employers over physicians.
Dr. Patel is a clinical instructor, department of pediatrics, at Columbia University, New York, and a pediatric hospitalist at Morgan Stanley Children’s Hospital of New York–Presbyterian. He reported a conflict of interest with Medumo.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
The other day, I received a flowery, elaborate email from none other than a physician recruiter: “Beautiful parks, hiking, great schools, blah blah blah, worked RVU production bonus on top of base pay.”
That last part – RVUs. I’m lost. I hear mixed reviews from physicians who work in RVU-based systems. The entire thing seems overly complex and confusing, so let’s clear it up. I did my research, and I’m going to explain RVUs.
Types of RVUs
RVUs, or relative value units, are a standard set by Medicare, used to measure physician productivity and ultimately determine compensation. There are three types:
- Work RVUs (basically everything that happens during a patient encounter).
- Practice expense RVUs.
- Professional liability insurance RVUs.
Now, envision this equation. All three of those RVUs are each multiplied by a geographic practice cost index to come up with a total number, and then that is multiplied by the Medicare conversion factor, which right now is around $33 to $34, to come up with a total dollar amount.
Work RVUs make up the bulk of total RVUs and they get their value from CPT codes. That value is determined by CMS. The AMA’s Relative Value Scale Update Committee, or RUC, which is made up of 32 people from various medical and surgical subspecialties, regularly meets and makes recommendations on the value of various CPT codes.
Is specialty representation fair and balanced?
CMS historically has accepted a high percentage of RUC’s recommendations, so this is a very influential committee. This is also why RUC has led to some controversy, with some stating that there is a lack of primary care representation, and perhaps this is why CPT codes related to procedures tend to reimburse higher.
How does one weigh the value of an hour-long palliative conversation against the quick removal of a benign skin lesion? That’s a loaded question.
This is especially important if your salary, or at least part of it, is determined by total RVUs. You want to have a sense of the pros and cons of working in an RVU system and how this relates to your specialty, your practice, and your schedule.
An RVU-based system provides an objective measure on complex patient encounters, volume, and procedures, and it’s a somewhat unified measure. The cons are pretty clear because these models favor you seeing many patients and billing a lot, and often this favors employers over physicians.
Dr. Patel is a clinical instructor, department of pediatrics, at Columbia University, New York, and a pediatric hospitalist at Morgan Stanley Children’s Hospital of New York–Presbyterian. He reported a conflict of interest with Medumo.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
The other day, I received a flowery, elaborate email from none other than a physician recruiter: “Beautiful parks, hiking, great schools, blah blah blah, worked RVU production bonus on top of base pay.”
That last part – RVUs. I’m lost. I hear mixed reviews from physicians who work in RVU-based systems. The entire thing seems overly complex and confusing, so let’s clear it up. I did my research, and I’m going to explain RVUs.
Types of RVUs
RVUs, or relative value units, are a standard set by Medicare, used to measure physician productivity and ultimately determine compensation. There are three types:
- Work RVUs (basically everything that happens during a patient encounter).
- Practice expense RVUs.
- Professional liability insurance RVUs.
Now, envision this equation. All three of those RVUs are each multiplied by a geographic practice cost index to come up with a total number, and then that is multiplied by the Medicare conversion factor, which right now is around $33 to $34, to come up with a total dollar amount.
Work RVUs make up the bulk of total RVUs and they get their value from CPT codes. That value is determined by CMS. The AMA’s Relative Value Scale Update Committee, or RUC, which is made up of 32 people from various medical and surgical subspecialties, regularly meets and makes recommendations on the value of various CPT codes.
Is specialty representation fair and balanced?
CMS historically has accepted a high percentage of RUC’s recommendations, so this is a very influential committee. This is also why RUC has led to some controversy, with some stating that there is a lack of primary care representation, and perhaps this is why CPT codes related to procedures tend to reimburse higher.
How does one weigh the value of an hour-long palliative conversation against the quick removal of a benign skin lesion? That’s a loaded question.
This is especially important if your salary, or at least part of it, is determined by total RVUs. You want to have a sense of the pros and cons of working in an RVU system and how this relates to your specialty, your practice, and your schedule.
An RVU-based system provides an objective measure on complex patient encounters, volume, and procedures, and it’s a somewhat unified measure. The cons are pretty clear because these models favor you seeing many patients and billing a lot, and often this favors employers over physicians.
Dr. Patel is a clinical instructor, department of pediatrics, at Columbia University, New York, and a pediatric hospitalist at Morgan Stanley Children’s Hospital of New York–Presbyterian. He reported a conflict of interest with Medumo.
A version of this article first appeared on Medscape.com.
Take two pills and make a donation
I was a resident, on morning rounds. The attending neurologist was young and ambitious (weren’t we all once?), trying to get the hospital to help him fund a research program in his subspecialty of interest.
One of the patients we saw that morning was a locally known successful businessman who’d been admitted, fortunately not for anything too serious.
My attending took the history, verifying the one I’d presented, and examined the gentleman. He then made some teaching points and explained the care plan to the patient.
Pretty standard up to that point.
After answering questions, however, the attending suddenly went into a sales pitch on his new research program, asking the guy for a financial donation, and giving him the card for the person at his office handling the funding.
I don’t remember anymore if he repeated that with other patients, but even now it still leaves a bad taste in my mouth. As a resident I wasn’t in a position to criticize him, nor did I want to endanger my own standing in the program by talking to someone higher up.
He was, fortunately, the only attending I ever worked with who did that. It still stands out in my mind, perhaps as an example of what not to do, and sometimes I still think about it.
Perhaps I’m naive, but I assumed he was an aberration. Apparently not, as the American College of Physicians recently issued a position paper advising its members not to ask patients for donations to the doctor’s workplace. There’s actually an acronym, GPF (Grateful Patient Fundraising) for this.
I understand a lot of these doctors are in academics and need funding for research and other programs. I know that a lot of good comes from this research, and I fully support it.
But this seems to be a bad way of doing it. Standing at the bedside on that long-ago morning, I remember thinking the patient (who looked kind of surprised) was going to wonder if this was a vague sort of hint: You’ll get better care if you pay up. Or a veiled threat that you may not get decent care if you don’t. I have no idea if he donated.
There must be a better way to get funding than hitting up a patient as part of the care plan. Perhaps discharge materials might include a brochure about how to make a donation, if interested. Or the ubiquitous portal might have a “donate” box in the task bar.
If the patient were to initiate this on his own, I wouldn’t have an issue with it. He gets out of the hospital, is grateful for his care, and calls the physician’s office to say he’d like to make a donation to whatever his program is (or just goes online to do it). That’s fine. I’ve even had the occasional patient call my office to say they’d like to make a donation to my favorite charity, and I give them a list of various neurology research foundations (none of which I’m affiliated with, for the record).
But to actively solicit donations from someone under your care is tasteless and inappropriate. It creates a conflict of interest for both parties.
The patient may believe he’ll get better care, and is obligated to keep giving – or else. The physician may feel like he’s stuck going beyond what’s really needed, ordering unnecessary tests and such to keep the financial VIP happy. And what happens if the big donor patient calls in because he hurt his ankle and needs a Percocet refill that another doctor won’t give him?
The statement by the ACP is appropriate. The only thing that bothers me about it is that it had to be made at all.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I was a resident, on morning rounds. The attending neurologist was young and ambitious (weren’t we all once?), trying to get the hospital to help him fund a research program in his subspecialty of interest.
One of the patients we saw that morning was a locally known successful businessman who’d been admitted, fortunately not for anything too serious.
My attending took the history, verifying the one I’d presented, and examined the gentleman. He then made some teaching points and explained the care plan to the patient.
Pretty standard up to that point.
After answering questions, however, the attending suddenly went into a sales pitch on his new research program, asking the guy for a financial donation, and giving him the card for the person at his office handling the funding.
I don’t remember anymore if he repeated that with other patients, but even now it still leaves a bad taste in my mouth. As a resident I wasn’t in a position to criticize him, nor did I want to endanger my own standing in the program by talking to someone higher up.
He was, fortunately, the only attending I ever worked with who did that. It still stands out in my mind, perhaps as an example of what not to do, and sometimes I still think about it.
Perhaps I’m naive, but I assumed he was an aberration. Apparently not, as the American College of Physicians recently issued a position paper advising its members not to ask patients for donations to the doctor’s workplace. There’s actually an acronym, GPF (Grateful Patient Fundraising) for this.
I understand a lot of these doctors are in academics and need funding for research and other programs. I know that a lot of good comes from this research, and I fully support it.
But this seems to be a bad way of doing it. Standing at the bedside on that long-ago morning, I remember thinking the patient (who looked kind of surprised) was going to wonder if this was a vague sort of hint: You’ll get better care if you pay up. Or a veiled threat that you may not get decent care if you don’t. I have no idea if he donated.
There must be a better way to get funding than hitting up a patient as part of the care plan. Perhaps discharge materials might include a brochure about how to make a donation, if interested. Or the ubiquitous portal might have a “donate” box in the task bar.
If the patient were to initiate this on his own, I wouldn’t have an issue with it. He gets out of the hospital, is grateful for his care, and calls the physician’s office to say he’d like to make a donation to whatever his program is (or just goes online to do it). That’s fine. I’ve even had the occasional patient call my office to say they’d like to make a donation to my favorite charity, and I give them a list of various neurology research foundations (none of which I’m affiliated with, for the record).
But to actively solicit donations from someone under your care is tasteless and inappropriate. It creates a conflict of interest for both parties.
The patient may believe he’ll get better care, and is obligated to keep giving – or else. The physician may feel like he’s stuck going beyond what’s really needed, ordering unnecessary tests and such to keep the financial VIP happy. And what happens if the big donor patient calls in because he hurt his ankle and needs a Percocet refill that another doctor won’t give him?
The statement by the ACP is appropriate. The only thing that bothers me about it is that it had to be made at all.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I was a resident, on morning rounds. The attending neurologist was young and ambitious (weren’t we all once?), trying to get the hospital to help him fund a research program in his subspecialty of interest.
One of the patients we saw that morning was a locally known successful businessman who’d been admitted, fortunately not for anything too serious.
My attending took the history, verifying the one I’d presented, and examined the gentleman. He then made some teaching points and explained the care plan to the patient.
Pretty standard up to that point.
After answering questions, however, the attending suddenly went into a sales pitch on his new research program, asking the guy for a financial donation, and giving him the card for the person at his office handling the funding.
I don’t remember anymore if he repeated that with other patients, but even now it still leaves a bad taste in my mouth. As a resident I wasn’t in a position to criticize him, nor did I want to endanger my own standing in the program by talking to someone higher up.
He was, fortunately, the only attending I ever worked with who did that. It still stands out in my mind, perhaps as an example of what not to do, and sometimes I still think about it.
Perhaps I’m naive, but I assumed he was an aberration. Apparently not, as the American College of Physicians recently issued a position paper advising its members not to ask patients for donations to the doctor’s workplace. There’s actually an acronym, GPF (Grateful Patient Fundraising) for this.
I understand a lot of these doctors are in academics and need funding for research and other programs. I know that a lot of good comes from this research, and I fully support it.
But this seems to be a bad way of doing it. Standing at the bedside on that long-ago morning, I remember thinking the patient (who looked kind of surprised) was going to wonder if this was a vague sort of hint: You’ll get better care if you pay up. Or a veiled threat that you may not get decent care if you don’t. I have no idea if he donated.
There must be a better way to get funding than hitting up a patient as part of the care plan. Perhaps discharge materials might include a brochure about how to make a donation, if interested. Or the ubiquitous portal might have a “donate” box in the task bar.
If the patient were to initiate this on his own, I wouldn’t have an issue with it. He gets out of the hospital, is grateful for his care, and calls the physician’s office to say he’d like to make a donation to whatever his program is (or just goes online to do it). That’s fine. I’ve even had the occasional patient call my office to say they’d like to make a donation to my favorite charity, and I give them a list of various neurology research foundations (none of which I’m affiliated with, for the record).
But to actively solicit donations from someone under your care is tasteless and inappropriate. It creates a conflict of interest for both parties.
The patient may believe he’ll get better care, and is obligated to keep giving – or else. The physician may feel like he’s stuck going beyond what’s really needed, ordering unnecessary tests and such to keep the financial VIP happy. And what happens if the big donor patient calls in because he hurt his ankle and needs a Percocet refill that another doctor won’t give him?
The statement by the ACP is appropriate. The only thing that bothers me about it is that it had to be made at all.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Burnout in medical profession higher among women, younger clinicians
The poster child for a burned-out physician is a young woman practicing in primary care, according to a new study of more than 1,300 clinicians.
The study, published in JAMA Network Open. investigated patterns in physician burnout among 1,373 physicians at Massachusetts General Physicians Organization, a hospital-owned group practice. It assessed burnout in 3 years: 2017, 2019, and 2021.
Respondents were queried about their satisfaction with their career and compensation, as well as their well-being, administrative workload, and leadership and diversity.
Female physicians exhibited a higher burnout rate than male physicians (odds ratio, 1.47; 95% confidence interval, 1.02-2.12), while among primary care physicians (PCPs), the burnout rate was almost three times higher than among those in internal medicine (OR, 2.82; 95% CI, 1.76-4.50). Among physicians with 30 or more years of experience, the burnout rate was lower than among those with 10 years of experience or less (OR, 0.21; 95% CI, 0.13-0.35).
The fact that burnout disproportionately affects female physicians could reflect the additional household and family obligations women are often expected to handle, as well as their desire to form relationships with their patients, according to Timothy Hoff, PhD, a professor of management, healthcare systems, and health policy at Northeastern University, Boston.
“Female physicians tend to practice differently than their male counterparts,” said Dr. Hoff, who studies primary care. “They may focus more on the relational aspects of care, and that could lead to a higher rate of burnout.”
The study used the Maslach Burnout Inventory and three burnout subscales: exhaustion, cynicism, and reduced personal efficacy. The cohort was composed of 50% men, 67% White respondents, and 87% non-Hispanic respondents. A little over two-thirds of physicians had from 11 to 20 years of experience.
About 93% of those surveyed responded; by comparison, response rates were between 27% and 32% in previous analyses of physician burnout, the study authors say. They attribute this high participation rate to the fact that they compensated each participant with $850, more than is usually offered.
Hilton Gomes, MD, a partner at a concierge primary care practice in Miami – who has been practicing medicine for more than 15 years – said the increased rates of burnout among his younger colleagues are partly the result of a recent shift in what is considered the ideal work-life balance.
“Younger generations of doctors enter the profession with a strong desire for a better work-life balance. Unfortunately, medicine does not typically lend itself to achieving this balance,” he said.
Dr. Gomes recalled a time in medical school when he tried to visit his former pediatrician, who couldn’t be found at home.
“His wife informed me that he was tending to an urgent sick visit at the hospital, while his wife had to deal with their own grandson’s fracture being treated at urgent care,” Dr. Gomes said. “This illustrates, in my experience, how older generations of physicians accepted the demands of the profession as part of their commitment, and this often involved putting our own families second.”
Dr. Gomes, like many other PCPs who have converted to concierge medicine, previously worked at a practice where he saw nearly two dozen patients a day for a maximum of 15 minutes each.
“The structure of managed care often results in primary care physicians spending less time with patients and more time on paperwork, which is not the reason why physicians enter the field of medicine,” Dr. Gomes said.
Physicians are not alone in their feelings of physical and mental exhaustion. In the Medscape Physician Assistant Burnout Report 2023, 16% of respondents said the burnout they experienced was so severe that they were thinking of leaving medicine.
In 2022, PCP burnout cost the United States $260 million in excess health care expenditures. Burnout has also increased rates of physician suicide over the past 50 years and has led to a rise in medical errors.
Physicians say that programs that teach them to perform yoga and take deep breaths – which are offered by their employers – are not the solution.
“We sort of know what the realities of physician burnout are now; the imperative is to address it,” Dr. Hoff said. “We need studies that focus on the concepts of sustainability.”
The study was funded by the Massachusetts General Physicians Organization. A coauthor reports receiving a grant from the American Heart Association. No other disclosures were reported.
A version of this article first appeared on Medscape.com.
The poster child for a burned-out physician is a young woman practicing in primary care, according to a new study of more than 1,300 clinicians.
The study, published in JAMA Network Open. investigated patterns in physician burnout among 1,373 physicians at Massachusetts General Physicians Organization, a hospital-owned group practice. It assessed burnout in 3 years: 2017, 2019, and 2021.
Respondents were queried about their satisfaction with their career and compensation, as well as their well-being, administrative workload, and leadership and diversity.
Female physicians exhibited a higher burnout rate than male physicians (odds ratio, 1.47; 95% confidence interval, 1.02-2.12), while among primary care physicians (PCPs), the burnout rate was almost three times higher than among those in internal medicine (OR, 2.82; 95% CI, 1.76-4.50). Among physicians with 30 or more years of experience, the burnout rate was lower than among those with 10 years of experience or less (OR, 0.21; 95% CI, 0.13-0.35).
The fact that burnout disproportionately affects female physicians could reflect the additional household and family obligations women are often expected to handle, as well as their desire to form relationships with their patients, according to Timothy Hoff, PhD, a professor of management, healthcare systems, and health policy at Northeastern University, Boston.
“Female physicians tend to practice differently than their male counterparts,” said Dr. Hoff, who studies primary care. “They may focus more on the relational aspects of care, and that could lead to a higher rate of burnout.”
The study used the Maslach Burnout Inventory and three burnout subscales: exhaustion, cynicism, and reduced personal efficacy. The cohort was composed of 50% men, 67% White respondents, and 87% non-Hispanic respondents. A little over two-thirds of physicians had from 11 to 20 years of experience.
About 93% of those surveyed responded; by comparison, response rates were between 27% and 32% in previous analyses of physician burnout, the study authors say. They attribute this high participation rate to the fact that they compensated each participant with $850, more than is usually offered.
Hilton Gomes, MD, a partner at a concierge primary care practice in Miami – who has been practicing medicine for more than 15 years – said the increased rates of burnout among his younger colleagues are partly the result of a recent shift in what is considered the ideal work-life balance.
“Younger generations of doctors enter the profession with a strong desire for a better work-life balance. Unfortunately, medicine does not typically lend itself to achieving this balance,” he said.
Dr. Gomes recalled a time in medical school when he tried to visit his former pediatrician, who couldn’t be found at home.
“His wife informed me that he was tending to an urgent sick visit at the hospital, while his wife had to deal with their own grandson’s fracture being treated at urgent care,” Dr. Gomes said. “This illustrates, in my experience, how older generations of physicians accepted the demands of the profession as part of their commitment, and this often involved putting our own families second.”
Dr. Gomes, like many other PCPs who have converted to concierge medicine, previously worked at a practice where he saw nearly two dozen patients a day for a maximum of 15 minutes each.
“The structure of managed care often results in primary care physicians spending less time with patients and more time on paperwork, which is not the reason why physicians enter the field of medicine,” Dr. Gomes said.
Physicians are not alone in their feelings of physical and mental exhaustion. In the Medscape Physician Assistant Burnout Report 2023, 16% of respondents said the burnout they experienced was so severe that they were thinking of leaving medicine.
In 2022, PCP burnout cost the United States $260 million in excess health care expenditures. Burnout has also increased rates of physician suicide over the past 50 years and has led to a rise in medical errors.
Physicians say that programs that teach them to perform yoga and take deep breaths – which are offered by their employers – are not the solution.
“We sort of know what the realities of physician burnout are now; the imperative is to address it,” Dr. Hoff said. “We need studies that focus on the concepts of sustainability.”
The study was funded by the Massachusetts General Physicians Organization. A coauthor reports receiving a grant from the American Heart Association. No other disclosures were reported.
A version of this article first appeared on Medscape.com.
The poster child for a burned-out physician is a young woman practicing in primary care, according to a new study of more than 1,300 clinicians.
The study, published in JAMA Network Open. investigated patterns in physician burnout among 1,373 physicians at Massachusetts General Physicians Organization, a hospital-owned group practice. It assessed burnout in 3 years: 2017, 2019, and 2021.
Respondents were queried about their satisfaction with their career and compensation, as well as their well-being, administrative workload, and leadership and diversity.
Female physicians exhibited a higher burnout rate than male physicians (odds ratio, 1.47; 95% confidence interval, 1.02-2.12), while among primary care physicians (PCPs), the burnout rate was almost three times higher than among those in internal medicine (OR, 2.82; 95% CI, 1.76-4.50). Among physicians with 30 or more years of experience, the burnout rate was lower than among those with 10 years of experience or less (OR, 0.21; 95% CI, 0.13-0.35).
The fact that burnout disproportionately affects female physicians could reflect the additional household and family obligations women are often expected to handle, as well as their desire to form relationships with their patients, according to Timothy Hoff, PhD, a professor of management, healthcare systems, and health policy at Northeastern University, Boston.
“Female physicians tend to practice differently than their male counterparts,” said Dr. Hoff, who studies primary care. “They may focus more on the relational aspects of care, and that could lead to a higher rate of burnout.”
The study used the Maslach Burnout Inventory and three burnout subscales: exhaustion, cynicism, and reduced personal efficacy. The cohort was composed of 50% men, 67% White respondents, and 87% non-Hispanic respondents. A little over two-thirds of physicians had from 11 to 20 years of experience.
About 93% of those surveyed responded; by comparison, response rates were between 27% and 32% in previous analyses of physician burnout, the study authors say. They attribute this high participation rate to the fact that they compensated each participant with $850, more than is usually offered.
Hilton Gomes, MD, a partner at a concierge primary care practice in Miami – who has been practicing medicine for more than 15 years – said the increased rates of burnout among his younger colleagues are partly the result of a recent shift in what is considered the ideal work-life balance.
“Younger generations of doctors enter the profession with a strong desire for a better work-life balance. Unfortunately, medicine does not typically lend itself to achieving this balance,” he said.
Dr. Gomes recalled a time in medical school when he tried to visit his former pediatrician, who couldn’t be found at home.
“His wife informed me that he was tending to an urgent sick visit at the hospital, while his wife had to deal with their own grandson’s fracture being treated at urgent care,” Dr. Gomes said. “This illustrates, in my experience, how older generations of physicians accepted the demands of the profession as part of their commitment, and this often involved putting our own families second.”
Dr. Gomes, like many other PCPs who have converted to concierge medicine, previously worked at a practice where he saw nearly two dozen patients a day for a maximum of 15 minutes each.
“The structure of managed care often results in primary care physicians spending less time with patients and more time on paperwork, which is not the reason why physicians enter the field of medicine,” Dr. Gomes said.
Physicians are not alone in their feelings of physical and mental exhaustion. In the Medscape Physician Assistant Burnout Report 2023, 16% of respondents said the burnout they experienced was so severe that they were thinking of leaving medicine.
In 2022, PCP burnout cost the United States $260 million in excess health care expenditures. Burnout has also increased rates of physician suicide over the past 50 years and has led to a rise in medical errors.
Physicians say that programs that teach them to perform yoga and take deep breaths – which are offered by their employers – are not the solution.
“We sort of know what the realities of physician burnout are now; the imperative is to address it,” Dr. Hoff said. “We need studies that focus on the concepts of sustainability.”
The study was funded by the Massachusetts General Physicians Organization. A coauthor reports receiving a grant from the American Heart Association. No other disclosures were reported.
A version of this article first appeared on Medscape.com.
FROM JAMA NETWORK OPEN
MOC opposition continues to gain momentum as ASH weighs in
ASH president Robert A. Brodsky, MD, sent a letter to ABIM’s President and Chief Executive Officer Richard Baron, MD, highlighting hematologists’ concerns about the MOC process and outlining immediate actions ABIM should take.
“ASH continues to support the importance of lifelong learning for hematologists via a program that is evidence-based, relevant to one’s practice, and transparent; however, these three basic requirements are not met by the current ABIM MOC program,” Dr. Brodsky stated in the Sept. 27 letter to Baron.
Dr. Brodsky highlighted, for instance, the fact that the Longitudinal Knowledge Assessment – the alternative to the 10-year exam – “does not reflect real life practice, nor does it target each individual’s scope of practice.” Dr. Brodsky added that, according to members of ASH, the assessment is also “creating high levels of stress and contributing to burnout.”
The letter from Dr. Brodsky urged ABIM to “establish a new MOC program” that does not involve high-stakes assessments, reduces the number of Longitudinal Knowledge Assessment questions physicians receive, and eliminates redundancy between the MOC requirement to have a current license and the requirement to report continued medical education to ABIM.
The ABIM shared a copy of the letter in a Sept. 28 blog post defending the MOC process, highlighting past collaboration with ASH that “has led to meaningful enhancements to the [MOC] program” and committing to “continue to listen to and learn from the physician community going forward.”
The recent backlash against the MOC process stemmed from a petition demanding an end to the MOC. The petition was launched in July by hematologist-oncologist Aaron Goodman, MD, from the University of California, San Diego, who has been a vocal critic of the MOC process.
The criticism largely centered around the high costs and the “complex and time-consuming process that poses significant challenges to practicing physicians,” Dr. Goodman wrote in the petition, which has garnered more than 20,700 signatures.
In August, the Society for Cardiovascular Angiography and Interventions (SCAI) published “SCAI Position on ABIM Revocation of Certification for Not Participating in MOC.” The Electrophysiology Advocacy Foundation and the Heart Rhythm Society (HRS) issued statements pushing back on the MOC as well.
On Sept. 21, the SCAI, HRS, American College of Cardiology, and the Heart Failure Society of America went a step further and announced plans to create a new certification process that is independent of the ABIM MOC system.
The American Society of Clinical Oncology (ASCO) is now also surveying members about their MOC experience. A Sept. 26 announcement encouraged recipients to check their inboxes for a link to an anonymous MOC Experience Questionnaire before Oct. 12 and thanked respondents for their “engagement as ASCO works to address this critical issue for the oncology community.”
After ASH sent its letter to ABIM, Dr. Goodman applauded the society’s stance in a post on his X (formerly Twitter) account. Vincent Rajkumar, MD, a hematologist at the Mayo Clinic in Rochester, Minn., commented on ABIM’s response to ASH’s letter via X, noting, “If I were @ASH_hematology leadership, I would take ABIM response as disrespectful. A hasty response within a day is not a sign of good faith.”
A version of this article first appeared on Medscape.com.
ASH president Robert A. Brodsky, MD, sent a letter to ABIM’s President and Chief Executive Officer Richard Baron, MD, highlighting hematologists’ concerns about the MOC process and outlining immediate actions ABIM should take.
“ASH continues to support the importance of lifelong learning for hematologists via a program that is evidence-based, relevant to one’s practice, and transparent; however, these three basic requirements are not met by the current ABIM MOC program,” Dr. Brodsky stated in the Sept. 27 letter to Baron.
Dr. Brodsky highlighted, for instance, the fact that the Longitudinal Knowledge Assessment – the alternative to the 10-year exam – “does not reflect real life practice, nor does it target each individual’s scope of practice.” Dr. Brodsky added that, according to members of ASH, the assessment is also “creating high levels of stress and contributing to burnout.”
The letter from Dr. Brodsky urged ABIM to “establish a new MOC program” that does not involve high-stakes assessments, reduces the number of Longitudinal Knowledge Assessment questions physicians receive, and eliminates redundancy between the MOC requirement to have a current license and the requirement to report continued medical education to ABIM.
The ABIM shared a copy of the letter in a Sept. 28 blog post defending the MOC process, highlighting past collaboration with ASH that “has led to meaningful enhancements to the [MOC] program” and committing to “continue to listen to and learn from the physician community going forward.”
The recent backlash against the MOC process stemmed from a petition demanding an end to the MOC. The petition was launched in July by hematologist-oncologist Aaron Goodman, MD, from the University of California, San Diego, who has been a vocal critic of the MOC process.
The criticism largely centered around the high costs and the “complex and time-consuming process that poses significant challenges to practicing physicians,” Dr. Goodman wrote in the petition, which has garnered more than 20,700 signatures.
In August, the Society for Cardiovascular Angiography and Interventions (SCAI) published “SCAI Position on ABIM Revocation of Certification for Not Participating in MOC.” The Electrophysiology Advocacy Foundation and the Heart Rhythm Society (HRS) issued statements pushing back on the MOC as well.
On Sept. 21, the SCAI, HRS, American College of Cardiology, and the Heart Failure Society of America went a step further and announced plans to create a new certification process that is independent of the ABIM MOC system.
The American Society of Clinical Oncology (ASCO) is now also surveying members about their MOC experience. A Sept. 26 announcement encouraged recipients to check their inboxes for a link to an anonymous MOC Experience Questionnaire before Oct. 12 and thanked respondents for their “engagement as ASCO works to address this critical issue for the oncology community.”
After ASH sent its letter to ABIM, Dr. Goodman applauded the society’s stance in a post on his X (formerly Twitter) account. Vincent Rajkumar, MD, a hematologist at the Mayo Clinic in Rochester, Minn., commented on ABIM’s response to ASH’s letter via X, noting, “If I were @ASH_hematology leadership, I would take ABIM response as disrespectful. A hasty response within a day is not a sign of good faith.”
A version of this article first appeared on Medscape.com.
ASH president Robert A. Brodsky, MD, sent a letter to ABIM’s President and Chief Executive Officer Richard Baron, MD, highlighting hematologists’ concerns about the MOC process and outlining immediate actions ABIM should take.
“ASH continues to support the importance of lifelong learning for hematologists via a program that is evidence-based, relevant to one’s practice, and transparent; however, these three basic requirements are not met by the current ABIM MOC program,” Dr. Brodsky stated in the Sept. 27 letter to Baron.
Dr. Brodsky highlighted, for instance, the fact that the Longitudinal Knowledge Assessment – the alternative to the 10-year exam – “does not reflect real life practice, nor does it target each individual’s scope of practice.” Dr. Brodsky added that, according to members of ASH, the assessment is also “creating high levels of stress and contributing to burnout.”
The letter from Dr. Brodsky urged ABIM to “establish a new MOC program” that does not involve high-stakes assessments, reduces the number of Longitudinal Knowledge Assessment questions physicians receive, and eliminates redundancy between the MOC requirement to have a current license and the requirement to report continued medical education to ABIM.
The ABIM shared a copy of the letter in a Sept. 28 blog post defending the MOC process, highlighting past collaboration with ASH that “has led to meaningful enhancements to the [MOC] program” and committing to “continue to listen to and learn from the physician community going forward.”
The recent backlash against the MOC process stemmed from a petition demanding an end to the MOC. The petition was launched in July by hematologist-oncologist Aaron Goodman, MD, from the University of California, San Diego, who has been a vocal critic of the MOC process.
The criticism largely centered around the high costs and the “complex and time-consuming process that poses significant challenges to practicing physicians,” Dr. Goodman wrote in the petition, which has garnered more than 20,700 signatures.
In August, the Society for Cardiovascular Angiography and Interventions (SCAI) published “SCAI Position on ABIM Revocation of Certification for Not Participating in MOC.” The Electrophysiology Advocacy Foundation and the Heart Rhythm Society (HRS) issued statements pushing back on the MOC as well.
On Sept. 21, the SCAI, HRS, American College of Cardiology, and the Heart Failure Society of America went a step further and announced plans to create a new certification process that is independent of the ABIM MOC system.
The American Society of Clinical Oncology (ASCO) is now also surveying members about their MOC experience. A Sept. 26 announcement encouraged recipients to check their inboxes for a link to an anonymous MOC Experience Questionnaire before Oct. 12 and thanked respondents for their “engagement as ASCO works to address this critical issue for the oncology community.”
After ASH sent its letter to ABIM, Dr. Goodman applauded the society’s stance in a post on his X (formerly Twitter) account. Vincent Rajkumar, MD, a hematologist at the Mayo Clinic in Rochester, Minn., commented on ABIM’s response to ASH’s letter via X, noting, “If I were @ASH_hematology leadership, I would take ABIM response as disrespectful. A hasty response within a day is not a sign of good faith.”
A version of this article first appeared on Medscape.com.
The future for the primary care physician?
“The doctor won’t see you now.”
The editor of the alumni magazine had succeeded in getting my attention. The shock value of the headline hooked me and I was drawn in to chase down the research. A study by a team of researchers at Harvard Medical School has published a study in the British Medical Journal revealing that “from 2013 to 2019 the share of U.S. health care visits delivered by nonphysicians such as nurse practitioners or physician assistants increased from 14% to 26%.” In other words, at more than a quarter of the health care visits in this country the patient is not seen by a physician. The percent seen by advanced-practice providers varied by complaint and specialty. For example, 47% of patients with a respiratory complaint saw a nurse practitioner or physicians assistant, while for an eye condition only 13% were seen by an advanced-practice provider. However, overall the increase was dramatic.
It doesn’t require much deep thinking to come up with some explanations for this shift in provider involvement. It boils down to supply and demand. Compared with other similar nations, we have fewer physicians. Physicians are leaving the profession for a variety of reasons, including disappointment with their work-life balance and a sense that too much of their day is devoted to meaningless work with user unfriendly computer systems.
The number of nurse practitioners and physician assistants is growing faster than that of physicians. In fact it has been predicted that over the next 2 decades advanced-practice providers will increase by more than 50% while the physician pool will grow by less than 5%.
We can mull over the how-we-got-here ad infinitum, but this recent study suggests that we had better hustle and invest some time rethinking the role of a physician and how we should adapt our education system to better prepare for those choosing the path through medical school. This mirror gazing is particularly critical for those of us doing primary care.
While in years past I often heard a discontented grumble from patients that “I was ‘only’ seen by the nurse practitioner,” this complaint has become much less frequent as patients have gained more experience with advanced-practice providers and have begun to accept the new reality and see the change as inevitable.
When someone tells me that their daughter or nephew or second cousin is planning on becoming a doctor, I pause and listen patiently as they go on proudly about it before asking if the young person has considered becoming a physician assistant. I say, “Ya know, if I were 60 years younger I think I would bypass medical school and become a nurse practitioner because they get to do all the cool things that I enjoyed about seeing patients. Sure, my mother wouldn’t have been able to introduce me as her son the doctor. But, my parents and I would have spent less time and money on my training, and I would have had less administrative hassle heaped on me once I went into practice.”
The essence of good primary care is Availability, Continuity, and Expertise. The first two attributes aren’t taught in medical school and rely on commitment and having enough bodies to deliver the care. When it comes to expertise, how important is the broad and deep education of traditional medical school when the provider is seeing the relatively narrow spectrum of bread-and-butter everyday complaints that fill the day for most primary care providers? Particularly, when the population has already been preselected by age, geography, and socioeconomic factors.
The usual argument against my assertion is that a higher-priced and more arduous education pathway better provides the physician with the tools to deal with the outliers, the diagnostic enigmas. My reply is that any good provider regardless of his or her years spent in training is taught to first admit what they don’t know. When faced with an enigma, call a consultant or, in the near future, access a Chatbot.
If the natural market and economic forces continue to drive the growth of advanced-practice providers, what role(s) remains for the medical school–trained primary care provider? Does she or he remain the leader of a team of providers? Does she or he still see patients and somehow remain the first among equals?
While patients seem to be warming to the notion of seeing a nonphysician provider, I often still hear the complaint but “I see a different provider every time I go to the office.” Continuity is one of those three keystones of quality primary care. It is not incompatible with a team concept of care delivery, but it does require a commitment to the concept and creative scheduling that allows the patient to see the same provider at almost every visit. I’m not sure where having a first-among-equals provider fits into that scheme. Is it just one more “different” provider?
Maybe the medical school–trained provider becomes a consultant physician, much as the British and Canadian systems seem to work. She or he would see patients only after the advanced primary care provider has done an evaluation and is unsure of the next step. Would this be at the same site or electronically? Is there a time lag? In my old-school interpretation, if the visit is not the same day or maybe the next day then it doesn’t satisfy my Availability requirement of primary care.
Primarily an educator who generally doesn’t see patients but instead trains advanced primary care providers, organizes them into teams that function to provide care in a timely fashion that emphasizes Continuity, and then performs ongoing, real time assessments to assure that care provided is at the highest level of Expertise.
It sounds like an interesting and challenging job description requiring a deep and broad education. Just not one that appeals to me. I would rather be a nurse practitioner or physician’s assistant who is on the front line and hands on.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected]
“The doctor won’t see you now.”
The editor of the alumni magazine had succeeded in getting my attention. The shock value of the headline hooked me and I was drawn in to chase down the research. A study by a team of researchers at Harvard Medical School has published a study in the British Medical Journal revealing that “from 2013 to 2019 the share of U.S. health care visits delivered by nonphysicians such as nurse practitioners or physician assistants increased from 14% to 26%.” In other words, at more than a quarter of the health care visits in this country the patient is not seen by a physician. The percent seen by advanced-practice providers varied by complaint and specialty. For example, 47% of patients with a respiratory complaint saw a nurse practitioner or physicians assistant, while for an eye condition only 13% were seen by an advanced-practice provider. However, overall the increase was dramatic.
It doesn’t require much deep thinking to come up with some explanations for this shift in provider involvement. It boils down to supply and demand. Compared with other similar nations, we have fewer physicians. Physicians are leaving the profession for a variety of reasons, including disappointment with their work-life balance and a sense that too much of their day is devoted to meaningless work with user unfriendly computer systems.
The number of nurse practitioners and physician assistants is growing faster than that of physicians. In fact it has been predicted that over the next 2 decades advanced-practice providers will increase by more than 50% while the physician pool will grow by less than 5%.
We can mull over the how-we-got-here ad infinitum, but this recent study suggests that we had better hustle and invest some time rethinking the role of a physician and how we should adapt our education system to better prepare for those choosing the path through medical school. This mirror gazing is particularly critical for those of us doing primary care.
While in years past I often heard a discontented grumble from patients that “I was ‘only’ seen by the nurse practitioner,” this complaint has become much less frequent as patients have gained more experience with advanced-practice providers and have begun to accept the new reality and see the change as inevitable.
When someone tells me that their daughter or nephew or second cousin is planning on becoming a doctor, I pause and listen patiently as they go on proudly about it before asking if the young person has considered becoming a physician assistant. I say, “Ya know, if I were 60 years younger I think I would bypass medical school and become a nurse practitioner because they get to do all the cool things that I enjoyed about seeing patients. Sure, my mother wouldn’t have been able to introduce me as her son the doctor. But, my parents and I would have spent less time and money on my training, and I would have had less administrative hassle heaped on me once I went into practice.”
The essence of good primary care is Availability, Continuity, and Expertise. The first two attributes aren’t taught in medical school and rely on commitment and having enough bodies to deliver the care. When it comes to expertise, how important is the broad and deep education of traditional medical school when the provider is seeing the relatively narrow spectrum of bread-and-butter everyday complaints that fill the day for most primary care providers? Particularly, when the population has already been preselected by age, geography, and socioeconomic factors.
The usual argument against my assertion is that a higher-priced and more arduous education pathway better provides the physician with the tools to deal with the outliers, the diagnostic enigmas. My reply is that any good provider regardless of his or her years spent in training is taught to first admit what they don’t know. When faced with an enigma, call a consultant or, in the near future, access a Chatbot.
If the natural market and economic forces continue to drive the growth of advanced-practice providers, what role(s) remains for the medical school–trained primary care provider? Does she or he remain the leader of a team of providers? Does she or he still see patients and somehow remain the first among equals?
While patients seem to be warming to the notion of seeing a nonphysician provider, I often still hear the complaint but “I see a different provider every time I go to the office.” Continuity is one of those three keystones of quality primary care. It is not incompatible with a team concept of care delivery, but it does require a commitment to the concept and creative scheduling that allows the patient to see the same provider at almost every visit. I’m not sure where having a first-among-equals provider fits into that scheme. Is it just one more “different” provider?
Maybe the medical school–trained provider becomes a consultant physician, much as the British and Canadian systems seem to work. She or he would see patients only after the advanced primary care provider has done an evaluation and is unsure of the next step. Would this be at the same site or electronically? Is there a time lag? In my old-school interpretation, if the visit is not the same day or maybe the next day then it doesn’t satisfy my Availability requirement of primary care.
Primarily an educator who generally doesn’t see patients but instead trains advanced primary care providers, organizes them into teams that function to provide care in a timely fashion that emphasizes Continuity, and then performs ongoing, real time assessments to assure that care provided is at the highest level of Expertise.
It sounds like an interesting and challenging job description requiring a deep and broad education. Just not one that appeals to me. I would rather be a nurse practitioner or physician’s assistant who is on the front line and hands on.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected]
“The doctor won’t see you now.”
The editor of the alumni magazine had succeeded in getting my attention. The shock value of the headline hooked me and I was drawn in to chase down the research. A study by a team of researchers at Harvard Medical School has published a study in the British Medical Journal revealing that “from 2013 to 2019 the share of U.S. health care visits delivered by nonphysicians such as nurse practitioners or physician assistants increased from 14% to 26%.” In other words, at more than a quarter of the health care visits in this country the patient is not seen by a physician. The percent seen by advanced-practice providers varied by complaint and specialty. For example, 47% of patients with a respiratory complaint saw a nurse practitioner or physicians assistant, while for an eye condition only 13% were seen by an advanced-practice provider. However, overall the increase was dramatic.
It doesn’t require much deep thinking to come up with some explanations for this shift in provider involvement. It boils down to supply and demand. Compared with other similar nations, we have fewer physicians. Physicians are leaving the profession for a variety of reasons, including disappointment with their work-life balance and a sense that too much of their day is devoted to meaningless work with user unfriendly computer systems.
The number of nurse practitioners and physician assistants is growing faster than that of physicians. In fact it has been predicted that over the next 2 decades advanced-practice providers will increase by more than 50% while the physician pool will grow by less than 5%.
We can mull over the how-we-got-here ad infinitum, but this recent study suggests that we had better hustle and invest some time rethinking the role of a physician and how we should adapt our education system to better prepare for those choosing the path through medical school. This mirror gazing is particularly critical for those of us doing primary care.
While in years past I often heard a discontented grumble from patients that “I was ‘only’ seen by the nurse practitioner,” this complaint has become much less frequent as patients have gained more experience with advanced-practice providers and have begun to accept the new reality and see the change as inevitable.
When someone tells me that their daughter or nephew or second cousin is planning on becoming a doctor, I pause and listen patiently as they go on proudly about it before asking if the young person has considered becoming a physician assistant. I say, “Ya know, if I were 60 years younger I think I would bypass medical school and become a nurse practitioner because they get to do all the cool things that I enjoyed about seeing patients. Sure, my mother wouldn’t have been able to introduce me as her son the doctor. But, my parents and I would have spent less time and money on my training, and I would have had less administrative hassle heaped on me once I went into practice.”
The essence of good primary care is Availability, Continuity, and Expertise. The first two attributes aren’t taught in medical school and rely on commitment and having enough bodies to deliver the care. When it comes to expertise, how important is the broad and deep education of traditional medical school when the provider is seeing the relatively narrow spectrum of bread-and-butter everyday complaints that fill the day for most primary care providers? Particularly, when the population has already been preselected by age, geography, and socioeconomic factors.
The usual argument against my assertion is that a higher-priced and more arduous education pathway better provides the physician with the tools to deal with the outliers, the diagnostic enigmas. My reply is that any good provider regardless of his or her years spent in training is taught to first admit what they don’t know. When faced with an enigma, call a consultant or, in the near future, access a Chatbot.
If the natural market and economic forces continue to drive the growth of advanced-practice providers, what role(s) remains for the medical school–trained primary care provider? Does she or he remain the leader of a team of providers? Does she or he still see patients and somehow remain the first among equals?
While patients seem to be warming to the notion of seeing a nonphysician provider, I often still hear the complaint but “I see a different provider every time I go to the office.” Continuity is one of those three keystones of quality primary care. It is not incompatible with a team concept of care delivery, but it does require a commitment to the concept and creative scheduling that allows the patient to see the same provider at almost every visit. I’m not sure where having a first-among-equals provider fits into that scheme. Is it just one more “different” provider?
Maybe the medical school–trained provider becomes a consultant physician, much as the British and Canadian systems seem to work. She or he would see patients only after the advanced primary care provider has done an evaluation and is unsure of the next step. Would this be at the same site or electronically? Is there a time lag? In my old-school interpretation, if the visit is not the same day or maybe the next day then it doesn’t satisfy my Availability requirement of primary care.
Primarily an educator who generally doesn’t see patients but instead trains advanced primary care providers, organizes them into teams that function to provide care in a timely fashion that emphasizes Continuity, and then performs ongoing, real time assessments to assure that care provided is at the highest level of Expertise.
It sounds like an interesting and challenging job description requiring a deep and broad education. Just not one that appeals to me. I would rather be a nurse practitioner or physician’s assistant who is on the front line and hands on.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected]
From scrubs to screens: Growing your patient base with social media
With physicians under increasing pressure to see more patients in shorter office visits, developing a social media presence may offer valuable opportunities to connect with patients, explain procedures, combat misinformation, talk through a published article, and even share a joke or meme.
But there are caveats for doctors posting on social media platforms. This news organization spoke to four doctors who successfully use social media.
Use social media for the right reasons
While you’re under no obligation to build a social media presence, if you’re going to do it, be sure your intentions are solid, said Don S. Dizon, MD, professor of medicine and professor of surgery at Brown University, Providence, R.I. Dr. Dizon, as @DoctorDon, has 44,700 TikTok followers and uses the platform to answer cancer-related questions.
“It should be your altruism that motivates you to post,” said Dr. Dizon, who is also associate director of community outreach and engagement at the Legorreta Cancer Center in Providence, R.I., and director of medical oncology at Rhode Island Hospital. “What we can do for society at large is to provide our input into issues, add informed opinions where there’s controversy, and address misinformation.”
If you don’t know where to start, consider seeking a digital mentor to talk through your options.
“You may never meet this person, but you should choose them if you like their style, their content, their delivery, and their perspective,” Dr. Dizon said. “Find another doctor out there on social media whom you feel you can emulate. Take your time, too. Soon enough, you’ll develop your own style and your own online persona.”
Post clear, accurate information
If you want to be lighthearted on social media, that’s your choice. But Jennifer Trachtenberg, a pediatrician with nearly 7,000 Instagram followers in New York who posts as @askdrjen, prefers to offer vaccine scheduling tips, alert parents about COVID-19 rates, and offer advice on cold and flu prevention.
“Right now, I’m mainly doing this to educate patients and make them aware of topics that I think are important and that I see my patients needing more information on,” she said. “We have to be clear: People take what we say seriously. So, while it’s important to be relatable, it’s even more important to share evidence-based information.”
Many patients get their information on social media
While patients once came to the doctor armed with information sourced via “Doctor Google,” today, just as many patients use social media to learn about their condition or the medications they’re taking.
Unfortunately, a recent Ohio State University, Columbus, study found that the majority of gynecologic cancer advice on TikTok, for example, was either misleading or inaccurate.
“This misinformation should be a motivator for physicians to explore the social media space,” Dr. Dizon said. “Our voices need to be on there.”
Break down barriers – and make connections
Mike Natter, MD, an endocrinologist in New York, has type 1 diabetes. This informs his work – and his life – and he’s passionate about sharing it with his 117,000 followers as @mike.natter on Instagram.
“A lot of type 1s follow me, so there’s an advocacy component to what I do,” he said. “I enjoy being able to raise awareness and keep people up to date on the newest research and treatment.”
But that’s not all: Dr. Natter is also an artist who went to art school before he went to medical school, and his account is rife with his cartoons and illustrations about everything from valvular disease to diabetic ketoacidosis.
“I found that I was drawing a lot of my notes in medical school,” he said. “When I drew my notes, I did quite well, and I think that using art and illustration is a great tool. It breaks down barriers and makes health information all the more accessible to everyone.”
Share your expertise as a doctor – and a person
As a mom and pediatrician, Krupa Playforth, MD, who practices in Vienna, Va., knows that what she posts carries weight. So, whether she’s writing about backpack safety tips, choking hazards, or separation anxiety, her followers can rest assured that she’s posting responsibly.
“Pediatricians often underestimate how smart parents are,” said Dr. Playforth, who has three kids, ages 8, 5, and 2, and has 137,000 followers on @thepediatricianmom, her Instagram account. “Their anxiety comes from an understandable place, which is why I see my role as that of a parent and pediatrician who can translate the knowledge pediatricians have into something parents can understand.”
Dr. Playforth, who jumped on social media during COVID-19 and experienced a positive response in her local community, said being on social media is imperative if you’re a pediatrician.
“This is the future of pediatric medicine in particular,” she said. “A lot of pediatricians don’t want to embrace social media, but I think that’s a mistake. After all, while parents think pediatricians have all the answers, when we think of our own children, most doctors are like other parents – we can’t think objectively about our kids. It’s helpful for me to share that and to help parents feel less alone.”
If you’re not yet using social media to the best of your physician abilities, you might take a shot at becoming widely recognizable. Pick a preferred platform, answer common patient questions, dispel medical myths, provide pertinent information, and let your personality shine.
A version of this article first appeared on Medscape.com.
With physicians under increasing pressure to see more patients in shorter office visits, developing a social media presence may offer valuable opportunities to connect with patients, explain procedures, combat misinformation, talk through a published article, and even share a joke or meme.
But there are caveats for doctors posting on social media platforms. This news organization spoke to four doctors who successfully use social media.
Use social media for the right reasons
While you’re under no obligation to build a social media presence, if you’re going to do it, be sure your intentions are solid, said Don S. Dizon, MD, professor of medicine and professor of surgery at Brown University, Providence, R.I. Dr. Dizon, as @DoctorDon, has 44,700 TikTok followers and uses the platform to answer cancer-related questions.
“It should be your altruism that motivates you to post,” said Dr. Dizon, who is also associate director of community outreach and engagement at the Legorreta Cancer Center in Providence, R.I., and director of medical oncology at Rhode Island Hospital. “What we can do for society at large is to provide our input into issues, add informed opinions where there’s controversy, and address misinformation.”
If you don’t know where to start, consider seeking a digital mentor to talk through your options.
“You may never meet this person, but you should choose them if you like their style, their content, their delivery, and their perspective,” Dr. Dizon said. “Find another doctor out there on social media whom you feel you can emulate. Take your time, too. Soon enough, you’ll develop your own style and your own online persona.”
Post clear, accurate information
If you want to be lighthearted on social media, that’s your choice. But Jennifer Trachtenberg, a pediatrician with nearly 7,000 Instagram followers in New York who posts as @askdrjen, prefers to offer vaccine scheduling tips, alert parents about COVID-19 rates, and offer advice on cold and flu prevention.
“Right now, I’m mainly doing this to educate patients and make them aware of topics that I think are important and that I see my patients needing more information on,” she said. “We have to be clear: People take what we say seriously. So, while it’s important to be relatable, it’s even more important to share evidence-based information.”
Many patients get their information on social media
While patients once came to the doctor armed with information sourced via “Doctor Google,” today, just as many patients use social media to learn about their condition or the medications they’re taking.
Unfortunately, a recent Ohio State University, Columbus, study found that the majority of gynecologic cancer advice on TikTok, for example, was either misleading or inaccurate.
“This misinformation should be a motivator for physicians to explore the social media space,” Dr. Dizon said. “Our voices need to be on there.”
Break down barriers – and make connections
Mike Natter, MD, an endocrinologist in New York, has type 1 diabetes. This informs his work – and his life – and he’s passionate about sharing it with his 117,000 followers as @mike.natter on Instagram.
“A lot of type 1s follow me, so there’s an advocacy component to what I do,” he said. “I enjoy being able to raise awareness and keep people up to date on the newest research and treatment.”
But that’s not all: Dr. Natter is also an artist who went to art school before he went to medical school, and his account is rife with his cartoons and illustrations about everything from valvular disease to diabetic ketoacidosis.
“I found that I was drawing a lot of my notes in medical school,” he said. “When I drew my notes, I did quite well, and I think that using art and illustration is a great tool. It breaks down barriers and makes health information all the more accessible to everyone.”
Share your expertise as a doctor – and a person
As a mom and pediatrician, Krupa Playforth, MD, who practices in Vienna, Va., knows that what she posts carries weight. So, whether she’s writing about backpack safety tips, choking hazards, or separation anxiety, her followers can rest assured that she’s posting responsibly.
“Pediatricians often underestimate how smart parents are,” said Dr. Playforth, who has three kids, ages 8, 5, and 2, and has 137,000 followers on @thepediatricianmom, her Instagram account. “Their anxiety comes from an understandable place, which is why I see my role as that of a parent and pediatrician who can translate the knowledge pediatricians have into something parents can understand.”
Dr. Playforth, who jumped on social media during COVID-19 and experienced a positive response in her local community, said being on social media is imperative if you’re a pediatrician.
“This is the future of pediatric medicine in particular,” she said. “A lot of pediatricians don’t want to embrace social media, but I think that’s a mistake. After all, while parents think pediatricians have all the answers, when we think of our own children, most doctors are like other parents – we can’t think objectively about our kids. It’s helpful for me to share that and to help parents feel less alone.”
If you’re not yet using social media to the best of your physician abilities, you might take a shot at becoming widely recognizable. Pick a preferred platform, answer common patient questions, dispel medical myths, provide pertinent information, and let your personality shine.
A version of this article first appeared on Medscape.com.
With physicians under increasing pressure to see more patients in shorter office visits, developing a social media presence may offer valuable opportunities to connect with patients, explain procedures, combat misinformation, talk through a published article, and even share a joke or meme.
But there are caveats for doctors posting on social media platforms. This news organization spoke to four doctors who successfully use social media.
Use social media for the right reasons
While you’re under no obligation to build a social media presence, if you’re going to do it, be sure your intentions are solid, said Don S. Dizon, MD, professor of medicine and professor of surgery at Brown University, Providence, R.I. Dr. Dizon, as @DoctorDon, has 44,700 TikTok followers and uses the platform to answer cancer-related questions.
“It should be your altruism that motivates you to post,” said Dr. Dizon, who is also associate director of community outreach and engagement at the Legorreta Cancer Center in Providence, R.I., and director of medical oncology at Rhode Island Hospital. “What we can do for society at large is to provide our input into issues, add informed opinions where there’s controversy, and address misinformation.”
If you don’t know where to start, consider seeking a digital mentor to talk through your options.
“You may never meet this person, but you should choose them if you like their style, their content, their delivery, and their perspective,” Dr. Dizon said. “Find another doctor out there on social media whom you feel you can emulate. Take your time, too. Soon enough, you’ll develop your own style and your own online persona.”
Post clear, accurate information
If you want to be lighthearted on social media, that’s your choice. But Jennifer Trachtenberg, a pediatrician with nearly 7,000 Instagram followers in New York who posts as @askdrjen, prefers to offer vaccine scheduling tips, alert parents about COVID-19 rates, and offer advice on cold and flu prevention.
“Right now, I’m mainly doing this to educate patients and make them aware of topics that I think are important and that I see my patients needing more information on,” she said. “We have to be clear: People take what we say seriously. So, while it’s important to be relatable, it’s even more important to share evidence-based information.”
Many patients get their information on social media
While patients once came to the doctor armed with information sourced via “Doctor Google,” today, just as many patients use social media to learn about their condition or the medications they’re taking.
Unfortunately, a recent Ohio State University, Columbus, study found that the majority of gynecologic cancer advice on TikTok, for example, was either misleading or inaccurate.
“This misinformation should be a motivator for physicians to explore the social media space,” Dr. Dizon said. “Our voices need to be on there.”
Break down barriers – and make connections
Mike Natter, MD, an endocrinologist in New York, has type 1 diabetes. This informs his work – and his life – and he’s passionate about sharing it with his 117,000 followers as @mike.natter on Instagram.
“A lot of type 1s follow me, so there’s an advocacy component to what I do,” he said. “I enjoy being able to raise awareness and keep people up to date on the newest research and treatment.”
But that’s not all: Dr. Natter is also an artist who went to art school before he went to medical school, and his account is rife with his cartoons and illustrations about everything from valvular disease to diabetic ketoacidosis.
“I found that I was drawing a lot of my notes in medical school,” he said. “When I drew my notes, I did quite well, and I think that using art and illustration is a great tool. It breaks down barriers and makes health information all the more accessible to everyone.”
Share your expertise as a doctor – and a person
As a mom and pediatrician, Krupa Playforth, MD, who practices in Vienna, Va., knows that what she posts carries weight. So, whether she’s writing about backpack safety tips, choking hazards, or separation anxiety, her followers can rest assured that she’s posting responsibly.
“Pediatricians often underestimate how smart parents are,” said Dr. Playforth, who has three kids, ages 8, 5, and 2, and has 137,000 followers on @thepediatricianmom, her Instagram account. “Their anxiety comes from an understandable place, which is why I see my role as that of a parent and pediatrician who can translate the knowledge pediatricians have into something parents can understand.”
Dr. Playforth, who jumped on social media during COVID-19 and experienced a positive response in her local community, said being on social media is imperative if you’re a pediatrician.
“This is the future of pediatric medicine in particular,” she said. “A lot of pediatricians don’t want to embrace social media, but I think that’s a mistake. After all, while parents think pediatricians have all the answers, when we think of our own children, most doctors are like other parents – we can’t think objectively about our kids. It’s helpful for me to share that and to help parents feel less alone.”
If you’re not yet using social media to the best of your physician abilities, you might take a shot at becoming widely recognizable. Pick a preferred platform, answer common patient questions, dispel medical myths, provide pertinent information, and let your personality shine.
A version of this article first appeared on Medscape.com.